Feature / Together we stand

CIPFA’s new president, former HFMA chair Jaki Meekings Davis, tells Steve Brown about the need for an integrated response to today’s financial pressures.

The challenges facing the NHS cannot be solved in isolation. They will require a pan-public sector response. The Total Place pilots,  looking at how a whole-area approach to public services can lead to better services at lower cost, are one example. But sharing back office and other services across traditional boundaries of responsibility are likely to be more evident as we move forward.

These are the observations of Jaki Meekings Davis, former HFMA chair and new president of public sector accountancy body the Chartered Institute of Public Finance and Accountancy (CIPFA). Ms Meekings Davis, who takes up her new role at the CIPFA conference this month, believes the institute has a major role in supporting this integrated approach to reducing costs and increasing productivity, while maintaining and improving services and outcomes.

‘The answer to the current financial issues will be across the whole public services,’ she says. ‘We need a vibrant exchange with other parts of the public sector. The NHS can’t afford to plough its own furrow in isolation. Those days are over.’ She adds that CIPFA, with its broad church of accountants trained for public service and with experience across a range of services, is well placed to support this. It offers the perfect opportunity for public sector accountants to get together, share ideas and spread best practice.

All accountants working in the public sector have a part to play in the push to deliver productivity improvements – the NHS must save an estimated £20bn over the coming four years – but Ms Meekings Davis says CIPFA accountants will make a key contribution. They are trained to have a broad understanding of how the wider public service works – to ‘see the bigger picture’, as she puts it. This is part of the CIPFA curriculum and many CIPFA-trained accountants have experience in different parts of the public services – Ms Meekings Davis is a good example (see box).

For many would-be accountants, the very act of choosing CIPFA – the only public sector accounting body in the world – is a demonstration of their public sector ethos (even though a CIPFA qualification does not restrict accountants to a career in the public sector). She accepts that CIPFA has no monopoly on commitment to the public sector, but that public services do need finance practitioners who are passionate about public service. She is disappointed at the drop-out rate from and immediately after the national graduate schemes.

Ms Meekings Davis admits that CIPFA has lost market share of new accountancy students in the NHS over the past decade. It remains the single biggest qualification at finance director level, but only just over one in five of all CCAB-qualified accountants in the NHS are now CIPFA qualified. At student level, CIPFA only accounts for about 5% of all CCAB students. This is in contrast to CIPFA’s performance in general, which in 2009 saw an increase of 17% in overall student numbers.

CIPFA’s new president says the institute is determined to reverse this decline and start to grow its share in the NHS – a clear aim for Ms Meekings Davis in her year in office. As a result of a major listening exercise, it has acknowledged issues around costs and access to education providers and plans to announce measures to address them in the near future.

Big decisions

Returning to the challenges facing the NHS and the wider public sector, Ms Meekings Davis believes big decisions need to be taken. Some are at a higher level than can be taken by single services or individual organisations. The nation’s productivity is an issue and this could mean tackling difficult subjects such as the affordability of employment conditions.

She believes it is the role of public sector finance professionals, through professional bodies such as CIPFA and the HFMA to ensure decisions are well informed. CIPFA has a good reputation on technical guidance and as an authority on public sector finance, particularly within local government. Its opinions are taken seriously and outputs such as After the downturn, released in December 2009 and updated in March, will continue to inform political decisions.

Again, the role for finance professionals is to ensure the full implications of any decisions are understood. Ms Meekings Davis gives as an example public sector pensions. She says any decisions on such a big issue need to look not just at the direct costs but the impact of any changes. So, if pension benefits reduce, will there be a greater burden on welfare budgets when staff retire?

She is confident that productivity can be improved in the NHS through a combination of national decisions and local action to eliminate waste, ensure right first-time treatment and optimise pathways. She also believes the NHS can lead the way in ‘recalibrating productivity’ across the public sector. ‘In the NHS our finances won’t be cut as much as in other parts of the public sector. That means it is incumbent on us to take a lead. We need to be honest about our productivity, how we might improve and face some uncomfortable truths.’

The NHS has a good track record in taking the lead, she says, citing the work done on governance – before the Nolan inquiry – at the outset of the internal market. But work on capital charges and costing/pricing (nothing close to the NHS reference costs exists for local government services) are other good examples.

Turnaround credentials

Recent turnaround work to turn a national deficit into a surplus will also stand the service in good stead. ‘There is very little that many people in NHS finance have not experienced as part of their careers – and that provides a good grounding for the challenges ahead.’

She adds that finance managers in the NHS have the fortune – and challenge – of working with some of the most talented people in the country, particularly in the clinical workforce.

If the NHS can play a leading role in steering the public services through the current economic turbulence, it is perhaps fitting that public sector accountants body should have chosen this year to appoint a health professional to its most senior honorary position. Ms Meekings Davis is only the fourth CIPFA president to be appointed from the NHS and the first former HFMA chair to take up the president’s position in any CCAB body.

CIPFA chief executive Steve Freer believes her election is timely. Describing her as ‘a very safe pair of hands with extremely good judgement’, he says the challenges facing the whole public sector make her a good choice.?

‘It is really good to have someone from the NHS,’ he says. ‘It will be tough for all the public services [in the coming years] but none more so than the NHS. Although people talk of the protection given to the NHS, the scale of the financial challenge is huge in health.’

He echoes his new president’s call for a cross-public sector response to the economic challenges and believes Ms Meekings Davis can help encourage a whole-system approach.

Ms Meekings Davis admits that the public sector may be an uncomfortable place to be in the coming years but that ‘accountants are up for the challenge’.

‘Public sector finances may face significant problems, but the public sector finance function – working across the public services – is in good health and well placed to work with the newly elected government.’

She is clear that CIPFA’s role – and hers for the next year – is to ensure government decisions are as well informed as possible and to support members. ‘Every accountant has professional and statutory responsibilities and we need to ensure they are supported with guidance. But we also need to provide support at a personal level as members may have difficult decisions to take and difficult messages to deliver.’

In public service

Jaki Meekings Davis is a director of MD Associates, which provides interim management, mediation and mentoring services to the public sector. She spent nearly 20 years in the NHS, joining in 1990 as assistant finance director of Wessex Regional Health Authority, where she led work on improving governance.

She later became regional finance director and then, in 1995, deputy chief executive/director of finance of Wiltshire Health Authority.

In 1999 she sidestepped out of finance to lead on specialised commissioning, first for the South West, then South of England, where she stayed until 2007. She was a member of the Carter Review of Commissioning Arrangements for Specialised Services and chaired the finance and capital group for high-security hospitals.In December 1997, Ms Meekings Davis became the first woman to chair the HFMA.

Before joining the NHS, Ms Meekings Davis spent 15 years working in local government and the water industry. She is also a qualified mentor, accredited Centre for Effective Dispute Resolution mediator (one of a team that deliver the HFMA’s HCS Dispute Resolution Service) and trustee of a small charity.