Feature / The ICE man cometh

As 2007 turns into 2008 most people will be looking forward to cosy evenings in front of the fire. But as January frost potentially gives way to snow, new HFMA chairman Chris Calkin will be thinking only of ice. ‘My theme for the year is ICE – influencing, connecting and engaging,’ he explains.

‘We are looking to review our strategy, particularly around influencing the agenda. We will take a systematic approach to identifying our key partners and who we should be talking to.

‘I want the HFMA to build on its influence with key people, such as the Department of Health, Monitor and the Darzi NHS Next Steps review. But I also want us to extend our influence further and look for opportunities to do so on a wider stage.’

Mr Calkin believes it is important the HFMA ensures it has some influence with the Darzi review, as finance will play a key role in its implementation. ‘My concern is that there will be two competing philosophies. On the one hand, there’s the market, payment by results and patient choice, but on the other Darzi is expected to be more restrictive of choice with fewer specialist centres. And with less choice there’s less of a market.’

The next element of his theme – connecting – will focus largely on nurturing links with HFMA members. ‘We have our target to increase membership and add value for members through new services,’ says Mr Calkin, ‘so I will be making sure the new website, for example, beds down and delivers what we want it to do. We must use that as a building block for developing our links with the membership.’

‘Connecting’ also means improved ways of working with the branches. ‘We have been building this up over the past two years, and I think there is now a positive relationship between headquarters and the branches,’ says Mr Calkin. He hopes to explore this theme during an event for branch chairmen. ‘I want to bring them together to discuss how they feel the relationship with branches has developed and how it can be developed further.’

The third element of Mr Calkin’s theme may attract the most attention. ‘I want “engagement” to particularly focus on clinicians, and I am keen this should build on the piece of work that the Audit Commission has just completed in this area.’

The Audit Commission report, A prescription for partnership: engaging clinicians in financial management, says that failure to engage clinicians in budget management has been at the heart of NHS financial problems and leads to poorer services for patients. Its recommendations include prompt provision of accurate financial information that is tailored to clinicians’ needs and training for clinicians in financial management (for more details, see page 14).

‘There is a need for us to get closer to clinicians, particularly with service line reporting and service line management,’ says Mr Calkin. ‘I want to make this the big theme of my year.’

The arguments for involving clinicians in service line reporting and management have been well rehearsed, but Mr Calkin wants to turn the sentiment into reality. His first step will be to approach clinical organisations such as the royal colleges and the British Association of Medical Managers (BAMM).

‘We are considering holding a policy forum with people like BAMM, the Royal College of Nursing and the professions allied to medicine in which we could look at these issues across the finance-clinical interface and work to achieve our joint objective – that is, improving patient care,’ he says.

He adds that engagement on issues such as service line management and driving up productivity means working with other healthcare professionals. ‘We should work with the human resource managers because they can influence a lot of what we want to do in terms of change. So, we should talk to the Chartered Institute of Personnel and Development and the Institute of Healthcare Management.’

Arising from this work, Mr Calkin expects to see a clearer definition of the role of the director of finance. ‘This is something that has changed a lot over a relatively short period of time. We now have an opportunity to reconsider that.’

There may be some barriers to overcome. Finance staff can be an easy target for clinical leaders – the bean-counter bogeyman is a one-dimensional image that they have perhaps used too freely in the past when complaining about service cuts or pay rises that fail to meet expectations. But Mr Calkin feels passionately that now, more than ever, such stereotypes should be consigned to the dustbin and finance staff and clinicians combine to benefit patients.

‘Sometimes, there is a feeling that finance people are only concerned about the pound notes and not the patient,’ he says.

‘I have no experience of that. Knowing finance people and having spent more than 30 years in the NHS, I know that is not the case. They care about both and they want to use the pound notes to carefor more people. Most of the forward-looking senior clinicians of whatever profession recognise that.’

Mr Calkin continues: ‘We want more of them to work with us and help us make our contribution to delivering better healthcare. If we can work more closely with clinicians, we can get big benefits, such as improved clinical audit and better costing and pricing.’

He believes that finance staff at the coalface can help engage with clinicians and can use the Audit Commission report as a springboard for success. ‘There are lots of things we can do in terms of our professionalism, using the training we have had and finding common areas we can all work towards,’ he says. ‘The obvious one is improving patient care, and accountants are interested in that as much as clinicians.’

As he takes up his chain of office, how does Mr Calkin envisage the HFMA 12 months from now? ‘Obviously, I want to see progress around my three areas. I want the association to have more influence with the Department and with Monitor,’ he says.

He sees the HFMA as being a ‘critical friend’ to these bodies, one that is able to confront them with the truth, however harsh, and in private if necessary. But this stance is not necessarily negative – the HFMA will offer constructive criticism, he says.

Mr Calkin has set a daunting agenda – possibly made even more so by the fact that he starts a new job in January (see box) – but he holds a strong belief that it is the right one, not only for the profession, but most of all for patients.


Chairman’s pathway

Chris Calkin will become director of finance at University Hospital of North Staffordshire NHS Trust in January, a trust he knows well.

Mr Calkin had his first spell at the North Staffordshire trust as director of finance between October 1991 and 1998. Not only did he prepare and present the proformas needed to achieve trust status but he also set up the trust’s finance directorate.

The new HFMA chairman, who is an associate member of the Chartered Institute of Management Accountants, moves back to North Staffordshire from Derby Hospitals NHS Foundation Trust, where he has been director of finance and information since January 1999.

He acknowledges some people will be surprised that he is moving from a foundation to a non-foundation trust, but he insists this is far from a backward step. ‘It’s a new challenge for me and a different challenge. It’s a teaching hospital that has a private finance initiative scheme worth £300m plus. And it has aspirations to become a foundation trust by the end of the year.’

During his nine years at Derby he helped lead the trust to foundation status, which it attained in July 2004.

He also led the negotiation of the financial and legal aspects of the trust’s £330m private finance initiative scheme. This will build a 1,050-bed district and general hospital on the site of Derby City General hospital, which is due to open in 2009.

Mr Calkin, who has worked in the NHS for 30 years, has also been a general manager. He was unit general manager for elderly care services with North Staffordshire health authority immediately prior to taking up the director of finance job at the North Staffordshire trust for the first time. He was responsible for a 700-bed elderly care unit spread over seven sites.

During his five years there he oversaw the building of two new hospitals and major upgrades of another two.

In his spare time Mr Calkin enjoys music, cookery and travelling.

He is not the first member of his family to head up the HFMA – his uncle, Jim Turnbull MBE (pictured left), was the association’s president in 1964/65.