Understanding how money works and spending wisely is essential for people working in the NHS. The evidence suggests that when money is spent well, the quality of services provided to patients is correspondingly high.
But NHS money will only be used well if clinicians are fully engaged in managing it. Financial management may not be at the forefront of clinicians' minds - and nor should it - but it is an important part of their role. Ultimately, it is clinicians who are responsible for the way in which services are delivered to individual patients and it is they who commit the resources.
That is why the Audit Commission has worked with others, including the Academy of Medical Royal Colleges, the Royal College of Nursing, the Healthcare Financial Management Association and the Department of Health, to produce a joint statement that sets out the benefits of clinician involvement in the business side of the NHS. This statement outlines some clear expectations about training, provision of prompt and accurate information, and involvement that goes beyond simply being given a budget and being expected to manage it.
We are not expecting doctors and nurses to develop an in-depth knowledge of financial issues, but we do think all clinicians should recognise and understand their role in committing resources and how good use of resources will lead to better service provision. And the more senior the clinician, the more important it is that they understand the business and financial aspects of their service or department, either in a hospital or in the community, and that they are helped to do so.
In control
Looking at it a different way, it is about clinicians being in control. It is about enabling them to plan and design the best possible services with the money available. Quite simply, health minister Lord Darzi's vision will not be achieved without the strong involvement of local clinicians in the management of services.
Some clinicians are already doing this and services are reaping the benefits. In December 2007, the Audit Commission published A Prescription for Partnership: engaging clinicians in financial management, which looked at how clinical and finance staff can forge better working relationships for the benefit of patients.
The 19 case studies in the report showed just what can be done and how. We found that clinical engagement has to be built on mutual trust, and trust has to be built on solid foundations. The solid foundations are technical financial proficiency, robust data and a clear organisational structure where management and clinical responsibility are aligned with financial accountability. Clearly, managers and finance staff have a key role to play in making this possible.
Best value
But this is the issue we have to get right if services are to be significantly improved and best value got for taxpayers' money. Where there is not proper engagement, decision making can be poor and progress very slow. But where they can come together, services and finances can be radically improved.
It may seem distasteful to some to talk about money alongside the saving of lives, but on the other hand using money well means that more care of a better quality can be provided to more people. Now that has to be worth counting the beans for.
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