NHS accountants have a responsibility to act in the public interest


By Dr Eleanor Roy, CIPFA Policy Manager Health and Social Care

According to the pioneering survey undertaken over the summer by CIPFA, accountants in the NHS appear to feel more pressure to compromise their ethical values than those in the wider public sector.

Accountants work not only for their clients, or employers, they also have a responsibility to act in the public interest.  What we are talking about here is that intangible set of values that comprise ethical responsibilities: integrity, objectivity, professional competence, due care, confidentiality and professional behaviour.  This framework of values are inherently expected to be in place, but are only really discussed when something has gone awry.

The survey aimed to gain a picture, for the first time, of how much pressure public sector finance professionals felt they were under to act in an unethical manner.  This was prompted by evidence from CIPFA’s Helpline they are facing more and more ethical dilemmas. This is perhaps not as surprising as it first appears when considered in the context of the funding pressures at play after years of austerity, to a degree not experienced by previous generations of public sector accountants.

Around 11% of the responses received came from the NHS, and in comparison to the wider public sector, ethical challenges in the health sector appear to be more keenly felt.  Although the proportion of respondents who felt under pressure to act unethically was broadly the same as across the wider public sector, the incidence appeared to be more frequent in the NHS, with more reporting that they had felt such pressure on numerous occasions.

The proportion of respondents who felt ‘under threat’ was much greater in the NHS than the average across the wider public sector.  Those reporting that they had gone on to carry out the unethical action, whether wholly or partially, was also higher. The most commonly cited unethical actions also differed.  The top two were common across the whole public sector where accountants were asked to state excessive optimism in budgets and downplay risks.  However, NHS respondents also indicated requests to submit savings plans without evidence or risk assessments and to postpone the recognition of costs and liabilities were more common than elsewhere in the public sector.

This is perhaps not surprising given the financial and demand pressures on the NHS and the ‘top-down’ approach inherent in its organisation.  The NHS is also rightly held up as a ‘national treasure’, thus an inherent optimism bias from the desire to paint a rosier picture is perhaps to be expected. One respondent stated:

'It’s amazing that we have all these policies in place but do not protect the finance department at year end or month end.' Accountant, NHS.

CIPFA considers that the survey results are likely reflective of the austere financial climate in recent years, but that this should not impact on the standards and principles that accountants are expected to apply.  The survey aimed to gain a sense of what is happening on the front line and gain baseline data against which to measure future change.  

The proposed new code from the International Ethics Standards Board for Accountants is set to be adopted worldwide next summer.  CIPFA however has approved the Code to be adopted as a statement of professional practice effective from 1st November 2018. CIPFA becomes the first UK professional accountancy body to take this step.

CIPFA is also putting in place a system of support for students and members to seek help and advice and intends to offer relevant training. It is essential that leaders and managers (who themselves may be accountants) understand and respect the professional responsibilities of accountants and the consequences of applying pressure to these colleagues. It is also vital that those facing challenges to their professionalism can access support and that these issues are brought into the open so that the profession is enabled to support itself in these challenging times.

This article first appeared in the Health Service Journal.

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