Comment / Practical knowhow

By Tony Whitfield

The Budget last month was a sobering event. Aside from the politics, the underlying prospects for our economy remain grim for the foreseeable future.  But we knew that. And the positive message from the chancellor’s pronouncements and the underpinning Treasury red book is that the NHS budget continues to be protected. This special treatment for health, relative to other spending departments, reflects not only the government’s priorities, but also the significant pressures facing the service from an ageing population and the burden of chronic disease.

The Budget extended the 1% pay restraint until 2015/16, which will add a clear financial pressure after two years of pay freeze. But we will need to understand more about the chancellor’s comments around seeking ‘substantial savings’ from pay progression – which has generated its own pressure in recent years, despite being out of the public view.

Against this broad economic outlook, the NHS is embarking on the next major phase of its evolution.  With the new architecture will come the inevitable tensions and the massive task of transition – moving money from one commissioning group to another. I know how hard my local colleagues are working to make the transition as transparent and controlled as they can. The real work lies beyond transition, in driving up standards as part of the quality, innovation, productivity and prevention (QIPP) challenge.

I am delighted to see Don Berwick having a role to play again in the NHS. His comments to our annual conference in December should reassure us that his route to QIPP is through quality improvement, reducing harm and so reducing waste. I recall his story about shouting at his car when it wouldn’t do something it was not designed to achieve. This has direct resonance for us in finance.

For example, we need to have confidence that budgets or required cost improvements are achievable. Setting a budget that is insufficient to deliver the required outcomes and then shouting about the failure is pointless. Savings need to be targeted at the right places or we need to engage in multidisciplinary discussions on redesigning services to better meet patient needs within the resources.

It all fits with my theme for the year, ‘Knowing the business’. As finance professionals, we need to have a better understanding of the realities of how healthcare operates on the frontline – giving us a better grasp of the likely consequences of higher level decisions or savings requirements.

The HFMA aims to support this goal with briefings, seminars and webinars. And at Salford Royal, we are taking the next step – all finance staff are to spend two days this year working in some frontline activity.

It is an aspiration that stretches beyond the finance community. In the aftermath of the government’s response to the Francis report, both health secretary Jeremy Hunt and health minister Norman Lamb referred to a plan to ensure all civil servants have ‘real and extensive’ experience of the frontline. Good PR? Maybe. But surely of good practical value too.

The realities are that we need to constantly look to improve quality and patient safety. And do that within budget. No one suggests it will be easy, although there is big potential in areas such as zero-harm care and seven-day services (a financial evaluation of which the HFMA has been asked to contribute to).

But this can only be done with real engagement between clinicians and finance managers. That demands much better mutual understanding of each other’s business and a single-minded focus on the needs of the patient.

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