CFOs are intrinsic to the success of the NHS, particularly in the current challenging financial climate. They help to set their organisation’s strategic focus, lead corporate operations and make essential decisions. They are responsible for setting their organisation’s financial tone and establishing a culture of partnership and innovation. And, crucially, their work impacts patient care.

In a recent policy statement, the Healthcare Financial Management Association (HFMA) set out essential NHS CFO attributes in four key areas:

1. the role of the CFO;
2. principles and values;
3. professional qualifications, skills and experience; and
4. personal characteristics.

The role of the CFO

The role of an NHS CFO is akin to that of CFOs in large commercial organisations. They have traditional responsibilities in financial accounting and controls, but they are also board members. As a board member, they are responsible for the quality of care their organisation provides.

The precise mix of a CFO’s responsibilities will naturally vary according to their organisation's size, type and structure. However, HFMA broadly groups NHS CFO responsibilities into six key areas, which largely align with core public sector CFO responsibilities previously set out by CIPFA:

• corporate leadership and management;
• stewardship and accountability;
• financial management;
• business development;
• professional leadership and management; and
• working with partners.

The final responsibility is a newer addition. Its inclusion follows the Health and Care Act 2022, which places a legal duty on all NHS organisations to collaborate. CFOs are now expected to look across organisational boundaries and work towards the collective financial position of the NHS system.

Principles and values

NHS CFOs must also adhere to several working principles and display certain values. This starts with the NHS Constitution, which sets out the rights of patients, the public and staff and details the commitments the NHS has pledged to achieve. Alongside these principles and values, CFOs must also be aware of the duty of candour, one of the Care Quality Commission’s fundamental standards of quality and safety that every provider must meet.

NHS initiative ‘One NHS Finance’ (ONF) has also established six underpinning values for the finance function, which CFOs are responsible for embedding within the organisation’s overall culture. 

CFOs must also display personal integrity to do the right thing regardless of internal or external pressure. They are expected to adhere to the codes and standards for finance professionals, including the International Code of Ethics for Professional Accountants and the codes published by their own accountancy body, such as the ICAEW Code of Ethics.

Finally, CFOs must also understand the fit and proper persons test. The NHS leadership competency framework, which sets out the guiding principles for operating at a senior level in the NHS, has been designed to support such assessments.

Professional qualifications, skills and experience

NHS CFOs must either be members of CIMA or one of the five accountancy bodies that make up the CCAB, which includes ICAEW. The HFMA statement explains that NHS CFOs also need to have gained sound technical knowledge by working across a wide range of finance department functions.

Knowledge and skills must also be developed by ongoing CPD, which will depend on the exact requirements of the individual’s accountancy body. NHS CFOs are also expected to take a key role in talent management strategy and helping to develop staff across their local areas.

Personal characteristics

The HFMA statement sets out several character traits that NHS CFOs need to possess. These include resilience, adaptability and far-sightedness. Individuals must also be effective leaders, team players, and role models who are innovative and forward-looking in their approach and focus on value. NHS CFOs should also conduct themselves according to NHS Leadership Academy’s Our Leadership Way, which details six principles based on compassion, curiosity, and collaboration.

When it comes to leadership, CFOs need to understand the broader healthcare system and recognise the priorities of other statutory organisations in addition to their own. Equally, they must understand how wider economic, social, and environmental systems influence the healthcare system and vice versa, not least because the CFO’s decisions may have an impact, positive or negative, on other systems.