Changing working practices of the NHS finance function

by Lisa Robertson

05 August 2020

Throughout August we are taking the opportunity to focus on some key areas of the HFMA’s policy and technical work and remind members about some of the outputs that might be useful. Each week we are highlighting a different topic. This week, the focus is on the NHS finance function.

The Covid-19 pandemic has fundamentally changed the way in which the NHS operates and shown that it is possible for many staff to work differently. In some areas, change has been a rapid response to immediate need. In others, change that had already begun has been accelerated. As the NHS resets, there is a desire to take the opportunity to create a new normal for the role of the NHS finance professional that best meets the needs of the NHS of the future.

The NHS finance function has worked hard to support the service throughout the pandemic. Many staff have been working remotely, developing innovative new ways of carrying out processes that were previously thought to be impossible away from the office. Finance staff have been involved in many aspects of the work to address Covid-19, working with procurement functions, delivering personal protective equipment (PPE), supporting Covid-19 testing, and working at a system level to carry out scenario modelling. A number of these stories have been shared in the HFMA news #doingourbit series and HFMAtalk podcasts.

Working in a different way has highlighted a number of good practice areas that should be retained such as: flexible working; speed of decision-making; increased system response; cross-skilling; a streamlined financial regime; and greater use of technology. These have been an essential part of the response to Covid-19 and many are keen to retain these unexpected positive outcomes from the pandemic.

Finance departments now have the opportunity to reflect on the success of changed processes as a result of Covid-19 and which ones are appropriate to retain longer term. For example, what governance arrangements add value and what is the right balance between speed and approval processes to minimise bureaucracy while retaining control and assurance? Or how do we continue to engage effectively with clinicians and operational managers – both within organisations and the wider system – over budget reports and performance?

Much of what the NHS finance function needs to do now to prepare for the future had already begun – albeit on a small scale or under specific local initiatives. Published in December 2019, the paper from HFMA, Future-Focused Finance (FFF) and PwC, NHS finance: designing our future explores the challenges and opportunities for NHS finance, setting out a suggested long-term vision for the finance profession in the NHS. It also touches upon the role of the finance business partner, which provides a key link between frontline services and the finance function. Exploring the role of the NHS finance business partner  looks further at the key aspects of the role and the skills required to be a successful finance business partner.

There is an overwhelming consensus that the NHS must not be allowed to slip back to how it was before Covid-19. Instead it needs to take this opportunity to consider where beneficial changes could be made, learning from good practice across the country and seeking out ideas and innovations to meet the challenges of a 21st century health system. This must be done in the context of delivering a financially, and environmentally, sustainable health and care system. The future NHS financial regime in England: a discussion paper sets out key areas where lessons can be learnt from the experiences of recent months. The results of a survey, conducted following this discussion paper, will inform a final report from HFMA in the autumn, which will consolidate and share our views.

The NHS people plan, We are the NHS: people plan 2020/21 – action for us all  takes the opportunity to consider the learning from the pandemic and consolidate good practice as the NHS develops new ways of working. (The HFMA has produced a summary of the plan, available here.)

With many NHS finance teams working from home during the pandemic, HFMA members have also welcomed the webinars and on-line learning resources to support them with the challenges they face and their own development. A series of CPD webinars have included topics such as: management and leadership; motivation and relationship management; and communication and presentation. These are available on-demand. The HFMA has also produced a directory of resources  with FFF, to signpost to the resources available to members and the wider NHS finance community.

Alongside the pandemic, the Black Lives Matter movement reminds us that greater diversity and inclusion must be a characteristic of the future NHS finance function. There is a clear desire and will to make changes to improve diversity and inclusion in NHS finance. However, the challenge is translating this into sustained actions to get to a position where diversity and inclusion is embedded in ways of working for everyone Diversity and inclusion: how you can make a difference  considers the practical actions that can make a difference and drive positive change.

There is no doubt that 2020 will be a year to remember – filled with challenges, uncertainty and opportunities. For finance teams, the ultimate goal is to capture the lessons learnt along the way. And using these lessons, the function as a whole should embed a new normal for NHS finance that supports organisations and systems back to recovery.