Comment / Why counting really counts

The latest HFMA/FSD finance staff census gives an opportunity to track the impact of policy changes and new ways of working on the function

There are those in the media who appear to think the NHS could be run by doctors and nurses alone. Any NHS accountant, they imply, is an accountant too many.  The fact that the NHS in total spends a budget of £100bn seems to be overlooked. Finance’s role in governance, accountability and even simply ensuring the vast NHS workforce is paid on time is equally conveniently forgotten.

If you wanted to go beyond that and try to convince the public of finance’s broader role in supporting the improvement of service quality, pathway redesign and cost-effectiveness – you might as well forget it.

While finance staff frequently cite ‘public service’ in their reasons for pursuing a career in NHS finance, they have not done it to win the regard of the public. While NHS accountants may have moved on from being categorised as bean counters, the derogatory term ‘bureaucrat’ is still too often flung in their direction. But understanding the size, roles and make-up of the NHS finance function is important. And this month the HFMA, working with the NHS Finance Skills Development team, has published an updated census of NHS finance staff.

This is the second time the census has been run in its current format, having first been undertaken in 2009 as part of the association’s world class finance theme.

A briefing on the census findings is included with this issue of Healthcare Finance and on page 22 you will find a quick run-through of the main headlines.

However, the census is not undertaken to provide a defence for the role of finance, although the total numbers will seem modest to many, considering the vast sums involved, the current efficiency agenda and the need to demonstrate good use of tax payers’ funds.

And this year’s figures do find a reduction in NHS finance staff compared with 2009, suggesting finance is making a contribution to the reduced running costs of the service.

Instead the census provides an opportunity for the finance function as a whole to understand its overall make-up. Although average finance department sizes need to be handled with care due to the wide range of reasons that can lead to actual staffing levels, they do provide a starting point for organisations to ask questions about their own local set-up.

And by tracking changes in size and skill mix over the years, we should see the impact of different policies, structures, shared services and other new ways of working. For example, we have been told for years that finance needs to harness new technologies so staff can be freed from transactional activities to work in more strategic and decision support roles.

The census – with its analysis across principal finance roles and across Agenda for Change pay bandings – provides the means to replace anecdote with real numbers and evidence.

The census also has a very practical application in supporting local FSD managers to understand local finance profiles and to devise the right staff development programmes for staff across their economies.

There are questions raised by the census figures that the HFMA is keen to look into. For instance, should the service be worried by the apparent fall in CCAB (or equivalent) accountancy students? This may be normal variation or reflect reduced interest in this specific career route. But ensuring the service produces the right level of qualified staff to meet its needs in the future is important. Is too much being left to chance? The census provides an opportunity to look into this issue further.

The association, through its committees and special interest groups, will be exploring the potential to undertake further work over the coming months on the back of the census results.