Salford Royal is a CQQ rated ‘Outstanding’ integrated provider of hospital, community, primary care and as of 1 July 2016, adult social care services. We employ over 7,000 people who provide a comprehensive range of local services to the City of Salford, as well as specialist services to Greater Manchester, the North West of England and beyond.
For the last 15 months Salford Royal has been providing management support to Pennine Acute Hospitals NHS Trust and has now put in place governance arrangements to manage both organisations through a group structure, with four care organisations established underneath to manage the £1.3bn of services delivered across five main sites.
As Group Chief Financial Officer I am responsible for designing and overseeing the financial strategy and policies that ensure the statutory financial duties of the group are met and that it is able to deliver the investment needed to achieve its strategic objectives. I am also responsible for all aspects of financial governance, financial assurance and financial control and am the executive lead for a range of other corporate functions including procurement, contracting and informatics.
Like all board directors I also have collective responsibility for the wider corporate agenda for quality, innovation and productivity improvement to support the delivery of high quality care for patients. It is this wider responsibility and knowing that what you do every day makes a real difference to the lives of people in our local communities that makes a finance job in the NHS so rewarding.
Bringing two separate systems (health and council) together into the Integrated Care Organisation was never going to be easy or quick when you consider these are systems that have operated for such a long time under different governance arrangements and with different processes. It requires a high degree of trust and shared ownership of the risks it generates. Yet the strong and well established relationships between organisations within Salford definitely made this much easier to manage.
The integration has thrown up a number of technical issues, particularly around VAT and pensions, which have the potential to be a barrier to integration and CIPFA needs to be a vocal and key voice in finding solutions to these.
Most importantly however there is a human element to the integration and it’s important not to underestimate the scale of organisational development input needed. The first nine months in Salford have been all about safe landing and bringing together of the two parts. The big test now is to drive the innovation and service changes out of integration that deliver the improved service to patients and carers and the improved productivity from the budgets.
While everyone sees integration as the only game in town, there is little if any evidence of the benefits achieved. Thee wider system needs the vanguard sites like Salford to be able to demonstrate these benefits, to give others the confidence to work round the difficulties and take the risks, because the prize is big enough.
Over a 27 year career so far in NHS finance I’ve been fortunate enough to have been involved with a number of hugely exciting and challenging transactions and programmes. When I started in the NHS many of the people at a similar level to me working in the private sector judged the public sector old fashioned and simple.
Those people are now looking enviously at my career, which has included delivering more than £300m of capital build, taking to market and establishing one of the only patient facing public private joint ventures in the service, and negotiating the merger and acquisition of a number of organisations. Today I help lead a £1.3bn turnover organisation and have been part of the innovation that has established groups and integrated care organisations with the potential to change services for patients for the new few decades.
While all of these have been immensely satisfying, my proudest moments however are reserved for watching talented people I’ve nurtured, either directly in teams and departments I’ve led, or those that I’ve coached and mentored, do more amazing things than I could ever dream of doing.
It’s essential. In the first instance it’s the entry ticket to the career. It gives you the technical knowledge to be able to work in the profession and the critical thinking and decision making skills to be able to contribute to a department, team or organisation’s success. Most importantly however the reason accountancy is a profession is that it’s not binary, wrong or right. It requires judgement, and the qualification and the continued development allows you to operate in the space between the two and navigate this safely. Over a career most accountants will be tested to be brave and do the right thing and it’s the professional status that protects and serves as a guide.
If at the start I could have had three of the pearls of wisdom I’ve gathered, I think I would have had the ones that said:
No one looks after you like you. You have to be proactive and take personal responsibility for your career. Actively seek out the opportunities and be confident enough to take on the seemingly challenging ones. Most of us get doubts but this is often our brains playing tricks; all the evidence in our career to date shows we shouldn’t doubt ourselves.
Constantly strive for distance and pace of travel in everything you do. It doesn’t matter what you do differently, only that you don’t stand still. Teams that don’t innovate and push boundaries can be the best around today but will look old fashioned by tomorrow if they don’t evolve.
As finance professionals, especially working in public services, we have a responsibility to be moral guardians as well. The decisions we make around resources have a direct impact on the people we provide services to. Yes, we have to manage within the resources we have, but we have to deliver services people have the right to expect. If we can’t then we have the wrong service solution and need to find a different one.