Feature / Opportunity knocks

New HFMA president Andy Hardy believes finance professionals must grasp their chance to become leaders in the NHS. Seamus Ward reports


Albert Einstein said: ‘In the middle of difficulty lies opportunity’. It is a principle that could be applied to the NHS, according to new HFMA president Andy Hardy.

The service is certainly enduring difficult times; stretched by the need to meet increased demand while improving quality, increasing safety and making efficiency savings. However, Mr Hardy sees an opportunity for the NHS to rebuild its services around patients, and he believes finance professionals will help lead the process.

He has backed this with his presidential theme, ‘Leading by numbers’. The size of the funding gap alone warrants leadership from the financial discipline, he says. But other factors make it imperative.

‘We know finances are likely to get tighter. If you think about the fact that we have been lucky up until now in that the health budget has been protected compared with other government departments through to 2015, it’s a fair bet that, whoever is in government after the next election, this will not continue.’

Even with its budget protected, the NHS will still have to make significant efficiencies. The initial Nicholson challenge aims to deliver a total of £20bn of savings by 2015. However, last summer NHS England looked further ahead and estimated the total savings needed by 2020/21 to be £30bn.

‘It’s a tough situation with the £20bn challenge and more to come,’ Mr Hardy says. ‘But the challenge also brings an opportunity for finance professionals to come to the fore and play a leading role in the NHS.’

The theme builds on immediate past president Tony Whitfield’s theme, ‘Knowing the business’, which aimed to improve finance professionals’ understanding of the delivery of healthcare. Mr Hardy wants the profession to take the next step and use this understanding and their financial knowhow to help lead the service into a new era.

‘Leadership means a lot of things. It’s not just about the finance director or the person at the top of the organisation. You can have a leadership role at any level. It’s about taking on challenges and trying to find solutions,’ he says.

‘Clinicians and general managers may be intimidated by the size of the challenge and think this is all undoable. That is where the finance profession can come to the fore and give a real sense of what the numbers are telling us. We are going to have to reshape the NHS over the next five years and I’d like the HFMA to get round every table discussing this.’

Bigger picture

Each year, the focus is on whether the NHS budget is growing or being reduced and the savings that are required. While these are valid areas for debate, Mr Hardy feels more attention should be paid to the bigger picture.

‘We spend a lot of time talking about the QIPP challenge or the cost improvement programme, but I am interested in talking about the £100bn-plus that we spend,’ he says.

Mr Hardy is chief executive of University Hospitals Coventry and Warwickshire NHS Trust, a large teaching hospital with a range of specialist and tertiary services.

‘We need to talk about the whole budget in the round and getting the best care for that budget we can provide. At a local level here at this trust, you shouldn't be talking about the £25m you have to save but the £520m you

have to spend. We still have more than £100bn of taxpayers’ money. You don't have to go far back in history to see funding of a lot less.’

The work of the seven-day services forum and the urgent and emergency care review highlighted the need for change. To implement the improvements in services to patients recommended by these reviews and remain financially sustainable will mean consolidation. Not every trust will be able to provide 24-hour services, he says.

He recognises this agenda will be difficult to sell to the public, many of whom will view consolidation as a downgrading of the status of their local hospital, both in terms of the services offered and their status. He adds that with just over a year to go before the next general election, it is unlikely politicians will sanction widespread transformation. However,  the two years after the general election will see significant changes.

‘We need to have an honest conversation with the public – if you say to people that if they travel eight miles up the road their chances of survival will be better, they will take that option and travel the eight miles. But we have tended to shy away from that conversation. People need to understand what is clinically and financially viable.’

The HFMA will support the ‘Leading by numbers’ theme with a range of initiatives, says Mr Hardy. These include a new HFMA costing institute.

‘One of the questions that comes up often is: “What’s value in different parts of healthcare?”. You can’t say something is value for money if you don't understand the costs. The HFMA and the Department of Health has done some great work on costing already and the institute will build on that work,’ he says.

The president also wants to launch an accredited coaching service for finance professionals to help bring out their leadership skills. And he hopes to engage with colleagues in social care. This is a key area for NHS accountants, with the launch of the better care fund in 2015/16. This will transfer more than £3bn of health service money to local authorities to help deliver NHS aims – increasing community care capacity, for example, to aid appropriate earlier discharge from hospital.

‘I want people to think about how they can come forward to take these opportunities and to build their leadership skills.’

He says some might be wondering why a chief executive, rather than a finance director, is president of the HFMA. But it is not unusual for an experienced finance director to become a chief executive – many hold the joint title of finance director and deputy chief executive.

Mr Hardy became his trust’s chief in June 2010 after spending six years as its chief finance officer – and he insists he is still a finance professional at heart.

‘The president is normally a finance director or someone high up in NHS finance leadership. I am a chief executive, but my roots are in finance and I strongly feel I am a finance professional,’ he says.

‘I am still an accountant and I am proud of the professionalism that brings. We have a lot to be proud of. We are the people who over the years have got the NHS out of scrapes. We contribute to the making of lots of big decisions already, but I think there will be lots of opportunities for even more. I use the professional ethics and ways of working that accountancy brought to me every day.’

Rising to the challenge

The year as HFMA president is known to be hectic and rewarding, and involves plenty of travel. Mr Hardy says he is prepared for this.

He adds: ‘One of the benefits of living in the West Midlands is that most places are only two or three hours away. I also see it as an opportunity to get out and about to meet new people and hear new ideas. My organisation can benefit from that.’

Despite the tough financial climate, Mr Hardy is optimistic about the future. ‘After 2015, our budgets may not be protected in the way they have been over the past few years, and it may be cut back in the three, four or five years after that. But around 2020, I can see this changing following new growth in the economy.

‘It took a lot to put the health budget as a proportion of GDP where it is now, but with new growth in the economy I think there will be public demand to make sure that proportion is protected or brought back up to that level if it has fallen behind,’ he says.

‘That is almost two Parliaments away and in that period the NHS will “right size” itself, driven by clinical drivers such as consolidation and seven-day working, so it will be ready for any growth that might happen. But to achieve these things, we will need financial leadership and insight.’

He wants HFMA members to speak up and say what they want from the association.

 ‘If you see something that the HFMA can help you or the profession with, then tell us,’ he says. ‘I think there is a real opportunity for the HFMA to be even more influential and to pass on our understanding of what the future is going to look like to ministers and senior leaders in the NHS. We should be the go-to people on finance throughout the NHS.’