focus on health
‘Fit for Purpose’ is a term rarely used for an organisation as complex or as diverse
as the NHS. There is little question that the clinical and related health services
delivered by this vast organisation are rated from good to excellent on most of
the criteria on which they are examined. But as in the swan analogy, there is
fierce paddling going on beneath the surface of the institution to manage its
resources and ensure that it can deliver to that standard at all levels from general
practitioners to advanced hospital procedures.
That explains why the administration of the NHS North Staffordshire Combined Health
NHS continues to evolve in ways that attempt Care Trust in the district, and – in 2008 - the
to increase operational efficiency. payroll of the University of North Staffordshire
What has emerged over the past decade is a NHS Hospital Trust. Formal control and host-
tiered structure of ‘business units’, of which ing of the service rests with NHS Stoke-on-
the Primary Care Trusts (PCTs) and NHS Hos- Trent, although it has its own shared-service
pital Trusts probably have the greatest vis- manager, and maintains a high degree of au-
ibility to the public. tonomy.
While most of these units have a degree of According to Neil Davies, System Services
autonomy over their management and admin- Manager at the Service, there was scope for
istration, it has been demonstrated that shar- extensive rationalisation of the business ap-
ing essential back-office services such as plications supported across its ‘client’ trusts.
payroll and purchasing between NHS organi- There were, for example, two different types
sations in the same area increases efficiencies of general ledger in use: after streamlining,
and helps reduce overhead costs. this has been reduced to a single system for
the three sites whose ledgers are operated by
Shared Service established
the Shared Service.
That was only part of the solution, however.
It was into that environment that the North “The ledger was not inherently underpinned
Staffs Finance and Registration Shared Serv- by a relational database. Its flat file structure
ice was established in 2003 to run finance made it difficult to extract information with
and payroll functions for two PCTs (NHS North sufficient flexibility to produce the array of
Staffordshire and NHS Stoke-on-Trent), the reports needed by our client. There was a need
58
The Informed Executive
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