By Huw Edwards, ACCA member, NHS Graduate Management Scheme – Finance
Clinicians are, quite rightly, at the heart of the new structure of the NHS. This means that now more than ever before, the relationship between finance professionals and clinicians is crucial to its success.
Clinical leaders are likely to need our help if they are to maintain financial grip whilst delivering radical change. Learning how to work with clinical staff is therefore an important part of the development of student accountants such as me. But this relationship is a two-way street. Clinicians need to work well with accountants if they want to lead the change we need to deliver a high quality, sustainable health service. The temptation from both sides is to wait until we’re in more senior positions before really getting to know each other. But if we can build relationships at the start of our careers, we should reap the rewards for many years to come.
In any industry or sector, student accountants need to get to know their business. We need to do this so we can translate the knowledge gained from studying into something usable in the real world. After all, in order to be applicable across the whole spectrum of business in the UK and abroad, the ACCA syllabus will always be somewhat abstracted from the day-to-day work we do. Part of the challenge of qualifying is balancing the demands of passing the exams with learning our business in order to make our studies relevant.
Getting to grips with the technical aspects of healthcare finance, from the internal market and payment by results to service line reporting and management, is hard enough. Then there is the shifting landscape of organisations as a result of the reforms. Accounting for the closedown of PCTs and SHAs is sure to be a testing experience for our colleagues in commissioning this year-end.
Financial implications of clinical decisions
In healthcare if we want to really know our business, we need to know our clinicians. The decisions clinicians make have far reaching financial implications. Whether it’s in treating an individual patient or (following the Health and Social Care Act) planning services at population level, clinicians are the major driver of cost in the health service. Finance teams are going to have to help them understand the financial consequences of these decisions, whether that’s by modelling what may happen, or monitoring what has happened, as a result.
Looking ahead, our ability to assist and influence clinical staff will be a key skill for accountants and is something we must develop.
Some hard decisions
It would be difficult to exaggerate the challenge facing the NHS over the coming years. The expected rise in demand as a result of demographic changes and the increasing complexity of healthcare, combined with a prolonged economic winter, mean we are going to have to radically change how we deliver services.
But neither the public nor those of us working in health will accept radical change if it is at the expense of quality. If we are going to protect, and indeed improve, the quality of our health services in this hostile economic climate it is clear that we need to make some tough decisions.
Clinicians are now the main group responsible for rationing care. Clinical Commissioning Groups (CCGs) put clinicians at the heart of planning health services for their local population, and clinicians already ration care in a less transparent way, through the decisions they make with individual patients – so called ‘Bedside rationing’ – such as deciding which type of drug to prescribe or what diagnostic tests to undertake. So an awareness of the financial result of their decisions is more important for clinicians than ever before. They are being tasked with taking costs out without diluting the quality of services.
Working closer together, sooner
Working together should be seen as a key part of the development of both student accountants and junior doctors. But just as student accountants don’t see much of our clinical colleagues at present, junior doctors are unlikely to have regular (or indeed any) contact with their finance department. I expect there is little knowledge among them about how their service is funded, beyond the odd telling off from their consultant for not coding all the multi-morbidities on discharge summaries. There are a number of possible reasons for this, but perhaps it’s just part of learning a profession; the world tends to be quite insular for trainees of any profession as we balance studying with the day job.
The sooner we start talking and finding out what each other does the easier it will be to get the tough decisions right.