NHS finance directors pressured to act 'unethically'

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.