Comment / HFMA 2020: diversity and technology take centre stage

The conference was a huge success with nearly 2,800 delegates attending the virtual event spread over 12 days – surely the biggest ever gathering of NHS finance staff, albeit virtually. At some individual workshops in the first week, before the plenary sessions got under way in week two, as many as 750 delegates were tuning in.

Workshops and main conference sessions covered a range of topics – from guidance on how to improve monthly report writing to the NHS role in addressing the wider determinants of health. But the issues of diversity, technology and finance staff development were never far from the surface.

Julian Kelly (pictured), NHS England and NHS Improvement chief financial officer, made his first address to the annual conference, after last year’s planned appearance had to be called off because of civil servant rules ahead of the then imminent general election. He told the conference that the NHS would continue to move back towards ‘something that looks like normal’ over 2021/22 and 2022/23, building on the financial regime put in place for the second half of the current year.

He suggested that the additional costs of managing Covid-19 and the vaccination programme would need to be factored in. But he called for systems to build on the work of programmes such as Getting it Right Frist Time to get back to thinking about reducing unwarranted variation and improving efficiency.

He also put his weight behind proposals to produce more timely costing data – the NHS had lots of costing data, but by the time it was processed it was 18 months old. Quarterly collection has been proposed (see Healthcare Finance December 2020) and Mr Kelly said it was about ‘getting a balance between good costing data and timeliness’.

However, he made a specific call in terms of improving the diversity of the finance function at the senior level. ‘If women make up half of the population as a whole, why shouldn’t they be half of senior finance staff,’ he asked. ‘Looking at the population of the finance function as a whole, should there be more women at senior levels?’

Similarly, black, Asian and minority ethnic (BAME) staff make up 25% of the function overall, but only 8% of its senior staff.

In a separate session, Daniele Fiandaca urged finance leaders to ‘listen to the quietest voice in the room’ to promote inclusion and diversity. The co-founder of Utopia and Token Man, businesses that seek to help organisations become more inclusive, told the conference to listen to the people who aren’t speaking and find out what they are feeling. ‘The thing that makes me positive about the future is that once you start filling the ignorance gap and they understand the behaviours that exclude certain people on a daily basis, people start to change,’ he said.

Panellists at a Future-Focused Finance inclusion and diversity session were challenged to identify the one thing they would change to create a more diverse leadership. For Edward John, Frimley Health NHS Foundation Trust director of operational finance and Future-Focused Finance diversity lead, the wish list would start with stricter reporting requirements.

‘I would make equality, diversity and inclusion (EDI) statistics and the progress of action plans mandatory reporting on a monthly basis,’ he said. ‘We are always working to make changes, and all believe in the benefits and nature of EDI, but the day job seems to get in the way.’ Too often the topic fell into the important, but not urgent category – meaning pace of change was slower than it should be, he added. ‘We are changing, but it is too slow for my liking.’

Technology was another hot topic throughout the conference – both the rapid adoption of IT solutions as part of the Covid-19 response and how automation is starting to transform finance departments.

Mark Britnell (pictured), chairman and partner of KPMG, said that the accelerated use of IT was one of a number of trends that could be seen across the globe in the response to the pandemic. He highlighted a number of examples in addition to an increase in virtual consultations, including the use of wearables to monitor patients at home in Italy and the move to cloud-based records in Canada.

Patrick Mitchell, director of innovation and transformation for Health Education England, reminded delegates that digital transformation was about much more than technology. There was a huge people factor as well. The wider adoption of technological solutions – from apps to telemedicine and robotics – required a major culture change and the development of new skills and even new types of staff. Bioinformaticians would be needed in greater numbers, but all staff would need to develop a broader range of skills and this would need to be planned for as part of training programmes.

But this being a finance conference, the role of technology within finance teams was inevitably going to command some stage time. Robotic process automation (RPA) is already a reality in some finance departments and its role is going to expand. Great for undertaking high volume, repetitive, rule-based activities, RPA is really about ‘buying capacity’ Simon Perks, head of robotics and AI at Agilisys, told a workshop. RPA can work 24 hours-a-day, doesn’t get bored or tired and won’t be distracted by a phone call.

It can be applied in areas such as compliance, reporting, payroll and accounts payable/receivable and can free up staff for more value-adding activities.

Improving systems and processes was one of three themes identified for all the nearly 15,000 contributions to FFF’s consultation exercise on creating OneNHSFinance – a conversation that aims to shape the future finance function. There was clear support for standardisation across the service – with recognition that using different processes and systems can lead to a lack of comparability and waste time and effort. However, there was also recognition that imposing a single system for a particular function would be difficult, particularly with the current structure of separate statutory organisations.

However more than half the conversation as part of the consultation was around the theme of ‘people’. Finance staff liked their jobs, but felt the role should be promoted more proactively. There was also a good sense of belonging to an NHS finance profession, not just a specific organisation. However, there were some calls for greater flexibility in where and how people work. And consistency was also needed in providing opportunities for staff to progress in their careers.

A further conference panel session (right) discussed the importance of retaining positive changes that emerged in the wake of the pandemic, with simpler funding flows enabling faster transformation in many cases. One major change for finance teams this year has been how so many people have moved to home working. Ian Moston, chief finance officer of Northern Care Alliance NHS Group, told the session that this move had been made almost overnight, without disruption to vital function operations, such as payroll and payments to suppliers. It had been a huge achievement and ‘there should be no debate about our contribution to the service’s response to Covid-19’, he said.

However while many staff enjoy aspects of the new normal working arrangements, Mr Moston said there was a downside to home working, with staff mental health potentially being affected. The function will need to tease out the right balance between home and office working once the NHS moves into a post-Covid world.

The HFMA has to find a similar balance. Next year the annual conference is likely to return to its ‘in person’ format, which provides such good opportunities for networking outside the sessions. It also provides a better platform to celebrate best practice in NHS finance and governance through the HFMA Awards, which this year saw Catherine Phillips named Finance Director of the Year (see HFMA Awards 2020 supplement). But with the virtual conference having gone so well, especially in terms of reaching a broader section of the finance community, the association will be looking at opportunities to extend its reach.

For further reports from HFMA 2020, see Top Stories.