No ordinary accountant

16 September 2020 Seamus Ward

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Asked what he would do differently if given the chance to change any part of his 30-plus years in the health service, Paul Cummings (pictured) thinks a moment, then says: ‘I’d try to listen more and speak less. I’d try to spend more time at the coal face – because we can be all about balancing the books and not much about the quality of care.’PaulCummings_2_Sept20_P

That doesn’t sound like a typical accountant’s answer. He replies by telling a story about being asked by JK Rowling’s charity, Lumos, to talk to ministers and officials in Bulgaria about resettling children with learning disabilities from long-term institutions. ‘I was introduced by the head of Lumos as the first accountant they’d met who talks like a social worker – that’s the best compliment I’ve ever had.’

Taking up this theme, Mr Cummings says social care must receive as much attention as acute services. ‘It’s about getting the balance between what happens in hospital and what happens outside. You can make a difference in how you fund Early Years and change children’s lives and make a bigger difference in the long run.

He speaks with compassion and sincerity, talking warmly of the people he has met, from porters and security guards to consultants and ground-breaking medical researchers.

Having trained at Northern Ireland Electricity (NIE), he admits to ‘falling into’ working for the Health and Personal Social Services – Northern Ireland has an integrated system. But his rise was rapid, and he got his first director of finance job at Belfast’s Mater Hospital, aged 27. ‘The Mater was the most rewarding job in my career,’ he says. ‘It was an organisation that was small enough to spend a day in theatres, or with the physiotherapists or to work with the nurses for the day. You get to understand the business at that level.’

Now director of finance at Northern Ireland’s commissioner, the Health and Social Care Board, he holds firm to the importance of getting to know the business. ‘When I was working at a trust, trainee accountants would spend their first two weeks as porters, on the night shift or in A&E.

‘I learnt that at NIE – for the first year they didn’t let you near finance, you worked in a showroom, a power station or with the overhead linesmen. So, when you went into finance, you knew who to ring if there was a problem. It gives you credibility.

‘But it must be a two-way street – sometimes the doctor needs to be in charge of the finance; in patient-level costing, maybe a clinician needs to be the lead, not the finance team.

‘I say all the time to staff: the more you get out, the more you are able to do your job. Listen to patients and carers.’

The Mater’s location, close to Republican and Loyalist communities in the city, meant it often cared for the casualties of the Troubles. Mr Cummings recalls a bomber, the injured and relatives being treated on the same ward; paramilitaries stationed in corridors guarding their organisation’s members; and a hospital security guard being shot. And the violence meant not knowing if the route to work or home would be disrupted.

Even so, he adds: ‘It was tremendously rewarding. The team in hospital faced adversity and was united, regardless of background, and saved many, many lives. For such a small hospital, it did some ground-breaking work and when I go back there, people still know me even though I haven’t worked there in 20 years.’PaulCummings_conf03_Sept20_P

In 2003, he was the first person from outside the English NHS to become HFMA chair (pictured), and he feels this was a turning point in his career.

‘In Northern Ireland, we think we are in some way inferior to the rest of the UK, but when I took up the post as chair I realised the work we were doing was just as good. They had as much to learn from us as we had from them.

‘This is something I think the HFMA doesn’t do enough of. We need to make sure the whole of the UK and beyond learn from each other.’


Learning from others

The US/UK exchange was a way for him to continue learning from other health systems. But, as well as being good for professional development, it produced enduring links. Indeed, involvement in the HFMA has given him lifelong friends. ‘For me, people are the most important thing. It’s why I was able to send a team to see how Wales was dealing with patient-level costing despite Covid.’

Mr Cummings led the profession in talks about the Agenda for Change pay structure – a pivotal moment for NHS finance staff across the UK. ‘It was about where we sat in relation to other professions. There was a real danger we were going to be downgraded as a profession. But the work we did showed the worth of the profession and, after that, we were not seen as a support service but a vital equal around the top table.’

There were concerns that new starters in some lower paid grades – payroll, for example – could see their salaries reduced by up to 30%. Mr Cummings successfully argued for changes in job profiles to protect salaries.

Coming to the English health system as an outsider worked in his favour, he believes – he was able to say things others could not. Without the intervention, newly qualified NHS accountants would have started on Band 6 – negotiations led to them being set at Band 7.

Success in the negotiations gave the association a new confidence, he adds. ‘I think the HFMA was just getting up and running after it split from CIPFA. It was finding its feet and realising that it could promote itself and provide tremendous value to its members
and the whole health service.’

Back in Northern Ireland, a secondment to the Northern Trust had a profound effect. ‘I was brought in not because of the money but because of patient care concerns. There were challenges around A&E and the clinical governance of staff. A review uncovered 21 historic serious adverse incidents, where the trust fell far short in its care to individuals, resulting in significant harm or death. There was a culture that needed to be acknowledged and changed. It took courage not to ignore that but it was the right thing to do.’


In the headlines

Local and national media picked up the story. ‘Appearing in front of the media to apologise on behalf of the trust was difficult, but meeting families to apologise for the death of their loved ones were the most difficult days of my career. We let them down and nothing I could say would change that.’

Asked whether he has enjoyed his career, Mr Cummings states: ‘Absolutely. I didn’t choose a career in the health service, but I wouldn’t have stayed if I didn’t enjoy it. I am in favour of using your accountancy skills to influence policy and strategic decisions. In the health service, your ability to influence people can’t be underestimated. As a director of finance, don’t think you do not make a difference. I have letters from clinicians stating how many people are alive now because I got them the funding.’

He leaves the service predicting tough times ahead, particularly around workforce, as he feels too few people are joining the caring professions. He would like to see the politics taken out of health, and longer-term planning for financial and strategic decisions.

Retirement will mean a break from work, but at 57 he’s not about to spend his time playing golf – which he took up two years ago – though he is hoping to work on his 20 handicap. ‘I want to do something where I feel I can make a difference,’ he says.

Making a difference is what this accountant who talks like a social worker has long done.

A career in finance
Paul Cummings trained as an accountant with Northern Ireland Electricity (NIE) before joining the Eastern Health and Social Services Board in 1987.PaulCummings_HF02 cover_Sept20_P
‘I fell into it,’ he says. ‘NIE had a European grant to train three accountants every year, but when I qualified, they didn’t have a job for me as an accountant. I was supernumerary, but I didn’t want to sit around waiting.’
A job came up in the local NHS. ‘I was lucky enough to get it, but it means I started in the same building I’m finishing up in – I’ve gone from being the most junior accountant to director of finance for the whole of Northern Ireland.’
Things have changed a lot since he joined the service. He remembers with a chuckle his first day, when staff broke for morning tea, served in china cups, with the director of finance. ‘Computers were just starting to be used in offices and the finance director said: “Get this man a computer. In fact, get him two”. ‘
So, I was given one of the first 286s, which nobody knew what to do with, and [spreadsheet program] Lotus 1-2-3, which I had to go on a course to learn how to use.’
Mr Cummings has held a number of finance director posts in Northern Ireland, the first at the Mater Hospital in Belfast. ‘I’ve just had my 30th set of accounts signed off – all of them unqualified, which is not bad.’
Supporting documents
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