Comment / Mirror, mirror

The finance staff census – published every other year by the HFMA, Skills Development Network and Future-Focused Finance – is an important exercise and report. It may not be a mandatory return, but its value is massively enhanced by its comprehensive coverage. So – thank you for taking the time to fill in the returns.

The 2019 census – the report for which has just been published – shows a remarkably stable position in terms of the overall numbers of finance staff working in provider and commissioning bodies over the years – see Healthcare Finance’s analysis of the headline findings. But it is at the more detailed level that the census can help to shine a light on the make-up of the function, its requirements and where improvements may be needed.

In holding a mirror up to the finance function, it shows that it is an increasingly qualified function – with 43% of the 16,788 finance staff qualified with or studying for a CCAB or equivalent qualification. But there are other areas where we clearly need to do better.

In particular we have a lot still to do to improve diversity in our function, with the numbers of women and black and minority ethnic (BME) staff at more senior levels simply not reflecting the make-up of the finance function as a whole or the populations they serve.

The presence of a glass ceiling around band 8a is quite clear. We don’t fully understand what creates that ceiling, but it is something we need to take down. And this is a job for the whole service – not something that can be fixed from the centre.

Trusts should be looking at the whole career pathway for their staff and ensuring all grades of staff have access to training and support. Finance leaders at all levels need to make sure they are aware of the issues and barriers that some staff encounter and work closely with human resources and organisational development teams on this.

Job descriptions need to be written in a neutral way, shortlists developed that acknowledge unconscious bias and recruitment panels need to be balanced and representative – not just composed of the existing team. We all need to take time to understand the value that different backgrounds, perspectives and experience can bring. (See the HFMA/FFF report Diversity and inclusion: how you can make a difference).

As a starting point I’d encourage trusts to make full use of their organisation-specific diversity metric reports, which will be sent out by the HFMA and FFF in October. These provide an opportunity for finance directors to make the mirror a bit more local, understand their own key challenges and set out action plans to address them.

The census also gives us a benchmark against which we can measure changes in the function as we move forward. We know the finance team of the future will be different to today as structures and financial flows change and we move to much more system working. But technology and new ways of working will also drive change.

We started to look at what this might mean in terms of future skill mix and training needs last year, but the context has changed with the Covid-19 pandemic. The outbreak – and the NHS response to it – has confirmed some of the changes we thought were likely and accelerated some of the developments that we thought were on the horizon.

A year ago, who would have thought that finance teams would have moved almost wholesale to homeworking? But, in this period, we have also brought in or expanded use of technology to support new ways of working – cloud-based ledgers have come into their own and we’ve moved to electronic submission of accounts and coped with a remote audit process.

We now need to listen to the service about how it thinks the future will pan out. What have we learnt from the Covid experience – what works and what doesn’t and how can we build back stronger? Are there aspects of the current temporary finance regime that will help us to achieve the ambitions of the NHS long-term plan, including a greater focus on population health, working as integrated care systems and a move away from competition?

You will hear more about FFF’s ‘one NHS finance’ engagement exercise over the next week or so. And we hope that future finance staff censuses will help us to chart changes in the function as it develops to meet these challenges.