Comment / Let’s build on the common view

February’s Commons health committee report on health and social care expenditure provides a good summary of where the NHS stands a few years into a period of unprecedented financial challenges.  I would encourage you all to make the time to read the committee’s report.

Any of you who have also read the HFMA’s written evidence to the inquiry leading up to this report will notice a huge amount of common ground in the conclusions. A sensible reading of this correlation is that the committee has listened closely to what the association had to say about the current challenges and what needs to be done to meet them.

It is absolutely right for the committee to listen to the association. Our submission was directly informed by a thorough survey of our members – an approach we plan to take far more often as we look to raise the HFMA’s voice to help shape workable and effective policy. But the really important message in all this is the degree of consensus that is breaking out, particularly around the transformation agenda and the need to face up to the implications of this transformation.

Finance managers’ view, as reflected in our evidence, is that transformational change is ‘necessary’ but will need ‘support from the public and politicians’. There need to be ‘significant changes’ to care pathway management and ‘greater use of centres of excellence’ – all driven by the desire to improve outcomes for patients. ‘Some services will no longer be provided or will be provided differently to make them clinically, operationally and financially sustainable,’ the association says.

The requirement for transformation and greater integration of services is echoed back from the health committee report. It states that the ‘argument for reconfiguration, leading to reduced emphasis on acute services, is supported by consideration of clinical quality as well as economic pressure’. Even more robustly, it states: ‘Advocating service integration without recognising that the consequence of integration is reconfiguration of acute services is simply dishonest.’

NHS England got the debate about the future of the NHS under way with it’s The NHS belongs to the people: a call to action report last summer. But we now need to build on this growing consensus and help to keep the discussion in the public domain.

We must tackle head-on the suspicion, often kindled by the media, that service change and closing bricks and mortar facilities are always motivated by financial pressures. Finance professionals have a clear role in all this, standing alongside clinical colleagues to make the case for change – whether this is about re-providing services in the community or redrawing the boundaries of routine and specialised activity.

We also need to be clear that these changes will be delivered by local clinicians, finance and other NHS staff understanding the opportunities and making the case for local transformation. We can learn from emerging good practice, but this will not be a centrally led transformation.

We can only also agree with the health committee in calling for tariff payments to reflect the costs of treatment and to distinguish between different types of case. It says this, in part, to address the possibility of cherry-picking simpler, better paid services by some providers. We also need payment systems that allow local health economies to transform services without an additional financial hurdle to overcome.

But we can’t sit back and wait for tariffs that incentivise local health economies to transform services. We in the finance community are better placed than most to understand the lead times to produce these kinds of systems. We simply don’t have the time. The message from our membership, which is reflected in our submission and in the health committee’s conclusions, is simple. We know the challenges. There is growing agreement about the likely solutions. Let’s get on and help deliver them.

Paul Briddock is policy and technical director at the HFMA