A personal perspective on the gap between the front line and the back office.

*Trigger warning – contains references to child loss which some readers may find disturbing.

When I was 11, I had a crush. Her name was Kate, and she was one of the most popular girls in my primary school. She was pretty, and she was kind. One day, I was certain she would hold my hand. Perhaps even give me a kiss. But before she had a chance to do that, Kate died of meningitis. She was just 12 years old.

It was 1982, and the dangers of this life-threatening infection weren’t particularly well-known. No-one would have thought to do a glass test, or be alarmed by her stiff neck and sensitivity to light.

Fast forward a couple of decades. It’s 2001, and the woman who will one day become my wife is watching in terror and rage as her nine-month old son dies from the same condition. This time, there IS awareness. She’s pretty sure she knows what the problem is. But she can’t get the doctors to understand her concern.

Thankfully, Charlie survived – just – but parts of his brain were irreparably injured. My beautiful stepson – now 22 years old – will never be able to live independently.

Why am I sharing all of this deeply personal stuff in a finance blog? What’s it got to do with the everyday tasks of NHS finance professionals?

Three reasons.

• Firstly, awareness is everything.
• Secondly, bad things happen when people aren’t understood.
• The third you’ll need to wait for – it’s at the very bottom of this article.

Awareness.

I’m noticing the gap between the NHS front line and back office growing wider every year. Roles are becoming increasingly specialised, and, whilst that can be a good thing, I’m seeing the unintended consequence of a growing lack of awareness around what the clinical and non-clinical sides of a trust actually do.

The good news is, this can be fixed. Look at things like your induction process and your new starter training. Multidisciplinary teams are the norm almost everywhere, but how often do they include the back office? Even simple programmes, like Randomised Coffee Trials (look it up if the term’s unfamiliar) can help.

Understanding

So you’ve started to get people talking. That’s great – but are they understanding each other?

Amid multiple pressures, clinicians and finance teams often start to look inwards, concentrating on their comfort zone rather than on understanding others.

When I hear (as I often do) clinicians complaining that they don’t understand their trust’s finances, or finance professionals aggrieved because someone on the front line has side-stepped procedures yet again, my spider sense starts tingling.

And that worries me, because I know from personal experience that when people don’t understand each other, bad things happen.

One great example is jargon. I’m betting you use a lot of it without even realising. Accruals? POs? GL? CoA? All of these may seem self-evident to you, but I promise, they mean nothing to almost all your patient-facing colleagues.

Here’s where we can take a lesson from the clinicians. They’re trained in the use and abuse of jargon. For example, in the presence of an agitated patient a doctor might ask a colleague if they’re dealing with an EtOH issue. Or they might ask the patient if she’s been drinking. The meaning is the same, the language is different.

The most effective trusts demonstrate strong relationships between clinicians and the back office. Finance and procurement teams are able to flag up issues like overspends or price rises before they become problems. Patient-facing teams understand their trust’s financial procedures, and their own fiscal responsibilities. Once again, there’s no magic wand here, but training finance teams to minimise their use of jargon, and arming them with one-sentence explanations for common terminology is helpful. For example: “An accrual is money that’s been spent but not yet paid.” Such a simple explanation can really aid understanding.

Finally, I promised you a third reason for sharing my personal story with you. It’s this. I recently became a trustee of Meningitis Now, the national charity dedicated to ensuring no-one in the UK dies from meningitis and everyone affected gets the support they need.

Although I joined Meningitis Now for purely personal reasons, it has – somewhat to my surprise – been a fantastic experience. Even though I’ve worked in the NHS all my life, I’ve been given a new perspective on the role of the front line teams providing care, and the way in which the NHS works with charities and the third sector. I’ve also met some wonderful and inspirational people.

So, a final suggestion. NHS finance can be fascinating, but it can be gruelling. Taking some time to experience something new – perhaps seeing the NHS you work in through the lens of a charity – can help give you perspective, energy and clarity. Why not give it a go?