Feature / Kitemarked for success

An assessment process aims to give the financial seal of approval to potential chief finance officers for new commissioning bodies. Jane Tomkinson tells Steve Brown how it will work and the opportunities for finance professionals.

The Health and social care bill’s progress towards the statute books may appear agonisingly slow. However, clinical commissioning groups (CCGs), at least in shadow form, are already up and running in many parts of England. And preparation for their formal establishment is picking up pace.

Nowhere is there more activity than within the finance arena. NHS deputy chief executive David Flory used the HFMA annual conference in December to confirm that CCGs would be expected to have a chief finance officer on their governing body. The HFMA had lobbied against earlier suggestions from the Department of Health – in response to the Commons health committee – that these groups would be free to decide the CFO status.

Mr Flory also flagged up a process to assure prospective CFOs in advance of CCGs being established. The clear aim was for CCGs to have a source of accredited, technically competent finance leaders to choose from when they started to appoint to local structures. That process is well and truly under way. In fact, NHS North West director of finance Jane Tomkinson, who is leading on the accreditation work for the Department, says that the process will be completed by the end of April. ‘It is ambitious but I am confident, we’ll achieve this,’ she says.

Ms Tomkinson says the process of assurance – which will be supported by external advisers and cover CFO roles in commissioning support organisations (CSOs) and local offices of the NHS Commissioning Board, as well as CCGs – needs to be sensitive to finance professionals.

She recognises that some of the potential candidates have been scrutinised several times over recent years – through appointments to primary care trusts, the PCT clustering process and even within the world class commissioning assurance process. ‘We need to look at how we can use the outputs of recent assessments. We need to minimise inputs and maximise outputs, in particular minimising colleagues’ time away from organisations at a crucial time in the financial year,’ she says.

However, she says the assurance process is important and essential to getting the new structures properly established and able to hit the ground running. ‘The CFO will be a critical role and we have to assure that the CFOs have the right skills, both from a technical point of view and in terms of leadership, to manage these organisations post 2013.’

It is not just about getting the right starting point. Ms Tomkinson has set up five work streams as part of the assurance process and one of these will look at how assurance can be gained in subsequent recruitment rounds, once CCGs are established.

The assessment will be a two-stage process. The first step is to assure that the potential candidates have the right technical competencies and experience from a finance perspective to do the job. In effect Ms Tomkinson says finance leaders that are successful will gain a ‘finance kitemark’.

At this point the process will dovetail with the broader leadership assessment process that’s being run by the Commissioning Board to accredit the chair and accountable officers, which will focus on leadership qualities and values.

There is no attempt to circumvent CCGs’ and other bodies’ local decision-making. But CCGs will have to demonstrate that their CFO is accredited, whoever they appoint.

‘It is not about imposing a CFO on a CCG, but about supporting them to get the right quality,’ she says. ‘The whole process is designed to take the hard work away from CCG leaders and give them the assurance that these potential CFOs are “kitemarked”.  CCGs appointing from this accredited group would then be looking to match individuals with their own organisation on the basis of how they fit with the broader team, geography and local priorities.’

Recruitment waves

So who will the kitemarking process focus on? Ms Tomkinson suggests there will be two or three tranches of recruitment, starting with those people formally identified as at risk from the approaching restructuring, moving on to those from other posts and broadening out across the wider NHS and beyond.

Existing PCT locality finance directors – broadly those in PCT director roles before the clustering process took place – and those managers who have been assigned as lead finance officers for emerging CCGs are the obvious candidates. But with potentially 300 or more positions to fill across CCGs, CSOs and local offices, the process will have to look beyond those with director-level experience (see box).

Recent papers about the design of the NHS Commissioning Board state that the CFO role (or head of finance and CCG assurance) will either be pegged at band 9 under Agenda for Change or set as part of the very senior manager’s pay (VSMP) framework. (Band 9 currently pays between £77,000 and £97,000, while the VSMP suggests salaries for PCT finance directors from £79,000 to £112,000 depending on weighted populations.)

The CFO roles within CCGs and CSOs are expected to be at a similar level.

Job descriptions are being developed for the various roles as part of the workstreams. But Ms Tomkinson suggests that, to an extent, the roles mark new territory.

‘The CCG role is different from PCT roles that have gone before,’ she says. ‘In some ways they are smaller - primary care and specialised commissioning fall under the Commissioning Board, for example. But at the same time they are more developmental. CFOs will be working with new governing bodies with responsibilities that haven’t been delivered at that level before.

‘CCGs will have to live within a fixed financial resource and maintaining financial viability is absolutely fundamental to delivering  improved patient outcomes.

The CFO role in supporting the accountable officer in delivering that will be absolutely business critical – or, more accurately, patient care critical.’

Underlining the new territory being charted, she adds: ‘These new statutory organisations simply don’t exist at the moment. There is nothing to look back on, no blueprint or manual.’ But she points out that the NHS finance profession has a good track record at setting up organisations, while retaining financial governance and supporting delivery of objectives. ‘The finance community has shown itself to be very adaptable and financial results in recent years speak for themselves.’

Away from CCGs, which have been the focal point for discussion about proposed changes, CSOs perhaps provide more challenging roles to appoint to – certainly from the existing skillset in the NHS. While the short-term future for CSOs is to be hosted by the Commissioning Board, beyond 2016 their future lies outside the core NHS. There are believed to be almost two roles for the chief finance officer. At the outset the role may be more about delivering services to CCGs, while as the organisation develops, the CFO may need an increasingly commercial skillset.

All in all it spells significant change for the finance function supporting the commissioning of NHS care. But it is a change that should be seen as positive by the profession, Ms Tomkinson argues.

‘The changes mean a whole new range of opportunities for existing finance directors and, by virtue of the numbers we need, deputies and senior finance colleagues who are thinking about their next step,’ she says.

Even within CCG CFO roles, the different sizes of organisations and potential multi-organisation roles will provide opportunities for a range of finance managers/directors with different levels of existing experience. ‘There is no one single model of skills and experience that will be needed,’ she says.

Clearly some jobs are at risk – which is an inevitable consequence of hitting QIPP targets. The predicted 3,500 jobs in the Commissioning Board, replacing the 8,000 believed to be undertaking those roles, gives an indication of how extensive those cuts may be. But Ms Tomkinson believes within finance there will be more opportunities for senior posts.

She counters suggestions that commissioning has proven an uncertain career path for those who have chosen it. ‘Commissioning finance clearly has longevity,’ she says.

The provider landscape is also likely to change as mergers lead to fewer, bigger organisations. But she says change has to be a fact of life for today’s NHS finance professional. ‘The whole landscape of NHS finance is changing,’ she says. ‘Finance colleagues need to be aware of the opportunities but they also need to be able to adapt both their skills and their career plans in response to those changes.’