• Senior figures at CIPFA worried about pressures placed on finance directors to act “unethically”
  • Concerns also raised that NHS accountants often lack support to “do the right thing”
  • Warnings come after survey responses suggested that significant numbers have succumbed to pressure

NHS finance directors and their teams are being put under pressure to act “unethically” in their reporting, senior figures at the Chartered Institute of Public Finance and Accountancy have said.

The professional body told HSJ some finance directors are not being supported by boards or regulators to “do the right thing”.

It comes after CIPFA received 487 responses from public sector accountants to a survey, of which 52 were NHS staff.

Of the 52 NHS staff, 19 said they had experienced pressure to act in a “professionally unethical way” and had carried out the task either partially or fully. This was a higher proportion than that reported in other sectors (see box below for more details).

Comments submitted by respondents suggested the “pressure” included threats of being passed over for promotion, aggressive or unpleasant behaviour, implied threats of redundancy or being made to feel their job was at risk.

Margaret Pratt, chair of CIPFA’s ethics working group and former interim chief finance officer at St George’s University Hospitals Foundation Trust, acknowledged the survey was self-selecting and the sample of NHS respondents was relatively small.

But she told HSJ: “The main thrust of the survey results is very clear. People feel under pressure to act unethically, and more worryingly, people know what they’re being asked to do is wrong and yet they are still doing it.

“It reflects my own experience and that of colleagues. I’ve had a 25 year career working in or for the NHS and absolutely recognise those pressures, while colleagues continue to raise these concerns with me.

“We need to support members to do the right thing and to raise a red flag when that needs to be done. The regulators need to respect professional integrity; in the long run it doesn’t help them if they are relying on reporting that is economical with the truth.

“In fact, it’s incredibly harmful to the integrity of the NHS and erodes trust and confidence. It’s always found out eventually.”

She warned that during periods of budget tightening there was a danger “people start to think it’s normal to stretch ethical standards”.

A spokesman for NHS Improvement said providers are expected to report their financial position accurately and added: “Any example of providers misreporting their financial performance faces regulatory action.”

There have been dozens of examples in recent years where NHS trusts have signed up to ambitious financial plans, before later admitting they would be missed by a large margin.

Mark Knight, chief executive of the Healthcare Financial Management Association, which represents NHS finance staff, said: “Any report of NHS finance professionals saying that they feel under pressure to act unethically is disturbing. We know there are significant financial challenges in the NHS, but acting unethically or pressurising others to do so is not the way to address them.”

The HFMA did not respond when asked whether there had been any increase or intensification of these types of concerns being raised by members.

The CIPFA survey

The survey received 487 responses from public sector accountants, in which 57 per cent said they had, at some point in their career, experienced “pressure to act in a professionally unethical way”.  

Of the 276 respondents reporting being placed under pressure, 36 per cent admitted carrying out the unethical task either partially or fully.

There were 52 responses from NHS staff, with 30 (58 per cent) saying they had experienced pressure to act unethically. Eleven of these said it had happened more than five times, with 19 saying it had happened fewer than five times.

The most common tasks were excessive optimism in budgets, unreasonably downplaying risks, and postponing recognition of costs, accruals or liabilities. Of the 30, two said they carried out the tasks in full, and 17 said they carried them out partially. Seventy-seven per cent of NHS respondents experiencing pressure said they felt under “threat”, compared to 57 per cent across all sectors.

Twenty of the 52 NHS respondents (38 per cent) said they had read their professional body’s code of ethics in the last three years, compared to 51 per cent across all sectors.

The survey data was analysed by Rick Tazzini, a member of the ethics working group and former finance director of Basildon and Thurrock University Hospitals Foundation Trust, who was not supported by his board when he cited “professional concerns” with signing up to a deficit target of £23m in 2017-18.

The trust agreed the target against his advice and went on to miss it by £6m.

Click here for a comment piece on the issue by Dr Eleanor Roy, policy manager for health and social care at CIPFA.