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3 July 2020
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Covid-19: when we forget the finance team, we miss a golden opportunity

Dr Yvette Oade

Medical Director, NHS Nightingale Yorkshire & Humber

In the NHS we are all too aware of the usual impact of an economic downturn on the funding of public services. Now, despite the fact that the NHS is appreciated even more by the public, the fact remains that we will have to now play our part - ensuring we are giving value for money - after this brief period where supply rather than money has been the problem.

This week I chaired a webinar which was a collaboration between the Healthcare Financial Management Association (HFMA) and FMLM on how we harness the power of clinical and finance collaboration to deliver value for patients at a time when the Covid-19 pandemic has had a profound effect on the way we practice medicine and on our national economy.

We heard from very experienced speakers, Dr Jean MacLeod, a Consultant in Diabetes & Acute Medicine in North Tees and Hartlepool and a GIFRT ambassador, and Duncan Orme, Director of Finance at Nottingham University Hospitals.

It is a fact that from medical student to consultant we really don’t have much exposure to how NHS finances work, and even less in the way of hands on experience managing budgets, until reaching the Clinical Director level when suddenly you might find you are the Accountable Officer for millions of pounds.

As a medical student, which was admittedly a long time ago, I spent four weeks in the Children’s Hospital of East Ontario, Canada, where my eyes were opened to billing. Every intervention to the child was accounted for – if it took more than one cannula to put up a drip, each cannula used was on the bill. Returning to the NHS nobody knew the price of a blood test, an ultrasound or a day in hospital. Although we still don’t run a patient bill, information is available to us in the form of PLICS – Patient Level Information and Costing System - we just need to ask a friendly finance colleague to help us interpret the data.

Having worked with numerous finance teams I can confirm they are a friendly bunch, just as dedicated to doing the right thing for patients as clinical staff, however often rebuffed by clinicians who think the finance just want to balance the books.

In Leeds Teaching Hospitals, through a collaboration with Virginia Mason, Seattle, clinicians learned about value and waste from a patients’ perspective. Focusing on value to the patient – timely service, a great experience and good clinical outcome, it was possible to reduce waste in the pathway and cost. Staff stopped talking about cost improvements and savings and instead started to identify waste reduction and improve quality.

During the Covid-19 pandemic digital consultations have taken off, many diagnostic tests have been drastically reduced, and patient pathways have been changed. So how are we going to assess if the changes were good for patients? We can use Friends and Family surveys and measure clinical outcomes, but we also need to look at PLICS data to assess if the changes have delivered value.

So how do we tackle the communication gap between doctors and finance teams? Nottingham have Clinical Accountants – just a name change but one that I think might help. Finance colleagues have much more clinical insight than we often give them credit for. We need more opportunities for doctors to have some finance training on the job – perhaps more joint webinars from FMLM and HFMA could be one way of delivering that, but don’t forget you can also knock on the door or send a Teams invitation to one of your friendly finance colleagues.

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