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Monday, March 26, 2007

HSJ Editorial 22 March 2007: Finance

Before my son's bike race at Darley Moor on Saturday*, I picked up the latest Health Service Journal and flask of coffee. Reading the editorial I was struck by the sequence of the two items and my experience or lack of it.

The first item 'Consistency and agreement are needed to spread success' concerned the Commons Public Accounts Committee report on financial management and its conclusions. These included the need to share lessons learned from successful financial turnaround programmes plus (paraphrased):

The performance of the finance function is too patchy, inadequate in more than a quarter of organisations. There are recurring problems with recruitment, training and development with the central issue being the role of clinicians in financial management.

The much desired engagement here is between senior clinicians and management. The recent BBC 2 series Can Gerry Robinson Fix The NHS? demonstrated the all-to frequent gulf between managers and senior clinicians.

Returning to the HSJ editorial: payment by results - the much vaunted tipping point for clinical engagement in finance has (thus far) not tipped. For mental health there's still time, but then déjà vu kicked in. Quite a few years ago I remember getting ready to catch micro-commissioning and run with it, but the pass never came. It is happening in some places, with big brother macro-commissioning. I was pleased and yet disappointed. Pleased because at the time I was Team Leader for a Community Mental Health Team for Older People and I - quite typically then and now for such posts - also had a caseload. The disappointment followed from recognition that not only had a learning opportunity been lost, but a management learning opportunity to boot.

Amid the taste of coffee irony filtered through: that missing tipping point, the need for wider cultural changes (service line accounting) and clinically in mental health (and elsewhere) the focus on risk. People 'at risk' must not fall through the net. Well I don't know the details of service line accounting and the like, but I do know that while planting trees provides instant results, it is labour intensive and risky compared with sowing seeds. After all - never rely on one prong when several can help get your point across...

Mr Robinson's series revealed that other clinicians can act as change agents. Shifting the risk context to finance, how many clinicians fall through the management net? OK, hands up, if like me seeing a bottom-line makes you blush? My 1st line management course was some twenty five years ago. Six, or seven years later saw me on a not-quite-a-middle-management-course. Then I listened out for him, but LEO never knocked on my door. (It's my own fault all those informatics events....!) Yes, I could have chased this and I will one day - honest. If clinicians are soft-wired to take detours around financial centres, somebody better make sure those seeds are carrots.

The second item concerned joint working - asset-sharing between the NHS and local government and the journal's features on patient-public involvement, population health-NHS-Local Authority, joint strategic needs assessments. It just struck me that there's so much we don't understand about the functioning of these distinct organisations. Will integration help, or is it creating another layer of complexity? I'm all for encouraging and nourishing new ideas, but how does your garden grow with too much nitrogen?

Up to a few years ago I had something in common with Alan from TRON:

"I don't even balance my checkbook on downtime."

Finances looked after themselves. Not any more: cue pension wake up call and we are all tax-payers...

Seriously though, where do we want our intelligence to be in 10-20 years time?

Imagine financial reports that also relate to local public (mental) health outcomes. Maybe these exist in some places? Now that's a code disc that really would summon in a new order. Make financial information relevant to the clinical practitioners who make up the [ holistic ;-) ] multidisciplinary team then the trees will start walking.


Nick Edwards (2007) Comment, HSJ, 22 March, p.3

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