Hacker News Reader

Comment by thedudeabides5 | Hacker News Reader

Funny how no one wants to talk about the reason that the NHS is doing these deals.

Of all the competent devs / data analyst in the UK, how many do you think actually want to work at the NHS?

So lots of demand / need (healthcare is a mess in part because of data management via paper) and no supply / interest of talent.

View on HN

It is a bit more complex than this.

The salaries aren't definitely not great compared with London...but they aren't terrible outside. I think the issue is that being a "dev" in the NHS is nothing like being an actual dev anywhere else. It is mostly about learning proprietary software, not development. So there are no real transferable skills (and ofc, NHS Trusts is always do "internal hires").

I have seen this in other businesses. They have huge IT departments but it is mostly about maintaining proprietary software (like SharePoint or whatever). The business then changed to a tech business and they have hundreds of IT people who have no useful skills (and the issue is management, in the NHS you have managers who are from the last century...no wonder Palantir rolled them).

(Somewhat ironically, one of these businesses actually employs a few top CS grads but they all work in the non-IT side of business...the issue is management in the UK not understanding what IT is for at a fundamental level).

I think many people talk about it but from a different context. The NHS is being de-funded by the same politicians whose friends benefit from these deals. Hard to hire competent people when your budget keeps getting cut.

https://fullfact.org/health/spending-english-nhs/

Total health spending in England was around £129 billion in 2018/19 and is expected to rise to nearly £134 billion by 2019/20, taking inflation into account.

That comes out to $2k/year/UK resident which is amazingly low I'd say. Staff are also limited to 1% salary increase per year since 2010 which is below inflation.

A little pedantic - England is not the UK and that budget quoted above was for England. The budget for all countries is larger, and England spends a bit less per citizen than Scotland, Wales and Northern Ireland. https://fullfact.org/health/what-is-the-nhs-budget/

Fair point although England is by far the majority of the population so per capita spend only goes up 20%. Still not a very high number and near the bottom for G7 nations.

Yes, it’s a big difference. I also noticed that the per capita spend is a fair bit higher in the UK when you exclude England, Northern Ireland in particular. This could be skewed to look more significant than it really is, because the economies of scale could be helping England.

How much of that is spent on front-line service provision, and how much on "management"?

Roughly 8% is spent on management which makes up 4% of the workforce. Which is significantly less than the private sector. That took me 60 seconds to Google btw.

I have worked extensively with the NHS and organisations who are attached to it. Part of the problem is that the NHS cannot pay market rates for developers, so they resort to contractors instead who are accounted for differently, and where the total cost is _much_ higher.

£136.7 billion seems like a lot. It also seems like it's been exponentially going up since 1950.

“Exponential” is almost certainly a good approximation, as I expect it to match the product of wage inflation and population.

Healthcare spending per capital for G7, note how the UK has historically been at the bottom, way below Germany, let alone the u.s.

https://i.imgur.com/iab51Zq.png

From OECD https://data.oecd.org/healthres/health-spending.htm

It seems it was between 1997 and 2003 where spending on the NHS began to dramatically increase. I'm not sure it's fair to say that between 1950 and 1997 that it's growth was exponential.

https://www.ifs.org.uk/uploads/images/election2017_images/bn...

https://www.ifs.org.uk/publications/9186

Perhaps a more fair statement to make would be that demand for NHS services has seen a dramatic increase since 1997 and as a consequence it's budget has seen dramatic adjustments.

That comes out to $2k/year/UK resident which is amazingly low I'd say. Staff are also limited to 1% salary increase per year since 2010 which is below inflation.

Compare that to systems which are not nationalised.

Of all the competent devs / data analysts in the UK, how many do you think actually want to work for GCHQ? I would have thought not very many, and yet plenty fo them do.

Can you suggest another job where you look through other people's emails? To paraphrase a great man, you underestimate how voyeuristic other people are.

Reply on news.ycombinator.com