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I'm currently working on our medium term resource plan. Finance have the overview and through our business partnering approach we sit alongside commissioners and budget holders who are accountable for the delivery of their commissioning plans. We work in partnership with them to understand what they are spending and, along with our Organisational Intelligence colleagues, the implications of any savings proposals, while at the same time providing constructive challenge and quite often offering ideas for savings. In addition the team provides financial advice and support to all the major procurements that takes place across adults and children’s services: recent examples are Pre-Birth to 19 provision, a Live At Home service, and Integrated Residential Nursing Care.
The big thing for me just now is our local authority engagement in the Sustainability and Transformation Plan (STP) process - we have three STPs that cut across the Essex County Council footprint! We have been engaging with the development of these plans to try to ensure that the social care financial position is reflected in them. I strongly believe that to be successful we have to embrace a system wide approach.
My team makes all of this possible - I have a fantastic team and I couldn’t do my job without them!
I think it is fundamental for both finance and non-finance professionals. It is about understanding the drivers of the organisation/business/service, the costs and what drives those, the impact of spending or reducing spend and how that will affect other areas of the system - I think this is absolutely crucial.
For me at the moment, the mutual understanding across health and social care finance cultures of the funding and regulatory regimes that work across the two is really important. Unless you have that understanding, I’m not sure how you can really move forward in collaboration or partnership because you don't know what it means to the other party. This is an area of focus for Essex (for the local authorities and our health partners).
The skills acquired through professional finance training are essential and we champion these in our financial business partnering model at ECC. We have three behaviours expected from all members of Financial Services – that we challenge, that we have a voice and it is heard within the business and that through insight we can identify innovative solutions for the business. We are usually involved at the outset of the decision making process as part of our multi-disciplinary way of working which is key. We have a voice and our use of it is welcomed!
I think it's absolutely key that whatever the proposal - particularly through the STP process, the Better Care Fund and integration – that we can articulate and model the impact so that informed decisions can be made and we fully understand what we're getting into. Finance professionals have a big role in helping determine what the impact will be and what the outcome would be. We sometimes act as a bridge between the service’s and helping then to convert theoretical aspirations into practical solutions.
For me this probably reflects the journey that we've been on in our organisation. Greater understanding about how health and social care finance works and the bureaucracy around the Better Care Fund. I think the intentions are very well meaning but I’m not sure it's really worked as as intended in practice. It's understanding what happens on either side of health and social care and the implications of that - I think the Better Care Fund hasn't really played a major role in bringing us together.
It's how we align social care finance with health - we've got different funding regimes at the moment and that doesn't work well. For example, there is the manual of accounts that the Department of Health publish for year-end closedown and also the accounting guidance from local authorities - the two don't necessarily reconcile or work together. If only we could align these more, it would be helpful to all. And where they have to differ a shared awareness of the reasons for these differences would also promote joint working.
Also we need to share a better the understanding of the care market pressures across health and social care. I'm not sure we always articulate these as well as we should from a local authority perspective, maybe that’s an area for further development and awareness/training. There is a clear a need to understand how we can use the system to work more effectively together.
Training to be an accountant is not all about the numbers!
Communication and relationship building are equally important, as is collaboration. The thing for me that I didn't really get when I was starting out all those years ago was just how important emotional intelligence is and being able to put yourself in the shoes of others.
One that stands out for me is under one authority’s voluntary improvement plan, I worked with them on their use of resources in the days of the Comprehensive Performance Assessment. That work was absolutely critical to securing the confidence of the inspection bodies as to the ability of that organisation to move forward - we achieved what we set out to achieve and I’m particularly proud of the work we did around value for money.
Another is the work I was involved in during the transition of public health to local government. I worked very much across the local authorities and the then Primary Care Trusts (PCT’s) to ensure that, so far as possible, within the quantum available, we could maximise the funding available for Essex when the public health transitioned. It was one of those things where you could write to the Department of Health and tell them if you felt it wasn't right but to be successful you really needed the firm commitment and signatories of the chief executives of all of the PCT's and the local authorities involved. As a result we received around an additional £11m of funding that we felt we should have had in the baseline.
The one which I am most proud of is the work in relation to the Care Act where I and the team at ECC were instrumental, in partnership with the County Councils Network, in convincing the DH that there was a significant affordability issue. There was a fixed quantum of funding and the work undertaken clearly demonstrated that there would be significant additional costs to local authorities. The outcome was a deferral of Phase II of the Care Act (Cap on Care).