As the UK government drives through radical reforms of the UK’s National Health Service (NHS), CIMA members' skills will be essential in managing the transition and meeting cost saving targets. Yet, as business journalist Tim Cooper reports, they can only take advantage of the opportunities and avoid the pitfalls of the transition if they keep their skills right up to date.
Under the Health and Social Care Bill, primary care trusts (PCT) and strategic health authorities (SHA) – which employ many CIMA members – will be abolished. PCTs will be replaced by clinical commissioning groups (CCG), which are to be governed by general practitioner (GP) doctors, nurses and other specialist doctors. CCGs will hold budgets and commission the majority of NHS services for patients.
The precise shape of the reforms is not yet clear, as a substantial number of amendments have been proposed and the government has paused the legislative process to allow for an independent review. Despite this, the government has made it clear that PCTs and SHAs will cease to exist in 2013.
Active promotion
Adrian Snarr, director of finance and contracting at NHS North Yorkshire and York, says, ‘Any system wide reform brings uncertainty for employees, and this will affect all finance staff including CIMA members.’
The reforms aim to deliver higher quality, affordable services while also reducing expenditure on administration and management. To help achieve this, says Snarr, there is ‘much talk’ about the establishment of commercial support units to deliver many back office functions for finance. ‘This would rightly include transactional services such as creditor payments, debtor management and payroll,’ he says. ‘New CCGs will be encouraged to buy support services from these units.
‘It is important that CIMA members work closely with the emerging CCGs to emphasise the importance of management accounting and the business support that they can offer. For many of the emerging GP leaders, organisations of this scale are a new concept and they may not all understand the difference between transaction financial services and management support.’
The emerging guidance on the establishment of CCGs clearly states that each body must have a chief financial officer and be able to demonstrate strong financial governance and control. ‘This is where CIMA members have a key role,’ says Snarr.
Commentators agree that CIMA members will also need to learn new ways of working across organisational boundaries.
‘CIMA members’ skills should be in demand in the new NHS but they must take an active role in promoting themselves and the profession,’ says Snarr.
Despite the changes, many systems (such as payment by results) will remain in place, and in fact expand into areas such as mental health. The skills of CIMA members will be required to continue to operate these systems and advise the new clinical leaders.
Updating skills
Stuart Wayment, finance skills development manager at NHS South East Coast, believes that most ACMAs will move to roles in commissioning groups.
‘There will be downsizing and at some point there will be fewer finance people, but the need for financial skills will not be diminished. It’s crucial for finance people to use their skills to ensure productivity and efficiency,’ he says.
‘GPs are trained to be GPs. Even though they may be financially astute, it’s not what they do – their job is to look after patients.’
Wayment feels that CIMA members who have recognised the changes and completed appropriate continuing professional development will be well placed to move into new jobs.
‘Part of the reforms is about promoting foundation trusts and that model needs CIMA people’s business and commercial skills. Commissioning groups will be looking for their stewardship skills.’ Wayment refers to the work CIMA has done on promoting business partnering skills. ‘There is a balance between stewardship and governance that should underpin [their] skills,’ he says. ‘That’s about becoming a business partner and understanding the business. People from PCTs should be familiar with that.’
The transition will need to be handled very carefully, says Wayment. ‘There is so much change going on, we don’t want to drop this somewhere in between PCTs and CCGs. It’s about bringing the right people into those organisations seamlessly.’
Working across boundaries
Phil Barden, programme director at the centre for performance, measurement and innovation, says that CIMA members have been an integral part of PCTs and SHAs. However, he agrees that they have been used to working only in their specific agency and will need to adapt to working across agency boundaries, as that is what the CCG structure will require.
‘Management accounting can be linked to organisational processes. If the processes through which health care is delivered change radically, budgets will have to change to reflect that,’ says Barden. ‘Because the changes will be cross agency, it will be a challenge for people who primarily manage budgets within single organisations.’
He warns CIMA members to be ‘enormously cautious’ in making the transition to the increasingly dynamic financial environment arising from the restructure, and to avoid initiatives ‘falling through gaps’ in shared budgets.
Barden agrees that finance professionals’ skills will be required regardless of the final shape of the reforms.
Despite the cost cutting agenda, working for CCGs will not necessarily mean accepting lower salaries. ‘The implications of the new regime on management and administration spend are unclear,’ says Barden. ‘There are indications some staff who lost their jobs in PCTs are being hired back on contracts at up to 1.7 times their previous salary.’
Another option is to look to the private health care sector. ‘One advantage of CIMA is that its brand is linked to both the public and private sectors,’ says Barden.
‘There are opportunities, but it would be incorrect to suggest that CIMA members aren’t going to have difficulties,’ he concludes. ‘Most importantly for them, it is no longer good enough to be just an accountant – you have to be able to translate accounting statements into their performance implications and consequences.’
The real challenge may be to continue to modernise the understanding of the role of the accountant in 21st century health care.
Links
Assessing the effectiveness of NHS budgeting
Costing in the NHS