Why financial leadership matters for every NHS leader

By Dawn Nisbet

I love a good spreadsheet.

All my work seems more ordered and manageable when I have everything beautifully linked, full of formulas, with a 3-year commissioning plan mapped to our business objectives. Throw in some conditional formatting, and I’m in heaven.

I come from a finance background; does it show?

Since joining the NHS, I’ve realised that for many colleagues, finance, budgets, and financial leadership aren’t areas of confidence.

Leading the business and finance team here at the NHS North West Leadership Academy, we’ve always made space for colleagues to work through budgets, spend profiling, and activity planning together.

We keep language simple and avoid jargon.

We try to explain the why of what we do and take the approach that no question is too odd or too basic. Every query gives us the chance to build confidence, remove barriers, and create more collaborative, accessible conversations about NHS financial leadership.

What is increasingly clear to me is that financial leadership in the NHS is for everybody.

We all need to take accountability for financial leadership because the quality of services depends on aligning clinical, operational and financial decisions. Those closest to patients and services understand local needs, so when they engage with financial choices, resources are used more effectively and sustainably. Shared accountability also breaks down silos and encourages collaboration.

When people feel supported, financial conversations become less about numbers and more about understanding, ownership, and improving the services we deliver, always with the patient in mind

When we collaborate, share understanding, and create safe spaces to learn, financial conversations become less about numbers and more about empowering people. This collective approach not only builds capability but also strengthens how we deliver value for our organisations and, ultimately, for the people and communities we serve.

In a recent episode of our Leadership Live podcast, Dawn Nisbet is joined by David Ellcock, Director of the North West Skills Development Network, and Kara Mason, Director of Finance, Planning and Estates at East Cheshire NHS Trust, to explore the vital role of finance in NHS leadership. Together, they unpack why financial fluency matters for leaders at every level, how fiscal responsibility can be balanced with patient safety and quality care, and what it takes to be a high-performing finance leader in today’s healthcare landscape.