Published: 12/08/2004, Volume II4, No. 5918 Page 28
Payment by results, recovery plans and foundation status - Jane Tomkinson itemises the day-to-day realities of a finance and performance director's work.
Name: Jane Tomkinson
Job title: Director of finance and performance, Countess of Chester Hospital foundation trust
Describe your career path I started as a trainee accountant in local government with Durham city council and worked in a metropolitan borough council after I qualified. It was a brilliant start as it helped me gain an in-depth understanding of most services provided by the public sector and I came into contact with some of the services interconnected with health.
I joined the health service in 1990 as unit accountant for Sunderland Royal Infirmary before becoming assistant director of finance in the merged City Hospitals trust in 1994. At the time we were getting to grips with GP fundholding and the implementation of trust status.
I came to the Countess of Chester Hospital in 1998, first as deputy finance director, then as director of business development in 1999. I did an MBA during that time, which helped me understand the commercial aspects of healthcare. I became associate director of finance in 2002 and took the executive finance director's position last year.
When I joined, the trust was moving into a recovery plan. It was a difficult time, but the whole trust worked hard. I believe this team approach allowed us to become a foundation trust.
What does your job entail and how do you juggle your responsibilities?
As well as finance and performance, my remit covers information management and technology and procurement. I am also executive lead for the women and children's clinical directorate. There are some areas of conflict, but nothing significant. It is useful to have the performance aspect [in my remit] because when you are making decisions about resources it is good to have a pan-hospital perspective.
It is primarily a strategic role, but in the short-term it is also about ensuring we have the financial, workforce and capacity resources to deliver targets.
One of the key issues for foundation trusts is liquidity, and I have to ensure there is sufficient cash available on a day-to-day basis.
What are your plans over the next few years?
Primarily to consolidate our position as a foundation trust within the local health economy. We will take on board the requirements and initiatives around patient choice and the national programme for IT as well as exploiting the freedoms we now have for the benefit of our patients. It will take up to five years to firmly establish the trust as an effective foundation trust.
We are constrained by capacity and are using our borrowing powers to give more freedom in the way we deliver services. In the long term we plan to develop an elective care centre to increase elective capacity to meet the aim of being the hospital of choice for the local economy.
I would like to fully understand the implications of payment by results, including the adequacy of the tariff. Over the last two or three years we have worked closely with commissioning partners to provide services in more appropriate care settings, and in many cases this has meant keeping people out of hospital. Under payment by results there is currently no financial recognition for secondary care without some form of admission.
How are you coping with payment by results?
We quickly established working teams to aid implementation, looking at areas such as whether our financial systems were robust enough to recognise the differences between types of care. Early on, we joined forces with the primary care trusts to work on disaggregating contracts.
We are now relatively confident we have the systems and infrastructure to collect and quantify the data needed to monitor activity. We have been concentrating on the tariff to gain an understanding of the impact on different aspects of the hospital - how we will disaggregate funding to incentivise directorates to do additional work and how directorates will manage the potential to lose resources through the under-achievement of targets.
Has the trust taken advantage of foundation trusts' financial freedoms?
We were one of the first to submit a borrowing application. The loan for£5.3m is to finance an emergency care centre that will consolidate facilities for emergency patients in one geographical area, including diagnosis and assessment.
How has foundation status affected the planning process?
In the longer term the assessment process and the regulator have required the trust to produce robust five-year financial plans, and this has injected a longer-term perspective into planning.
What do you do when you are off duty?
I enjoy salsa and Latin dance, as well as pilates.
Dancing is a good way of keeping fit and it is completely different from the world of NHS finance.
I firmly believe if the NHS provided pilates free of charge there would be a significant reduction in the number of back complaints. I love to water-ski and will enjoy skiing on Lake Windermere until speed restrictions are enforced in 2005. l