HFMA 2018: Financial flows and behaviours key for system working

Matthew Swindells (pictured), deputy chief executive of NHS England, said a ‘generational shift’ was underway with the move to greater system working. ‘After 30 years of the purchaser-provider split and a competitive environment, we are trying to move to a population health and system focus and optimise care around individuals and communities,’ he told the conference.

Many people, he said, had spent their whole careers in the ‘count it and bill for it’ environment.

‘We need your help to be at the front of how we change behaviours and how we get the new sets of analysis that we’ll need for place and population health systems,’ he said. ‘We need you to build the the financial flows model to support this change. In the best sustainability and transformation partnerships, they are looking at how we can move away from transactions without losing responsibility for individual patient needs.’

He said the service needed to drive down transaction costs created by generating and querying invoices. ‘That is not getting someone a hip replacement or a district nurse in their home helping them to live with dementia,’ he said. ‘So let’s get away from squabbling about data and eliminate the perverse incentives.’

New funding systems needed to ‘pay people to do the right things' with money ‘supporting the change we are trying to achieve’. But he said that the new approach also needed to recognise stranded costs – for example leaving an acute trust with unavoidable fixed costs with no covering income as the result of a move of services into the community ‘There maybe a bumpy transition but we can’t dump problems in one place while we design the future service somewhere else,’ he said. ‘We need to take collective responsibility for stranded costs and measuring system efficiency.’

The conference was also told that the increased focus on costing and data that has improved in the tariff era needed to be maintained. ‘Moving away from payment by results isn’t a move away from the need for really good data on what is happening and how much it costs.’