Feature / Learning power

There is little workforce planning in NHS finance outside individual organisations. But, with the recent finance census showing a fall in student numbers, is this cause for concern? Seamus Ward reports.

A recent  Commons health committee  inquiry into health education, training and workforce planning focused squarely on clinicians – but no mention has yet been made of how managers and finance staff of the future will be trained.

The recent HFMA/ Finance Skills Development census showed that the number of finance staff has fallen by 7% since the previous census in 2009. It also found an overall reduction of 173 in the number of students studying for CCAB or CCAB equivalent qualifications (CIMA, ACCA, CIPFA and ICAEW).

The study begs a number of questions. What is the correct size for the finance function? Can it ever be judged? Does the NHS have sufficient trainee accountants to fill qualified posts in the future?

Workforce planning in the NHS, particularly in management and finance posts, is difficult – in part, a consequence of the tendency towards restructuring at least once every 10 years and also because each organisation will have different needs. For example, a finance department that outsources its transactional work will need fewer staff, while one that takes on this work will need more.

Despite these problems, many finance managers believe it would be a good starting point to assess whether the NHS has enough finance staff to meet its needs now.

ACCA Council member Mark Millar insists long-term planning is essential for all organisations. ‘The finance function is an integral part of the NHS. It is important the NHS takes a strategic view when planning what finance resources it needs both now and in the future.’

He adds that ACCA has worked with KPMG looking at how organisations need to manage the talent they have. The research showed that half of the senior finance executives surveyed believed that finding and retaining skilled finance professionals was a major barrier to improved financial performance. Once the NHS reorganisation is complete I expect to see the number of finance trainees rise again. This will be good for the long-term financial health of the NHS.’

But what is to be made of the reduction in students in the latest census? The decrease in CIMA students since 2009 reflects current economic conditions, says Peter Simons, the institute’s research and development technical specialist.

‘Although demand for public sector services is increasing, current financial constraints mean many public bodies – including the NHS – must achieve these with fewer resources. Workforce planning is important and if the NHS is to deliver more for less it will need to develop management accountants with the skills to understand the drivers of cost, risk and value to support clinicians and management in making the difficult decisions ahead,’ he adds.

HFMA chief executive Mark Knight says the fall in student numbers since the last census is not necessarily a cause for panic. ‘It could be a normal fluctuation in numbers or a response to new structures and ways of working. However, it is an issue we need to keep under review and mechanisms such as the HFMA/FSD census play a vital role in this.

‘We cannot simply rely on the market to provide a supply of finance professionals in the future. We need to continue developing this expertise within the NHS and there are major advantages for the health service in having finance professionals trained within the NHS, having people who understand the complexity of the services being delivered and who are fully signed up to its values.’

The reduction in the number of students could be caused by a few factors says North West finance and informatics skills development manager David Ellcock. Anecdotally, he believes NHS organisations are reducing the funding for training. ‘I suspect that where in the past they may have been happy to support someone through the third re-sit of a paper, they are now saying they can’t afford to do so,’ he says. ‘I am not aware of anyone in the North West stopping training but maybe they are asking less successful trainees to reconsider.’

Financial support

Most trusts in the North West (and in other parts of the country) will pay a proportion of student membership and exam fees (typically 75%), though some are willing to cover the full amount. ‘With the pay freeze of recent years, perhaps some people are finding they cannot afford to study at the moment,’ he adds.

NHS London head of finance development and professionalism Sotiris Kyriacou says: ‘I assume any reduction in students may be due to training budgets being reduced or perhaps students registering privately, which may not have been picked up by the census.’

Some may have dropped out, while a large number of staff who were students in 2009 may have qualified by 2011. NHS structural changes could also be a factor – the formation of primary care trust clusters may have affected student-banded grades through staffing reductions.

Mr Kyriacou does not believe organisations in London have decided to cut student numbers. Indeed, the census found the capital has the highest proportion of students relative to overall staffing numbers (17%). The focus for him over the past few years is getting staff who are not qualified and not in training to pick up the books again. ‘This is what we have concentrated on and we have a significant number – more than 50 staff – training with the AAT,’ he says. ‘It’s about getting people into the pipeline and encouraging them to stay on the professional ladder.’

They are given a positive message about career progression and taking destiny into their own hands. He adds: ‘You make them aware of the importance of having transferable skills. A lot of these staff are in transactional roles and they would be quite naive to think, moving forward, that their jobs might not be outsourced or changed. You give them transferrable skills and choice for the future.’

Graduate schemes

The South West and the West Midlands have regional graduate finance training schemes that complement the national scheme and individual organisations’ own recruitment schemes. South West FSD Board chair Hugh Groves says the scheme was established in 2010 in response to concern about the number of trainees coming through that could form a new generation of finance leaders.

The training lasts just over three years and trainees are based in one county within the South West. The scheme, paid for by all the organisations in the region (which still offer their own training posts), recruited five trainees in 2010 and 2011 and is anticipating more in September.

‘Directors of finance acknowledge that things are tight. Nevertheless, as one director said, we don't stop training doctors and nurses in times of austerity. Finance staff are valuable members of the NHS workforce and this helps the NHS get the quality finance staff it needs,’ Mr Groves says. ‘NHS organisations in the South West are also recruiting school leavers as apprentice accountants – something we may see more of in the future.’

Like most regions, the North West does not have a centralised finance training scheme (outside the national graduate training scheme, which was not included in the census). Mr Ellcock says FSD encourages trusts to plan the structure of their finance departments, including the number of qualified and trainee accountants they will need. So when they recruit it is clear which posts are for trainees. Entry into NHS accountancy training can be via a number of routes: the national graduate training scheme; joining an NHS organisation in a junior finance role designated as a training post; or for those in junior posts via the appraisal process. In the latter, a line manager may agree the individual should train with the AAT, for example, which could lead to further professional qualifications.

Though it varies from organisation to organisation, most trusts will give students time off for exams and study leave prior to exams, as well as time to go to college. Rather than holding classes on one day a week, most colleges now run them in the afternoon and evening so the student and employer shares the commitment. Students typically get a half-day exam leave plus a half-day for pre-exam study. All other studying is completed in the trainee’s own time.

Mr Kyriacou says the NHS must not lose sight of the importance of training. ‘It’s important to keep training people, investing in students. We can’t disinvest in the finance staffing pipeline as these people are going to be the finance function of the future.’

The HFMA census can be found at www.hfma.org.uk