New national CFO to oversee commissioner/provider finance

Plans for closer working were unveiled in May at the bodies’ first joint board meeting. As well as a joint financial and operational planning process and performance management framework, they will have a joint executive team.

NHS England and NHS Improvement chief executives will lead the team, together with a national medical director, a nursing director and chief financial officer, who will lead the integrated financial, operational planning and performance oversight process.

HFMA president Alex Gild welcomed the proposals. ‘With moves towards greater system working, it makes sense to have a more integrated approach from the service’s leadership, ensuring better co-ordination and that a single message is delivered across providers and commissioners,’ he said.

NHS Improvement and NHS England said they wanted to hold a single conversation with trusts and clinical commissioning groups to avoid contradictory messages. Financial incentives and architecture would be better aligned to ensure whole-system improvement. NHS England and NHS Improvement would simplify and rationalise financial flows and incentives to improve provider efficiency and quality, and add value across patient pathways.

This will inform joint work, led by the new chief financial officer, to design and implement a new approach to managing collective NHS resources and driving value.

Regional directors and their teams will take on more responsibility, while national teams will generally provide support and intervention where agreed by the regional director.

Seven joint regional teams will be set up, fully responsible for quality, finance and operational performance in their areas. They will:

• Oversee local system financial planning and performance against the new framework
• Manage control totals across commissioners and providers
• Oversee delivery of system-wide cost improvement programmes
• Support the design of new payment and risk-sharing models
• Prioritise sustainability and transformation partnership (STP) capital plans.

Regional directors will also support the development of STPs and integrated care systems. Nationally, a new provider strategy lead will oversee reconfiguration of the provider landscape to deliver clinical and financial sustainability.

The improvement of estates, procurement and back-office functions will be led by a new chief commercial officer, while an NHS Assembly – a forum for debate – will oversee progress on the Five-year forward view and co-design the proposed upcoming NHS 10-year plan.

Chris Hopson, chief executive of NHS Providers, said trusts would welcome the changes, but there were risks.

‘This must be a genuine joint venture of two equal partners,’ he said. ‘Trusts have been asked to carry significantly more financial and operational risk than they believe is appropriate and this would have been a lot worse without NHS Improvement’s voice in the setting of the provider task.’