Comment / No distractions

Most practitioners in the finance community will have had a look at the proposals around the review of allocations policy.  Did your interest stop once you realised your area was likely to gain, so nothing to worry about? Or are you in an organisation that fears a double whammy – today’s challenges compounded by the risk of funding reductions in the future?

My reading led me to two thoughts. As with tariff-setting, this work may appear beguilingly straightforward. But scratch the surface and you uncover hidden depths of complexity. It is work many of us are glad is not ours to do.

The work is really important – getting allocations as ‘right’ as possible is key to equity and enabling health economies to deliver the best services they can. But it could also distract some organisations from our immediate service and financial challenge.

Organisations seeing a possible increase in their future share as a way out of current pressures may be tempted to sit and wait, rather than redesign and reform. At the same time, where current funding levels are ‘at risk’, organisations could focus attentions on lobbying for the status quo. The NHS cannot afford these distractions and the allocations document is completely clear: at this stage, it is too early to conclude anything.

Monitor’s Adrian Masters, interviewed for this issue (page 13), talks of a productivity challenge that will outlast short-term problems with the economy. Surely this means we must give our complete focus to developing sustainable, new ways of working to meet the demands of an ageing population.

I sense a mood change in recognising that now is the time for action and we need to build on this and not get distracted. The Royal College of Physicians has recently published its blueprint for future hospital services.  It is a visionary paper that makes bold statements, in particular about how one of our key groups of patients – the elderly – can be better served.

Monitor, NHS England and the NHS Trust Development Authority have also called on the service to imagine the future for healthcare provision as part of an NHS futures project.

Finance practitioners have a huge part to play in building on these opportunities. We need to ensure that current and future challenges are communicated clearly within our organisations and across our health economies. We need to support proposals for new ways of working with really robust cost and benefit analyses, so that decisions are taken on a fully informed basis. And we need to look beyond the boundaries and interests of our own organisations to ensure that we deliver quality services now and sustainably into the future.

Changes to services will be clinically led. Seven-day services is a perfect example. The drivers are all about improving patient services and outcomes. But  understanding the costs is fundamental to ensuring these services are delivered in a sustainable way. It can’t happen without finance being involved.

There are parallels with the high-speed rail debate. Should our focus be on short-term solutions – longer trains, bigger platforms? Or do we need to develop a different response – straight lines, high speed, great capacity – that will underpin the transport system and its role in the economy for years to come? Is now the time for quick fixes or radical thinking? I’d suggest our Victorian forefathers knew the answer.

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