Managing the finances of a group of NHS hospitals is a challenge even in the best of times. But what is it like to find yourself at the centre of a global pandemic and how do you steer a group of frontline hospitals through the biggest health and financial crisis in a century? We asked Dawn Scrafield, Chief Financial Officer of the Mid and South Essex NHS Foundation Trust.

What’s the atmosphere like at Mid and South Essex? What’s the reaction been to the moving shows of support for NHS staff nationwide?

It is hugely humbling to work with talented and committed clinical and non-clinical people and to be part of an organisation that is so critical in this crisis. It is impossible not to feel proud to work for the NHS, particularly with the massive public displays of gratitude.

Working in the NHS, I am extremely aware of the pressures and challenges that are facing the frontline. In the time of an incident it is critical that we are responsive in the management of resources and that we have a formal structure in place to ensure actions and issues are delivered quickly and escalation is swift.

What are your concerns for frontline colleagues who work for the hospitals?

My biggest concern for frontline colleagues is the emotional impact of this crisis on them. I think it is something which will take its toll on colleagues for years to come.

We are responding to circumstances that are unprecedented, and everyone is affected by what they are seeing first hand at work. They are making difficult decisions in the best interests of preserving lives, but at the same time as being human and juggling the worries of supporting family, children or older parents. Everyone will be affected by the sad loss of life. We recognise the importance of supporting each other and we talk opening about the importance of taking care of ourselves as well as our teams.

What are you doing now, day to day to combat the global pandemic?

As a Director for our organisation I am part of the Gold response to the emergency incident, which is the senior team leading our response to the crisis. Within a few days of the national Covid-19 incident being declared we quickly got into a ‘battle rhythm’ of reporting and actions.

Early on, we needed to enact our Business Continuity Plans, which for Finance is primarily paying suppliers. However, as we merged on April 1, earlier in March it was also mission critical to establish the single ledger for the new organisation.

Working in the NHS, there is a national financial framework and a further area that we have been asked to conclude are the accounts (recognising our responsibility for public accountability) and being mindful of the limitations of this task in the current environment. In support of the incident, we also needed to ensure we had appropriate governance in place to capture the costs in these unprecedented circumstances.

What actions/ mitigations have you already put in place? And what steps are you considering for possible use in the future?

When it became apparent that the emergency response would be for a sustained period, we established an emergency scheme of delegation to support the organisation with speedy decision-making.

We have also used the emergency response structure to ensure that resources that are committed are documented – e.g. using the log book in the incident rooms as a means to record decisions and also the Executive Gold meetings ensure we have clear communications and clear decisions and actions.

The main priority for the finance team is to support the business continuity requirements during the incident, which means I needed to put in place a way of communicating with my team quickly so we can speedily divert resources as necessary.

As part of our business continuity plans it is essential that all functions provided that are not in response to the incident have been reprioritised.

This allows us to redeploy resources where possible across the organisation and has supported us to convert the elective capacity we have to support the increased emergency demand due to COVID-19.

Looking ahead, after the crisis has passed, do you have an idea of the long-term effects on your hospital group? Do you think there needs to be any policy changes from Government in terms of funding and/or resources for NHS preparedness?

The NHS had a flu pandemic plan, but COVID-19 has far exceeded any emergency response imagined that would be necessary for a global pandemic. There will definitely be lessons learned from this incident, and no doubt future plans will attempt to challenge the boundaries of our thinking to ensure that we have resilience plans in place.

The recovery of routine elective activity according to the NHS constitution will take a very long time to address. However, I think the population might think more carefully about how they use NHS resources.

Have the hospital group had any financial assistance from the Government?

The NHS has been assisted with a Government financial response. We have been gathering the information on a daily basis and are required to report back to ensure transparency of public funding. There will no doubt be an audit and look back to ensure that public funding has been used appropriately.

Mid and South Essex already had financial difficulties with an annual deficit of £110m to £120m. How will the covid-19 pandemic affect that?

The NHS has responded to the emergency as expected and directed, which has meant that we have had to reprioritise resources and requirements. Due to this being a national incident the NHS financial framework has changed during this time and will be reviewed as part of the recovery phase post incident.

How has the organisation coped with adding a global pandemic to the existing pressures regarding obesity, smoking, and an ageing population?

Public health prevalence has no doubt impacted on the types of patients affected by this pandemic. However, the clinical evidence has yet to be confirmed regarding patients that have been affected by COVID-19. Given the restrictions from social distancing measures it will be interesting to see how the individual choices (such as smoking) may have been influenced during the crisis and if these lifestyle choices may endure post crisis.

Are you working from home? How are you continuing to function with meetings etc?

As part of the incident repose remote working facilities have been stepped up and we have been using tools such as Starleaf and Teams to work from home and stay connected. We seem to have just as many meetings and emails and the business delivery model has evolved quickly!

Do you have any words of advice for fellow finance professionals taking on enormous challenges created by covid-19 in their own industries?

My advice for any colleagues taking on enormous challenges would be:

  • Be flexible and adaptable to what is going on around you. The strategic objectives in a crisis are different to that in business as usual.
  • Always look for the positive or an opportunity – the need to use technology at such an accelerated rate will revolutionise how we deliver our services. We will find quicker and improved ways of doing things from learning. Even when it feels impossible, look for a positive.
  • Look after yourself – if you don’t, you cannot look after your team and those important around you!