Feature / Levelling up
But beyond word of mouth and interview promises, how can you demonstrate that an organisation is really serious about development? Accreditation, that’s how. The Towards Excellence programme, run by One NHS Finance, began life back in 1998, when it was introduced by finance directors in the North West and overseen by the North West Finance Staff Development Group.
The aim is to recognise good practice in finance skills development and it is awarded at three levels, from level 1 (good practice), through level 2 (high performance) to level 3 (leading edge). Accreditation at each level lasts three years and it would typically take three years to move up the three levels. As of January, there are 178 organisations with accreditation at one of the three levels. The One NHS Finance development strategy sets a target of having all NHS finance teams accredited to at least level 1 by 2026.
Given the accreditation programme is open to all NHS finance organisations – including regional and national teams, community interest companies, NHS audit agencies and shared services operation – it is not clear how many organisations still need to embark on their accreditation journey. However, there are 72 providers and 20 integrated care boards yet to achieve their first accreditation milestone.
Some ICBs were quick off the mark after their creation last July. In Greater Manchester, for example, all the predecessor clinical commissioning groups made a concerted effort to gain accreditation ahead of the ICB going live, enabling the board to quickly demonstrate level 1 accreditation.
Of the 178 accredited bodies, 34 are now at level 2, with just 18 being able to claim that they are leading edge in terms of skills development.
Gaining level 1, in most regions, involves self-assessment against published criteria in six standards covering: infrastructure; personal development; professional development; workforce and career planning; corporate financial competence; and business controls and policy.
The requirements included within the criteria get more detailed and representative of higher performance as organisations progress up the levels. Levels 2 and 3 require external assessment, with assessors recruited from across the NHS, and level 3 organisations are required to put forward an assessor for the national programme.
One NHS Finance claims that the benefits are wide ranging, helping to create a development culture that is underpinned by a competence-based approach. It helps to SHUTTERSTOCK healthcare finance | March 2023 23 skills development ensure that the finance function is constantly developing, adding or improving skills that can help steer their organisations to higher levels of performance. And it highlights the fact that the chief finance officer is serious about staff development and about the financial competence of their organisation.
These benefits are echoed by those organisations at all levels in the accreditation process, many of which suggest there are additional benefits in improving recruitment and retention and encouraging a sense of pride among finance team members.
Level 1: University Hospitals Dorset NHS Foundation Trust
Applying and successfully achieving level 1 accreditation has helped University Hospitals Dorset NHS Foundation Trust (UHD) to further establish its staff development culture following a merger of two trusts.
The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust and Poole Hospital NHS Foundation Trust merged in October 2020. This happened during an already difficult time, with the whole NHS in the first year of the Covid-19 pandemic.
According to the Dorset trust’s associate director of finance, Chris Hickson, the accreditation process was particularly helpful in building on the culture for the new trust finance team. ‘It really helped us to establish the UHD way,’ he said.
In part, the accreditation proforma provided a checklist to ensure the trust had the core infrastructure in place to deliver staff development across its unified team. Much of it was already there, adopted from the previous teams’ arrangements. As a first step, the trust ensured the new organisation was registered with all the relevant accountancy bodies for continuing professional development – a step Mr Hickson encourages others thinking of embarking on the accreditation journey to sort out early on. UHD then proceeded to ensure it could evidence all the other criteria. Mr Hickson says there was a noticeable increase in enthusiasm from staff in the 75-strong team about personal and professional development.
‘There was an uptick in staff resuming their qualifications or studies and the process led to a lot more people being engaged in various networks,’ he adds. The level 1 criteria require the trust to have staff members involved in various ambassadorial roles – for example, as a Future-Focused Finance value maker, a health and wellbeing champion or a finance and clinical educator. The trust has now easily exceeded the minimum requirements.
Level 1 also puts a focus on finance function diversity, expecting a trust to move towards a finance team make-up that mirrors its local population. In Dorset, the finance department has adopted the One NHS Finance equality, diversity and inclusion (EDI) action plan, overseen by an EDI steering group, which links in with the wider trust. Mr Hickson says this group has been highly successful and has further helped to establish the team culture.
The criteria also look for evidence of collaborative teamwork among clinicians and non-finance staff – something the trust could ably demonstrate given its deputy chief medical officer Ruth Williamson (pictured right with Mr Hickson) was named the 2022 HFMA Working with Finance – Clinician of the Year.
The evidence-based approach of the assessment is also helpful in reinforcing credibility with clinicians. The trust is the first provider in its system to gain accreditation and one of only 13 organisations in the South West out of a total 30 organisations. But Mr Hickson is clear that level 1 is a starting point. ‘I feel we have a lot of the building blocks in place for level 2 and we are keen to start working towards that,’ he says. He admits that the process takes time, but insists it is time well spent, with the robustness of the process making the award valuable.
Level 2: Norfolk and Suffolk NHS Foundation Trust
Norfolk and Suffolk NHS Foundation Trust’s finance team gained its level 2 Towards Excellence accreditation at the start of this year, following a December submission. Jodi Martin (pictured), senior strategic finance manager at the trust, says achieving the required level was a great feeling. But the real benefit has been the way that preparing for accreditation has fostered a culture around continual improvement.
‘It is not just a tick-box exercise,’ she says. ‘The accreditation programme gives you a reason to ensure you are doing things that you should be doing anyway. But we don’t just stop when it’s done. It has made us think about how we can continually improve.’
