ACCA - The global body for professional accountants
While there is some optimism that patient choice will increase in the long term there are real concerns about the loss of financial expertise and experience from the system, coupled with a fear that there could what has been termed a ‘postcode lottery’ when it comes to care provision because clinicians will have differing priorities
—Michael Schofield, chair of Health Panel, ACCA

Changes will bring more risk and red tape, accountants tell ACCA survey

The NHS reforms in England will lead to greater financial risk and bureaucracy, a ‘postcode lottery’ when it comes to service provision and staff who are disengaged because of job insecurities, according to a survey of senior health service finance professionals carried out by ACCA (the Association of Chartered Certified Accountants).

There are also fears that lack of commissioning experience of GPs will affect the implementation of the NHS reforms, that the new Care Commissioning Groups (CCGs) will result in the loss of experienced PCT managers and staff and that clinicians will have different priorities with no shared vision across the service following the shake-up.

The survey was developed to understand the perceptions of ACCA members on the recently proposed reforms to the NHS in England. The survey looks at the main benefits, disadvantages and risks related to the reforms. It also investigates how the reforms will impact the quality of patient care. 

More than 100 members (123) working in NHS Trusts, Clinical Commissioning Groups, Primary Care Trusts and local authorities in England took part in the online survey in June 2012.

Overall, 70% of respondents had a negative view of the NHS Reforms in England. While they accepted there are benefits of the reforms - such as closer clinical involvement in commissioning process (62%) as well as decision-making being closer to patients (37%) and clinicians having greater decision-making powers (34%), they fear that the reforms will bring increased financial risk (53%) and bureaucracy (44%). Nearly 40% expressed concern about the potential for inequity of service provision and 33% said that lack of engagement of NHS staff due to job insecurities was an issue.

Members believe that the impact of the reforms in the short-term will be more negative than in the medium-term, and they believe that patient choice will improve in the long run. Members fear that the changes will have a negative impact on financial control both in the short-term (74%) and in the medium-term (56%).

Following the implementation of the reforms, more than half of ACCA finance professionals (52%) believe that the main risks facing CCGs will be that clinicians will have differing priorities leading to no shared vision across the service. Thirty per cent saw overspending as a risk, while 24% cited poor governance and 21% expressed fears over lack of experienced commissioning staff.

In terms of post implementation risks from the provider perspective, more than half of those surveyed expressed concern about cherry picking of services, 44% said that the financial sustainability would be an issue and 41% highlighted the potential problems that may arise meeting the demands of inexperienced commissioning bodies.

Respondents said that while the reforms will result in new challenges for finance staff - such as meeting the demands of inexperienced CCGs; the pressure of dealing with multiple bodies and taking on more work because of the inexperience of CCGs, there would also be opportunities for good flexible finance professionals who could become more commercially-focused and offer business advice, rather than just processing transactions.

In order to mitigate the risks of the reforms ACCA members said there were four key areas that CCGs should focus on: governance (62%); developing strong relationships with commissioning bodies (61%); patient engagement (53%) and risk pooling (45%).

Chair of ACCA’s Health Panel, Michael Schofield, who is Director of Finance at NHS Sussex said: 'The concerns expressed by those working in the health sector identify a range of issues which need to be addressed if the reforms are to have the desired effect. While there is some optimism that patient choice will increase in the long term there are real concerns about the loss of financial expertise and experience from the system, coupled with a fear that there could what has been termed a ‘postcode lottery’ when it comes to care provision because clinicians will have differing priorities.'