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NHS challenges under spotlight

The challenges and conflicts for medical managers working in the NHS are coming under the spotlight in research headed by Christos Begkos, lecturer in management accounting.

Christos has been analysing the role of management accounts in the day-to-day functioning of the NHS and particularly how clinicians use accounts to set strategy as they are given increasing powers to manage budgets.

He says the subject strikes to the heart of the often conflicting challenges that clinicians face. “Public hospitals are driven by the diverse ideas, interests and objectives of policy-makers, clinicians and managers and these may, ultimately, be impossible to reconcile. Clinicians not only have to achieve quality healthcare outcomes but also meet cost objectives. How do they effectively balance the two? Is there an inherent conflict there? These are precisely the kinds of questions I have been investigating.”

Collaborating with fellow academics across Alliance MBS, Christos has been surveying clinicians and asking whether accounting tools play a positive or negative impact for their specialty or Trust, while also investigating the level of accounting training that they are receiving.

The questions are also set in the context of a harsh economic climate in which funding growth has stopped for NHS trusts which are being asked to make annual cost savings of up to five per cent.

Christos says this scenario actually creates an opportunity for clinicians to try and use accounting systems to their benefit. “The NHS is facing serious funding issues at the moment. In such a budgetary climate what is the role of accounting information and how can this information then strengthen the argument for more investment? For instance, how can health managers incorporate accounting and finance information into their business cases for recruiting new consultants?”

He adds that there are clear policy implications. “For instance there could be more of an emphasis put on getting clinicians to have more formal accounting training when they become medical managers. It is naïve to ignore the power of accounting information in decision-making.”

Christos’ work chimes with other Alliance MBS research in this area. For instance, the school has been working on a major research project funded by the Department of Health and the National Institute for Health Research, examining the use of patient level information and costing systems (PLICS).

The research, which will be published later this year, looks at how individual patient costs are being used by hospitals and who that information is shared with. The research is relevant to acute hospital trusts and commissioners, as any cash savings through the successful use of PLICS can potentially be redeployed across services. Christos says although PLICS have been in use since 2007 and two thirds of NHS trusts have the system, clinicians do not necessarily have access to the system.