Ms Martin led the accreditation programme at Norfolk and Suffolk and is also an assessor for the programme nationally. However, she says the trick to gaining accreditation is getting other members of the finance team involved. Assigning other people to oversee specific criteria and gather the necessary evidence not only spreads the workload, but it also encourages engagement in the process.
‘The more people who are involved, the more input you get from the grass roots,’ she says, helping to raise awareness of the accreditation programme overall and what the organisation does to support development. Moving from level 1, which is self-assessed, to the peer-reviewed level 2 is a significant step up. One NHS Finance describes it as moving from good practice to a high level of performance. For example, at level 1, organisations are required to demonstrate that all finance staff have up-to-date job descriptions, agreed objectives and personal development plans (PDPs).
But at level 2, objectives have to be reviewed and set at least annually and PDPs must be actively managed, with all staff having sixmonthly reviews. While level 1 requires a finance skills development strategy and action plan, at level 2 organisations must also produce an annual finance skills development report.
One of the areas needing most effort at Norfolk and Suffolk in pushing for level 2 related to finance staff development. It has made a difference by taking a much more active, hands-on approach to development compared with level 1. Previously, an email might have been sent to all staff making them aware of development opportunities.
But this didn’t mean these opportunities were taken up, either because they didn’t see the email or felt they were too busy. Now, managers actively “There was an uptick in staff resuming their studies and the process led to a lot more people being engaged in various networks” Chris Hickson 24 March 2023 | healthcare finance suggest training that they think would be relevant to team members.
Ms Martin says the accreditation process has helped bring the team together – particularly useful with everyone still mostly working from home after Covid-driven changes. She identifies pride among team members about having achieved the level 2 award, and says it is something other organisations are aware of. All seven organisations in the local system are at least level 1, with two now at level 2 and a further organisation submitting in April. ‘It has to help with recruitment and retention,’ she says, providing evidence to support an organisation’s promises of offering career development opportunities.
Level 3: Royal Papworth Hospital NHS Foundation Trust
Achieving level 3 in the Towards Excellence accreditation programme is not the end point in staff development. What it does do is encourage and embed the right culture to ensure that improvement is self-sustaining.
That’s the view of finance leaders at the Royal Papworth Hospital NHS Foundation Trust, which gained its level 3 accreditation in January – the highest level available under the programme. ‘We don’t consider you need a level 4, because level 3 provides evidence that you have embedded a culture of continuous staff development,’ says Sarah Brisbane (pictured), the trust’s head of commissioning and income. ‘Level 3 is not the end of the road, but is a springboard to go on to even better things.’
The trust began its accreditation journey in 2019, when it gained level 1 accreditation, achieving its level 2 in September 2021 and its level 3 15 months later. ‘It does take time, there’s no doubting that,’ Mrs Brisbane continues. ‘But it isn’t onerous if you plan well.’
The keys to success are a committed team of individuals to spread the load, as well as senior commitment to support and challenge – in this case, deputy chief executive and chief finance officer Tim Glenn.
Mrs Brisbane adds that the big step up was achieving level 2. Level 3 is more about demonstrating that the approach to staff development is fully embedded and consistently applied in the way the finance department operates.
Once delivered, the benefits are huge – for individual team members, the team as a whole, the organisation and, arguably, the wider finance function. For a start, the finance team saw accreditation as a badge of quality and a source of pride.
‘Papworth has a reputation as a hospital that is innovative and right at the cutting edge of clinical care, which is reflected in the outcomes we achieve,’ says Mr Glenn. ‘And it is reflected in our Care Quality Commission rating, which is outstanding across all five domains.’
Mr Glenn says finance and support services play an important part in delivering these standards. He liked the idea of something visible that showed the rest of the hospital the high standards adhered to by the finance team. He suggests that is exactly what the accreditation programme does.
‘If you are good at training people, you tend to attract the talent that wants to be trained. If you attract the right people with the right motivation and they grow and develop with you, that is how you get success,’ he says.
‘It also provides us with assurance that we are working to best practice,’ says Mrs Brisbane, ‘and striving to have an environment of excellence.’
She says the accreditation process has helped the finance team better understand what can be done. It is all too easy to sit back, especially when times are so busy, and think that you are doing everything right for the team. ‘But some of the accreditation criteria make you realise there is more you could do,’ she adds.
Getting accredited has been popular with the finance team. The finance department comes out top in the trust’s staff survey results, and Mr Glenn is convinced this is linked to the quality of service provided – happier and more motivated staff get better results.
Retention is good, but when staff do move on for promotions elsewhere, that is also seen as a positive outcome linked to the development provided. Mr Glenn says it is interesting how often candidates in job interviews mention the accreditation as part of the attraction of joining the trust.
Even if the accreditation process is a little time-consuming, Mr Glenn believes not focusing on development also puts a drain on resources. ‘Really there is no alternative. Not developing people also creates work,’ he says. ‘If people keep leaving the hospital, you have to keep recruiting and spending time in interviews. Having the right development culture is about channelling energy into something that is positive. It is just a decision as to where you want to put that energy.’
Mrs Brisbane believes once you start looking, there are lots of ways to improve an organisation’s development opportunities and resources. As an assessor for the wider programme, she has a great insight into good practice. ‘One of my pieces of advice to any organisation looking to pursue accreditation is to get a team member to become an assessor,’ she says. ‘As well as the networking, you pick up amazing ideas from other organisations. We’ve shared a lot of what we do – our skills matrix is a good example – but we’ve had lots of ideas coming the other way too.’
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