Feature / Stepping up

New HFMA president Sue Jacques believes finance staff have a central role in delivering a higher quality, more cost-effective NHS. But she insists this can only be achieved by working in partnership with clinicians and other health and care professionals. Seamus Ward reports

For Sue Jacques stepping up has never been a problem. As a young finance director she was able to inspire her team by calling on them to make a difference each day and she was named the HFMA’s Finance Director of the Year in 2008. Now she has become HFMA president at a time when the NHS finance function (like the rest of the service) is in a state of flux.

It promises to be another year of major change for the finance profession as the transition to new NHS structures continues and the service begins to deliver on the QIPP (quality, innovation, productivity and prevention) agenda. Yet Ms Jacques, who is chief operating officer and director of finance at County Durham and Darlington NHS Foundation Trust, is optimistic about the future for NHS finance staff.

She believes finance professionals can use their skills to improve healthcare services to patients. This is central to her theme for her year as HFMA president – ‘Making a difference’.

‘When I became a finance director I met my team and said to each one: “What can you do to make a difference?”. When I talk about “Making a difference” I am referring to how we serve patients – it is focused around the patient experience and outcomes for patients. We have to make them second to none,’ she says. ‘For a finance function to have that clear vision and to be continuously revisiting it is amazingly powerful.’

She reiterates her belief that finance and quality can go hand-in-hand and this is supported by the Department of Health.

‘One of the fantastic things in the operating framework is the quality agenda, including the increase in CQUIN from 1.5% to 2.5%. After a few years of moving towards better quality, there is now a significant financial incentive,’ she says. ‘With best practice tariffs there is an agenda to work alongside clinical colleagues to affect the care delivered to patients.’

Finance staff must get the basics right – proving their worth through the transition. ‘We must keep our discipline and not get distracted,’ she says. ‘There is a danger the changes to organisations will deflect attention so we have got to focus on the basics – agreed outcomes, patients’ experience, nurturing our workforce and delivering better value.

‘Things do get pushed out and during such marked structural change it is important organisations are calm and focused on their strategic objectives. Finance directors have an important role to play in this, but within the wider organisation financial professionals can also bring their calm heads and logic to keep everybody grounded.’

The NHS budget has been given significant protection – though it may not always feel as if this is the case. ‘When in discussions with clinicians I am sure we will all be aware of opportunities to make a transformation,’ she insists. ‘The challenge is to deliver better value, but the bottom line is quality. Finance and quality go hand in hand – it’s not the old way, where if you view it sceptically you played with one to the detriment of the other. Our role as technical accountants is at the core of the transformation programme.’

‘It is important that more experienced finance staff ensure the lessons are heeded from previous periods of low growth, she adds.  ‘We have been through a period of significant growth and perhaps some of my younger colleagues have not known anything different.’

Squaring up to QIPP

The QIPP agenda – which in England will see £20bn in efficiencies recycled back into frontline care by 2014/15 – has prompted some commentators to call for a major overhaul of the NHS. At the beginning of this year NHS Confederation chief executive Mike Farrar called on the NHS and politicians to make a compelling case for an end to the ‘outdated hospital-or-bust’ model of care. Resources should be shifted into community care, early intervention and self-care, he insisted.

Ms Jacques believes it is appropriate to continuously review the way services are delivered. ‘I think there are opportunities that didn't exist before for us to keep patients in their own homes, using technology to review any changes in their conditions and intervene as necessary.

‘The operating framework has signalled that integrated care is the way forward and there are opportunities to use technology to stop people coming into hospital unnecessarily,’ she says.

But IT systems must be in place to manage patients across organisational boundaries. ‘For elderly services in particular, organisations – including social services – have to work more closely together. A lot of patients will be very dependent, have significant levels of comorbidities and some level of social care requirements.

More care at home could lead to difficult decisions on reconfigurations as hospitals seek to close down disused wards or units.

In the past this has often pitched local politicians and public against hospital trusts, but Ms Jacques feels foundation trust membership could offer a way out. Foundations could use this base to consult with and win over local people to their plans.

