PracticePeople In PracticeNHS finance under the microscope

NHS finance under the microscope

The NHS Executive this week claimed that finance staff in the health service had made major strides forward in recent years despite missing key targets on increasing the numbers of qualified staff and improving gender balance.

The Executive has been taking a special interest in the development of the NHS finance function since the early 1990s when it launched its Framework for the Future initiative. Part of the original motivation was to counter a perceived shortage of appropriately qualified and experienced directors of finance.

But subsequent relaunches of the development programme – Building on Framework for the Future (BoFF) in 1996 and the Medium Term Development Programme (MTDP) in 1998 – have shifted the focus to cover the whole of the finance function.

As the Executive prepares to publish a new finance staff development strategy at the end of the year, this summer it took the opportunity to look back at the progress it has made over the last five years*.

The report (A review of finance staff training and development 1994-1999) shows there were 1,600 fewer finance staff in December 1998 than in 1994, a reduction that the Executive says is due to organisational changes including the outsourcing of internal audit, the introduction of payroll consortia and NHS trust mergers.

But over the same period the proportion of qualified CCAB accountants has increased from 15% to 18%, representing an increase of around 200 accountants. CIPFA remains the major qualification, with 37% of all CCAB qualified staff having the public sector qualification compared with 29% CIMA and 22% ACCA.

But this domination by CIPFA may be a historical hangover. Although half of all finance directors in 1998 were CIPFA qualified, the story is completely different at the entry level. Of 1,700 CCAB students, only about 270 were studying for CIPFA compared to 860 CIMA students and around 560 ACCA.

Although the Executive says it is keen to ensure students have a free choice of qualification, the report raises concerns about this trend.

‘The preference for a CIMA qualification is partly due to its marketing techniques,’ it says.

‘CIMA is considered to be a flexible management qualification whereas CIPFA is perceived as a basic public sector finance qualification. This causes some concern since the CIMA qualification is geared to the private sector.’

Robert Jelly, CIMA’s director of student development rejects this claim.

‘In fact it is the opposite, the CIMA qualification is cross-sectoral,’ he says. However, the institute is embarking on a change of syllabus and Jelly says the NHS will be a member of its new syllabus forum.

One further concern on students is a trend of trainee posts not being replaced when students pass their exams. While 15% of all finance staff were studying for a CCAB qualification in 1994, this dropped to 12% by 1998.

‘If the number of training posts continues to decline then this may create staffing problems in the future,’ the report says. Pat Taylor, head of finance staff development at the NHS Executive, reinforces the point.

‘It is disappointing to see this drop as the continuing challenging agenda means we need to have increasing numbers of qualified staff in the service.’

One of the key targets in BoFF was to reach 50% of finance staff either qualified or studying for a CCAB qualification or NVQ in accounting levels 2-4. This has still not been achieved. In fact the percentage has fallen from 43% in 1994 to 42% in 1998.

Executive vision

Taylor believes a target for the proportion of qualified staff is still relevant. But there is a question mark over what level it should be set at to be meaningful. The NHS finance function is facing a major transformation over the coming years as technology advances and shared services become more common.

According to a vision document, published by the Executive and currently out to consultation (Accountancy Age, 7 September), many jobs now done by finance will in future be done by staff outside the finance department.

‘If the vision is right, we could reach a point where far more than 50% of finance staff actually working in mainstream NHS organisations are qualified or student accountants because the support staff will be working in other shared service organisations,’ she says.

The Executive was also keen to see more women becoming qualified and reaching the top finance directors’ jobs throughout the service. Once again the service has failed to hit targets, although it is moving in the right direction and believes it may belatedly reach them later this year.

The close attention the Executive has paid to the development and training needs of NHS finance staff is unique. There is certainly no similar initiative for finance staff in local government. It has not tried to hide the fact that targets have been missed, although there is a feeling in the service that many of the targets were aspirational and not based on any scientific assessment.

But overall the Executive is pleased with progress. ‘We perhaps need to look at what targets should be, but what we’ve done generally is good,’ says Colin Reeves, director of finance and performance at the NHS Executive.

‘We’ve moved in the right direction on many things including women in finance and proportion of staff with a CCAB qualification.

Staff development

‘The very positive message is that the Executive is committed to development and training.’ Reeves also says that much progress has been made in areas not covered in the report such as the increasing take up of education and development opportunities by finance staff who do not want to take a formal qualification.

But the review does not mark the end of the push on training. Far from it. If anything training and development is about to become even more crucial for finance staff.

The creation of new primary care trusts should see a net increase of around 100 finance directors’ positions.

This explosion in senior finance jobs will create promotion opportunities throughout the finance function. Many staff will need training to prepare them for, or support them in, their new roles. Even more significantly, the Executive’s vision of the future finance function demands that finance staff acquire new skills.

That vision predicts an overall reduction in finance staff numbers. In another five years time the success of the Executive’s training and development programme may be judged by how many of today’s finance staff are still employed somewhere in the NHS.

Steve Brown is a freelance writer.


CIMA website

NHS finance manual

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