HFMA 2020: finance leaders look to the future

by Seamus Ward

09 December 2020

NHS finance departments must keep the positive changes that have emerged in the wake of the Covid-19 pandemic, such as faster decision-making and improved relationships, but they should also be aware of concerns over health inequalities and cost improvements.

In a panel session on the future of NHS finance, finance leaders discussed the few positives that had come out of the pandemic and how these should be retained. The temporary finance regime, which simplified much of the funding flows and contracting arrangements in England provided lessons for the future, they said.

finance.panel.l‘It allowed us to keep the show on the road,’ said Hannah Witty, director of finance, Central and North West London NHS Foundation Trust, adding that high levels of staff sickness absence and redeployment made delivery of services ‘incredibly difficult’.

‘The regime enabled us to achieve a lot of transformation programmes, and to make changes that were clinically led because we had the safety net of the [financial] top-up overall. We were able to do things rapidly and put in place new and enhanced pathways.’

Claire Wilson, executive director of finance at Wirral University Teaching Hospital NHS Trust, said that removing payment by results had improved relationships. ‘It has allowed conversations based on cost not income because we had turned away from the PBR element of it.’

However, the NHS would have to return to reducing its cost base. ‘The finance department has lost ground on cost improvement programmes in our organisation. We have lost eight months to a year on this and we need to step up our engagement with clinicians.’

But she added that finance staff must be mindful that clinicians will be exhausted when they are talking to them about reducing costs.

Some delegates questioned whether the finance regime had been simplified. Ms Witty said while it was simpler in the first six months of the financial year, the second six months have felt more challenging so far. This was largely due to increased requests for information from the centre.

‘When guidance comes out it would be good to get as much information as possible in one go. The drip feed [of guidance] was exhausting. However, I genuinely believe NHS England and NHS Improvement are trying to put something that’s simplified in the temporary arrangements that will get us through to where we are going towards blended payments.’

Panellists acknowledged the difficulty in providing all information at once given the fast pace of change with the pandemic, while returns were needed by the government and Treasury to oversee spending at national level.

The tariff engagement documents for 2021/22 propose a move to blended payments as the NHS takes further steps away from PBR. Panellists gave their backing to the introduction of blended payments in general, though concerns were expressed about the planned widespread implementation from April 2021 while the NHS seeks to recover services and tackle backlogs in waiting lists.

Nicci Briggs, executive director of finance, contracting and governance at Leicester City Clinical Commissioning Group, said local collaboration, such as when speeding up discharge from hospital, was a major benefit from the pandemic response.

With Covid having a greater impact on areas such as Leicester and Greater Manchester, she wondered if there was a need for greater flexibility in the new financial regime to address issues created by Covid. ‘We are on day 156 of lockdown here and Covid has had a huge impact on BAME staff and patients. We have a huge issue with 52-week waits that we didn’t have pre-Covid.’

Ian Moston, chief finance officer of Northern Care Alliance NHS Group, said Covid had increased awareness of inequalities and their impact on health and wellbeing. The question was whether the NHS deliberately include addressing inequalities as part of its decision-making around service recovery. ‘A man who lives in one of our more deprived areas and needs a hand procedure is never going to be prioritised in the current system. But if you see his family as a whole, he is the sole breadwinner and if he is not able to earn the family goes hungry or cold over the winter. We need to find a way to address that.’

He added that the move by finance staff, almost overnight, to home working, while keeping its vital functions operational – including payroll and payments to suppliers – was a huge achievement. ‘It was a tremendous effort and there should be no debate about our contribution to the service’s response to Covid-19.’

However, there was a downside to home working, with staff mental health potentially being affected. ‘When home working it is more difficult to define the working day – when to start and when to stop,’ he said.

The other panellists agreed that work-life balance was important when working from home, as well as finding a way to replicate the ‘kitchen conversations’ or informal chats vital to mental health and wellbeing

Pictured, clockwise from top left: Hannah Witty, Claire Wilson, Nicci Briggs, Ian Moston, with session chair Sandra Easton, 
national director of operational finance and performance, NHS England and NHS Improvement