CIPFA spoke to Bill Shields, chief executive of Royal Cornwall Hospitals NHS Trust, about the nature of his role, the challenges he faces and some of the most important skills that are required to do his job.
The trust has an annual budget of £340 million and three main sites; one in Truro, one in Hayle near St Ives, and one in Penzance. It serves over 400,000 people, a number that doubles in the summer, and employs 5,000 staff.
I’m chief executive of Royal Cornwall Hospitals NHS Trust. I’m responsible to the Trust Board for the effective running all of the services that the trust provides to the people of Cornwall and the Isles of Scilly.
I meet staff, patients and manage a group of executive directors who run the hospital. I also meet with external stakeholders and commissioners, MPs, other NHS organisations, and local councillors.
Where does finance come into your role?
I’m ultimately the accountable officer for the organisation taking delivery of the resources we have, so I have the responsibility for making sure we meet our financial plan; how quickly we can get back on track if we’re not achieving those things. The finance director is responsible for the delivery but it’s the chief executive who is accountable.
I’m still an accountant, I’m still on CIPFA’s council until July and I chair CIPFA’s audit committee. Although I’m a chief executive, I am still very much a qualified accountant and I still take professional standards very seriously.
It’s key. If you’ve got a finance team that is well motivated and well trained it can make a huge difference to an organisation. The more you invest in a team the more likely they are to get a saving.
If you under invest, such as by reducing training, or reducing CPD or reducing opportunities for your team to interact and learn from other organisations, the impact they can make as a team is diminished. You might make a bit of saving within the finance department, but that has got to be contrasted with investing some money in the finance department to see a significant benefit across the organisation in terms of savings and efficiencies that can be made through having a high quality team.
The finance teams I’ve worked with are some of the most dedicated anywhere in the health service. The professionalism and the work ethic they show, and the way they always go the extra mile, is because they do actually passionately care about the NHS and what it stands for.
When my finance team, the finance department at Imperial College Healthcare NHS Trust, won the Health Service Journal finance team of the year in 2013.
The reason I’m proud of that was that the department had gone from being a very challenging place to work - where it was difficult to recruit people, there was a big financial deficit and it was not known for CPD - to then being the HSJ finance team of the year was a great achievement. For me seeing a team develop like that was really gratifying.
What I’d like is some continuity in health policy. There is more continuity in European countries - it’s not as political as it is here. With the main parties debating the future of the NHS there are two very different directions of travel. I’m not going to say that one is better than the other, but they are different.
The first thing is the continuity in political terms that gives more time to plan - five years isn’t really long enough.
The second thing is some recognition that the NHS, like other public services, can’t continue to just become more efficient every year. I’m not saying there aren’t areas where we can improve, but the difference between the NHS being able to live within its means or not live within its means, is not just down to efficiency savings.
The Five Year Forward View says there is £30 billion required and we can make £22 billion through efficiency, which means we require another £8 billion over four years. I think that is the minimum and a lot of organisations will struggle.
I’d like longer-term planning and a recognition that finances are extremely tight, more than they ever have been, and that calls for some candour about how difficult it will be for organisations going forward.