Published: 14/04/2005, Volume II5, No. 5951 Page 34

Barnsley Hospital foundation trust finance director Jeremy Loeb tells Lynne Greenwood how he chose a career in the NHS over alpine accountancy

If the appeal of an accountancy practice in Italy had matched the lure of the country's ski slopes, Jeremy Loeb's career path might have looked very different.

More than 25 years ago he spent a weekend in Milan, considering a move after completing his training with chartered accountants in London. He decided against it and instead joined the NHS. Two decades later he is facing the challenges of the foundation trust status granted to Barnsley Hospital in January as its finance director.

'As an independent organisation, Barnsley Hospital foundation trust is not a business, but we need to be more business-like, ' says Jeremy. 'While we do not want our clinical management teams to lose any sense of being there to provide clinical care, we would like them to provide it in a business-like context.' He first joined the NHS in 1983 as a senior accountant for resource allocation and strategic planning for the then Oxford regional health authority. 'It was a real eye-opener moving into the world of bureaucracy from a West End commercial firm, ' recalls Jeremy.

After three years he moved to Newcastle upon Tyne to head a national resource management pilot project based at Freeman Hospital. At the start of the three-year project, he spent a week in the US studying healthcare and costing systems that enabled medical staff to understand the costs of treatment.

'It has some relevance to the more recent development of foundation trusts in the UK, ' he says. 'They were running a system called diagnostic related groups, which were the forerunners of healthcare resource groups, subsequently introduced in England and which form the basis of payment by results.

'We also learned that information alone is not sufficient to produce change.

The further development of trusts and then foundation trusts was needed to enable the system here to change.' When the project ended, Jeremy decided to move out of the health service into management consultancy, based in Birmingham, although much of his work was health-related. 'In three years I gained lots of useful experience but I realised I wanted to be part of influencing change rather than at the periphery, ' he says.

He then moved to his 'ideal job' at the time, deputy finance director at Northern General Hospital in Sheffield, involving a mainstream line-management role that was new territory for him.

As well as running a 36-strong department during a period of costimprovement targets and some waitingtimes targets, he was also the accountant responsible for renal services. 'My director of finance encouraged everybody to have some frontline accountancy work, which I think was a good approach, ' he says. 'And it is relevant to us now as a foundation trust because our chief executive is keen for the directors to understand the front line and spend regular time working with staff.' During his time at the Northern General, Jeremy completed a leadership course for healthcare professionals from different disciplines, enabling him to 'see myself from a distance'. For six months towards the end of his stay at Sheffield, he became acting finance director after his boss was appointed acting chief executive.

Both elements helped to prepare him for the move in 1999 to Barnsley, already a trust, financially stable but with little recent capital investment in the district general hospital. Medical staff identified an improved imaging department as a top priority and the trust is now two-thirds of the way through an£8m investment in a refurbished and expanded department to include an MRI scanner.

He also identified the need to devolve more financial responsibility to clinical management teams and speeded up the preparation of monthly budget reports.

After Barnsley achieved three stars in 2003 and 2004, it began the process of applying for foundation status.

'I worked alongside our director of strategy and service improvement to produce the financial projections that underpinned her service development strategy. That in total amounted to the foundation trust business plan for the next five years, ' he explains.

He also produced the working capital projections, which concentrate on the first 18 months as a foundation trust and focus particularly on cash-flow. He says Barnsley was 'not a certainty by any means'.

It was a pressurised period. 'Monitor expects any trust going forward to become an independent organisation to raise its game significantly, ' he says. 'So the whole application process is a hurdle, a test, and very much pass or fail.' Jeremy now has plans to boost his 26strong department with two more senior accountants and will strengthen cash management and develop the reporting systems to meet the quarterly foundation trust monitoring requirements.

In the medium term he plans to develop a contribution analysis at specialty level, ensuring that each specialty understands the net contribution it makes to the central overheads of the organisation. He also acknowledges the need for education and staff development to ensure 'everyone becomes an expert' in payment by results.

He is currently discussing his latest financial strategy with different clinical management teams as part of the consultation process. But he believes the financial environment provides an opportunity for foundation trusts to develop their finance functions. 'I want our accountants to become more commercial, more entrepreneurial, but not lose a sense of their professional integrity, ' he explains. 'I want them to be more aware of how a clinical service runs and at the same time understand the external environment.' For that reason, he believes ambitious junior accountants will benefit from commercial experience, because previous barriers between health organisations, the private sector and local authorities as employers are less obvious. But they must also be good technically, able to understand their business and relate to frontline staff.

His own ambitions are to have more freedom in the next 10 years to use his skills in different directions. As part of his personal development programme his 'enlightened' chief executive Jan Sobieraj allowed Jeremy, a clarinet player in an amateur orchestra in Sheffield, to spend a few days developing music workshops in the city. 'If that was to present an opportunity to diversify my own career, who knows if I might take it?'

Jeremy Loeb CV

1978-83 - completed chartered accountancy training with Stoy Hayward

1983-86 - senior accountant for resource allocation and strategic planning at Oxford regional health authority

1986-89 - head of national resource management pilot project based at Freeman Hospital, Newcastle upon Tyne

1989-92 - management consultant with private sector consultancy CSL, Birmingham

1992-99 - deputy finance director Northern General Hospital, Sheffield, including six months as acting finance director

1999 - finance director, Barnsley Hospital foundation trust