Feature / Improvement focus

As the future-focused finance strategy is formally unveiled, Steve Brown looks at the key work strands aiming to help finance teams maximise their contribution to the improvement of patient services

Few would argue with the need for the NHS to consider every service development and spending decision in terms of the value it delivers. But it is much harder to turn these warm words and sentiments into practice backed up by practical tools. But this is exactly the challenge that the NHS finance function has set itself.

Delivering the ‘best possible value’ is one of six action areas grouped within three broad, cross-cutting themes that make up the finance development strategy, Future-focused finance. The strategy, trailed in February’s Healthcare Finance (page 22), was formally launched in February by the six heads of the NHS finance profession (see box overleaf), and the service is now being asked for its views as part of a major engagement exercise.

A senior responsible officer has been appointed from the service to lead each action area. Caroline Clarke, finance director and deputy chief executive at the Royal Free London NHS Foundation Trust, has taken the reins of the ‘best possible value’ work stream.

It was an area that came up time and again during the preliminary work leading up to the current engagement. Clinicians in particular were keen for finance to get involved in helping them understand value, pulling together assessments of outcomes, patient experience and cost. ‘This is all about being practical and applying the discipline of the finance profession to the whole service,’ says Ms Clarke. ‘What we need is a different investment framework – something that helps people to evaluate the value return on competing investments in a disciplined way and to make choices around integrated care, new pathways and new technologies.’

The project also needs to be focused. ‘We can’t do everything, so we’ve got to scope this to make it reasonable and look at the areas that make the most difference,’ she says. Integrated care is a clear contender given the current agenda, but Ms Clarke is keen to hear from the service about other areas where decision support tools would be particularly helpful.

Good practice

She is determined not to reinvent the wheel, so will look to build on and scale up existing good practice both in the NHS and internationally. She is also keen to produce a model or models that work at organisation and system level. ‘The London stroke pathway changes are a great example of where we’ve used value to make a strategic intervention,’ she says. ‘We predicted, using a mix of clinical and financial variables, what the outcome of changing the stroke pathway would be, and then we measured it really carefully afterwards and showed that the stroke survival rates were massively improved.’  The work stream will learn from this approach.

‘I think we could end up with a case study-based toolkit with techniques and methods that other people can pick up and use,’ she says. She believes there is real appetite for such a toolkit and that one of the knock-on benefits of the work could be an improvement in data quality across the whole service.

The strategy is looking to deliver quick wins in other action areas too (see box overleaf). Cathy Kennedy, deputy chief executive and chief financial officer at North East Lincolnshire Clinical Commissioning Group, is leading work on ensuring the finance department is a ‘great place to work’.

‘We want finance staff to feel that they have interesting roles, that they are given opportunities for development and that they are encouraged to lead at all levels. We want them to see the NHS as offering them a diverse and challenging career path,’ says Ms Kennedy.

Again, she says it is about identifying and spreading existing good practice and getting finance staff to flag up any obstacles to achieving these goals. She adds that the significant structural changes over the past year – with the creation of commissioning support units, clinical commissioning groups and regional and area teams in NHS England – make the work particularly important.

‘Right up front we want to get finance directors and chief finance officers to sign up to a declaration about taking Future-focused finance forward in their organisations,’ says Ms Kennedy. ‘That will give us the right base to build on and show that we are all committed to making this happen.’

She also wants to create case studies to illustrate career models in the NHS finance function. ‘We want to show how our finance leaders from all NHS sectors – and not just the most senior leaders – got to where they are, how their experiences have contributed to their knowledge and expertise and what their current jobs entail,’ she says.

‘The idea is to give other staff a sense of what they could be doing – and where they could be headed.’

The ‘great place to work’ work stream is also looking to kick start a team self-assessment process. ‘The idea is to spell out how a great place to work might look and then help teams to benchmark themselves against this,’ she says, suggesting that some firm measures and  characteristics will be developed.

Building on these early initiatives, the work stream will move on to look at the role of coaching and mentoring and how the finance function can support itself and share experience and support. ‘And we need to look at mobility within the sector – are there still enough opportunities for people to pursue careers in different parts of the NHS?’ she says. ‘Seeing the service from different perspectives is vital as we increasingly look to deliver whole-health economy responses to current integration and transformation challenges.’

Dr Sanjay Agrawal, consultant in respiratory and intensive care medicine and associate medical director at University Hospitals Leicester NHS Trust, is leading the work on ‘close partnering’. ‘Clinicians are desperate for information about finance and business as it helps them understand how they can develop their services,’ he says. ‘It works both ways as finance people need an idea of what clinicians need. It helps everyone do their job better.’

Practical focus

Dr Agrawal says the work has clear links with the value work stream and again will have a practical focus. ‘We are keen to identify models that different organisations can put in place to support better partnering,’ he says.

Mark Orchard, finance director for NHS England (Wessex), is leading the Future-focused finance programme on behalf of the national heads of finance and overseeing an action

area to lay the ‘foundations for sustained improvement’. ‘The role of this work stream is to support the others and get the infrastructure right,’ he says. Early work will look to establish a communications hub to connect everyone in NHS finance. And he is keen to build on the use of Twitter, which the programme has been using to generate discussion and awareness.

Mr Orchard also wants to establish a network of value makers. Borrowing the idea from the nursing profession, where care makers have been established as ambassadors for the Compassion in practice strategy, value makers will champion the new finance strategy. ‘The early response to the initiative has been really positive,’ says Mr Orchard. ‘We want to build on this enthusiasm to drive all the work forward – and value makers are a great way to channel this energy.’

Long term, Mr Orchard can envisage the creation of a health business foundation. This could be a body owned and steered by all NHS organisations and the focus for supporting continuous improvement – potentially undertaking or supporting research or taking a central role in spreading best practice in delivery of financial services.

Mr Orchard says the strategy’s strapline – making people count – is key. ‘This is about ensuring everyone in finance can see how their contribution matters,’ he says. ‘It is about enabling clinicians to do the best possible job they can and helping people to understand and use healthcare finance. And it’s about equipping us all as individuals to deal with the change that is definitely coming.’

He encourages finance staff to use a series of March workshops (see box) to get involved and make their views known.