Feature / Financial quest

As his HFMA presidency comes to a close, Tony Whitfield tells Seamus Ward about the past 12 months and the importance of finance professionals in supporting change

HFMA president Tony Whitfield firmly believes finance managers have a key role in supporting transformational change, a belief strengthened by the association’s contribution to the seven-day services forum. He was closely involved in the analysis of the financial implications of seven-day services for emergency and urgent services and he feels that it provides a model for the type of inputs the finance community can give in local transformation initiatives.

Mr Whitfield, who is director of finance and deputy chief executive at Salford Royal NHS Foundation Trust, has long insisted on the importance of costing at national and local level. But he believes some finance professionals will have to add to their skills to contribute to local change plans.

‘Financial leaders should be paying attention to the quality of costing and our ability to do costing. The experience of our finance teams to undertake new-world costing is something that Monitor has recognised as important.

‘I’ve been associated with the HFMA costing committees for a number of years. It is one of my great interests. It is my belief that the NHS must get better at costing and create that professional community to get the skill set right, to close the gap that Monitor recognises, to enhance tariff setting and to create the financial insights into the changes in service as we prepare for the future.’

Costing should be a multidisciplinary activity and involve clinicians, operational and financial managers, he says. ‘You can’t do costing from the comfort of the finance department and, in a world of finite resources, you can’t create clinically sustainable frameworks in the absence of cost data.

‘The most progressive organisations recognise that to perform costing properly, you must involve the people who know how best to meet the needs of patients – clinicians and managers who know organisational processes, and finance people who understand costs. With this triumverate, you can understand most financial issues and create the means to deliver the best outcomes for patients.’

Finance professionals should use their skills to enhance the patient experience, quality, safety and value, he adds. ‘As a patient, you would like to think there’s nothing in this process that means suboptimal care can happen. As a taxpayer, you want no opportunities for waste that would deny another taxpayer treatment.’

The HFMA’s role in seven-day services was one highlight of a particularly busy year for the association. Mr Whitfield’s theme, Knowing the business, appeared to capture the zeitgeist. Its aim – to give finance professionals a greater understanding of the clinical services commissioned or provided by their organisation to help them support decisions on the future of services – fits neatly with the transformation of care agenda, which seeks to change how and where services are delivered to improve quality, safety and efficiency.

Timely theme

He says the theme was timely. ‘It came when we had the second Francis report on Mid Staffordshire trust and the Berwick report on zero harm. I have been taken with the amount of interest people have shown in the theme and have found it helpful.’

His belief in the power of costing to help transform services is based not only on the recommendations of the Francis and Berwick reports, but also on direct experience. ‘One of the things I have talked about as I have gone round the branches – and I don't mean this to be sentimental – is my personal experience of healthcare,’ he says. ‘My mother died at the beginning of the year and I experienced the reality when you are at the receiving end of what we offer.

‘After three weeks in hospital, she died of hospital-acquired pneumonia. Everyone in the hospital – staff, doctors and nurses – was as good and as caring as they could be. There appeared to be no shortage of staff. But the system was designed to be slower than it needs to be. The first two weeks she spent in hospital, the investigations were being done, and then she had a week before she died. The clinical commissioning group will have been presented with a bill for three weeks care. But it raises questions: could the outcome for my mother and the cost to the system been different if the diagnostic phase had happened over three to four days?’ Another factor is that ‘at 89 years old, she was one of the youngest patients on the ward’. This reflects the age profile in many wards, says Mr Whitfield, and is one reason why September’s Royal College of Physicians’ report on out-of-hospital care – Future hospital: caring for medical patients – is so important. ‘We need to be able to deal with the increasing number of older people with comorbidities. The RCP report gives us a start point,’ he says.

He is delighted with the development of the HFMA over the past year. ‘It was a proud moment when Rochester Row opened. To have a facility in London for members is wonderful. It has been great working with committed trustees and HFMA colleagues, who are passionate and recognise the changing environment and want to make sure the association adapts to the new world.’

He also wants to put on record his thanks for the support and respect given to the association by key financial leaders in all four nations.

An HFMA president does a lot of travelling to meet local association members and this was a part of the role he enjoyed the most. ‘One of the highlights was getting around the branches in England, as well as Wales, Scotland and Northern Ireland,’ he says. ‘The energy and enthusiasm was fabulous, as well as the contrasting approaches of the four nations. I was particularly inspired by the presentations of [Scotland director of finance, e-health and pharmaceuticals] John Matheson and [Scotland chief medical officer] Harry Burns at the Scottish conference, with insights into harm prevention and the determinants of health.’

International lessons

In a similar vein, a trip to meet colleagues in the US HFMA was enlightening. ‘The way we learn is to find out how others are doing things and then bringing that knowledge back into our own organisations. We have tried to do this in Salford for years. We have searched around the world for better ways of doing things – we feel no embarrassment in doing that.’

Speaking ahead of a fact-finding trip to Australia in November, Mr Whitfield says: ‘I am  interested in what they are doing around costing, coding and tariffs. Given that our payment system was plagiarised from Australia about 10 years ago, I want to see where they have been and how they are making progress.’

He is due to hand over to his successor, Andy Hardy, on 6 December, but soon after that, he is heading off for another challenge. In the new year, he will also leave Salford and head over the Pennines to become director of finance at the Leeds Teaching Hospitals NHS Trust.

‘[Former HFMA chair] Chris Calkin said to me that when you stop being president you go through a few months where you feel like you are going through a bereavement. Life becomes less hectic. I decided to avoid that sense of loss by taking the opportunity of a new challenge.

‘I’ve had a brilliant 11 years at Salford. We’ve done some great things of which I’m immensely proud and it’s been a privilege to work with some fantastic colleagues, such as David Dalton, the chief executive. But I feel I’m at an age where I have one big challenge left in me. The ambition Leeds has for itself made the opportunity irresistible.’