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英文原文Budgetmanagement1IntroductionTheNHSreformshavehadfarreachingimplicationsforcliniciansofallgradesandspecialties.Amongotherchanges,ithasbeendeliberategovernmentpolicythatseniorcliniciansshouldhavemoredirectmanagementandbudgetaryresponsibilitywithintheirownclinicalareas.Trusthospitalshavedevelopedadirectoratebasedmanagementstructureanddevolvedbudgetstoclinicaldirectors.A&Edepartmentshaveeitherbecomedirectoratesintheirownrightorassociatedirectorateswithinlargerdirectorates.A&Econsultantswhotakeonclinicaldirectorshipresponsibilitieswillhavemoredirectcontrolofspendingwithintheirowndepartment.Atfirstthismayseemintimidating,buttheadvantagesofhavingcontroloutweighthedisadvantagesofmoreadministrativeactivity.Thisarticleaimstogivesomeguidelinestohelpmakethetasklessdaunting,aswellassometipsbasedonpersonalexperience.Idonotintendtocoverfundraisingactivityortheorganizationofpostgraduateeducationanditsfunding.Briefmentionwillbemadeofbusinessplanningattheend.Andwehaveoutlinedwhatmanagementbudgetingisandhowitdiffersfromtraditionalbudgetarycontrolsystemsinhealthauthorities;consideredwhatitaimstoachieve;anddiscussedtheparticipationofcliniciansinthemanagementbudgetingprocessanditslikelyimpactontheirmethodsofworking.2Whatisabudget?Traditionalbudgetarycontrolsystemsarebasedprimarilyonastructureofwhatarenormallytermedfunctionalordepartmentalbudgets.Inthisstructurebudgetsareheldbythosepeopleresponsibleforprovidingaservice.Thereisnormallynoparticipationofclinicalstaffinthisbudgetarycontrolstructureotherthanthepossibilitythatthebudgetholdersforpathologyandradiologymightbetheconsultantsincharge.Thisseemsstrangegiventheconsiderableinfluencethatclinicianshaveovertheuseofhospitalresources.Inanysystemofbudgetarycontrolakeyprincipleisthatindividualbudgetholdersshouldbeheldresponsibleonlyforthoseitemsofexpenditureoverwhichtheycanexertcontrol.Inhealthauthoritiesthisprincipledoesnotalwaysapply.Anextremeexampleofthisconcernsthepharmacybudget,wherethepharmacistisoftenheldresponsiblefordrugsexpenditureeventhoughhehasnodirectcontroloverthelevelofspending.Althoughabudgetisasumofmoneygiventoyoutorunyourservice(includingsalariesandwagesofallpersonnel)itisimportanttorealizeitisessentiallyapaperexercisesimilartorunningyourownbankaccountandreceivingabankstatement.Youwillneveractuallyseethemoneyandthenitty-grittyofmanipulatingtheaccountisdonebyyourmanagementcolleaguesandthefinancedepartment.Yourroleasclinicaldirectoristokeepawatchingbriefonitandtomakeexecutivedecisionsastohowitisspent.Therearethreebroadcategoriesofbudget:(1)Steadystate-youareallocatedthesameamountofmoneyeachyearwithanallowanceforinflation.Althoughitofferspredictabilityforfutureplanningitisinflexibleanddoesnotallowforsurgesinactivityorunfundedgovernmentandtrustleadinitiatives.ThemajorityofA&Edepartmentsreceivetheirfundinginthisway.(2)Activitybased-theamountofmoneyprovidedreflectstheworkdone.Itisaccurate,flexible,andisthebasisofmuchpurchaser/providercontractactivity.Itisgenerallynotavailableuntiltheworkhasbeencompletedandwillvaryfromyeartoyear.(3)Lumpsum-thegovernment,region,ortrustreleasesalumpsumofmoneyforaspecificpurpose(forexample,tostarttriageorauditortocompleteawaitinglistinitiative).Thisisunpredictable,oftencomesatshortnotice,andcanrarelybeusedforlongtermplanning.AlthoughthemajorityofA&Ebudgetingfallsintothefirstcategory,lumpsummoneyisavailablefromtimetotime.Anaveragedepartmentseeing50000patientsayearmayhadeanannualbudgetofapproximatelyonemillionpounds.Whentakingonabudgetaskthesequestions:(1)Howbigisit?Whoactuallycontrolsit?(2)Doyoureallyhavecontrolofitorisitonlytheoretical,Howoftenwillyoureceiveastatement?Whodoyouspeaktomakechangeswiththebudget?Withwhomandhowdoyounegotiatewithinyourinstitution?(3)Asktobetakenthroughabudgetstatementandhaveaclearexplanationofallterms,etc.Itisnormallydeliveredmonthlyandalthoughitmaylookcomplicateditiseasytomasterandisreallylittledifferentfromyourownbankstatement.(4)Gothroughitcarefullyasmistakesareanoccasionaloccurrence(althoughtheycanberectifiedretrospectivethroughthefinancedepartment).(5)ThefinancialyearrunsfromApriltoMarch.Thetheoreticalaimistomakethebooksbalancebytheendofthefinancialyearandnotfrommonthtomonth.Shorttermoverspendsorunderspendsarenotimportant.(6)Apositive(+)signmeansanoverspendandanegative(-)signmeansanunderspend.(7)Concentrateonthebignumbers;donotworrytoomuchaboutlittlenumbersalthoughtheydoneedtoreanalyzedatsomestageassavingscanprobablybemadewithoutaffectingthequalityofservice.(8)Devolvecontrolofthenursingbudgettoyourclinicalnursemanagerbutbepreparedtoinvolveyourselfinnursingactivities(forexample,thedevelopmentofnursepartitioning).(9)Bepreparedtonegotiatewithotherdirectoratesaboutcertainitems,similarissuesarisewithfundingforanestheticagentsandbloodproducts.(10)Usecreativeaccountancy.Thisislegitimateandwillevenreceivethesupportofyourfinancialcolleagues.Akeyprincipleofmanagementbudgetsisthatallusersofservicesshouldbeinformedoftheircosts.Thisisachievedbymeansofrechargesmadebetweenthosebudgetholderswhosupplyservicesandthosewhouseth