Comment / Support networks

Finances are arguably the biggest challenge facing the NHS. With an increasing deficit among providers and no sign of a reduction in the efficiency requirement, the challenge of delivering sustainable – high-quality, accessible and affordable – services simply gets harder.

Of course, finance is a collective responsibility for boards and the wider workforce, with the finance director acting as principal financial adviser. But in practice, when finances get tough, it is the finance director who can become the sole focus of attention.

We have seen several provider finance director resignations this year. NHS Confederation chief executive Rob Webster has also been raising concerns about the ‘revolving door of leadership’ – particularly chief executive resignations.

Without commenting on the circumstances involved, the loss of such experienced managers raises questions about whether we expect too much of our finance and other leaders and provide sufficient support.

In happier times, these jobs were the most coveted and fiercely contested. Now some boards are lucky if they can create a credible shortlist. I think we all have to be concerned about the impact this will have on the morale of our staff and on how school and university leavers might view a potential career in NHS finance.

There have been concerns before. David Flory, when he was finance director of the Department of Health back in 2007, raised concerns about finance director shortlists that were ‘too short’. This led to HFMA research into the career aspirations and development needs of deputy finance directors.

But the current difficult financial position has the potential to bring the issue back to the top of the profession’s ‘to do’ list.

We need to reflect on whether we could do more to develop and support people who take on these jobs and how we can help when things don’t work out.

But our support needs to start much earlier than when directors are already in place. We need clear plans to provide development throughout finance professionals’ careers so they acquire the right skill sets to succeed in this challenging environment.

We do not come at this from a standing start. There is some great work going on as part of the future-focused finance initiative, which aims to deliver a future finance function with the right skills to succeed. Welsh finance directors have their own similarly focused strategy.

And the HFMA, alongside its normal work programme and bespoke activities such as its ‘Stronger together’ events and webinars, is busy with plans for the introduction of a set of qualifications that will build and accredit skills in NHS business and finance.

But despite this, I get a sense that some people are thinking twice before embracing the challenge of the top finance jobs, particularly in the acute sector. Our staff attitudes survey, which we are currently undertaking, should provide some useful insight into finance staff morale and career aspirations.

But even without this intelligence, we know we have some great staff who are certainly not afraid of a challenge. And we have a whole raft of development offerings and networks.

But we also have downward pressures from tariff, increased regulation and the unrelenting drive to increase efficiency and productivity while also overseeing quantum increases in staffing.

It raises the question as to whether the problem lies with the jobs, their accompanying support arrangements and how we define success in these roles?