Comment / Searching questions

The past few weeks have been unusual ones in my career. I have nearly 30 years’ experience of working in the NHS, nearly two months of being president of our association, and two weeks’ direct experience of our health service – alongside my family – looking after a very poorly 89-year-old mother.

As I consider the finance role in the transformation of NHS services, I find I draw on all three experiences. As finance professionals we have multiple loyalties: to our employers; to our profession; and to our commissioner/provider organisations. But our overriding loyalty must be to patients and taxpayers.

So whatever the day-to-day pressures – and they are substantial – we must ask ourselves: what benefit did we offer patients today? For example, at Salford Royal, we have had a decent electronic patient record (EPR) for more than 10 years. We could no more function without it than we could without medical gases. Yet this is not the case for all hospitals. Imagine a finance department relying on ledger books and analysis paper as its primary source of knowledge.

So how are you supporting your clinicians to deliver better care? Could you articulate the case for an EPR or are you using national failures to implement a solution as an excuse for local inaction? The first is hard and the second convenient, but which route offers the best outcome for the patient?

Are you involved in helping your organisation really understand possible new ways of working? Take the current focus on seven-day working. The rationale is compelling and there are growing calls for progress, not least from the medical royal colleges. It is intuitively attractive and chimes on a personal level too. What I want for my mum is to know her day of admission does not impact on a timely diagnosis or that ongoing care is not compromised at weekends.

As a finance profession, we have a clear role in this, ensuring the debate also factors in the financial implications based on detailed analysis. Finances are not the reason for moving to seven-day working, but we need to understand where and when costs will arise alongside the likely financial impact of the expected service benefits.

This will inevitably lead to questions about what might need to change in local areas to create affordable quality. Service reconfigurations may be one conclusion. Radical changes to the models for delivering stroke services in London and Manchester have certainly delivered huge changes in outcomes.

Financial input is vital in this process and we must ensure we have the right skills. That means more than being spreadsheet wizards. Costing has to be a partnership of operational and financial expertise.

I may not understand detail of the complex science behind a treatment, but I should know the basics of how services work. If you do your costing without walking the shop floor, you miss the point. You may follow the rules, but will you end up with a figure that accurately reflects the cost of treatment – a figure you’d be confident presenting to a clinician?

Finance professionals have a big part to play in the transformation agenda. It is good to see Monitor recognising the importance of costing as it prepares for its role in price setting. That is vital to ensure funding covers the costs of quality service provision and incentivises models of care that deliver the best services. But good costing is about much more than price setting and will help ensure we build the right business cases for change and enter into new ways of working with our eyes open to the cost implications.

Contact the president at [email protected]