The NHS needs positive partnerships

9 Apr 15

Moves to boost the role of the finance profession in the NHS require a new collaboration between accountants and doctors, as well as an improved understanding of costs across the health service.

At a time of unprecedented change and tight budgets in the health service, the Future Focused Finance initiative is taking steps to ensure that accountants can help ensure best possible value for public money by working closely with clinical colleagues.

The importance of this was emphasised at a roundtable event at CIPFA’s London headquarters on March 30, where experts with backgrounds in health, research and local and central government came together to discuss how the 15,000 finance staff in the NHS can help managers make the right decisions.

Caroline Clarke, the senior responsible officer for FFF’s work on best possible value, explained how the programme would equip the health service’s finance community with the tools, skills and attitudes needed to be welcomed at the top table.

Attendees agreed there was a need to concentrate on outcomes for both patients and the whole population, with a focus on people living independently as long as possible with minimum medical intervention, rather than on increased health activity.

Doctors present at the discussion said financial decisions also had to be practical, but too many were made on the instinctive grounds that more spending must be good – for example on extra nurses – without an explanation about what outcomes will be improved.

Delivering this shift will require better ways of making the key allocative decisions, in which finance is crucial. How can we spend more on prevention and less on cure? How can we decide between the unquantifiable aspects of competing clinical strategies?

It is therefore vital to establish a new working partnership between clinicians and finance staff. A shared agenda around patient and population outcomes is required, tied to opportunity costing. Every decision to spend is another opportunity lost – so are the right decisions being made in that context? Accountants should see themselves as contributing to those health goals, and clinicians must accept that money needs to be controlled.

To contribute to this new relationship, finance staff need to be broad-based business enablers, with an outward-looking understanding of how the whole public sector works. They mustn’t take a narrowly organisational or numerical point of view. They should be “porpoising” – that is diving down into the detail when necessary but also leaping up to the strategic view. They need soft skills so clinicians involve them in decisions, and both groups need to be able to put themselves in each other’s shoes.

It might be too much to hope for perfection, but practical, porpoising finance staff will at least be making progress.

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