The Critical Role of an NHS Band 9 Chief Finance Officer
A Band 9 Chief Finance Officer (CFO) within the NHS is a pivotal executive leadership role that ensures financial governance, strategic budget planning, and long-term financial sustainability across healthcare trusts or organisations. This position is responsible not only for overseeing multi-million-pound budgets but also for influencing decisions at board level, aligning fiscal priorities with patient outcomes, and ensuring compliance with NHS financial frameworks.
Typical responsibilities include leading the finance team, strategic financial planning, risk management, performance monitoring, and contributing to broader trust-wide objectives such as improving efficiency, reducing health inequalities, and ensuring value for money.
According to the latest NHS Agenda for Change pay scales, a Band 9 salary ranges from £107,000 to £123,000 per year, with further opportunities for benefits and performance-related bonuses. As one of the highest-paid non-clinical roles, competition is fierce—preparation is essential.
Below are 20 tailored interview questions (and answers) for candidates applying for this highly strategic role.
Top 20 NHS Band 9 Chief Finance Officer Interview Questions and Answers
What motivated you to apply for a CFO role within the NHS?
Answer: My passion for public service and financial stewardship aligns strongly with the NHS’s mission. I’ve spent over 15 years in senior finance roles, and I see the CFO position as an opportunity to drive impactful change, ensuring that financial strategies support patient care and organisational sustainability.
How do you ensure financial sustainability while maintaining quality care?
Answer: By using a value-based approach to budgeting. I focus on aligning financial resources with outcomes—analyzing service data, understanding demand trends, and identifying cost efficiencies that don’t compromise care quality.
How do you influence clinical and non-clinical stakeholders who may not understand finance?
Answer: I simplify financial language using visual dashboards and relatable analogies. Building trust and offering collaborative problem-solving opportunities also helps align financial goals with operational realities.
Describe a time you led financial transformation in a healthcare setting.
Answer: At my previous trust, I spearheaded a cost improvement programme that saved £12 million over two years. It involved streamlining procurement, investing in digital solutions, and engaging clinical leaders to identify inefficiencies.
What financial governance frameworks are you most familiar with?
Answer: I’m proficient with NHS Improvement standards, the NHS Long Term Plan, and the financial elements of the Integrated Care Systems (ICS) framework. I’ve implemented Standing Financial Instructions (SFIs) and am comfortable presenting financial statements to the Audit Committee.
How do you handle financial risks in long-term strategic planning?
Answer: I use scenario modeling and sensitivity analysis to predict outcomes under various assumptions. I also maintain a robust risk register and ensure regular board reviews.
How do you approach Cost Improvement Plans (CIPs) ethically?
Answer: I prioritise patient safety, ensuring that any cost savings are evidence-based and supported by quality impact assessments. I actively involve clinicians and service users in evaluating the impact.
Describe your experience with capital planning and investment.
Answer: I’ve overseen capital budgets exceeding £50 million, including estates redevelopment and IT infrastructure upgrades. I ensure alignment with organisational goals and regulatory approvals before execution.
How do you align financial strategies with ICS objectives?
Answer: I maintain active relationships with ICS finance leads and participate in regional planning boards. I ensure our trust’s financial strategies support integrated service delivery and population health improvement.
What financial KPIs do you track at board level?
Answer: Operating surplus/deficit, cost per weighted activity unit, CIP delivery rate, cash flow, creditor/debtor days, and capital programme delivery—all linked to patient outcomes and service performance.
Tell us about a time you dealt with a significant budget overspend.
Answer: In one instance, agency staffing overspends created a £3.5 million deficit. I led a taskforce to implement tighter rostering, agency caps, and an internal staffing bank, reducing spend by 40% in 6 months.
How do you foster a culture of financial accountability?
Answer: I embed financial KPIs across departments, provide training to budget holders, and encourage open discussions about financial challenges and opportunities at all levels.
What’s your experience with NHS financial reporting systems?
Answer: I’m well-versed in ESR, Oracle, Power BI, and NHS Improvement templates. I also lead on producing annual accounts and NHS Digital submissions.
How do you lead and develop your finance team?
Answer: I mentor staff, provide succession planning, and ensure continuous professional development (CPD). I’ve developed graduate training schemes and led team restructuring to improve capability and morale.
How would you handle conflicting priorities between finance and clinical demands?
Answer: By acting as a mediator and enabler. I seek solutions where both clinical needs and financial constraints are respected—often by exploring phased investments, grants, or innovation pilots.
How do you stay up to date with NHS policy and finance trends?
Answer: I attend HFMA events, subscribe to NHS England updates, and maintain active networks with peer CFOs. I also collaborate with think tanks and participate in working groups.
What’s your leadership style in high-pressure environments?
Answer: Calm, collaborative, and data-driven. I provide clear direction, empower my team to act decisively, and maintain open lines of communication during crises.
Describe a successful negotiation you’ve led.
Answer: I negotiated a shared service agreement across three trusts, saving £1.2 million annually by consolidating finance operations without compromising service delivery.
How do you ensure financial inclusivity and equality?
Answer: I audit spend by demographics to ensure equitable service funding, support inclusive procurement, and contribute to Equality Impact Assessments on financial decisions.
What would your first 90 days as CFO look like?
Answer: I’d prioritise stakeholder engagement, financial performance reviews, team capability assessments, and alignment with ICS strategies. I’d also aim to identify quick wins while planning a 3-year transformation roadmap.
Final Words: Preparing for Your NHS CFO Interview
The NHS Band 9 Chief Finance Officer role demands not just financial expertise but strategic foresight, stakeholder acumen, and a deep commitment to public value. Prepare by researching the organisation’s financial history, aligning your experience with NHS priorities, and practicing articulating complex financial data in clear, impactful terms.
Remember: confidence is built on preparation. Use these questions as a framework but also be ready to adapt your answers to your specific experience. Focus on impact, accountability, and leadership—and you’ll stand out.
Good luck, future NHS finance leader!
