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Bean counters of the world unite



Keen observers may have spotted that an edited version of the last but one post on here (Patients not profits) was very kindly published by The Guardian on their website. There’s a link here if you’ve not already seen it. They’ve done a fine job of whittling it down from a two thousand word rant into something a bit punchier and there’s also a link to the original post at the end of the article that’s a nice touch.

The response to the post has been overwhelmingly positive. Thanks to everyone that’s read, shared, liked, retweeted, favourited or commented on it, particularly those that have wished me well. Commenters included nurses, hospital consultants, junior doctors, therapists, fellow finance workers including a few Finance Directors, General Practitioners, the leader of the National Health Action Party and several local councillors. A reminder of what a vast organisation the NHS is and how much love there is for it.


Here’s a small selection of some of the comments;

“I’m a frontline clinician and witnessing/being part of what’s happening has actually made me ill. It’s good to be able to share someone else’s account of what is going on without being emotive myself”

“Really good to be reminded of the somewhat old fashioned concept of a public service ethos”

“Good to have such forthright views from someone on the inside and brave”

“Brilliant and much needed article from brave NHS bean counter who sheds light on NHS underfunding”

“I felt enthused when I read this… brave there are others willing to follow”

Inspiringly insightful blog, made me reconsider quitting my job as a consultant psychiatrist equally disillusioned with loss of public service ethos that had attracted me to the NHS in the first place”

Most of the time I’m a right grumpy bugger so for anyone to say that they’ve been enthused or inspired by something I’ve written has grabbed me by surprise. It’s a piece that I’d been meaning to write for a while and something that was written from the heart. I’m passionate about what the NHS stands for and proud to work for a health service that was recently ranked the best in the world by the Commonwealth Fund ( We should be shouting from the rooftops about our health service not carving it up and flogging it off to the private sector.


A few people took the opportunity to remind me that some finance directors have already been calling for an open and honest debate about the state of NHS finances. Both the Healthcare Financial Management Association and the King’s Fund ( have recently published reports that highlight the concerns of Directors of Finance about the current state of the NHS’s finances. This is admirable but, I can’t help feeling, somewhat lost tucked away as it is in reports that will be read by few outside the NHS. And I wonder how talk of driving “transformational efficiency savings” and QIPP (quality, innovation, productivity and prevention) grabs the attention of the general public. I have difficulty enough in understanding them.

What I was attempting in the “patients not profits” piece was to articulate the need for finance staff to take a step back from the hard nosed business economics that have dominated much of our thinking in the last decade and adopt a different approach that places the needs of patients at the heart of everything we do. Something far removed from the world of slick Powerpoint slides, bullet points and corporate logos. Something different, perhaps even a little rebellious. I provided some examples of how we could do things differently in the original post so I won’t regurgitate them here.

This is our NHS, not NHS England’s, not the Department of Health’s and certainly not this government’s. It’s ours and we collectively have the power to make it what we want to be. And finance staff and other non-clinical staff should be in the vanguard of this process because (a) we are well placed to observe the damage being done to our NHS and (b) we are able to take action without it directly affecting patient care.


In a large organisation like the NHS, with over a million employees, decisions are taken everyday that affect patients, staff, the wider public and other organisations. Let’s look at one small example of how we, as finance staff, could do things differently. The HFMA’s annual conference is the health service’s largest gathering of finance staff with several hundred accountants attending three days of events at a plush London hotel. It’s a glitzy, end of term bash including a black tie dinner, motivational speakers and an awards ceremony. The numerous corporate sponsors, all eager to grab a slice of the NHS cake, are always thanked for their support but sadly we all too often fail to show our appreciation for the low paid hotel staff who scurry around catering for the every need of the delegates.


Most of these workers are employed by agencies and paid the minimum wage. The London living wage, the rate that is reckoned to give workers enough to cover the costs of living in the most expensive city in the UK, is currently £8.80 per hour, yet these workers are paid a pitiful £6.31 per hour. Staff at the hotel have expressed a number of concerns to the Unite trade union regarding working conditions including the low wages and the lack of dignity and respect that they receive from many guests. They also complained of feeling very tired at the end of long shifts. No doubt exacerbated by the fact that it’s almost impossible for low paid workers to afford to live close to their places of work in central London and most face long journeys to and from work on public transport late at night or early in the morning. Some also pointed out that were paid so little that they could not afford English lessons to help them improve their language skills.


You don’t need to be a medical expert to appreciate the damaging impact that long hours and low pay can have on the mental and physical health of these hotel workers. The evidence is stark in the huge health inequalities across London. By ignoring these issues we are storing up problems for the health service in the future. Short term cost cutting plunges more workers into poverty and, in the long run, places greater demands on the NHS. Yet these hotel workers are the modern day ragged trousered philanthropists that make it affordable for us to hold conferences at smart hotels. How does this sit with the NHS’s sense of social solidarity and the need to think holistically about healthcare? We can do better.

The typical response of most NHS organisations to any financial crisis tends to be recruitment freezes and cutting non-pay costs by, for instance, printing documents on both sides of the paper or using less paper clips. This is fine in the short term but what about the bigger picture? Where’s the so-called joined-up thinking that connects our actions to the wider world? It’s a privilege to work for the NHS but with it comes responsibilities. We’re not in the business of manufacturing tins of beans or flipping burgers. We exist to treat patients and improve the health of everyone. Each decision that we take about the use of resources, no matter how big or small, should be imbued with a sense of compassion, care, respect and kindness. We need to move away from lazy, short term decision making based on numbers on spreadsheets or glossy corporate reports.


The next few weeks will see many people standing up to defend the NHS. On Saturday 16th August the Peoples’ March for the NHS set out from the north east and will retrace the three hundred mile route of the 1936 Jarrow march to London. It’s been organised by a group of mums from Darlington calling themselves 999 Call for the NHS ( and the march aims to raise public awareness of the dismantling of the NHS by the current government. It will conclude with a demonstration in London on Saturday 6th September.

Meanwhile on 28th August the Unison trade union will begin balloting its health service members over proposed strike action later in the year. The strike will ostensibly be about the cuts to pay suffered by many NHS staff but it will also represent a protest at the privatisation of the health service. I’d like to think that the bean counters of the NHS will play a significant part in these protests. I’m not holding my breath though.



From → NHS, Uncategorized

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