Responding to COVID-19: insight, support and guidance
The job has two main components. I advise ministers on financial policy and support decision making to secure the best outcomes from our total £13bn resources. I am also responsible for the financial management of NHSScotland – this is not just about meeting core financial targets such as operating within budget, but also making sure we understand the value we get from that resource – in the short, medium and long term.
So whereas in England you have the Department of Health and NHS England as separate bodies, in Scotland these functions are combined within government.
In Scotland I think finance professionals have already begun to drive the agenda. We have legislated to integrate health and social care and are now coming to the end of the first full year of implementation. Finance professionals from across health, local government, Audit Scotland and CIPFA came together early on in the process to develop the governance and assurance model that you need for that to work.
The principle on integrating resources was that the money would lose its identity and we have created the environment for that to happen and keep going with that kind of approach. We need to work as a profession across our organisational boundaries, share knowledge, build trusted relationships and put finance professionalism at the forefront of what we do.
I think that people often see finance leaders as being the ones who can do things like governance really well and think about corporate responsibilities, and it’s important that we influence and keep going with that – we shouldn’t wait to be asked what we think.
People often ask the question, ‘how is it that you can afford to have some of the policies that other parts of the UK don't have such as free personal care or free prescriptions?’ when we are all doing the same thing, providing broadly the same core health service. You can’t make a direct comparison and no single system has all the answers, but there are some things that are different in Scotland that are worth noting.
Governance is relatively uncluttered which can make it easier to make change happen. There are just 14 health boards– these are whole systems which plan, commission and deliver services to their geographic populations. This whole system working can and should make it easier to see changes right through, to identify and address variation and to improve. We also have eight national boards, for example the ambulance service and one body that provides support services such as procurement to NHSScotland.
The fact that we have legislated for integration of health and social care makes it a bit more straightforward than in some other countries but we by no means have that cracked! We now have 31 local partnerships so that adds more complexity in terms of governance but it feels manageable. These partnerships now manage 60% of our health and social care resource so it's absolutely fundamental that we get that right.
Funding and costing are quite different in Scotland. Boards receive block funding using a weighted capitation formula, so money doesn’t follow the patient. This provides stability but has also meant that competition isn't a strong feature of our system and we haven't developed our costing infrastructure to the same extent as other health systems because we haven't needed to - that’s now an area that we need to really develop to drive value.
I think the things we've done best are when we've used data and analysis to evidence our planning and decision making. The fact that we've really invested in data analysis to support local planning teams in integration authorities should give us a much better outcome. Teams are now looking at variation in practice in local areas, what that means and how they can use that analysis to drive changes in practice.
I don’t believe it really matters what structure you put in place, if you create the environment to plan for a locality using the best information available, involve the right people and remove barriers, you're more likely to get a better outcome.
What I've learned is that I don't have all the answers... and I don't need to.
When I started out in my professional career I thought I needed and was expected to have the answers and I wanted to have the solution developed before talking to people about it – over time I’ve learned that the earlier you involve other people, particularly people with different perspectives, in the development of new thinking, the better the result and the more likely it is to be a successful outcome.
My first goes back some time... I won't put a date on it! I was working for a management consultancy and was involved in setting up what was then the UK’s largest shared financial services project, for NHS England, based in West Yorkshire. I was responsible for the migration of the first wave of nine Trusts to the new services - that was a pretty proud moment for all of us, but also the toughest thing I've ever done in my career and something that I learnt a lot from.
Fast forward to more recent times, one of the really positive things that I've done in Scottish Government is working with colleagues across the public sector to put in place the conditions to integrate £8bn of health and social care resources. That's definitely something I feel very proud of - even though we have still got a way to go to make that a reality on the ground - having led on that was a big achievement!