Back to business

by Caroline Clarke

24 January 2020


We need to be honest about how much recovery is needed before transformation

Like many people, I’m relieved to have got the election out of the way, so that we can at least return to business in the public services. Whatever you think of the result, we now have a government with a working majority that will be able to enact policy in a way that the previous government struggled with.

I was struck by the performance data that the NHS released in January. It was pretty grim reading, with less than 80% of patients treated within four hours, rising waiting lists (6% higher than last year, with 4.6 million people waiting for treatment), more patients staying longer in hospital, away from their families and familiar places of care, and pressures across the mental health system showing huge increases in demand across the board. 

This data was published a year after the NHS long-term plan.  I’m a pretty optimistic person, and there’s plenty in the plan to be cheerful about – a focus on integrated, digital and personalised care, action on inequalities and prevention, some great commitments about some of the biggest killer conditions, and a return to financial balance.  What’s not to like? 

But we’ve got to be honest about current performance and how much recovery we have to do before we transform. We are going to need both cash and time to clear waiting lists and treat our patients. 

We also need to be super clear on how we think current concerns on ailing physical infrastructure (across the care system) should be addressed, as well as the well documented crisis in social care.  And finally we need to be much more explicit about how we grow and develop a workforce that is fit for the future and capable of working in an increasingly digital environment – the NHS has been astonishingly slow to adopt new technologies. 

These are all pretty general concerns, but we have a particular job as finance professionals to ensure that we maintain objectivity and clarity, and to grow a focus on the balance sheet, the medium to longer term future, as well as the here and now. We must be more future focused. 

I note that there’s been some tariff action with a consultation on blended payments and some further complexities that left me a bit cold. I do worry that the focus on ever more complex pricing mechanisms is in danger of missing the point that systems need to concentrate on reducing system cost and on integrating, rather than passing money around. 

Perhaps that is naive, but I think that we have limited bandwidth and our intellectual endeavor needs to be on the big health issues in front of us rather than transactions. For me, as a taxpayer and a patient, those issues are reducing the overall cost of care, increasing the quality of care, and reducing unwarranted variation in both cost and quality to improve value.  

Whatever happens, 2020 – international year of the nurse and midwife as well as the HFMA’s 70th anniversary – is going to be a year to remember. The NHS will be high on the government’s agenda, and we will have an opportunity to shape the service for future generations.  And I think that the HFMA and finance professionals have got a massive part to play in that.  Happy new year everyone.



This blog also appears in the February issue of Healthcare Finance