Building relationships

by Debbie Paterson

16 November 2018


Changes are needed to the capital system, but estates and finance staff also need to work better together and speak each other’s language

At the moment, thinking about capital and non-current assets is the theme of my working life.  Most of last month was spent working on the HFMA’s recent briefing, NHS capital – a system in distress? Since, its publication I have spoken to other thinktanks about capital and the capital financing system and, this week, I attended the HFMA’s first ever event on estates.

I expected that the day would be spent talking about eye watering numbers and how to resolve the problems that NHS bodies are having keeping their estates in good working order, let alone investing in new capital schemes.  These were, of course, discussed at all points along the way.

However, it struck me that the recurring theme of the day was actually people – the value that they bring and the importance of good working relationships.

Relationships between NHS bodies and their suppliers, between regulators, between regulators and NHS bodies, between NHS bodies themselves, between primary care and secondary care, within wider health and social care systems, between finance staff and estates staff, estates staff and clinicians and so on.

Clearly, buildings need to be fit for purpose and the right equipment needs to be in the right place, in working order.  However, none of that can happen without people and good working relationships.

We heard how the University Hospital of the North Midlands now has a collaborative partnership with its private finance initiative (PFI) partner with common objectives and a focus on quality for the patient. This has not happened overnight or by accident, but is the result of hard work over a number of years. The process was, at times, difficult but it was worth it, as all of the metrics are moving in the right direction.

The event was attended by both finance and estates staff and a key message was that they need to work together and speak each other’s language. In some places this is working well and the benefits are being realised.  NHS Improvement has established a collaborative hub for estates staff in the NHS to allow them to develop good working relationships and share best practice. Perhaps the next step is to invite finance colleagues to join the hub too? NHS Improvement is developing training programmes for estates staff to help them understand finance in the NHS. 

NHS Improvement and the Department of Health and Social Care discussed the capital system and the work that they are doing to improve it. I think that most people at the event would agree that the current system is not working as well as it should and it is probably far too complicated at the moment. 

Capital is vital both to maintain existing service models, where that is appropriate, and facilitate new models of working with more community support and much greater integration of services across whole systems. More capital funding is undeniably needed. And even with this in place, the NHS needs a more transparent system for how these resources are allocated.

But what is clear is that there is an appetite for change and people working in all parts of the system understand each other’s problems and frustrations. This is not enough on its own, but it is a good first step to improving working relationships and moving towards a system of partnership where everyone in the process adds value.

Presentations from the estates forum – run as part of HFMA president Alex Gild’s Brighter together programme – are available by clicking here.