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.