Clinicians: don’t forget the finance team

by Dr Yvette Oade

28 July 2020

Assessing pathway changes during Covid-19 must look at clinical outcomes, but patient-level cost data can also help understand if the changes have delivered value.

In the NHS we are all too aware of the usual impact of an economic downturn on the funding of public services. The NHS is appreciated even more now by the public. However the fact remains that we will have to play our part – ensuring we are giving value for money – after this brief period where supply rather than money has been the problem.

Recently, I chaired a webinar on how we harness the power of clinical and finance collaboration to deliver value for patients at a time when the Covid-19 pandemic has had a profound effect on the way we practice medicine and on our national economy.

During the webinar – a collaboration between the HFMA and the Faculty of Medical Leadership and Management (FMLM) – we heard from very experienced speakers including Dr Jean MacLeod, a consultant in diabetes and acute medicine in North Tees and Hartlepool Hospitals NHS Foundation Trust and a Getting it Right First Time ambassador, and Duncan Orme, operational director of finance at Nottingham University Hospitals NHS Trust.

It is a fact that from medical student to consultant we really don’t have much exposure to how NHS finances work. And we have even less in the way of hands on experience managing budgets –  until reaching clinical director level when suddenly you might find you are the accountable officer for millions of pounds.

As a medical student, which was admittedly a long time ago, I spent four weeks in the Children’s Hospital of East Ontario, Canada, where my eyes were opened to billing. Every intervention to the child was accounted for. If it took more than one cannula to put up a drip, each cannula used was on the bill.

Returning to the NHS, nobody knew the price of a blood test, an ultrasound or a day in hospital. Although we still don’t produce a patient bill, information is available to us in the form of PLICS – patient-level information and costing system data. We just need to ask a friendly finance colleague to help us interpret it.

Having worked with numerous finance teams I can confirm they are a friendly bunch, just as dedicated to doing the right thing for patients as clinical staff. However they are often rebuffed by clinicians who think that finance just want to balance the books.

In Leeds Teaching Hospitals, through a collaboration with Virginia Mason, Seattle, clinicians learned about value and waste from a patients’ perspective. Focusing on value to the patient – timely service, a great experience and good clinical outcomes – it was possible to reduce waste in the pathway and cost. Staff stopped talking about cost improvements and savings and instead started to identify waste reduction and improve quality.

During the Covid-19 pandemic, digital consultations have taken off. Many diagnostic tests have been drastically reduced. And patient pathways have been changed. But how are we going to assess if the changes were good for patients? We can use Friends and Family surveys and measure clinical outcomes, but we also need to look at PLICS data to assess if the changes have delivered value.

So how do we tackle the communication gap between doctors and finance teams? Nottingham has clinical accountants – just a name change, but one that I think might help. Finance colleagues have much more clinical insight than we often give them credit for.

We need more opportunities for doctors to have some finance training on the job – perhaps more joint webinars from FMLM and HFMA could be one way of delivering that. But clinicians should not forget they can also knock on the door or send a Microsoft Teams invitation to one of their friendly finance colleagues.

Watch the HFMA and FMLM webinar on Harnessing the power of clinical and financial collaboration.


The HFMA has made a number of its bitesize courses free for NHS staff through the Electronic Staff Record. Short, intermediate and advanced courses are available covering a range of topics from how the NHS is funded and governance arrangements through to motivating and leading teams and board-level decision making.