Feature / In the fast lane

The reforms of the NHS in England should make finance professionals’ jobs more interesting and fulfilling, but in the short term they could be more challenging, says HFMA president Sue Jacques.

Ms Jacques was speaking at the first of two ‘Making a difference’ residential events in October. The three-day course aimed to give finance professionals the skills to lead change and facilitate sustainable improvement. Most in attendance were in second-in-command positions (deputy, associate or assistant directors of finance). She said the event would enhance their skills and give them a chance to pass on new knowledge to colleagues back at the office.

Despite the changes and?challenges of the last few years,? finance staff had, in general, delivered a health service within budget that was providing more efficient and more cost-effective care.

‘The world around us is changing very quickly and it’s important we help our organisations negotiate the choppy waters ahead. We are not bean counters – clinicians accept that, I think. We can add value by getting in alongside the clinicians to help them deliver their services,’ she said.

However, Ms Jacques warned finance must not stifle clinicians’ innovation. ‘We must work in partnership with them and facilitate their development of new and innovative ways of delivering clinical services.’

‘We need to be able to articulate the position we are in so clinicians understand and have no doubt about the challenges we have. ’

Call for innovation

Finance managers must develop innovative funding and pricing arrangements to support new ways of delivering services and put themselves in patients’ shoes to understand the true impact of proposed changes. She said NHS accountants had to gain a better understanding of clinical pathways and their costs. ‘The finance director of Gregg’s knows how a cheese pasty is made. It is important for us to know how our organisations work,’ she said.

Salford Royal NHS Foundation Trust finance director and HFMA vice president Tony Whitfield echoed Ms Jacques call for finance staff to gain a greater understanding of the care delivered to patients. ‘How many of us take the time out to understand what we are trying to deliver to patients and why? How can we come to terms with the economics of our situation if we don't understand what we do and why?’ he asked.

He outlined a local partnership with commissioners and the local authority to deliver QIPP (quality, innovation, productivity and prevention) in urgent care. The first step was to understand GP access, why patients went to Salford Royal for urgent care and the role of community services, which the trust subsequently took over under Transforming community services. Then, much of the work focused on a few patients who attended A&E regularly.

Acute, community and primary care clinicians working together created a new model for the delivery of urgent care. Mr Whitfield said finance managers often ‘stood back’ while clinicians worked on the model. ‘Our finance role was sometimes to sit on our hands, allow people to develop an understanding and then come in at the right time to develop a financial model that works for the provider and the commissioner,’ he said.

Ms Jacques added that the model of healthcare delivery was no longer always appropriate and the medical royal colleges were starting to say this. Finance professionals must work closely with the medical royal colleges and clinical colleagues in their own organisations. ‘The royal colleges and clinicians have to explain the case to the patients we serve. Reconfiguration is difficult to get through, but, to a degree, it is inevitable over the next five to 10 years if we are to get the service our population deserves.’

Successful integration will be one of the big challenges facing the service over the next few years. Salford Royal chief executive David Dalton said NHS providers were already looking at this. The trust had an informal alliance with local trusts that had resulted in the trusts ‘sharing’ the provision of some services. ‘When trusts began, there was a sense that they should be in control of their own destiny, self-sufficient and do everything in their own hospital. Those days are numbered and a number of people are looking at alternatives. We will see new organisational shapes – they don't have to be mergers, they could be joint ventures or collaborative arrangements.’

Those attending the conference were left in no doubt about the scale of the challenge facing the NHS, but also went back to the office with the knowledge of the central role the finance profession will play in developing and delivering the solutions.