Finance: a matter for all in the NHS

23 Oct 15

Everyone in healthcare needs to understand finance, and finance staff need to know about clinical issues. The NHS Future-Focused Finance programme is bringing them together

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Everyone involved in NHS finance needs the skills, methods and opportunities to influence decision-making to support safe, high-quality services. Ensuring this happens is a goal of the NHS Future-Focused Finance (FFF) programme.

FFF was launched in February 2014 by finance chiefs at NHS England, the NHS Trust Development Authority, Health Education England, Monitor, the Department of Health and the Healthcare Financial Management Association.

The scheme intends to change the culture, nature and practice of NHS finance; its scope covers finance staff as well as their colleagues, patients and communities.

The FFF vision has three strategic themes: securing excellence; knowing the business; and fulfilling our potential. Each theme has two action areas (detailed below) led by a senior NHS professional. A small central team supports the programme and a host of volunteers – value makers and finance educators – are helping to bring FFF to life. A great deal has been achieved.


Best possible value

The best possible value action area seeks to put value at the centre of all NHS decisions, and focuses on improving decision making in organisations and health economies.

The area group has worked with Bain & Co to adapt its Rapid decision-making tool, which enables decision makers to show they have considered patient outcomes, safety and experience, as well as revenue and capital costs. After pilots at Liverpool Clinical Commissioning Group and Mid Cheshire Hospitals NHS Foundation Trust, the tool has been made available to NHS organisations via the FFF website. CIPFA has played a central role in supporting this work.

This area is led by Caroline Clarke, chief finance officer and deputy chief executive at the Royal Free London NHS Foundation Trust.


Efficient systems and processes

This area supports organisations as they assess their financial systems, and benchmark and improve them.

In the first phase, a tool was developed with EY to allow NHS organisations to measure their financial systems against benchmarks and to identify areas needing improvement. The second phase will see the tool developed and moved online; the web version will make it easier to complete the assessment, compare data with peers and collaborate on improvements.

The delivery group is working with NHS Shared Business Services (SBS) to improve the quality and functionality of the latter’s financial support to the NHS. SBS will develop and trial processes in a health economy before a roll-out; it will also consider a clearing house for all NHS financial transactions, and a standardised accounts chart throughout the service.

Suzanne Tracey, deputy chief executive/chief financial officer at the Royal Devon and Exeter NHS Foundation Trust, is leading this area.


Close partnering

The close partnering action area aims to improve working relationships between finance and other staff.

This includes improving how NHS finance staff impart their knowledge to clinical colleagues while learning about clinical issues. Some 170 finance educators are working across England; the next step will be to train clinical educators – doctors, nurses and other clinical staff – to deliver financial messages.

An online survey on working relationships, drawn up with Ipsos Mori, was completed by more than 800 staff over the summer and the findings are due to be published later this year. Alongside this, The King’s Fund is developing a toolkit to help staff to reflect upon and improve working relationships. This is being trialled in 20 organisations, with a roll-out planned for early December.

Another aim is helping the public to understand NHS finance. Findings from discussions about this will be published soon.

Finally, the group is working with NHS England and other organisations to raise awareness about waste in the NHS.

The area is led by Dr Sanjay Agrawal, a consultant respiratory intensivist at University Hospitals of Leicester NHS Trust.


Skills and strengths

This area plans to develop a framework to ensure that NHS finance staff believe: “We all have the skills and strengths for our roles.”

Four skill-set areas have been identified: I’m a finance professional; I’m a team player; I drive value for patients and tax payers; and I make change happen. The theory is that staff should work towards having the skills needed for their role in all four areas.

This action area is planning an online model to assist staff with development, which has three linked areas – assess, use and inform. There will be a focus on ‘use’ – applying learning to work – as anecdotal evidence shows much development activity does not improve performance.

This action area is being led by Richard Alexander, chief financial officer at Imperial College Healthcare NHS Trust.


Great place to work

This area has two main aims: to build a consensus on what makes an NHS finance team a great place to work; and to understand NHS finance careers, and how staff might be supported – and support themselves – in career development.

One of FFF’s first projects was the finance director declaration. More than 170 NHS finance directors and chief finance officers show public support for FFF by signing declarations; they are being surveyed about the effects of this on their departments.

A pilot to encourage secondments and job swaps is being undertaken in the Yorkshire & Humber region – 13 secondments are being supported.

Other work includes: increasing the uptake of coaching and mentoring; improving the diversity of the finance workforce to match that of populations served; publishing case studies of more than 20 finance staff at different career stages; and supporting aspirant finance directors.

Cathy Kennedy, deputy chief executive/chief finance officer at North East Lincolnshire Clinical Commissioning Group, is leading this area.


Foundations for sustained improvement

This area has three sub-areas – a foundation, a volunteer network and the FFF website. The foundation oversees FFF’s work and ensures it links to work by the NHS Finance Skills Development teams and the Healthcare Financial Management Association. The foundation has set strategic objectives for staff development work.

The value maker network, led by Cathy Kennedy, is a group of almost 170 volunteers who work with the FFF team to promote FFF and to bring its values to life. They are on Twitter (see links below) and attend events across the country to bring FFF’s message to the attention of as many people as possible.

The FFF website has more than 2,500 registered users and, while we’re delighted with this, we are working to extend that.

All of the above has only been possible thanks to the senior finance leaders, volunteer value makers and finance educators and through the passion and commitment of everyone who has engaged with the project since its launch.


Follow FFF on Twitter via @nhsFFF or send an email to [email protected]

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