Consistency and agreement are needed to spread success

For all the fierceness of its interrogations of NHS and Whitehall officials, this week's Commons public accounts committee report on financial management (see page 6 of this week's issue) in most respects reflects the existing concerns of managers. However, it does make a number of important points.

First, it argues that the performance of the finance function is too patchy, and inadequate in more than a quarter of organisations. Although this raises familiar issues about recruitment, training and development, the central issue the report highlights is the role of clinicians in financial management.

Payment by results was supposed to be the catalyst for stoking clinical passions for financial management, but the potential has been stymied by wider issues around the relationship with corporate management. This was a point well made in the recently published national inquiry into management and medicine from Leeds University ('2 tribes', pages 22-24, 15 March issue). Achieving it will require both 'technical' issues such as service-line accounting but also much wider cultural changes.

Second, the public accounts committee report calls for the lessons learned from turnaround programmes that have delivered results to be shared with the wider NHS. But at the moment the evidence for the effectiveness of the turnaround process remains opaque. The report highlights widespread improvement in delivering cost improvement plans (a significant failure in forecasting in the past). But that is just one element. How many have been successful? Are there consistent and agreed success criteria?

A national programme requires a national review. NHS South West chief executive Sir Ian Carruthers' review of reconfiguration plans last month was a welcome attempt to cast a rule over a disparate set of consultations and pull together common success criteria. If turnaround is going to have a sustainable effect on NHS performance, it would benefit from the same kind of treatment.