Transforming Healthcare Finance: £1.4M Recovery Case Study

Case Study: How Strategic Finance Leadership Recovered £1.4m and Stabilised a Healthcare Organisation’s Cashflow

Sector: Large private hospital & registered charity


Turnover: £50m


Funding streams: Multiple NHS/ICB contracts, Private Medical Insurance (PMI), and self-pay patients


Engagement: Strategic finance leadership & transformation

The Situation

This organisation was delivering essential healthcare services, but behind the scenes, its financial systems were overwhelmed. Years of under-managed NHS contracts, delayed commissioner payments and weak internal controls had created a serious cashflow crisis.

The symptoms were clear:

  • NHS reconciliation processes were almost a year behind
  • Monthly ICB payments weren’t being monitored — and in some cases weren’t being received at all
  • Overperformance payments were taking up to 12 months to be paid
  • Audit concerns had been raised around NHS transaction management
  • £700k of PMI invoices were rejected or stuck in limbo
  • No cashflow forecasting existed
  • Leadership regularly discovered cash shortfalls after they happened
  • The finance team was overstretched, under-led and nearing burnout
  • Nearly £1m in overperformance income had gone unidentified and unclaimed

The organisation wasn’t just facing complexity, it was facing real financial risk.

What I Did

Brought in to stabilise, simplify and strengthen the financial function, I led a full strategic transformation across contracts, cashflow, systems, and team structure.

1️⃣ Brought the NHS contracts back under control

Cleaned and simplified reconciliation spreadsheets

Caught up the reconciliation backlog

Implemented monthly monitoring to track expected vs actual ICB payments

Introduced new processes to quickly identify missing payments

Attended commissioner meetings to agree actions, resolve issues and set payment timelines

Tidied and corrected NHS transactions in the accounting system

Fully resolved the audit concern around contract management

2️⃣ Recovered payments and improved commissioner relationships

Renegotiated an overperforming contract to increase monthly payments

Agreed a monthly reconciliation cycle with one ICB to speed up income

Recovered £900,000 in overdue NHS payments

Alerted leadership to an underperforming contract that had gone unnoticed

3️⃣ Fixed the PMI billing crisis

Identified why invoices were being rejected by the provider’s system

Worked with the PMI provider to correct the issue and secure payment for historic invoices

Submitted all outstanding invoices through an exceptions process

Recovered £500,000 in PMI payments

Strengthened the long-term processes and provider relationship

4️⃣ Created cashflow forecasting from scratch

Designed and implemented a robust, daily-updated cashflow model

Gave leadership full visibility of cash over coming weeks and months

Enabled proactive planning instead of reactive crisis management

Ensured payroll and supplier payments were protected

5️⃣ Rebuilt the finance team for long-term stability

Restructured the department

Created missing roles and recruited to fill critical gaps

Reduced the pressure on remaining staff

Introduced a business partnering model for all budget holders

Strengthened cost control through improved collaboration

The Results

The transformation was significant, measurable, and immediate.

💰 £1.4 million recovered in cash

Across NHS and PMI income, previously unidentified or stuck payments were recovered and brought into the organisation.

📉 Cashflow stabilised

No more surprises

No more last-minute fund transfers

Leadership had clarity, control and confidence

📑 Audit concern fully resolved

The year-end audit closed the NHS contract management issue satisfactorily.

⚙️ Strong, simple systems

Reconciliations became clear, streamlined and manageable.
Tracking was transparent.
Information was accurate.

👥 A stronger, more supported finance team

Clear structure, clear roles, clear leadership, and far less stress.

🔍 Improved cost control

Budget holders gained ownership and accountability, with many achieving 5%+ savings in their areas.

The Transformation

By stabilising income, strengthening systems and embedding strategic leadership, the organisation moved from financial firefighting to financial confidence.

They now had:

  • Reliable cashflow
  • Clear processes
  • Strong commissioner relationships
  • A confident, empowered finance team
  • A leadership team who understood their position and could plan forward

This is what happens when finance stops being reactive, and becomes strategic.

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