Comment / Breaking down barriers

The spotlight shines bright on system working as we put The Health and Care Act 2022 into practice. As such, I was really pleased to take over as chair of the HFMA’s System Finance Special Interest Group when it relaunched earlier this year.

At our latest meeting, the outgoing interim chair, Nigel Foster, left us with a challenge to break down barriers between organisations in health and care. These barriers are artificial, in that they exist only for those of us working in the sectors and are not recognised by the people who use our services. People want us to care for them in their time of need. They don’t want to see the lumps, bumps, bureaucracy and disagreements of our complex system. And they certainly don’t want it to disrupt their care.

This is a great test and challenge for us all. And it’s the overriding mission of the System Finance Special Interest Group. As finance professionals, we have an important role to play in making it easier for different organisations to work together. This in turn makes for a better patient or service user experience.

Right now, one of the difficulties we have is the intense financial pressure facing the NHS and local authorities. When finances are tight, the temptation is to protect your own, and there’s a risk that more barriers go up. In many cases, NHS providers are not just struggling financially, but also in terms of healthcare delivery, for instance on A&E waits and elective recovery. Local authorities have similar financial and service delivery challenges. There is a tendency to see system working as only helping in the long run and not helping to solve current problems. And so we look inwards to our own organisations to find quick fixes. Again, the barriers go up.

Looking at your own system and facing these difficulties every day, it can feel quite overwhelming. In challenging times, being a senior finance leader is a lonely position to be in. It’s refreshing to come together with colleagues from other systems, share issues and advice, compare notes and think practically about what we can do. 

One of the first things we can do is to demystify the finance and governance structures at different organisations across the system. We have many examples between us where we’ve been tripped up by not quite knowing what to expect of our partner organisations and their processes. To help, the HFMA has published a briefing called Local authority finance and governance: what NHS finance professionals need to know. This is the first of a series, with more to follow on charities, social enterprises and other partners.

Another thing we can do is look for and share practical examples. The 42 integrated care systems are all approaching things slightly differently, so there is a lot we can learn from one another. Some of the areas that we’re particularly interested in are how we make savings, move money and manage risk across the system, and how we can help to tackle health inequalities and improve population health. I don’t think that any of us can, hand on heart, say that we’ve got these things sorted. But we do have nuggets that we can share and examples where things are working well.

I’m keen that our conversations are not just focused on the NHS, which can tend to dominate simply because of its size. I hugely appreciate the contributions made by colleagues at local authorities, social enterprises and other partner organisations, and would welcome more into the group. So please do get in touch if you’d like to join us.

I’d like to end by thanking Nigel for the insight and energy he has brought to the System Finance Special Interest Group across the years and wishing him the very best in his new role as senior responsible officer for the new hospital programme at Frimley Park.

The System Finance Special Interest Group is part of the HFMA Hub and the wider committee structure at the HFMA. It has members from across the health and social care system and provides an opportunity to work on solutions for common issues relating to system finance. It is here to represent the views and concerns of all HFMA members with an interest in system finance. If there is something you think the group should be exploring contact [email protected].