Checklist for reorganisation

by Debbie Paterson

17 November 2017


In an era of system working and partnership, mergers have taken a back seat. But formal restructuring is still a live issue in some areas and there is practical help available to support finance teams.

The jury is still out on the effectiveness of structural reorganisations to effect change. It is universally accepted that they are time consuming and labour intensive. And when used as a response to provider financial challenges, a King’s Fund report found it was unclear whether mergers addressed the root cause of problems.

There is also no political will for major restructuring, with Brexit being virtually all consuming of Parliamentary time.

However mergers appear to very much on the cards within the commissioning sector. There have been reports that NHS England has approved mergers involving 18 clinical commissioning groups to create six new organisations, with others given approval in principle.

Accountable care systems currently seem likely to move forward initially on the basis of partnership rather than formal mergers. But downstream, few would argue against the focus on sustainability and transformation plans and system working leading to more formal integration of provider bodies.

It is against this backdrop that the HFMA has produced a checklist for NHS bodies to use when they go through a structural reorganisation such as a merger. This practical tool is intended to help NHS finance teams manage that burden.

It is in fact the third version of this checklist for finance teams – it has been updated to reflect simple things such as changes to organisation names, but also to include questions about sustainability and transformation partnerships.

The checklist is a very practical tool for finance teams to use – it does not address any questions about how and why a reorganisation should take place. Instead, it starts from the point at which the decision has been made and aims to identify the many issues that the finance team needs to consider. The checklist was developed with the help of colleagues who have been through the process and wanted to share their learning with others facing the same task.

It is, perhaps, no surprise that it is nearly 50 pages long. It is a deliberately detailed list that states the obvious – that new bank accounts need to be set up and stationery needs to be revised. But it also picks up those things that might get forgotten. Things like the need to discuss with NHS Improvement whether a new market forces factor needs to be calculated for the new organisation or the need to consider whether costing practices are aligned and in accordance with NHS Improvement’s latest requirements. For CCGs, there are questions around the Integrated Single Finance Environment and how archived versions will be accessed.

Unusually for an HFMA document, the checklist is available in word format so it can be tailored by NHS bodies for their needs. As always, if you have any feedback on how we could make it better please let us know.