HFMA 2017: ACSs urged to use control total flexibility

Speaking at the HFMA conference, Matthew Style (pictured), NHS England director of strategic finance, said ACSs could move to system-wide financial control totals from April 2018. With these new local freedoms, national regulators were working with accountable care systems to ensure they did not stand in the way of the benefits of cross-system thinking.

‘All ACSs are going to be given the opportunity to operate within a shared system control total from next year onwards. One of the most consistent pieces of feedback I have had is about the way institutional financial controls have been the biggest threat to some of the benefits of system thinking and population health,’ he said.

‘As we co-design how shared control totals will work in practice, we will help systems to make sure they have flexibility at the planning stage and in-year to flex their control totals between institutions as long as the system impact is level.’

Mr Style added encouragement to non-ACSs to think about applying these principles locally. And he called on areas that had mature relationships and felt they could move ahead quickly to ‘come knock on our door, because we are committed to moving with and supporting areas that can move at pace.’

On pricing, national bodies were trying not to be prescriptive in the approach that should be taken locally and decisions should be based on the steps that will maximise resources. However, there were issues to consider – he hoped most ACSs will not opt for block contracts, but will also consider cost and value, so the benefits of payment by results will not be lost.

He believed system administration costs – across providers and commissioners – would come under further scrutiny in the coming months, even though many clinical commissioning groups were sharing senior managers and mergers between CCGs were growing.

Recent capital allocations had been decided by sustainability and transformation partnerships (STPs) and he believed they would get more involved in prioritising capital investment. National bodies would help local areas prioritise their capital requirements, including in primary care, with resources used across the system.

‘There is a real expectation from central government for local areas to show how NHS assets and the proceeds of disposals can be used more collectively to drive improvement priorities,’ he said.

The bottom line was that capital funds had to drive improvements across whole populations rather than just in individual institutions.