International Women’s Day Liz Flavell-Smith’s Journey to Leadership in NHS Finance

A Fellow of the Chartered Association of Certified Accountants (ACCA), with a Master of Business Administration (MBA) and 40 years of NHS experience.

Career path

After leaving school at 18 in the mid 1980’s with ‘A’ levels and following my dad’s advice to get a career where I could study part-time to obtain a professional qualification (he worked in sales all his professional life, which could sometimes be financial rewarding, but was not very secure!), I initially got a job as a trainee Quantity Surveyor studying a part-time degree. I enjoyed the financial estimation aspect of the job and also working in a busy office with a team, but wasn’t so keen on being in all weathers on building sites and also as a young woman at the mercy of the builders calling out whatever they wanted and being too shy to reply!

I replied to an advert for the job of Assistant Management Accountant at the West Midlands Regional Health Authority, which was equivalent of an A4C Band 3. I was supported to have one day a week to attend Birmingham Polytechnic (now Birmingham City University) to study a two year Foundation course in Accountancy. Working at the Regional Office was a good grounding in how NHS finance worked and provided insights into each of the provider trusts across the West Midlands. After 5 years at the WMRHA, and having started studying for the Association of Chartered Certified Accountants (ACCA) professional qualification, I secured promotions first as a Management Accountant at City Hospital NHS Trust in Birmingham, and then a couple of years later at Solihull Healthcare Community NHS Trust where I headed up a small team of Management Accountants. In these more senior roles I was no longer able to have day release to continue with my studies and switched to a correspondence course. I really enjoyed the roles in provider trusts and the direct support I could provide to the clinical budget holders and the personal difference I felt I was making to patient care, for example negotiating contracts with GP budget holders to provide physiotherapists in their practice, and setting up contracts with providers for people with Learning Disabilities to move out of long stay hospitals into the community.

After I passed my final ACCA exams in 1997 I decide to move to London as a Finance Manager for Cardiac and Neurosciences at King’s College Hospital NHS Trust. I did this for two years before taking up the opportunity to move from finance into firstly a Business Manager role, and then a General Manager role, as I wanted the opportunity to more directly make a positive impact on how healthcare is delivered. I was responsible for operational targets, such as managing waiting lists and waiting times, theatre utilisation etc. and got experience of managing admissions managers, bed managers, medical secretaries and Neuro Physiologists who all supported the clinical teams on the wards, as well as experience writing a successful business case for a new cardiac Catheter lab and overseeing delivery of the hospital’s new Patient Administration System.

While at King’s I attended Kingston University at weekends for two years to undertake a Masters in Business Administration to provide academic as well as operational insight into being an effective manager in the NHS.

In 2003 I took up a role at University College London Hospitals NHS in Trust’s New Hospital Commissioning Team delivering a major PFI project (£225m) to relocate four of the Trust’s existing hospitals sites onto one new site.

Having successfully achieved the move on time to the new site, and within budget, I felt it was time to take the skills I had developed in general and project management back into finance in a leadership role and this, combined with  wish to move back to the Midlands, led me to take up the role of Deputy Director of Finance at Northampton Primary Care Trust in 2004, which was my first experience in commissioning healthcare. Since then I have enjoyed the more strategic approach to making change happen through working with others (inside & outside the organisation) that commissioning organisations offer in developing collaborative solutions in the successful transformation of patient services. I moved to a similar role in Warwickshire in 2009 where I have worked in a variety of deputy DoF/CFO roles since. I have provided financial leadership and oversight in a number of key developments since then, including a new outcome-based contract (£60m) for the Out of Hospital Programme; securing s106 monies from housing developers for new primary care facilities; and joint procurements with local authorities for a number of childrens and adults services.

My current role – ICB Director of Finance

I enjoy my role because it is so varied. In a single day I could be debating with colleagues how we can best use our Population Health Management data to support commissioning decisions; advising on production of the ICB Financial Plan and annual budgets; followed by meeting with our auditors to review our Annual Accounts; then advising a commissioning manager of the most appropriate way to procure a new contract and later presenting a report to a committee to gain support to invest in building new GP premises.

Work-life balance

Initially pursuing professional qualifications while working full-time, with young children and then later working in senior roles in the NHS requires personal resilience and having a full and active life outside of work provides me with the necessary energy, positive mental and physical strength to give the necessary commitment to my team and organisation to deliver the very best support possible.

I enjoy spending time with friends (many of whom I first met through work), my two adult children and other family members. I particularly enjoy the theatre and music events; travelling (having managed to visit all the continents over the years); trekking and walking; yoga and general fitness.

I volunteer at a local youth theatre (for 7 to 17 year olds) and am also a Trustee of the local community centre where we hold our rehearsals and productions.

Although much of my NHS career has been unplanned, (only looking for new opportunities when I felt I had given my current role my all), if I was to start my career again there’s very little I would change.

Liz Flavell-Smith, ICB Director of Finance, NHS Coventry and Warwickshire ICB