Don't stop believing

by Mark Orchard

01 December 2017


Together, let’s aim to achieve what at times may again feel impossible.

The aggregate mid-year financial results for the NHS in England confirm the immediate challenges faced by colleagues striving to support the delivery of safe and effective services within a cash constrained environment. This challenge is equally felt across all three devolved nations and reflects a UK economy unable to support NHS investment in line with either demand or meaningful per capita comparisons.

Neither the provider financial performance to quarter two, nor the consolidated commissioning system results to month seven, will be a surprise. Indeed the results simply support member responses to our latest HFMA NHS financial temperature check.

The chancellor’s November budget announcements were therefore entirely welcome, albeit substantially less than we may have hoped. But the NHS has again been singled out from all other public services – this time on supporting a funded pay review. Indeed the extra revenue made available for this winter and next year should enable health systems to be more resilient than would have otherwise been the case, even if this funding is not automatically available again in later years.

So where does that leave us today?

Let’s first assume – despite the immediate lack of clarity – that all of the new funding for England is available for optimal deployment within local systems. And let’s also assume that each of the three devolved nations will receive a timely equivalent distribution of funding.

We know that the additional revenue (and capital), though extremely welcome by service commissioners, providers and users, will simply not be enough to consistently achieve the levels of performance standards prescribed by the NHS constitution.

We know that the underlying financial position of many NHS organisations – the ‘normalised run-rate’ after adjusting for non-recurrent short-term and often non-cash measures – will not be reversed by non-recurrent funds. This is despite NHS productivity often outperforming comparative health productivity worldwide, as well as our own wider UK economic productivity measures.

But without any doubt, we know that working alongside our service colleagues, NHS finance will continue to support the highest possible standards of service and care within cash limits.

We all know the frequent difficult judgements, choices and risk-based decisions this demands. It is often for this reason that we do what we do. In uneasy times we make the most difference.

Together, our professional network has in recent years supported the achievement of what many considered impossible. NHS finance has provided incredible leadership, direction and momentum against which colleagues have been able to thrive.

Despite the extra funding announced in the Budget, we have further significant challenges ahead. Thank you for the support you have shown to your colleagues once again in 2017. I am confident that we can continue to count on each other for the remainder of this year, next and beyond. And together, we can continue to achieve what at times may again feel impossible.

This blog also appears as a comment in the December issue of Healthcare Finance.