FINANCE

Published: 08/09/2005, Volume II5, No. 5972 Page 34 35

An ability to stop people spending money helped convince Katie Aves and Danielle Cecchini to pursue finance careers. Emma Forrest reports

A career in finance was never the intention of Rugby primary care trust finance assistant Katie Aves. More surprisingly, it was never the intention of finance director Danielle Cecchini either.

Katie joined Rugby PCT three years ago. After temping as a receptionist she was offered a job in the finance department. 'We saw that she was good at stopping people spending money, ' says Danielle, who describes Katie as a 'finance assistant extraordinaire'.

A love of horses initially led her to equine studies, but Katie now has her sights firmly set on qualifying as a finance technician later in the year. She plans to follow that up with further training to become a part-qualified accountant.

For Danielle, her initial plans to be a teacher after graduating with a degree in modern European studies quickly changed - 'I did a year as a language assistant and was rubbish at it.' After a number of jobs, British Gas gave her the opportunity to train in accountancy. She joined the NHS in 1992.

'It was around the time of trust status being founded and there was more emphasis on accountancy. I moved to Leicester General Hospital. It had rotating finance staff, and that gave me the opportunity to work in different departments.' Like Katie, who spent a year travelling in Australia before joining Rugby PCT, Danielle spent some time temping in London, largely at Great Ormond Street, before spending six months in India.

After returning to the UK she eventually became acting finance director of Leicestershire primary care group and joined the PCT in June 2002.

Three years later the PCT is celebrating gaining three stars, just one year after it was given zero. Danielle and Katie are clearly thrilled. 'We did not feel like a zero-star trust before but we were not expecting to get three this time, ' says Danielle.

'It was brilliant, like passing your exams. We are the only three-star PCT in our patch and our providers are threestarred too so it is great for the people of Rugby.' With some back-office work contracted out to a shared service centre, the PCT's finance department is just four strong, and there is little opportunity for Danielle and her team to be distant from other departments.

'In a large trust you can sometimes lose sight of the ability to link the money to what you do and who you do it for, ' says Danielle. 'When I was at Leicester General Hospital we never saw anybody and never got involved in anything but accounting.' Conversely, the small size of the PCT allows for close working between the executive team and other departments, and both Danielle and Katie believe it can make it easier to get things done.

It has also allowed both of them to expand their roles. Rugby PCT is the regional lead on commissioning and Danielle is the executive lead, a remit that includes working with GPs to engage them in moves towards practice-based commissioning. Katie has also been working on specialist services financing, which has enabled her to learn more about learning disability and mental health services. 'It has opened my eyes to what care actually costs; the public has no idea, ' she says.

Working for a small organisation can have drawbacks. Katie acknowledges that staying there could limit her career prospects as there is little opportunity to rotate roles. But she says working in a large organisation would be a culture shock, and she has no current plans to leave. There is also the spectre of PCT reconfiguration, although both Danielle and Katie say there is little anxiety within their own organisation about the impact of Commissioning a Patient-led NHS .

A small team also means all hands on deck at busy times; Danielle says that there is no longer any 'down time' in the NHS calendar.

The agenda is daunting: setting budgets, preparing local delivery plans, staying one step ahead of payment by results and preparing end-of-year accounts are all done in the same department. In a larger trust, different teams or departments would have some of the responsibilities. As crucial as final accounts are, the work they require can leave other areas temporarily neglected.

'We have not had a slack period for six years, ' says Danielle.

Financial management in PCTs has been frequently criticised as inadequate.

Danielle acknowledges that good people are thinly spread, but adds that it can be difficult trying to improve the situation while under an obligation to contain management spending.

Both say they would like to continue to be involved in strategic work, and believe finance must have a broader status in the health service.

'Finance does have a high profile, but it is not always a positive profile, ' says Danielle. 'It would be useful for finance to get more into planning and policy. At the minute the way the public see it, to be a manager is bad enough, but to be an accountant is even worse. At the end of the day we are charged with achieving financial balance so It is easy for the finance director to be the bad guy.'

Katie Aves CV

2002 - receptionist, Rugby primary care trust. Soon offered position as finance assistant

2001-02 - travelled in the Far East and Australia for a year. Temped at Layman solicitors on her return

2001 - after leaving school, completed a course in equine studies at Warwickshire College's Moreton Morrell centre and then worked at a stable

Danielle Cecchini CV

2002 - finance director, Rugby primary care trust

2001 - finance manager, Leicestershire health authority, supporting primary care groups to become PCTs. Acting finance director, South Leicestershire PCT

2001 - deputy director of finance, West Hertfordshire Hospitals trust

1999-2000 - freelance work at a number of London trusts, plus six months' travel in India

1993-1999 - finance department, Leicester General Hospital trust

1992 - Leicestershire Mental Health trust

1987 - British Gas, where she was funded for four years to train as an accountant