Alison Tonge is the Regional Director of Commissioning for NHS England and NHS Improvement for the Midlands.
She is a highly experienced executive, having enjoyed a number of roles in the healthcare sector, delivering strategic, financial and transformation projects both within the NHS and while working abroad in public sector-focused consultancy roles.
Alison has been involved in public sector healthcare for more than 30 years. She started her career in local government as a graduate trainee accountant at Manchester City Council in 1985, before moving into healthcare two years later as a financial planner for Manchester Regional Health Authority, where she gained her CIPFA qualification in 1988.
Over the next few years, Alison's career progressed through a number of roles, gaining experience in financial accounting and management accountancy, while working in provider trusts and in primary care. After a brief spell in healthcare consultancy, in 2000 Alison became Director of Finance at North Stoke Primary Care Trust (PCT), moving to Stockport PCT two years later.
In 2008, Alison decided to move out of finance and took on the role as the Executive Director of Health System Development at NHS Northwest. Her career then took her to Canada, and she spent three years as Executive Vice President Strategy and Performance at Alberta Health Services, where she led a series of strategic transformation programmes to facilitate the merger of a major integrated healthcare system.
Alison returned to the NHS in 2012 as Director of Finance for NHS South East London, before being appointed Director of Operations for NHS England in 2012. She has since been involved in various roles in system management and commissioning for the organisation, beginning her current position as regional director in April 2019.
What led you to qualify with CIPFA?
I was always drawn to economics, and studied it at A-level and for my degree. I was very interested in macroeconomics and public service, and how to make a difference through that. I was more interested in the financial management associated with public service and the economics of it rather than pure accounting, so I thought a CIPFA qualification would definitely be a good transition from my degree, because of its public finance focus.
What have been the highlights in your career so far?
A pivotal moment for me was moving out of finance into a wider system development and system leadership role. I was at a point where my career trajectory within the finance world was to become a regional director of finance, and I think I could have been very successful at that. But I consciously decided to move out to take a much broader role.
In terms of key successes that I'm particularly proud of – the first was when I was working in Stockport PCT. We were the very first organisation to take on contracting, which was then a 'brave new world'. I forged a leadership approach around that, and steer the organisation through a few years of very difficult negotiations and financial management to keep the PCT in good shape, and develop primary care networking. I'm very proud of that period of my career.
The second, more recently, was when I worked in Canada and I led the development of a health system strategy and was able to create clear priorities for the health system, with both the system and the strategy being politically supported and properly funded. I'm proud of these two things for different reasons: the first was technically difficult and was very complex from a financial management negotiation perspective, driving efficiency and value for the system; the second was much more strategic, and I had to use my skills to get everyone onboard with a complete set of priorities that everyone bought into.
What have been the greatest challenges, both during your career and within public sector finance?
One that stands out is an ongoing challenge about demonstrating value. It is very hard to measure what you get from a public service, whether that's in healthcare, local government, or other public sector organisation. It's hard to measure productivity and value, so one of the biggest challenges is to be able to demonstrate 'bang for buck' – to demonstrate when you put investment in, what you want to get from it, and ensuring you get value from it. If you work in the public sector, how do you constantly prove that you are adding value? You don't necessarily have to do that in the private sector in quite the same way.
How has being a CIPFA member supported you in your career so far?
It's been very helpful in terms of helping me to pursue a career in finance. In the early days I was an examiner for CIPFA, and I really enjoyed the professional aspects that brought with colleagues, and the wider networking and support that CIPFA offered. And working in the public sector, it's also been a really well valued and recognised qualification – it's been a very valuable qualification to have in my world.
What's the best piece of advice you've been given, and by whom?
It was from Richard Popplewell, a chief executive I worked with earlier in my career. His advice was that when you're trying to influence or negotiate with someone, always try to see it from the other person's – or organisation's – viewpoint as well as your own, and understand what they're looking for from that negotiation, because that approach will usually help you to get the best outcome.
What would you say to somebody think of becoming a CIPFA member?
I would say that you can have a very fulfilling career in the public sector. It's a really complex environment to work in, and it encourages you to make the most of the resources you have available. You'll never be able to satisfy everyone's needs, but that's part of the interest in working in the public sector – it's very challenging. So if you want to work in a complex, thought-provoking environment – which can be politically tricky at times too – it's definitely a place to be. You'll learn a huge amount.