The hidden treasures of a career in NHS Finance

content NHS Finance

Imagine a career path that provides excellent training, progression and benefits, where the work is challenging, testing and incredibly rewarding, where your effort directly benefits society, and where at the end of the day you can go home with a genuine sense of being part of something bigger than you, something that will touch everyone you know at some point in their lives.

Few interested in a finance career think of the NHS when considering their options, it’s often private commerce, industry or practice. However, the NHS is a hidden gem for finance careers; while it might not appear obvious amid the bluff and bluster of the Big 4 and multinational corporations, the NHS is a treasure trove of opportunity and reward.

Doctor and nurses, of course, but accountants?

Alex Bramley, a finance management trainee at Royal Devon and Exeter NHS Foundation Trust, immediately began looking into private firms when he decided upon a career in finance. ‘I didn’t once consider NHS Finance as an option, mainly because finance isn’t the first thing that comes to mind when I think about the NHS.’

However, when looking for apprenticeships after leaving school, he came across one within the Ambulance Service. ‘I was intrigued and excited by the idea of being a part of an incredible organisation. Luckily, I landed the role and I’ve never looked back,’ he says.

From day one, Bramley was made aware of the endless opportunities with NHS Finance. Not only has he worked in the Ambulance Service, but he’s gained experience at Acute Hospitals, Mental Health Trust and Clinical Commissioning Groups (CCGs).

‘While they all fall within the NHS, every single trust has been completely different and I’m constantly learning, even seven years down the line. That’s exactly why I would recommend anyone to consider a career within NHS Finance. It’s exciting, the career progression is huge and it’s incredibly rewarding,’ he says.


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Private sector beating opportunities and variety

This is echoed all the way up the finance food chain by Portsmouth Hospitals’ CFO Mark Orchard FCCA encouraging anyone wishing to pursue a career in finance to consider the NHS. 

‘The sheer variety of opportunities is immense and much broader than many equivalent roles within traditional accountancy bodies,’ he says.

Finance roles in the NHS include finance apprentice, accounts payable, accounts receivable, supply chain assistant, accountancy assistant, procurement officer, management accountant, cost accountant, buyer, business partner, CFO, financial analyst, finance manager and so on (see below for descriptions).

Jeff Buggle FCCA, regional director of finance East of England for NHS England and NHS Improvement, joined NHS Finance as a trainee management accountant on leaving school, enabling him to study to become an accountant at the same time as gaining valuable workplace experience. ‘NHS Finance training provides a breadth of exposure to different aspects of accountancy which was not matched by other training programmes.’

‘The support on offer to assist with the experience needed, alongside gaining qualifications, as well as the salary potential during and post qualification, are hard to beat. Within the NHS in particular, we have invested so much over recent years to give new starters and trainees the best possible experience,’ continued Orchard.

This translates into finance staff feeling materially connected to the entire organisation, from financial data and accounts to surgery and frontline care.

‘NHS Finance has always worked extremely closely with clinicians and others within frontline services, and through their training, expertise and judgement contributed to frontline teams. The best NHS Finance staff I’ve worked with have both understood the pressures faced in frontline services and worked side by side with clinicians,’ says Buggle.

Eleanor Wightman, a finance graduate trainee at Dorset County Hospital NHS Foundation Trust, agrees. ‘Finance professionals in the NHS are continuously requesting feedback from frontline staff. When new supplies or services are introduced, finance needs to ensure it is working for the staff implementing them. I’ve had first-hand experience observing surgeries to oversee patient pathways and how finance decisions can impact this for better or worse.’

These are decisions for finance that do not arise in many other sectors, making unique some of the obstacles finance professionals must overcome with often strict controls on available resources in order to bring value to patients and the community, which is one of the reasons Wightman enjoys working for the NHS.

Values and pride amid a pandemic

A key part of working in the NHS is shared values, a sense of ‘being in it together’ and working towards a common goal that benefits society, which from a professional point of view is again not something easily found in other sectors. This really came into sharp focus amid the pandemic when the bravery and determination of NHS workers was acknowledged by widescale shows of public support and gratitude.

‘I think we’ve seen how amazing the NHS and its staff are during the pandemic, and with the Thursday night clapping and other gestures how much the public value the role the NHS plays in people’s lives. Within NHS Finance, we have seen our colleagues move into different roles and provide support to different areas, demonstrating the commitment of staff but also the strength and adaptability of accounting training,’ says Buggle.

‘I’m extremely aware of the pressures and challenges my frontline colleagues are dealing with. It’s phenomenal to work as part of a team that supports emergency services, recognising how crucial it is in my role that we are responsive in the management of resources,’ says Dawn Scrafield FCCA, CFO at Mid and South Essex NHS Foundation Trust.

Scrafield is involved in supporting teams with critical decisions to ensure actions and issues are delivered quickly, with escalation occurring swiftly in reaction to the pandemic to get the right resources in place to support the response. ‘It’s hugely humbling to work with talented and committed clinical and non-clinical people and to be part of an organisation that played a fundamental part in responding to the pandemic. It’s impossible not to feel proud to work for the NHS, particularly with the massive public displays of gratitude during the early phase of the crisis.’

For Scrafield, joining the NHS means an alignment of values, particularly associated with caring about a public service and contributing proactively to make a difference as opposed to a profit motivated environment. 

