NHS finance staff gather in a basement meeting room to discuss changes. Two finance departments are to integrate after our merger with another hospital, and it’s an anxious time. A guest speaker advises us on how to cope with change but, for most in the room, restructuring and reorganizing have been an almost constant feature of our jobs for many years. We’re still dealing with the fallout from the 2012 Health and Social Care Act.


I attended a meeting with local clinical commissioning groups (CCGs) colleagues to review outstanding payments from the second quarter of this financial year, which ended five months ago. All the patients that go through the hospital are recorded, and the finance department attaches a price to each for the treatment they received. This time, a CCG is challenging £9m of the £27m we have billed.

Many disputes rumble on for months, exacerbated by the financial pressure on both parties. CCGs are reluctant to pay for any activity they don’t consider their responsibility or that they deem clinically inappropriate, while cash-strapped trusts are eager to protect their revenue streams. The meeting, scheduled for one hour, lasts for nearly three.

Afterward, I work through my list of challenges. Often, that means looking at details of individual patients’ care, and it can be a laborious process. One query relates to a charge for a patient’s bespoke dental prosthesis, which cost several thousand pounds. NHS England should pay for dental services

Not CCGs – hence the query. I discovered the item in question was used in a maxillofacial (jaws and face – not dental) procedure and, after an exchange of emails, the CCG accepts the charge. Behind the numbers, someone has undergone a life-transforming procedure. Amid the byzantine financial flows system that reduces hospitals to mini-businesses and occupies far too much of our time, it’s easy to forget the important things.