28 November 2008
Rock fan Bill Shields hopes to promote a 'world-class' finance system for the NHS when his biggest gig — chairing the Healthcare Financial Management Association — starts in December. Here, he tells Tash Shifrin what this means
It was the best of times, it was the worst of times. Just as the fortunes of the health service seem to hover between the two, Bill Shields takes over as chair of the Healthcare Financial Management Association He starts work at the end of the HFMA's conference on December 6.
Shields, director of finance and commissioning at the South West Strategic Health Authority and a CIPFA member, says: 'This is the best period of sustained growth in the NHS that we've ever had or are ever likely to have.' But he adds: 'We are coming to the end of that. My view is we still have what is relatively a strong settlement for the NHS, compared with other spending departments, and I expect and believe that will be honoured.
'But in 2011/12 we're going to be in a very, very different environment. We cannot just pretend the global economic crisis is not going to have some impact on public spending.'
Shields is a no-nonsense, face-the-music type, who has spent a career of more than two decades in NHS finance, with 12 years in director posts. Before joining the SHA last year, he had seen all sides of the health service's commissioning process. He has experience in both hospital trusts and primary care trusts, with a reputation for tackling tough financial situations.
As chief financial officer and deputy chief executive at Portsmouth Hospitals NHS Trust, he spearheaded a financial recovery plan that turned an £8m projected overspend in 2003/04 into a £5m surplus in 2005/06. In 2005, he became acting director of finance for the South East Hampshire Primary Care Trust Cluster, moving it from a £30m projected deficit to a small surplus in nine months.
But as a man who spends some of his spare time learning to play an electric guitar – 'I like the thrashy, rocky kind of stuff' – he jokes that his biggest achievement this year is securing a ticket to see hard rock band AC/DC in April. 'I'm going to lock it in a safe,' he says.
Perhaps it is just as well that Shields says he has 'mellowed a bit' since his earlier days as a punk. His role at the SHA makes him one of the most senior finance chiefs in the NHS. It also puts him in an unusual situation as incoming HFMA chair – his is not quite the voice of the rank and file. Shields acknowledges this. 'As someone who is an SHA finance director, I've got a view that... will probably be more closely aligned to the Department of Health view than it might be if I was working in a different part of system,' he says.
HFMA chief executive Mark Knight says that the association will retain outgoing chair and trust finance director Chris Calkin as a spokesman, while Shields will take on a 'more presidential role'.
Shields has a typically forthright take on what his new position means. 'It would be very easy for someone to use this as a platform to complain about their pet hate, to go on about the fact they never get told things on time or that [the new NHS treatments tariff] HRG4 is a bit difficult. That is not as I see it. The role is about how we engage with people we don't normally engage with, how we can take the service forward.'
He says his plan for his year in the HFMA hot seat is helping to build 'world-class finance'. The 'world-class' tag is usually attached to elite footballers but has been recently adopted by the NHS for its World Class Commissioning programme, aimed at making commissioners rather than providers the drivers of change in the NHS.
Shields describes himself as a 'fairweather supporter' of his hometown football club, the less-than-elite Dundee, but says he has two world-class players – Manchester City's Brazilian star Robinho and Chelsea playmaker Deco – in his fantasy football team at work. He also has the occasionally gaffe-prone goalkeeper David James, but says world-class finance is more than a safe pair of hands – it needs 'some flair' as well.
There may be some way to go before NHS finance can bend it like Robinho, however. There are skills gaps, particularly in primary care, and Shields says: 'That's only going to become more pronounced.' The World Class Commissioning programme, with its required competencies and assurance process 'will throw up issues'. PCTs 'haven't got the finance skills and wherewithal to plan the way best providers do'.
He says: 'If a fundamental underlying principal is that PCTs should be the leaders of the health economy, then they need to have the best people, they need to have the best skill sets, and I don't think anybody would say that's the case.'
What Shields dubs 'the foundation trust movement' has given provider trusts 'much more robust governance and finance management'.
Part of the problem is that there is no clear picture of the state of the finance function in the NHS. 'We don't actually know what it looks like. I don't think anybody does,' says Shields. 'What is the workforce in NHS finance, what are the kinds of people we employ, what are we doing in terms of continuing professional development?'
Whether the NHS has its future finance leaders lined up is another unknown, Shields says. 'Do we have a lot of budding finance directors within that community or don't we?'
He adds: 'A lot of evidence... suggests there are a number of people who have been in the NHS for some time, who may be successful deputy directors of finance but they don't become directors, they don't want to make the step up.'
Pay, issues of work-life balance and – most importantly, Shields argues – adequate support for new directors to ensure they don't 'fall flat on their faces', discouraging others from the boardroom, are all concerns. It is crucial to make sure deputy directors continue to move up to the top jobs, Shields argues. 'If we don't, we've got a sort of timebomb ticking.'
Better information on the state of the finance workforce should be accompanied by a greater focus on supporting and developing staff throughout their careers, Shields believes. 'If you think about the medical profession, we wouldn't accept doctors not doing continuing professional development, but when it comes to accountants, there's always something much more important, more pressing,' he says.
He also argues for secondments and job shadowing to make sure finance staff gain experience in different parts of the NHS – and across the provider-commissioner divide.
'My experience in this job is that sometimes the best people at doing commissioning are people who've done a lot of provision, because they understand how the provision system works, how secondary care providers work and what levers need to be pulled,' he says.
Shields will no doubt pull a few levers of his own as he seeks to use his time in the HFMA chair to turn more attention to the development of the NHS finance function, and ensure it is fit to face the tough times ahead.
PFnov2008
