Squaring up to the time pressure

01 November 2017 Steve Brown

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The NHS needs a model of care that is fit for the 21st century and the population as it is now. And it is a shame that the NHS did not change its model of care 15 to 20 years ago, when it could see the coming changes in population and had more money at its disposal.

So said Ted Baker, the new chief inspector of hospitals at the Care Quality Commission in an interview at the end of September. 

Few in the NHS would argue with this assessment – the ageing population and the growth in prevalence of long-term illnesses were no secret and the levels of funding growth available at the time could have provided a firm foundation for transformation.Nurses watch

The funds bought improved access and reduced waiting times among other things. But the NHS may have missed an opportunity. 

At least now it has – belatedly – set itself on the right track, recognising that current service models are simply not sustainable. There is an acceptance across the UK that there needs to be a greater focus on prevention and self-management, and that care services need to be more integrated and delivered at the right time and in the right place. And that will mean changes to how and where services are delivered.

The challenge is making rapid and significant progress on this agenda, while meeting hugely demanding targets on access, quality and finance in the short term.

As Mark Orchard says is his column, NHS finance managers need to deliver for today and tomorrow in equal measure.

This is a daunting ask as the transformation and sustainability agenda is broad. Sustainability cannot just mean that services are sustained within budget and using staff numbers that can realistically be trained and retained. It also needs to be sustainable in terms of its environmental impact.

The environmental agenda has almost certainly been seen as a ‘nice to’ rather than ‘must do’ by finance professionals – though this is completely understandable given what must seem like more pressing, critical deliverables. The reality is that this is too short-sighted. Changes in service provision or procurement decisions that increase air pollution will come back to haunt the NHS with increased demand in future years. 

Processes need to change so that environmental sustainability is factored into the decision-making process. The good news is that there remain opportunities to deliver environmental wins that also cut costs. 

In addition, there are increasing numbers of clinicians and managers who believe that
a move to value-based healthcare – an evidence and data-driven approach that seeks to deliver value with every decision, measured in terms of both outcomes and costs – is the way forward.  

The clear evidence from the HFMA Healthcare Costing for Value Institute’s second international symposium is that a value approach can deliver the very cost and service improvements needed to meet shorter term financial goals – as well as locking services into a cycle of continuous improvement.

No-one pretends that this is easy – far from it. An immediate injection of cash from November’s Budget would clearly help. A realistic longer term settlement for the health and social care sector would be better. But in the interim, NHS leaders need to find ways to address the time pressure. 

Finance practitioners and colleagues have a huge agenda currently, but they need to be given time to support these major changes in approach and look beyond immediate short-term targets.

The alternative is that in another 15 years’ time, we will find ourselves lamenting yet another missed opportunity for the health service.