The future careers of thousands of NHS finance workers could depend on pilot schemes started this month. The service may soon have as few as 10 shared service centres for finance across England.
The beginning of the month saw the start of two large pilot schemes to assess whether most finance functions could be run from either 10 or 25 centres.
Management consultants KPMG were asked two years ago to draw up plans for how shared service centres could work. They suggested that most routine finance processing could be done by as few as eight centres.
The Department of Health has decided the figure should be either 10 or 25, and has set up pilots to test which would work better.
The West Yorkshire area pilot is using a model that assesses the impact of 25 centres, and the pilot in south-west England is testing the 10-centre model.
The pilots will run for two years, and prepare a full business case after 18 months to ensure rapid progress.
Although there will be obvious concerns among thousands of finance workers about whether their future is safe, and where they might have to work, the full impact of such changes is not likely to be felt for four to five years.
However, finance directors have made it clear that there are likely to be significant moves to share services in local areas over the next couple of years. One service centre per health authority is one option on the short-term agenda.
NHS acting finance director Christine Daws says the rationalisation is 'about driving down costs', but 'the real driver has to be better service. When we save money from this, we will release resources for patient care. '
Ms Daws says: 'Lots of people are very concerned about staff.
Will people lose their jobs? One of the key messages is we will try our best to retain them.
'There are lots of opportunities for staff with qualifications. When KPMG did the report, it said we would need to spend a lot of money on redundancies. '
However, she says, the intention is to retrain and relocate staff wherever possible.
Junior health minister Lord Hunt backs up this view, telling HSJ: 'At the end of the day we are recruiting staff. This is a service that is expanding and we can offer new opportunities. '
Ms Daws says the payback on the rationalisation would come after three years.
It is anticipated the initial investment costs would be around£500m, and that about half of this could be paid by the private sector if the centres were funded through a private finance initiative deal.
Finance directors certainly welcome the pilots, but have concerns about the impact on staff.
University Hospitals Coventry and Warwickshire trust director of finance Paul Elkin says: 'I think many of us have some concerns about the technology aspects, and obviously about the potentially destabilising aspects of this. '
Suffolk HA director of finance Mark Millar says the pilots are the right thing, but morale could be badly affected in the meantime: 'It affects a lot of people who have worked for us for a lot of years.
From a finance director's point of view, we have the responsibility to keep services running, ' he says.
He says there are many shared services schemes running now - not just involving finance - and that rationalisation is on the cards. 'If you talk about one for each HA, the first phase would be about 100. '
He predicts this could happen over the next two years.
However, in terms of rolling out the final configuration of either just 10 or 25 centres, he predicts it would be 'five years from now'.
Shared services taskforce finance director Julie Armstrong, who was finance director of St Mary's trust, London, until the end of March, says the centres will be NHS-led. 'Our view is that it will be run by the NHS, for the NHS. It could be a special health authority. '
Ms Armstrong says the pilots must have proved themselves within 18 months, but there is a clear programme for what they must achieve in the 'first 100 days'.
She says the pilots will involve '80 per cent cultural change and 20 per cent IT'.
In terms of what would be left in individual trust and HA finance departments, Barts and the London trust finance director Barry Elliott says the focus of activity is likely to become 'financial management support', and this means 'we will be able to give more support to clinical services. '
The wind of change has started blowing through finance departments.
What is clear is this is just the start, and other services are likely to be close behind.
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