To turn NHS managers into great budget holders, it is crucial to improve their knowledge, confidence and motivation. Louvain Coxall explains

The NHS finance team has historically been good at addressing the technical aspects of training that develop managers into good budget holders. But with financial control increasingly in the spotlight, should it be doing more?

Take the following scenario for example. A manager works to control her budget carefully, creating savings to purchase equipment or improve the working environment. But she is not allowed to use the underspend. She feels all the effort has been wasted and gone to bail out another manager who made no effort to control spending. All her motivation is lost.

Responsible managers should be rewarded wherever possible and not feel they are being penalised for good housekeeping. To achieve this, finance staff need the communication skills to keep managers motivated and share the corporate vision. With this in mind, I have developed a model for influencing managers based on three characteristics: knowledge, confidence and motivation. It may be useful in identifying training and development needs.

It is important to use this model in a non-judgemental way. Managers will be some way along each dimension and need to identify where they are - the object is to develop them to where they want to be. Looking at the extremes of each axis of the model, a profile of different types of budget holder emerges. Eight combinations are possible. Remember, this is a dynamic model so there will be movement along each axis and in either direction.


Needs lots of support and encouragement. Knowledge and confidence will normally follow if motivation can be triggered. Increased confidence alone is not enough.


Ineffective for the organisation, tends not to stop in one post long. Needs to be identified quickly to limit the problems they could cause. Can be very evasive and difficult to engage with. Develop motivation.


Typically experienced but involved with budget holding for the first time. Tends to be confident, so concentrate on developing technical knowledge. Not unusually, confidence dips as knowledge increases. Can also lose motivation.


Most common entry point into management. Requires support appreciating their position is not unique. Traditionally, training has focused on enhancing knowledge, overlooking the confidence and motivation important for progression.


While knowledge can be high, low motivation is linked to low confidence. Often challenging to understand. Need to re-establish lost confidence as well as motivate.Get it right and the development path is into a good manager - get it wrong and create a Disaffected Expert.


Common development path for new and mature managers. New managers quickly gain knowledge but confidence may be slower to develop. Not unusual for confidence and sometimes motivation to fall.


Unwilling to manage - the most difficult category to engage. Often negative and disruptive in the organisation, resistant to change. Can be experienced, effective professionals in their field promoted into a managerial role to reward their expertise. Found in many organisations, the challenge is how to develop them into good managers.


This is the standard to which we are aiming to develop all our managers.

*081113 gmol chart

Tailored treatment

Teaching can be delivered one to one or through formal courses, with on-going support from finance staff.

As well as technical ability, this model suggests that finance staff need to be equipped with the interpersonal skills to recognise and approach different people using a variety of styles. One size definitely does not fit all.

For their part, general managers should realise the importance of broadening their focus from analysis and the mechanics of budgets to their personal development, specifically with regard to motivation, while receiving reassurance that low levels of confidence are not uncommon.