Finance’s key role in plan

by Bill Gregory

25 January 2019

The new long-term plan sets the direction for the NHS, but there is an opportunity to shape the detail

The news about the NHS at this time of year is normally dominated by A&E pressures and waiting times.  While our frontline teams have done a sterling job in dealing with these pressures through the Christmas and new year period, it was good see the Brexit fog lift for a couple of weeks and the positive media speculation about the contents of the NHS long-term plan.

We need speculate no longer! This month saw the publication of not only the plan, but also the detailed planning guidance for 2019/20.  The plan is an opportunity to reset the direction of healthcare delivery and development, following a very difficult period in the NHS’s history. It certainly points the way for a health service for this century.

Often NHS resets are accompanied by significant restructuring plans. And while the long-term plan indicates changes to the commissioning landscape and confirmation of the importance of the new regional teams, rightly its main focus is on improving patient outcomes and experience. 

From a resources point of view, the continuing focus on reducing unwarranted variation and effective use of resources is clearly spelt out.  The initiative to look at reducing unnecessary outpatient appointments is something that ticks all the boxes – quality, experience and resources.  I am sure many of us have attended hospital and GP appointments and wondered if the appointment could have been delivered as effectively via phone or email. 

I believe this outpatient initiative has the potential to go way beyond this, using technology and patient peer support to monitor disease progression over time.  This is fertile ground for deploying the concepts of value-based healthcare to evaluate improvement in outcomes and costs as these changes get implemented.

As expected, the planning guidance sets out the arrangements for a transition year, but is a step in the right direction towards putting the whole NHS back on a sustainable footing.  There is quite a lot of excitement about the size of the clinical commissioning group allocation uplifts. But while there will be new money in there, we should not forget they will also include the system impact of the market forces factor changes and sustainability funding being fed into the tariff. 

Provider sustainability remains a key priority, and the combination of the payment mechanism changes and tariff increases for emergency care should help acute providers.  The establishment of the fund to support ‘essential services’ in deficit providers should also give the new regional teams the opportunity to incentivise local improvement plans.

Similarly, sustainability and transformation partnership and integrated care system control totals should give organisations further incentive to work collaboratively as an integrated system.

As part of my Value the opportunity theme for my year in office, I have talked about the HFMA helping to shape and influence the financial architecture.  There is still much to be landed in this transition year. This includes: capital, particularly backlog maintenance in providers; influencing how the public health grant is deployed; and how we manage the idea of competition in an integrated health system.  Our members can and should help to shape approaches in these areas for the future.

It is a challenging agenda – locally and nationally – but one that the finance function has a key role in delivering. We have the opportunity to add value – and we need to take this chance.

This blog is taken from the February 2019 issue of Healthcare Finance

See the HFMA’s A summary of the NHS long-term plan
See the HFMA’s A summary of NHS operational planning and contracting guidance 2019/20