Understanding performance – sharing insights from practice

by Helen Gilburt

24 November 2017

Holding the purse strings and ensuring that money spent represents best value means finance directors have a unique perspective on performance. Listening to on-the-ground insight from NHS professionals is an important element of The King’s Fund’s work and it was with this in mind that I sought insights from participants attending the HFMA annual mental health conference* on some of the key issues.

What is happening with funding and how do we best understand performance in the mental health sector? Are there more cost improvements that can be delivered and what role are mental health providers playing in developing place-based models of care? Here’s what I heard and my reflections. 

Mental health care has a long history of underfunding, so it’s of little surprise that funding featured strongly within the discussion. Yet most notable were participants’ reflections on the growing financial pressures within local areas, including clinical commissioning groups and local authorities in particular, and, in turn, the negative impact this was having on mental health provision. As one participant put it, ‘You can challenge the CCG for your share, but this is pointless if the CCG is also broke…’

At the same time there was a consensus on the need to get a better grip on service performance. What is the value of each service, what outcomes do they deliver and what contributes to safe and effective care? What struck me was how much more work needs to be done within organisations to understand what represents good ‘value’ in mental health care, rather than it just being a case of articulating the importance of services more widely. 

I also noted the insights shared by finance directors working in mental health who had moved between sectors. Operational management of mental health providers could be seen as somewhat antiquated to those who had come from the acute sector. At the same time the more limited managerial capacity of mental health providers and the wide geographical spread of services had meant that the management task within a mental health provider was an altogether different challenge. 

When it comes to new models of care, accountable care systems and sustainability and transformation partnerships, the word ‘fight’ came up repeatedly in the discussion. The fight to ensure mental health was core to plans and to protect investment in services. The option of mental health providers pursuing their own approaches was seen as favourable, while elsewhere reflections were of acute providers still preoccupied with their own issues such as hospital reconfiguration.

There’s a risk that if mental health providers sit back to see what happens, they might miss the boat on involvement. But the question of ‘what difference does this make for mental health’ felt like an important one we should all be asking.

This is rich food for thought. The traditional measures of funding and performance remain important. But should we be asking whether services are improving outcomes and where best value can be achieved? There are definite cultural differences between acute and mental health providers, but should mental health really be ‘unique’?

And what should we read into the ambivalence to evolving place-based systems of care? What is clear is that our next delve into performance will benefit greatly from considering many of the insights shared by the HFMA members. 

*Mental Health Finance Faculty members can access presentations from the HFMA annual mental health conference by clicking here

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