Feature / Yes minister

Ministers and politicians have added a touch of ‘celebrity’ to HFMA conferences over the years. Steve Brown flicks through the association’s memoirs

The HFMA annual conference has not always managed to entice politicians to make the short journey from Westminster. It can be an intimidating business for ministerial generalists to suddenly be faced by the might of the NHS accountancy profession.

Conservative health minister Tom Sackville’s appearance in the mid-1990s was certainly something of a ‘Daniel in the lion’s den’ moment. Poor briefing by officials left the young and enthusiastic minister out of his depth on technical finance.

In recent years, the video link has given ministers some protection – although Lord Warner needed no such barriers when he read the riot act in person to the assembled finance directors in December 2005. Deficits (to be clear, their elimination) and financial balance (its establishment, both at organisational and national level) were the subjects of the day.

While chief officers can add the most direct value to the amassed finance directors – more interested in detail and implementation than high-level policy statements – politicians

can add spice and ‘celebrity’ sparkle to proceedings. And in former decades, a ministerial appearance was de rigueur for the fashionable conference goer. Archive photographs provide evidence of health secretary Barbara Castle’s attendance in 1974, and political heavyweights Richard Crossman, Keith Joseph, Enoch Powell and Virginia Bottomley have all spoken at conference.

Several shadow health spokesmen have also had their moments in the HFMA spotlight over the years, including Labour’s Robin Cook in 1990 at the 40th anniversary conference.

One early issue of Hospital Service Finance details the visit of Maurice Macmillan, who at the time (1968/69) was the Tory opposition spokesman on health and social security. (The magazine in question was delayed, we are told, because of ‘the loss of the conference report and photographs in the post’.)

Mr Macmillan addressed the issue of new area health boards, which were the new proposal for structural reform. While he acknowledged cross-party support for the idea, there were concerns. ‘What is to be their relationship with the new local government areas? How is the minister to discharge his responsibility to Parliament – particularly in the matter of the financial control of the vast sums of money involved,’ he asked conference. Sound familiar?

He added the reforms should be ‘liberating not stifling’ and greater independence should be given to the administrative units of the health service – a premonition of foundation trusts to come, perhaps.

Fast forward to 1997 and the then-fledgling Labour government, and Alan Milburn made his first appearance at conference. One can again be forgiven for wondering whether the conference exists in some kind of tear in the space-time continuum, such is the apparent relevance of former themes and messages to the current era.

The new health secretary was speaking ahead of the release of a white paper, which would usher in the latest thing in commissioning – primary care groups. He explained that the white paper would seek to deliver alignment of costs and financial responsibility, putting decision-making in the hands of family doctors and nurses in primary care.

Back then, as now, the focus for the finance community was governance. Mr Milburn insisted the emphasis would be on accountability, warning that primary care professionals’ rights to use NHS resources must be matched by accountability for the use of public funds.

Thirteen years on, many would argue that the warning is worth restating.