News / Conference review

Once again, the HFMA held a successful national annual conference in December 2012. There were many memorable moments, particularly from US-based speakers, but looking more parochially NHS deputy chief executive David Flory came up with a phrase that could sum up this decade in the NHS: ‘QIPP not cut’.

Delivering a keynote speech Mr Flory (below) insisted QIPP (quality, innovation, productivity and prevention) methods rather than cutting services was the way to address the productivity and efficiency challenge. Mr Flory said simply cutting services had a knock-on effect on the quality of care delivered to patients. The Francis report on the failings at Mid Staffordshire NHS Foundation Trust, due early February, would underline this message, he added. ‘The report will bring back in stark terms the consequences when things go wrong and what happens when you cut rather than when you QIPP. As we think about QIPP going forward we must check ourselves and each other on the question of whether it’s QIPP not cut. We need to focus absolutely on the patient and the taxpayer – that’s an “and” not an “or”. On the subject of cuts or QIPP, if you remain focused on what’s best for the patient you are likely to be on the right side of the road.’

While welcoming the announcement in the chancellor’s autumn statement that the health budget would continue to be protected into 2015/16 – the first year of the next spending review period – Mr Flory warned that savings would still be required. The acute sector would be significantly smaller, though this did not mean wholesale closure of services and units. By 2016 that meant 12% efficiencies for trusts and up to 5% of this would be ‘cash out’. ‘If all else is the same,’ he said, ‘you need to do whatever you do now 12% more efficiently and with 5% less cash.’

In his final HFMA conference before he takes up the full-time post of NHS Trust Development Authority (NTDA) chief executive, Mr Flory signed off with a rallying cry to the finance function. ‘You will succeed. Be optimistic, be confident, be bold and make sure the success we have prepared for and built over the last few years continues in the future.’

Next on the podium was Paul Baumann (below), NHS Commissioning Board chief financial officer, who was also optimistic about the future. He said that the finance function was reinventing itself in the wake of commissioning reforms in England and was well placed to support change. Clinicians in commissioning and provider organisations would take the lead, but there was evidence that close partnership between clinicians and finance mangers was a natural and key prerequisite for success, he said.

Finance could add value by analysing the impact of proposed changes, he said. ‘Finance needs to be there and have something meaningful to say. But being there is the easy bit.’

Mr Baumann acknowledged finance staff may need further training and he promised to develop a finance staff development strategy early in the new financial year. This could build on the HFMA ‘Making a difference programme’ over last year. One of the finance function’s greatest assets was its ‘unparalleled’ network that spanned organisational and geographical boundaries. There must be systematic support for finance staff, he said, especially those moving to their first chief officer jobs in clinical commissioning groups.

Then it was the turn of foundation trust regulator Monitor to give its message. Chief executive David Bennett (below) urged trusts to look to the horizon and develop more rounded five-year plans that take account of all risks. ‘I am not convinced many of the foundation trusts – and I am sure the same is true for non-foundations – have developed five-year plans that properly reflect an understanding of what’s going on with the health economy, what’s changing in the legislative environment, commissioner intentions, what’s going on with competitors and new models of care that are emerging. There are going to be huge amounts of uncertainties in any five-year plan, and they will have to have all sorts of contingency measures, but I still think it needs to be done.’

There was no suggestion from foundations’ three-year plans that the sector was heading for crisis next year. In fact, the plans said the next financial year would be better than this year. But, anecdotally, managers in charge of the trusts contradicted these claims.

Mr Bennett was concerned that when looking across the foundation sector in the current financial year, the I&E margin expressed as a percentage of turnover was flat at around zero for most trusts. ‘It won’t take a lot of pressure to see a significant increase in the number of trusts in deficit. That’s a worry,’ he said. He could not be sure the number of trusts in financial difficulty would not rise rapidly, but the regulator was looking at ways of measuring this.

The conference had a transatlantic feel, with five speakers from the United States healthcare system. This included a US perspective on overcoming the challenges to delivering best value healthcare and an enlightening keynote session from Don Berwick (left), the former administrator of the Centers for Medicare and Medicaid and founding chief executive officer of the Institute for Healthcare Improvement (see page 20). In the past he has praised elements of the NHS and he told conference that Scotland was well on the way to being ‘the safest healthcare system on the planet’.

A long-term advocate for the theory that high-quality services can also mean lower cost, he put a compelling case, drawing examples from Alaska and Sweden to show it was possible. ‘You can't say it can't be done,' he said. It can be done. It is a question of "are we willing to make the changes".'