Having been motivated by the inspirational weekly blogs I decided to put pen to paper with much trepidation as to whether the ramblings of an accountant would even vaguely interest the usual readerships of the weekly instalments. I’m not saying I was born an accountant, but my aptitude for maths was identified at an early age and made my career path inevitable
My introduction to the NHS in England was as a Management Accountant at a time when NHS Trusts were multiplying rapidly and the job market for NHS accountants was on the increase, which was lucky for me given I needed a job and I thought altruistically I could make a difference working in the public sector as oppose to commercial entities. That was 22 years ago and as we know the NHS has had many a restructuring, reimagining and reinventions since then, with my move to Dumfries in 1998 triggered by the latest iteration at that time.
Having decided to move here for a couple of years and accepting my chosen career as an accountant which came out of my ability in Maths, a dad who was a bank manager and saw it as a “safe job” rather than a burning ambition and was pretty much set when at 5 years old I had my first responsibility of collecting and adding up the school dinner money. The move to Dumfries proved to be an excellent but incredibly challenging career move for me and 16 years later, recently appointed to Director of Finance, it appears I’ve settled here for good!
The role of the accountant within the NHS has changed unrecognisably since I put on my first “grey suit” with the role these days much more focusing less on the “bean counting” and much more on the business partnering, added value role with the finance manager a key team member alongside the General Manager, Nurse Manager, Clinical Leads in supporting the decision making processes of the organisation.
I firmly believe that finance must earn its “keep”, we are a support function and are continually challenged to demonstrate it worth and value we provide to the organisation beyond the “technical” functions we provide and that our key role is as enablers to support the critical decision making within the organisation. But also to provide that critical friend role, to challenge outcomes, decision making to ensure that we haven’t been lazy in reaching an end point, that we have considered all alternatives, come up with new ideas and provide an important and different viewpoint to the argument being presented.
As Director of Finance I have a clear leadership role in the organisation and as defined by the Healthcare Financial Management Association (HFMA) in their publication “the Role of the Chief Finance Officer 2013” described the role under four main headings:
- Corporate leadership
- Stewardship and accountability
- Financial management
- Professional leadership and management
The role is not just about balancing the books (although that is an incredibly important part of the job!) but engaging as part of the leadership team and taking corporate responsibility for decisions which the Board makes.
You will all be familiar with the publication last year of the Francis report and this has been considered very seriously by finance professionals given the concerns about the focus on financial issues to the detriment of quality of care.
The HFMA published their response to this report which reminded financial professionals of their responsibilities to operate in a professional manner at all times and highlighted the following points:
- All NHS finance staff should remind themselves of the contents of the codes of conduct of their professional bodies, employing organisations & NHS constitution and adhere to them
- All governing Board members are equally responsible for quality, patient safety and financial performance of their organisations
- All NHS finance staff should understand how their role supports the achievement of organisational objectives & delivery of high quality patient care
- NHS finance staff should provide the most up to date, reliable, useful and complete financial information possible and aim for the highest standards of financial probity and financial reporting
- A focus on knowing the business and understanding the finances will lead to better services for patients
- Finance staff have a duty to promote the best use of resources and the achievement of value for money
As finance professionals this has reminded us of our responsibilities beyond the just the money and we can’t just drive financial efficiencies at the expenses of everything else and our professional and ethical codes supports this approach. The focus in NHS Scotland is driven by the quality strategy at the heart of what we do and to use this to drive improvements in person- centred and effective care. The engagement we have as financial professionals with clinical staff must reflect this, recognising that understanding the clinical challenges and engaging on quality and efficiency improvements can lead to a much more productive and constructive outcome for all involved.
Since the downturn in the economic position in 2008 the need to deliver efficiencies to balance the books has been an important consideration. We are clear that finance forms one of the four dimensions of our thinking along with our workforce, quality and service issues. None of these are more important than each other overall and we must take use a balanced approach to this and keep the patient at the centre of our thinking to ensure we come to the best decision. The focus has to be on quality driven financial management. Do we believe that if we get the quality right the financial efficiencies will follow?
As we move into what are set to be an incredibly challenging few years with the building of the new Hospital, Health and Social Care Integration and the demographic and economic inevitabilities, we must to focus on the opportunities, and continue to trust the people in “grey suits” to support us to make the decisions we need to make as an organise and to value/ develop the role within the clinical teams.
Footnote: although a reference the term grey suits to mean accountants neither myself nor most of my team conform to the stereotype
Katy Lewis is the Director of Finance for NHS Dumfries and Galloway