Under pressure

by Mark Orchard

12 October 2017

Financial reporting must reflect the real financial position and the challenges facing NHS bodies.

The recent warnings that senior NHS finance professionals are being bullied into reporting unachievable numbers are disturbing. As a jobbing finance director for an acute hospital, I know all too well that a key part of my role is to deliver an honest and true assessment of the financial position, even where this is often not what anyone wants to hear.

Integrity is central to our professional ethical code. Of course there are often a range of valid financial instruments, non-recurrent measures and short-term fixes that may be deployed to ‘shore up’ the bottom line. But unsubstantiated or unrealistic projections are simply unhelpful and avoid decisions that may be in the best interest of patients and sustainable services in the short and longer term.

The HFMA has picked up individual comments from directors of finance and chief finance officers about expectations on delivering financial results. And there is no doubt there is considerable unprecedented pressure on valuable NHS resources.

‘Doing what we said we would do’ has become a mantra – not just at Poole Hospital, where I am director of finance, and across Dorset, but for the vast majority of NHS boards and governing bodies across the UK. They know only too well that the autonomy of their organisations and wider health and care systems rests squarely on delivering what they have set out to achieve in financial and performance terms.

NHS boards remain responsible for delivering their approved plans, and chief executives are accountable for the consequences of success or failure whether that be linked to patient safety, financial liquidity or meeting nationally determined NHS access standards. The stakes are high, and the most senior finance professionals will be under unrelenting pressure to confirm deliverability at every stage of the journey.

We know that there is a range of experiences at the most senior levels of NHS accountancy. And the level of financial and system maturity at board and organisational level will vary also. The balance of support and challenge will feel very different depending on local context. But the role of the chief financial officer is clear and cannot be compromised.

Our job starts with telling it as it is – not worst case scenario or spreadsheet pessimism, and neither blind optimism with heroic assumptions. We then need to create an environment in which, working alongside our operational and clinical colleagues, we can facilitate the best possible plan – and then work towards delivering that plan step-by-step. Support from chief executives, boards and governing bodies is paramount.

I know only too well from my own experience that this can be tiring, often lonely and calls upon levels of deep personal resilience that can challenge even the strongest and most confident among us. Not accepting a financial control total target, signalling a move off course or being unable to support an otherwise good clinical case for making unfunded expenditure – these all require courage and often come with conflicting consequences.

The HFMA does not believe that there is systematic bullying in the NHS from regulators. But if bullying does exist – even in isolated cases – it needs to be called out. Just as all parts of the health and care system are under intense pressure, it is important to remind ourselves that accountants must also have regard to their professional ethical duties. 

The role of the NHS chief finance officer, an updated version of which has just been published for consultation by the HFMA, sets out the key components of what being a finance director in the NHS is all about. It also makes a good read for board colleagues and other stakeholders in understanding what to expect from their finance executive.

So we support our colleagues at the Chartered Institute of Public Finance and Accountancy in underlining the importance of financial reporting that reflects the real financial position and the challenges facing NHS bodies. The current HFMA staff attitudes survey and temperature check may shed further light on this issue when published in the autumn.

HFMA chief executive Mark Knight recently remarked that the association is a safe space for members, like an ‘oasis’ where professionals can come together to network and learn, however difficult things look back at the office. It strikes me that we must build on this, and support each other where professional integrity feels challenged and undermined.

We all have a job to do, to support good patient care and sustainable service delivery now and into the future. Our profession continues to be held in the highest regard and is central to finding the local and national solutions that will ensure that our NHS is fit for the future. So let’s stay focused on doing the right thing, always. Everyone counts and you are not alone.