It should be no surprise that strengthening financial management is a priority for the NHS. Trusts in England were in deficit by £1.8bn in 2015/16 and the NHS has the very ambitious target of achieving £22bn in efficiency improvements in England by 2020.
Alongside stretched funds, NHS England is dealing with the continued implications of radical restructuring arising from the 2012 Health and Social Care Act. This created a more diffuse, less centralised NHS. One of the implications of that legislation is that where a decade ago finance managers knew who led the profession within the service, the restructuring led to much less clarity around leadership.
“People in different roles in different types of organisation looked to different people as their professional heads,” explains David Ellcock, programme director of Future-Focused Finance (FFF). It was that lack of a clear centralised professional leadership role that led to the formation of FFF. It aims to ensure that everyone connected with the finance function in the NHS can influence decision-making in ways that support high quality patient services.
“This isn’t just about finance skills for finance managers,” continues Ellcock, “but finance skills across the NHS, including for clinicians. It is focused on the NHS in England, because it is funded by the regulators of the English NHS.” However, the website – http://www.futurefocusedfinance.nhs.uk/ – does have links to contacts in the other UK regions, helping to drive best practice across all parts of the NHS.
It was a little over three years ago that the Future-Focused Finance website was first set-up. It has just been radically revamped and improved to further assist finance professionals in the NHS. “This is the third iteration of the website,” says Ellcock. “It took some time to develop the second website, which was more community focused, asking people what they were doing and seeking contributions in the form of blogs. But that didn’t work particularly well as people were too busy doing their day jobs.
“So we launched the new website to freshen it up, to make it more ‘push’ focused, pushing news out to NHS staff, guiding website users to what we want them to see and to make it easier for visitors coming to the website to find the information they are looking for in a couple of clicks – gathering information together in one place. We encourage finance and other NHS staff to look at the site and contribute to it.
“We try to share good practice, give examples of how to do things better: for example, improving team working between different professional groups, in particular clinicians working with finance staff. In our ‘Finance and Clinical Educator’ (FACE) initiative we are sharing best practice on working with clinicians, helping finance professionals to improve their standing in the service. CPD should be a key part of what they are doing.
“In the Best Possible Value area of the website we consider decision effectiveness to help people understand how best to do what they are doing. We have ‘Hire-to-Retire’ and ‘Process-to-Pay’ process maps on the website, which provide guidance to help finance managers redesign their processes, reducing the time they spend on tasks, enabling them to add value. We also support close partnering, so there is better working between finance and clinicians. There are a lot of signs showing that we are getting things right and making a positive impact.
“We are about improving NHS finance for everyone. Whether people work in finance or not they all need access to the relevant finance skills, methods and opportunities to influence decisions affecting our services. This helps us to then work together to produce high value services and reduce waste in NHS spending.”
Although the establishment of FFF pre-dates the current scale of the financial difficulties facing the NHS, its operations today are very strongly connected with the NHS efficiency programme. “We have been challenged by the FLC [see box] that everything we are doing should help people address their bottom line, improving efficiency, providing better models in the way they work, etc,” explains Ellcock. “Everything we do must have an effect on the bottom line.”
To succeed with this ambition, FFF works closely with the accounting profession in strengthening the finance function in the NHS and in supporting CPD. Ellcock explains: “We have links with ACCA and we encourage more people [from ACCA] to get involved [in the FFF programme].”
Ellcock is also keen to support the recruitment of top quality finance staff. He is clear that ACCA qualifications can prepare an accountant for an NHS career. What the NHS needs from a candidate, he says is “somebody who is willing to be flexible, who can communicate well with people from different backgrounds, who can explain the finance position to people so that they can understand the detail and understand the complexities, helping them to see the wider picture. That is pretty much the skills that ACCA delivers to its members. The days when the accountant just focused on the numbers and the spreadsheets are over.”
Those thinking of a career in the NHS, Ellcock says, need to recognise the changed NHS environment. Expectations on accountants in the NHS today are different from what they might have been in the past. “They need to ensure they absolutely understand the service, so that they understand what it is that their organisation delivers; understand the clinical side as well as the numbers. They should join as many networks as possible, from across their organisation and profession. They should have a willingness to engage as widely as possible, be willing to work hard, sharing the ethos of what the service is about. It is essential that they understand what the NHS is trying to deliver.”
Context, Ellcock implies, is everything – the NHS is a complex service, that is changing, yet remains strongly value driven. Delivering high quality healthcare to a high number of patients involves getting the most out of NHS resources. This depends on effective partnerships between clinicians and finance managers. FFF is a bridgehead that helps to achieve that.
NHS Finance Leadership Council
The NHS Finance Leadership Council was formed in 2014 by Future-Focused Finance together with the Healthcare Finance Management Association (HFMA) and the Skills Development Network (then called the FSD Network) to secure the aims and objectives of FFF over the longer term. The FLC provides the strategic direction of FFF. It comprises the leading finance professionals in the NHS in England. Its members are Bob Alexander (Executive Director of Resources and Deputy Chief Executive at NHS Improvement); Paul Baumann (Chief Financial Officer of NHS England); Steve Clarke (Finance Director of Health Education England); Shahana Khan (Director of Finance at the George Eliot Hospital NHS Trust and immediate past president of HFMA) and David Williams (Director General, Strategy, Finance and NHS, at the Department of Health).
FFF is jointly funded by NHS England, NHS Improvement, the Department of Health and Health Education England to drive improved financial management in the NHS in England.