Comment / Knowing the finance team

Despite increasing pressures and demands on the finance team, 63% of staff hope to spend the whole of their careers working within the NHS. Yet even with good levels of job satisfaction and high motivation, many NHS finance staff have concerns about job security. Perhaps this is unsurprising against a backdrop of new models of care, changing organisational boundaries and greater integration across health and social care.

These findings - and others - are set out in The NHS finance function in 2017: England briefing, published this week. The HFMA worked with the NHS Skills Development Network (SDN) and Future-Focused Finance to produce the biennial report, which analyses the make-up of the NHS finance function, based on the SDN census as at the end of June 2017 and the HFMA finance staff attitudes survey collected during October 2017.

The pressures on frontline staff are widely reported, but these pressures are also felt in support services. All services need to be funded and managed in a way that is fair to all staff and sustainable for the future. Since 2015, staff numbers have remained relatively static with only a small increase of 1.5% across the finance workforce. Given that 70% of survey respondents report working extra hours each week, over 20 hours in some cases, it is clear that the demands on the finance function have grown at a faster rate than the function itself.

Within these numbers are some interesting variations. The acute provider sector workforce has increased by 4%, while community, mental health and ambulance trusts have all reduced headcount, but to a lesser extent. However, this may, in part, be a consequence of changing organisational boundaries. 

The commissioning sector increased by 2% but the workforce in commissioning support units decreased by 24%. The increase of 13% in CCGs may again reflect organisational changes with some functions moving between the two. The commissioning support units have also seen some consolidation since 2015, with two fewer now in existence. 

The decrease in commissioning support unit staff is certainly not indicative of a move away from outsourcing. Only 2% of CCGs and 19% of provider trusts reported that none of their financial services were outsourced, a reducing proportion from 2015. This is reflected in the increasing proportion of staff who now work in financial management rather than the more transactional areas. Just over half of staff (55%) work in financial management, preparing and monitoring budgets and developing long term financial plans. Bigger budgets, challenging control totals and increasing integration of funding streams mean that a greater focus on financial management is to be expected. 

Since 2015, finance teams have had to deal with a period of significant financial challenge in the NHS as well as increased pressure to support new models of care and transformation plans. However, the staff attitudes survey reveals that the majority of finance staff remain motivated to work in the NHS and 80% feel valued by their line manager. However, very few feel valued by the government or the public. 

This may have an influence on the fact that 60% of deputy or assistant finance directors do not aspire to become finance directors, citing heavy workload, stress and political interference as reasons for the post being unattractive. Of those who do aspire to become finance directors, the role is more appealing to women than men. This is hopefully an indicator that the continuing imbalance of women in senior roles when compared to the overall finance function will continue to reduce. But progress is slow. In 2017 28% of finance directors were women, compared with 26% in 2015.

It is encouraging to note that, even in these financially challenging times, 76% of respondents feel that they have been given sufficient opportunities to progress in their current role. The HFMA will be using the data from the census and survey to continue to support members and all NHS finance staff by providing high-quality training and development opportunities.

The NHS finance function in 2017: England

Distinguishing features, Healthcare Finance May 2018