Feature / Future vision

Besides the considerable issue of caring for patients with Covid, the priorities for the health service over the next year will undoubtedly include integration and reducing waiting lists. It would seem timely, then, that new HFMA president Owen Harkin has plenty of experience of both of these issues.

Mr Harkin (pictured), who is director of finance and estates, and deputy chief executive of the Northern Health and Social Care Trust in Northern Ireland, says his presidential theme, Reimagining the future, aims to reflect current issues facing health and care across the UK. But it also highlights the opportunities to adopt permanently the positive steps taken during the pandemic, and think again about how future health and care could look.

 

Three priorities

There are three parts to the theme – the short term (getting over the Covid crisis and recovery); longer term changes to the NHS; and the future of the HFMA.

In the short term, there are many challenges. The health service was running hot well before Covid, even more so in Northern Ireland where waiting times were, and remain, the longest in the UK. Mr Harkin says the pandemic hasn’t fully gone away, and the need to continue to care for Covid patients while switching services back on to tackle waiting lists has been challenging for staff.

He adds: ‘Winter is coming, and naturally we are asking how we will get through it. How can we stabilise the system to get ourselves through the next few months, and then look to move forward from there?’

Though the system locally has seen financial support through Covid, as with elsewhere, this is a short-term fix to help the service through the pandemic. There is a need for longer-term reviews of finance and workforce planning in order to address the significant staff shortages in medical, nursing and social care staff that exist across the UK. Social care, in particular, needs a clear strategy to build a sustainable and robust workforce across all service areas, including in independent sector care homes and domiciliary care.

‘We must take a longer-term strategic view to give us some confidence that we will have sufficient numbers in our workforce for the future, and we must build in sufficient flexibility to deal with issues that may arise, such as a future pandemic,’ he says.

Financial regimes could change as the threat of the pandemic recedes, Mr Harkin adds. ‘I think we might do things differently, back to more of a push to greater real productivity and not just efficiency savings. Are we delivering services at a system level in the best way we possibly can? If we’re not funded to the levels we think we need, then we must have an honest conversation on the services the public should expect. That would be a more proactive approach; engaging the public and encouraging them to take more control over their health.’

During the pandemic, the focus has been on delivering services rather than, as in recent years, the close monitoring of finances. ‘Finance teams had a reputation for control and grip, but now the challenge will be to try to get that corporate grip back in organisations. Where money hasn’t been such an issue for the past two years, it’s also going to become about waiting lists and a performance focus – and rightly so – especially in the run-up to the next general election.

‘Finance teams in the coming months will have a key role to play in maintaining credibility, control, and confidence. We must make sure we are as efficient as we can be, making sure we are not running too hot, while demonstrating efficiency and effectiveness to aid the case for the resources required, and prove that we will use them as effectively as we possibly can.’

Covid changed a lot, he says, and services must think about how the pandemic could alter their long-term development. ‘We have to look at what went well – and a lot did go well. A lot of barriers were torn down last year, between professions, divisions and sectors.

‘They fell away because they had to,’ Mr Harkin adds. ‘I think there’s an opportunity to maintain that collaborative working, which we had at all levels, to deliver the best service we can to our local populations. That’s why we are here.

‘It should not be about professional priorities, but engaging to deliver the best possible care. It might mean us being more flexible about the delivery of services, or asking if people are working to the top of their skills and professional accreditation with associated flexibility in skill mix, given the realities of workforce challenges.’

Integration gains

Health and social care have been integrated for the best part of 50 years in Northern Ireland, but Mr Harkin insists integration offers opportunities to work across organisations as well as within them. For example, clinicians could work across different organisations and across secondary and primary care. Finance staff have a part to play in facilitating these flexibilities to support the delivery of services.

‘Throughout Covid, finance staff have really stepped up, delivering with colleagues in areas such as personal protective equipment (PPE) procurement and distribution, fit testing, and oxygen monitoring, maintaining financial services while many worked remotely,’ he says.

‘Finance staff have proven ability in solving problems quickly while establishing robust processes and monitoring. Finance teams’ credibility has increased during Covid, and we must use that engagement with clinicians in a positive way in the future.’

He is convinced each part of the UK has something to teach health and care services in the other nations, and the HFMA has a key role in bringing them together.

An initial meeting of senior finance staff from the devolved nations took place in November, and Mr Harkin hopes this will develop into a useful forum for all parts of the UK.

 

HFMA strategy focus

The third part of his theme focuses on the HFMA, which will release a new three-year strategy during his term. He says the association has come through a difficult two years, thanks to the leadership of 2020 and 2021 president Caroline Clarke and chief executive Mark Knight. But now is a good time to review the strategy on the association’s activities, including research and education.

Mr Harkin has been working on a sub-committee looking at the association’s qualifications, and its recommendation, which will take effect in the January intake, will recognise the integration agenda.

He is also keen that the HFMA supports colleagues through the demise of clinical commissioning groups.

‘We can support our colleagues as they face the organisational challenges of the move to integrated care systems, helping them to prepare for the change, help with interviews, help them understand the new model,’ he says.

The HFMA is well respected for its research on financial challenges, the financing of the NHS, and health and social care integration, for example, and Mr Harkin would like to see the association taking a leading role in health and care, speaking up where appropriate.

‘We have an opportunity to engage with those in power – NHS England and NHS Improvement and the departments of health – to influence their thinking,’ he says.

‘We need to be willing, when the occasion is right, to speak truth to power. I would like to develop our role as influencers – up and down. Within the HFMA membership, we have a massive network of NHS finance experts. We need to try to harness that and use it.’

As he embarks on his year as president, Mr Harkin recognises the personal challenge presented by being largely based in the Northern Irish system – but it is a challenge he is willing to face, knowing that he can rely on the support of the HFMA team and fellow trustees from the NHS in England, Scotland and Wales.

He is also grateful for the support of his own trust and the directors of finance across Northern Ireland.

‘I am looking forward to it. It’s a massive honour, especially because I will be only the second person from Northern Ireland to be HFMA president,’ concludes Mr Harkin.

‘I believe the HFMA is about the members and the branches, and that’s why I want to do my bit and get to as many branch conferences as I possibly can.’

 

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