Capital ideas

by Bill Gregory

29 March 2019

Informed debate needed on how to support capital investment

By now I’m sure you will have a pretty clear idea where your financial position will land for 2018/19 – good or bad.  And so, I am sure attention will have moved to getting the new financial year off on a firm footing.

 I know from canvassing views from organisations in Lancashire, that despite the ‘extra money’ in the system, the process of agreeing plans and contracts for 2019/20 is proving to be very challenging.  When we are dealing with knotty problems like this, it’s always worth reminding ourselves that our patients come first.  In my experience with that mindset, most problems can be worked to a satisfactory conclusion.

I have mentioned in previous pieces the challenges around capital investment, particularly in the acute sector.  While the purse strings feel like they are getting ever tighter on capital, the alternate financing methods are not always that easy to navigate.  I think the time is right for an informed debate about where we go with capital investment as a service, and what realistic alternatives are available. For example, can the various LIFT companies be used to finance this badly need investment?

The HFMA made a good start in this debate with its NHS capital – a system in distress?  briefing last year, suggesting the characteristics needed in a new capital regime. It was good to see The Health Foundation making its contribution to this key topic during March. And the government is now consulting on how best to support private investment in infrastructure, given it has already announced it will no longer be using the private finance initiative or PF2 models. However, solutions are needed quickly if we are to realise the ambitions of the long-term plan.

During the last month HFMA chief executive Mark Knight and I hosted the branch chairs conference at 110 Rochester Row.  This provided a good opportunity to update the branch representatives on the progress the association is making with our education strategy – particularly the development of our formal qualifications that are increasingly valued by staff across NHS finance – and also the work of the Healthcare Costing for Value Institute and our policy team. 

Talking of the policy team, I would also like to congratulate Emma Knowles on joining the HFMA executive team as director of policy and research.  Many of you will be familiar with Emma’s work with the association. This role becoming part of the executive team highlights both the contribution Emma has made but also the importance we place on our policy and research work and how this can influence the development of policy across the four nations.

I was tempted to steer clear of Brexit altogether this month, but I have to admit the machinations in Parliament have been fascinating.  By the time of my next comment, we should know when and if Brexit will happen...but then again maybe not!  In the meantime, we can comfort ourselves that while our jobs in NHS finance are always challenging, our world is not quite as bizarre as European politics!

This blog also appears as a comment in the April issue of Healthcare Finance. Read the rest of the issue here.