Wanted: FDs for the NHS

Finance director jobs in the NHS are like buses. You wait years as a deputy for a suitable vacancy and all of a sudden two come along at once. Except in the health service it’s not just two finance directors’ jobs but up to 130 – all of which are due to arrive at the beginning of April.

The whole 2,500-strong body of CCAB qualified accountants stands to benefit as career opportunities open up throughout the NHS finance function.

Ironically after years of accountant-bashing from Labour when in opposition, ministers need a massive increase in the number of FDs to make a reality of their NHS reform programme. Labour’s ideological opposition to the two-tier system ushered in by GP fundholders paved the way for primary care groups to take over the role of commissioning hospital services.

Now these groups are fulfilling their destiny by taking over the provision of community services and becoming free standing primary care trusts (PCTs), each one of which needs its own dedicated finance director.

In fact, April will see come on stream in England – between 120 and 130 are expected to be given a ministerial green light.

They will join some 40 pioneering PCTs that went live in April and October last year. By the time the PCT movement has run its course, it is estimated the service will have added up to 250 FD to its ranks.

Finance booster
Although the increase in FDs is only a by-product of the NHS reforms, it is a major boost to the finance function. The average age of an NHS finance director is 35-45. For years there has been concern that reaching the top at a relatively young age has stifled the careers of finance managers lower down the ranks, forcing talented deputies and other senior finance managers to leave the service to further their careers.

‘It is good news for the finance function in terms of career progression,’ says Pat Taylor, head of finance staff development at the NHS Executive.

It was certainly good news for Helen Ashley, FD at first wave Central Derby PCT. ‘At the health authority (Southern Derbyshire) I’d reached a certain level and if PCTs hadn’t come along I don’t know where I’d have gone,’ she says. ‘PCTs have created new opportunities for many.’

But recruiting FDs in such numbers has not been without problems. Even now with 40 PCTs up and running, few finance staff in the wider NHS have much idea what the job entails. Taylor admits this is an issue. ‘There is still some uncertainty,’ she says.

This can be a stumbling block in attracting applicants. Those working in some of the major trusts or health authorities with big finance teams, could see the new organisations, where finance is a one-man-and-his-dog operation, as a bit of a step backwards.

PCT’s set for growth
But this would almost certainly be a mistake. PCTs are undoubtedly the future. They hold the key to co-ordinating the development of primary, community and hospital care. And if sitting squarely on top of the purchaser-provider split isn’t enough, in future the PCT job could get even bigger.

Last summer’s NHS Plan talked of a new kind of primary care trust, known as a care trust, that would also commission social services.

Keith Pickering was appointed to South Manchester PCT, a first wave trust, in August last year. The former acting director of finance at Manchester Health Authority is clear he has made the right move. ‘This is the direction of travel. PCTs are the leading edge and if PCTs are the future I wanted to get in early,’ he says.

The first six months have been largely about getting the basics in place ‘spending time with procedures and setting up standing financial instructions’. South Manchester is also the lead commissioner for the city’s three PCTs. So establishing service level agreements for the coming year has also taken a lot of time.

One major difference in PCTs is the lack of dedicated financial support.

With PCTs setting up agency arrangements for financial services, finance ‘departments’ are small. ‘At the health authority I had responsibility for information management and technology as well as finance and I had a staff of 60,’ says Pickering. ‘Now I have one part-time staff. One minute you’re talking strategy, then you’re coding an invoice.’

At Central Derby, Ashley agrees. For instance a PCT finance director may be responsible for report writing from start to finish. ‘I extract a lot of figures, write my own board reports and present them to the board. At a health authority, the preparation might be done by someone else, leaving the FD just to present the report.’

The role is being likened more to a deputy chief executive’s job than a pure finance role. Certainly, the finance director and the chief executive are the only two executive positions within the new trusts. This demands a wider knowledge of more general issues and an understanding of the trust’s strategy. For many the variety of the job is one of its main attractions, offering a chance to move out of a purely financial arena.

New experiences
For many new PCT finance directors, this will be their first taste of operating at board level. Matthew Tait, FD of Daventry and South Northants PCT, says ‘it is different operating in an environment with non-executives.

Good non-executives challenge a lot.’ Tait says the first year has been about getting the trust’s finances and procedures into place. For the pioneers the job was complicated by a lack of guidance up front, but their experiences should help this year’s newcomers.

Pickering talks of PCT’s unique clinical executive – a group operating beneath the board and made up of GPs, nurses and other front line staff – as introducing a ‘new dynamic’. Certainly most FDs identify working with GPs as a steep learning curve. The independent contractors are widely known to be a law unto themselves and some of their practices on hospitality and gifts from drug companies could pose a challenge to new finance directors as they introduce PCT-wide corporate governance arrangements.


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