‘This is an opportunity to work more closely with the population, but it requires us to co-operate with other bits of the health system. Finance has a role in explaining the reasons for any changes, while clinicians can front it up. Finance has the ability to explain the different costs that might be attached to different ways of providing services. We can explain what could be done with some of the funds that could be freed up.’

Service reconfiguration

Her trust has recently reconfigured its acute stroke service, moving it from two sites to one to ensure clinicians can achieve the best outcomes.

‘This was successfully negotiated with the population by our clinicians. The finance team was critical in helping stroke physicians understand how the changes being modelled would provide the optimum resource base for the activity we have. This meant they were well informed when they were standing on the platform explaining the changes to the public.’

She adds: ‘It is important as finance professionals that we work more closely with clinicians to meet some of the tremendous challenges we face. The last time the service was in this situation I was a newly appointed finance director and one of the things I learned was that working with clinicians is quite a powerful motivator.’

This was before service line management (SLM), which she believes is a major tool to stimulate engagement between finance professionals and clinicians.

‘SLM is about how people working in different roles work together to look for opportunities to enhance clinical outcomes and to do things more efficiently. At one level, the finance function has always set out to meet the principles of SLM – to tackle, where you can, any variation in a detailed way. Patient level costing (PLC), which often sits under SLM, allows clinicians to access data to ensure we are all on the same page. SLM allows us to present the information to clinicians and ensures the challenge is effective.’

In her experience, once parts of an organisation have used SLM they will not want to go back. Her own trust began implementing an SLM approach about five years ago with an 18-week pilot in general surgery. ‘Once we started, it wasn't long before all the clinicians in other clinical areas wanted it. Our biggest problem was holding everybody else back.’

She adds the power of PLC could be taken to another level if linked to a robust and comprehensive electronic patient record that includes all interventions on the patient pathway in hospital and the community.

‘PLC can tell you about variation in hindsight, but wouldn't it be great to have it at the time the decision is being made? That kind of sophisticated software has been deployed in the US, where they are following a similar agenda to us.’

While finance must engage clinicians to deliver QIPP, she insists NHS accountants must also lead by example. ‘We have to be resolute about this. If you are sitting in a finance department that hasn’t been reviewed, where it hasn't been benchmarked against peers, if you have no understanding of what customers want and have no idea if they are delighted with what you are doing or not, then it's a bit rich trying to encourage others to do these things,’ she says.

Association role

The HFMA will continue to support members and can make a difference on several levels, she adds. It can help to inform members, through e-learning and its publications, such as the Introductory guide to NHS finance in the UK. ‘I still carry this around with me,’ she says.

Over the past 12 months the association has extended its reach into social media such as LinkedIn, where members of the HFMA groups can debate and share knowledge on technical issues. The HFMA has embraced other web opportunities, such as the provision of webinars – giving members and their employers access to high-quality, low-cost training, she says. ‘Getting a train to London for training can take such a long time – for many people it means a day out of the office. Webinars can allow people to get training without having to do that.’

But she adds conferences will remain important – pointing to the success of HFMA 2011, one of the biggest annual conferences the association has organised.

‘Through “Making a difference” we will be looking to support individuals by offering them support in their professional and personal development. This could include everything from help with CV-writing or what steps they might need to take if they were looking to move into pastures new.’

It extends some of the work of the ‘Take control’ programme, set up by her HFMA predecessor Suzanne Tracey. ‘We are supplementing these with additional, practical sessions that help individual members of the finance team deliver on the ground, enable people to optimise the value they are adding and help them with the leadership challenge,’ Ms Jacques says.

Inspiration, knowledge and skills will be drawn from across the country and further afield, particularly the United States. ‘We will be putting in touch people who are working on similar issues – if you are an accountant in Liverpool working on theatre efficiency, we will be able to put you in contact with others who have done it so they can share their experiences.’

‘Our core objective is to support the membership – and we have never done more than we have over the past 12 months.’