No drop in intensity

16 September 2020 Steve Brown

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Steve BrownIt has been a half year like no other. Since the country first locked down as a result of the Covid-19 pandemic in March, NHS staff have performed heroics. And while the focus has understandably been on frontline clinicians, finance staff have played their part.

This has involved undertaking their normal activities in difficult circumstances. Accounts closure deadlines have been met despite finance teams moving rapidly to working from home. Finance staff have also managed the introduction of new financial flows and emergency governance arrangements, ensuring suppliers get paid promptly and getting new staff onto payrolls.

In some cases, they have swapped roles entirely to support their organisation’s frontline response to Covid in other ways. We’ve tracked how finance professionals have ‘done their bit’ throughout the summer in a series of online reports. They’ve driven buses, sorted personal protective equipment, worked on wards, modelled the virus impact and supported the testing programme – to name just a few activities.

Participants at a roundtable in September, organised by the HFMA and the Faculty of Medical Leadership and Management, explored clinical-financial engagement. It suggested that in some ways, despite many finance staff working from home, the finance function has become more visible during Covid.

If so, this visibility needs to be built on as the NHS looks to come back stronger.

Some new pathways are already in place, but continued transformation will need finance working closely alongside clinicians to understand the costs of new ways of working. It is only through collaboration that the service will identify opportunities for improvement. It will also allow it to move investment to prevention and different parts of the patient pathway to deliver better outcomes and value to the system overall.

There are significant challenges ahead. The impact of Covid-19 has created a huge backlog in elective activity and will almost certainly mean some patients will be presenting to the health service with diseases more developed than they might have been. And the Covid outbreak is not over yet – as the recent rises in infections have proved.

Aside from this twin challenge of addressing the backlog while maintaining Covid capacity, finance professionals need to ensure their voice is heard as the service implements new payment systems. There is growing support to use the opportunity afforded by Covid – and the break from activity-based contracts – to accelerate the move to something that supports system working and the delivery of integrated care. New governance and approval mechanisms – building on the trimmed down processes hastily put together to support fast decision-making under Covid while still providing assurance and control – will also need finance professionals’ input.

And behind this agenda, the function faces other pressures that will shape its future – as set out in last year’s report from Future-Focused Finance (FFF), the HFMA and PwC, Designing our future. First, there will be a move to system working, whether that involves increased partnership working or some form of structural change. There are opportunities to make greater use of technology such as cloud computing, artificial intelligence and robotic process automation and to reduce time spent on data gathering to make more time for data analysis.

The latest finance staff census arguably shows a baseline against which future changes across the function may be measured.

Finance staff numbers have remained broadly unchanged over recent censuses. The massive agenda facing finance might suggest that this general trend will continue. However, beneath this headline measure, the focus of the function and how it goes about its business may change more radically.