Comment / Even greater intensity

It is perhaps difficult to see past the enormity of last month’s referendum decision. Whatever your stance on remain-leave, everyone (I think) would accept that the decision to leave the European Union will have an impact on the NHS. It is the extent of that impact that is hard to judge right at this moment.

Both sides in the campaign were guilty of using scare tactics and exaggeration, but no-one in NHS finance will expect to see leave campaigners’ pledges of spending our EU contribution on the NHS come to fruition.

The economy is crucial to current health spending commitments and to any settlements the service might hope to receive in the future. As the Institute for Fiscal Studies pointed out, any impact on national income is likely to dwarf the UK’s current net EU contribution.

So how markets and businesses respond beyond the inevitable initial nosedive will almost certainly have implications on health and social care funding.

And we can only guess at the impact on staffing – in terms of continuing to source much needed healthcare workers and in terms of changes to regulations such as the working time directive. Any impact on research funding will also need to be understood.

Perhaps of most immediate concern is that we may well find ourselves in something of a planning blight. There will be so much work to do on the divorce proceedings and in appointing a new prime minister that political focus may inevitably be drawn elsewhere.

These challenges will add layers of complexity to what are already the most significant challenges the health service has faced since its creation. Most organisations (as I write this) have signed up to control totals for 2016/17. But there can be no doubt that, with agreement being the key to unlocking sustainability and transformation funds, some organisations have felt caught between a rock and a hard place.

The HFMA’s latest Temperature check  underlines this. Two-thirds of commissioner chief finance officers and half of trust finance directors rate their own financial plans for 2016/17 as high risk.

It is sensible NHS England has increased the time available to produce health economy-wide five-year STP plans. This recognises that footprint relationships are starting from different levels of maturity. More time won’t of itself deliver the robust and balanced plans that are demanded, but it suggests a degree of understanding of the severe challenges facing economies.

Even before the EU exit decision, we were warned to expect a ‘reset on the money’. So we know the pressure will only increase. Having completed six months as HFMA president, I am struck by how nothing has changed and yet everything has changed. In many ways we are still having the same discussions – about transformation, about Carter, about staffing costs – and facing the same pressures in keeping services operating. Yet we have also come a long way in terms of the detail we are talking about. This has to continue and, if anything, the intensity has to increase despite the impact of Brexit.

There are good examples of new models of working emerging, but this has to become wholesale across the NHS. Transformative change has to come out of discussion and into practice. And finance staff have a major role in making this happen.