Feature / The Financial Ward

Marking the launch of a joint Royal College of Nursing/HFMA initiative to improve awareness of NHS financial issues among nurses, Lynne Pearce examines why ward staff can no longer dismiss finance as someone else’s business

Grappling with budgets, cost codes and balance sheets was once seen as the primary preserve of finance departments – but not for much longer. Today’s clinicians, especially those in leadership roles, are expected to have a firm grasp of the purse strings and be able to make decisions that encompass sound business acumen.

Royal College of Nursing policy adviser Tim Curry admits that for most nurses it’s far from familiar turf. ‘Nurses are put off by the acronyms,’ he says. ‘There’s a lot of anxiety but we’re saying you don’t need to be frightened. You can use it to enrich your practice.’ 

HFMA chairman, Chris Calkin, director of finance at University Hospital of North Staffordshire NHS Trust, adds: ‘Nurses are frightened and that’s not surprising – I’m frightened of blood and gore. When we move out of our comfort zone, we’re bound to feel nervous. We’re trying to dispel the myths, get rid of the jargon and say to nurses that it’s not as bad as you think. Understanding finance actually helps you to do a better job, adding value to patient care.’

The old adage of ignorance is bliss is not an option. ‘There’s no such thing as a free NHS – it’s all taxpayers’ money and that needs to be spent wisely,’ says Mr Curry. ‘When you don’t think about how it’s spent, there’s an impact on patient care. It’s in the same way that a person who puts their foot down on the accelerator of their 4x4 has an impact on the environment.’

He argues that efficient organisations with robust financial systems perform better: ‘You can’t divorce good-quality patient care from effective business practice. What things cost matters. Every pound wasted is a pound not spent on patient care.’

So does all this mean that nurses need to become financial wizards, perhaps at the expense of their bedside skills?  No, says Mr Curry. ‘We’re not trying to turn nurses into accountants, but it’s in their interests to be able to speak in the language of the new NHS. It’s still orientated around the patient, but there’s a business savvy about it.’

Recognising the need to provide some practical support to help nurses improve their understanding of finance, the RCN and the HFMA will this month kick off a series of road shows under the banner ‘Not just numbers and money’, providing a one-day update on some of the key areas in NHS finance. With a series of presentations, workshops and question and answer sessions, the road shows will cover key finance terminology, how the service is funded, preparing a budget and making a business case as well as key policies such as payment by results and service line reporting

For nurses who are willing to invest in gaining financial expertise, there’s a myriad of opportunities waiting to be harnessed, not least ensuring that they have some of the tools to ensure that their roles are sustainable. ‘If nurses want to influence the future and protect existing services, one of the currencies is cost,’ says Mr Curry. ‘Does it cut any mustard to say “I’m a nurse and I’m caring for my patients”, without also knowing where the money is spent?’

On the other hand, if nurses can set out how many patients have been treated, at what charge, and where savings have been made, they are actively demonstrating their cost effectiveness. ‘It’s about making a business case for nursing, with nurses’ contribution becoming much more visible,’ argues Mr Curry.

Moves towards achieving closer working relationships between healthcare professionals and trusts’ finance departments are warmly welcomed by Mr Calkin. He cites the Audit Commission report, A prescription for partnership, published last December, which strongly advocates clinical engagement in financial management. ‘This new work links clinicians and accountants together to improve efficiency and so provide better patient care. I’m really excited by it,’ he says. 

While the rationale for improving nurses’ financial competence is persuasive, their knowledge appears to be patchy. Having met a group of clinical nurse specialists in charge of their own funds Mr Curry says: ‘Only a quarter understood their cost base, while around two-thirds knew their budget. Business skills aren’t taught as part of pre-registration nursing – but do we really want someone to be employed for 10 years before they learn this?’ 

Large-scale training
However, providing access to education and training for large numbers of staff can be challenging. That’s something Stacey Hunter discovered at first hand when, as a matron in cardiology at Leeds Teaching Hospitals NHS Trust, she became part of a multi-disciplinary project trying to engage staff with finance, particularly looking at what they needed to learn.

Now directorate manager for cardio-respiratory medicine, Ms Hunter says: ‘It’s easy to be critical but without training, it’s difficult for anyone to understand the significant changes in funding that have happened, especially over the last three or four years. We make lots of assumptions about what people know – and I believe that’s when we get into trouble.’  

While most of the trust’s expenditure occurs in clinical areas, at the project’s inception the widespread feeling was that financial accountability was always one step removed. Budget-holders – many of them nurses - received regular monthly reports, but in reality there was little awareness of what the figures meant. ‘We expected them to be budget monitors, but without the know-how to do it properly,’ says Ms Hunter. ‘A lot of nurses said that it felt like a paper exercise and that they were paying lip service, because they didn’t understand what they were seeing, so they didn’t give it a high priority.’  

Amongst the dilemmas was trying to educate high numbers of people – the trust has 14,000 employees, of whom up to 6,000 are nurses. As Ms Hunter points out: ‘You can’t send everyone on a study day.’ Having achieved some success with ‘e-learning’ in clinical areas, the project group teamed up with the HFMA to help develop a computer-based learning module to improve understanding of budgeting. The module examines the various components of an expenditure budget and can take up to two hours to complete, with nurses and other budget holders working through the module at their own convenience and then taking an assessment test at the end. The budgeting package now forms one of a suite of generally available e-learning modules produced by the HFMA providing a general introduction to NHS finance and covering issues such as payment by results, business cases, practice based commissioning and how to read the accounts.

Rolled out to the trust’s staff around 18 months ago, the budgeting course has been an overwhelming success. ‘Initially everyone was very nervous about it, even though they could appreciate why it was needed,’ Ms Hunter recalls. ‘But almost without exception everyone has said how good it was, that they’ve learnt things they’d never known before and that it was nowhere near as daunting as they’d thought. Everyone feels much better equipped now.’

Lynne Pearce is a freelance journalist.
This article also appears in the 7 May issue of Nursing Standard


On the road

The HFMA and Royal College of Nursing will put commitment to clinical engagement into practice with a series of roadshows starting this month and running until early November.

Both nurses’ and finance managers’ representative bodies believe that responsibility for financial management extends far beyond the finance department. Improving understanding of financial issues among nursing staff, budget holders and ward managers can help improve the use of resources and lead to significant patient and service benefits.

However the recent pace of change in the NHS – particularly affecting NHS finance – can be bewildering. The introduction of patient choice, plurality of provision, payment by results, practice based commissioning and foundation trusts have transformed the way the NHS goes about its business.

Raising financial awareness among clinical staff can have a significant pay-off. At its most basic level it can improve the understanding of the financial implications of actions and decisions on the front line. But it can also lead to a greater understanding of the costs of providing services at patient or service line level, help identify opportunities to cut waste and improve budgeting and the preparation of business cases.

• 21 May           Birmingham
• 4 June            Bristol
• 26 June           Manchester
• 15 July            Cambridge
• 8 July             London
• 9 September   Newcastle
• 25 September Leeds
• 9 October        Castle Donington
• 6 November     London

Further details at www.hfma.org.uk  or email [email protected]


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