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1、英文原文Budget management1 IntroductionThe NHS reforms have had far reaching implications for clinicians of all grades and specialties. Among other changes, it has been deliberate government policy that senior clinicians should have more direct management and budgetary responsibility within their own cl
2、inical areas. Trust hospitals have developed a directorate based management structure and devolved budgets to clinical directors. A&E departments have either become directorates in their own right or associate directorates within larger directorates. A&E consultants who take on clinical directorship
3、 responsibilities will have more direct control of spending within their own department. At first this may seem intimidating, but the advantages of having control outweigh the disadvantages of more administrative activity.This article aims to give some guidelines to help make the task less daunting,
4、 as well as some tips based on personal experience. I do not intend to cover fund raising activity or the organization of postgraduate education and its funding. Brief mention will be made of business planning at the end. And we have outlined what management budgeting is and how it differs from trad
5、itional budgetary control systems in health authorities; considered what it aims to achieve; and discussed the participation of clinicians in the management budgeting process and its likely impact on their methods of working.2 What is a budget?Traditional budgetary control systems are based primaril
6、y on a structure of what are normally termed functional or departmental budgets. In this structure budgets are held by those people responsible for providing a service.There is normally no participation of clinical staff in this budgetary control structure other than the possibility that the budget
7、holders for pathology and radiology might be the consultants in charge. This seems strange given the considerable influence that clinicians have over the use of hospital resources.In any system of budgetary control a key principle is that individual budget holders should be held responsible only for
8、 those items of expenditure over which they can exert control. In health authorities this principle does not always apply. An extreme example of this concerns the pharmacy budget, where the pharmacist is often held responsible for drugs expenditure even though he has no direct control over the level
9、 of spending.Although a budget is a sum of money given to you to run your service (including salaries and wages of all personnel) it is important to realize it is essentially a paper exercise similar to running your own bank account and receiving a bank statement. You will never actually see the mon
10、ey and the nitty-gritty of manipulating the account is done by your management colleagues and the finance department. Your role as clinical director is to keep a watching brief on it and to make executive decisions as to how it isspent. There are three broad categories of budget:(1) Steady state-you
11、 are allocated the same amount of money each year with an allowance for inflation. Although it offers predictability for future planning it is inflexible and does not allow for surges in activity or unfunded government and trust lead initiatives. The majority of A&E departments receive their funding
12、 in this way.(2) Activity based-the amount of money provided reflects the work done. It is accurate, flexible, and is the basis of much purchaser/provider contract activity. It is generally not available until the work has been completed and will vary from year to year.(3) Lump sum-the government, r
13、egion, or trust releases a lump sum of money for a specific purpose (for example, to start triage or audit or to complete a waiting list initiative).This is unpredictable, often comes at short notice, and can rarely be used for long term planning.Although the majority of A&E budgeting falls into the
14、 first category, lump sum money is available from time to time. An average department seeing 50 000 patients a year may hadean annual budget of approximately one million pounds. When taking on a budget ask these questions:(1) How big is it? Who actually controls it?(2) Do you really have control of
15、it or is it only theoretical, How often will you receive a statement? Who do you speak to make changes with the budget? With whom and how do you negotiate within your institution?(3) Ask to be taken through a budget statement and have a clear explanation of all terms, etc. It is normally delivered m
16、onthly and although it may look complicated it is easy to master and is really little different from your own bank statement.(4) Go through it carefully as mistakes are an occasional occurrence (although they can be rectified retrospective through the finance department).(5) The financial year runs from April to March. The theoretical aim is to make the books balance by the end of the financial year and not from month to month. Short term overspends or under