‘I love my job and I love working in the NHS. The chance to get involved with a range of opportunities is there if you are willing to get involved. There is so much to learn all the time and the people you work with are generally there for the same motivating reasons. The NHS is a complex place to work, so there’s never a dull moment and it’s constantly open to change, so the last 25 years have flown by,’ she says.

Entry points, varied paths, quick progress and work-life balance

It’s good to have options, right? Well there is no single career path for NHS finance staff, which is perhaps why Portsmouth Hospitals CFO Orchard would most strongly suggest choosing an NHS finance career above all other sectors. 

‘The variety of entry routes range from school leavers, apprenticeships, graduate trainees to mature learners. We really can cater for all. And once established as part of a local team the pathway to promotion and a fulfilling career is only limited by ambition and what fits best for the individual.’

Orchard speaks from experience. He joined the NHS in 1998 after serving the first part of his traineeship with a small accountancy firm studying ACCA. 'While I will always look back with fond memories on my private sector experience, I cannot tell you how fulfilling my roles have been at every step of the way to my current CFO role at Portsmouth Hospitals. 

‘I have been part of some great teams and led some exceptional teams too. At times I have specialised in Private Finance Initiative (PFI) and capital developments, broadened my role into audit, as well as enjoyed working across health and care systems as much as being in operational command as Gold Commander. I could not be more proud of the NHS and would highly recommend a career within the service to anyone wishing to have a fulfilled career in finance.’

Indeed, achieving ‘Gold Commander’ status is entirely in the realms of possibility for anyone, with progression in finance speedy for those who get stuck in. 

When Bramley started as a finance apprentice, he didn’t imagine that within a few years he’d be working towards a professional qualification and hold the title of finance management trainee. ‘It’s due to huge support from my colleagues and the opportunities the NHS has available, that I'm where I am today. I never imagined loving a role as much as I do or having as much experience as I do so early on in my career.’

And the experiences can be varied, beyond the numbers. ‘It’s easy to feel like you just look at numbers on a spreadsheet day-to-day, but during my time within the NHS, I have worked with many frontline staff and you get to see the work you do impacting their roles. Not only is the finance experience rewarding, but you also get the opportunity to work outside of finance, like experiencing time within the 999 Call Hubs, which really gives you the realisation of the work you do and the impact it has,’ continued Bramley.

Furthermore, work-life balance is a factor Wightman greatly appreciates. ‘Finance within private sectors is usually deemed to be stressful, with extended working days. The team culture within NHS Finance ensures that work is completed within the nominated working hours with fellow colleagues chipping in if timeframes are tight.’


NHS Finance is hiring now. Please take a look at opportunities at your local NHS organisation or by contacting One NHS Finance, which will be able to direct you to potential entry points

Visit ACCA’s Career navigator to see how you can plot your finance career in the NHS


NHS Finance Facts

  • Over 350 different types of career in the NHS
  • Including in finance, which supports often life saving services provided to patients by the NHS
  • The NHS workforce is diverse, with people from all walks of life, often motivated by personal experience or inspired to contribute to something more socially valuable than a company’s profit
  • NHS Finance provides an opportunity to work within a system that really matters to the British public 
  • NHS touches everyone at some point
  • Professional as well as personal satisfaction
  • By joining NHS finance, you’ll be part of a talented and passionate team of people committed to providing the best care and treatment
  • You’ll enjoy one of the most competitive and flexible benefits packages offered by any employer in the UK
  • NHS Finance actively recruits people of all ages, backgrounds and levels of experience

NHS finance staff work in four main areas

  • Financial services: cash management and supplier payments
  • Financial accounts: ensure everything is correctly accounted for
  • Management accounts: provides financial advice and guidance to other NHS departments
  • Procurement & supplies: manage the sourcing, delivery and supply of healthcare products to end-user departments

Finance roles

  • Finance apprentice: you’ll learn all roles across finance and study professional exams
  • Accounts payable: they check invoices for goods and services to the orders, if they match, release payment, if they don’t they’ll work with suppliers and departments to resolves issues
  • Accounts receivable: they send invoices to make sure the organisation has enough cash to pay staff and suppliers
  • Supply chain assistant: they replenish clinical consumables needed for patient treatment, while making sure not to under or over stock products
  • Accountancy assistant: they ensure financial transactions are properly carried out
  • Procurement officer: they source goods and consumables to treat patients and to keep hospitals running, while ensuring value for money
  • Management accountant: every department has its own budget to send on staff, goods and services. Management accountants produce monthly reports that tell budget holders how much they’ve spent and whether they’re over or under budget
  • Cost accountant: they work with financial data to know how much each procedure costs, by looking at staff hours, drugs used and length of stay in hospital
  • Buyer: they ensure all orders are placed with suppliers on time and transacted correctly, and provide advice to staff on how to use ordering systems
  • Finance analyst: they provide expert finance knowledge to business leaders, including financial aspects of NHS legislation and policies, to help division deliver a balanced financial position, including suggestions on savings initiatives
  • Business partner: they work with departmental managers as financial advisers, interpreting and using financial information to influence and shape business plans
  • CFO: they’re at the heart of an organisation’s management structure, playing a key role in corporate decision making, ensuring an organisation gets best value from its limited resources

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