NHS Voices blogs

Are NHS management accountants an endangered species? (And is that a good thing?)

Exploring the potential of a new future for NHS management accounts.
Mark Costello

15 March 2024

Mark Costello, head of strategic finance consulting at NHS Shared Business Services, imagines a world where the role of NHS management accountants is about both people and processes. 

Ever since I first darkened the doors of the NHS way back in 2001 as an entrant to the Graduate Financial Management Training Scheme, two truths have been held as self-evident.

The first is that NHS accountants will never give up their spreadsheets. Sadly, this remains the case.

The second is that management accounts are not about processes, solutions or automation, they’re about people.

Over the years I came to believe that the second truth was as immutable as the first, but now I’m not so sure.

There has to be a better way

I’ve seen the struggles of management accounts staff in NHS provider teams: The increased demand for more and more small-scale manual budget and actual adjustments; having to eke even more out of their often antiquated and isolated systems and usually having to make sense of the previous incumbent’s complex spreadsheet without the benefit of having been properly trained in the systems they are being asked to use because systems accountants are rather thin on the ground these days. 

I’ve often thought there has to be a better way of doing this.

And so, as core finance systems become enriched with functionality enabling them to integrate with other systems and expansion modules, I believe the time is now right to consider that management accounts could also be about systems, automation and processes.

It’s about the ability to offer strong, proactive, robust and accurate financial advice to budget holders who have more important things to do, like saving people’s lives

Don’t get me wrong, management accounts, and its more modern evolution, ‘finance business partnering’, is about people. It is about relationships. It’s about business understanding. It’s about the ability to offer strong, proactive, robust and accurate financial advice to budget holders who have more important things to do, like saving people’s lives rather than worrying about the minutiae of a complex spreadsheet and a monthly income and expenditure statement.

Really getting under the skin of care is why we all joined the NHS in the first place. Yet management accountants simply don’t have the time or the headspace to do this, as they’re increasingly becoming Jacks (and Jills) of all trades. They’re being asked for balance sheet code analysis, debtor reviews… and that’s before we get into the increasingly complex world of ever-decreasing month-end closedown periods, and the growing numbers of manual adjustments needed just to produce a month-end position that gets us anywhere near ‘accurate’.

There is a better way

But, I believe there is a better way. Vastly improved systems now exist that look at more efficient and streamlined processes across the purchase/sales ledger. They’re more intuitive and easier to use. For budget holders, they offer functionality that means a huge number of the manual adjustments which  management accountants spend days making  in the run up to month-end are automatically sorted, and can provide integrated and automated driver-based monthly forecasting. Integrating this into the annual budget-setting process can transform long-winded and painful processes into as much of a push-button exercise as is  possible, while still retaining the human touch required for socialising, testing and finessing all of these. Imagine if the monthly narrative reporting from ward to board could also be totally integrated and automated without losing the important sense of clarity of message.

This level of improvement … could begin to blur the lines between traditional financial accounts and management accounts

This level of improvement – if properly harnessed and deployed - could begin to blur the lines between traditional financial accounts and management accounts, opening up exciting new roles that currently don’t exist. 

These new roles could be transaction experts who fully understand the ability and functionality of these new systems, and make the most of them, using next-gen functions like machine learning and AI to automate and improve these outputs even further. The roles would be involved in every aspect of the production of a monthly financial position and – critically – they would incorporate an understanding of the business side of these services to provide much more accurate and efficient advice to budget holders, without needing to signpost to other members of the finance function.

And it’s not just me who is beginning to think like this. In September last year, NHS England published Corporate Services: Improvement Opportunities and Resources, highlighting 19 opportunities for finance to modernise. A number of them look at the work management accountants currently do.

The next generation

In short, the new generation of finance business partners would be able to produce robust and strategic financial advice firmly focused on the future. They would have the time to look further afield and start to integrate other data sets like the Patient Level and Information Costing System (PLICS), workforce and activity to build up a picture of truly integrated financial planning, while transaction experts align processing and cost/income recognition into a more accurate and understood financial position for services and budget holders.

Going one step further, imagine the possibilities if these shared financial systems could be deployed across an entire integrated care system , opening up opportunities to work and think outside of the single organisation, with a broader sense of vision on what is happening across multiple organisations.

It’s enough to make me want to ditch my spreadsheets.

Mark Costello is head of strategic finance consulting at NHS Shared Business Services. You can follow Mark on LinkedIn.