Careers / Simkins: pride in the core business

11 March 2024 Steve Brown

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Karl Simkins

Karl Simkins (pictured) called time on an almost 39-year career in NHS finance at the end of January. It is a career that started as one of the most junior members of the finance team and ended with 20 years as a chief finance officer.

There are many highlights, most recently overseeing the outline business case through Treasury approval for a new women and children’s hospital at the Royal Cornwall Hospital. But he says he is just as proud of going about the core business of being a chief finance officer, often in challenging circumstances. 

Mr Simkins has provided executive leadership across IT, business intelligence, planning and, in recent years, strategic and operational estates. 

It could all have been very different if the economics graduate had succeeded in getting the job in procurement he applied for back in 1985 at Nottingham Health Authority. However, at interview he was offered an alternative job in the accounts payable team in what turned out to be a career-defining moment. ‘It was one of the most junior roles you could get, with a lot of checking manual invoices against the paper order and the paper goods received note,’ he says.

He was lucky the NHS in the East Midlands provided opportunities to progress in different organisations, all within travelling distance of home, Mr Simkins says. And he took advantage of this, working in internal audit in Derby and in management accounts at the Kingsway mental health hospital before joining Leicester General Hospital. There he studied for his CIMA qualification, passing with high marks in 1996.

Just a year later he took his first deputy finance director role at the Queen’s Medical Centre NHS Trust (QMC), where he was to spend seven years. While there he developed the business case for the trust’s new accident and emergency department, with its distinctive wave-shaped entrance. He also got his first taste of being a finance director, in a novel arrangement where he and the then QMC finance director Tony Waite took the role of joint acting finance director for United Lincolnshire Hospitals NHS Trust, helping it recover from a deficit position. 

The franchising scheme, unique at the time in finance circles, lasted for around seven months and was covered by Healthcare Finance back in September 2003. It was successful in helping the Lincolnshire trust, but it was to be good preparation for Mr Simkins’ next move, a year later, into his first full-time finance director role at the George Eliot Hospital NHS Trust.

He spent another six years in the Midlands, adding a commissioning finance director role to his CV with four years at Leicestershire and Rutland Primary Care Trust. But then he moved with his family to Cornwall to become chief finance officer of the Royal Cornwall Hospitals NHS Trust, a trust that now has a turnover of around £650m. And he stayed here until his retirement in January, albeit sandwiching in a nearly three-year secondment as  finance director of the Cornwall and Isles of Scilly Sustainability and Transformation Partnership – the forerunner to the integrated care system.

Most recently, Mr Simkins has been preoccupied with a further major capital development, this time as part of the new hospital programme. The Royal Cornwall’s women and children’s hospital has been a long time in the planning and last year received formal Treasury approval for its outline business case – a milestone he was pleased to deliver before his retirement.

Mr Simkins is proud of his role in this project – acknowledging he has developed significant experience in the development and delivery of Treasury standard Green book business cases. 

But he says he is just as satisfied with all the ‘business as usual’ in his career across a wide portfolio – producing the accounts with clean audit reports, delivering the financial positions in difficult financial climates and spending limited capital funding wisely. ‘I just think that is something to be really proud of,’ he says, adding that there is a huge responsibility in being part of a leadership team of a big organisation that has so much impact on patient and staff lives.

He says he has never harboured ambitions to become a chief executive and felt comfortable in, and being part of, the finance family. He pays tribute to numerous former colleagues and finance leaders who helped him during his career – Mark Brearley, Colin Reeves, Tony Waite and Bob Alexander, to name just a few. 

Mr Simkins believes a finance director is only as good as the team he works with, and he thanks all his colleagues though the years. 

He also singles out the support of the HFMA in providing technical advice, networking opportunities and a community that benefits the whole finance function – a level of support that simply doesn’t exist for many of the other corporate professions, he says.
And he has certainly played his part in supporting the association, as a key member of the old Financial Management and Research Committee and more recently the Policy and Research Committee. Among wide-ranging contributions, he singles out his part in the collective effort to produce the HFMA Introductory guide to NHS finance. 

His support was recognised in 2017, when he was made an honorary fellow of the association and again last year when he was given an outstanding achievement award by the HFMA South West Branch. 

Mr Simkins says he plans to try to take things a little easier in his retirement. ‘Perhaps a little gardening and house redecoration,’ he says. ‘But I am planning to watch the England cricket team in the Caribbean this November, an ambition for many years, as well as starting to work through an extensive ‘bucket list’. 

‘I would also like to continue to support the HFMA and keep my hand in both professionally and academically, so perhaps voluntary work or a non-executive role in or outside the service at the right time would be a consideration.’