HFMA Awards 2019: governance

12 December 2019

Three bodies have been awarded this year’s HFMA Governance Award for a joint submission based on a shared governance framework that better supports the achievement of savings across the system.

Epsom and St Helier University Hospitals NHS Trust together with Sutton and Surrey Downs clinical commissioning groups believe this radical change to the delivery of savings required a paradigm shift in the level of trust and engagement with stakeholders. Gov 293

With joint financial analysis identifying a £67m gap across the two systems to the end of 2020/21, all parties agreed a change of approach was needed. And a programme has been created to deliver savings with no boundaries across the two CCGs, the acute hospital and two community services. This has involved dropping the payment by results approach to contracts in favour of a focus on reducing systems costs.

The organisations worked together to understand the scale of the deficits in each system and co-authored joint financial recovery plans for each locality reflecting local circumstances. These plans centred around four themes: planned care; urgent and integrated care; and clinical and non-clinical supporting programmes.

A comprehensive infrastructure and governance framework was created, supported by a joint programme management office (PMO) resourced with skilled individuals from across the organisations. This team included finance, business intelligence, programme management and operational management professionals as well as, critically, clinicians.

The executive lead for the PMO is the trust chief finance officer. However, individuals are managed by the programme leads rather than their organisational line managers, with an emphasis on removing traditional departmental and organisational boundaries. The new governance structure means the system is well placed for 2020/21, when it will work to a formal system control total.

The joint programme has already resulted in greater savings than would have been realised under conventional savings approaches.

Risk is managed at a system level by recovery delivery groups – one for each of the Sutton and Surrey Downs localities – so that programmes are only implemented where there is a net benefit to the system rather than any individual partner. A joint finance committee has executive and non-executive directors from the trust board and CCG governing bodies. This committee oversees the whole system, assessing risk and providing assurance on behalf of the individual trust board and governing bodies.

Lorna Hart (pictured right), deputy managing director of Surrey Downs Integrated Care Partnership, said: ‘The old purchaser-provider barriers have come down. We are talking honestly and transparently through all the issues and risks and this is turning into real change.’ Ciara Jones, assistant director of finance at Epsom and St Helier, added that, as part of a wider medicines programme, savings on one drug had been worth £700,000 in the first year. ‘That wouldn’t have been made if we had not been working in partnership.’

The judges praised the way the three organisations had worked together to develop a new approach to addressing their shared financial problems. ‘Their traditional approaches to financial recovery would not deliver, and more radical action was required to tackle their significant health economy-wide underlying deficits,’ they said.

The judges were also impressed that the partnership straddles two STP areas, adding additional complexity. 

Download our HFMA Awards 2019 supplement here


Also shortlisted

360 Assurance and Audit Yorkshire developed an audit committee good governance programme to support organisations to review and enhance governance arrangements. This includes an audit committee maturity matrix, enabling organisations to self-assess across 15 elements of good governance. Further support has included interactive learning events, discussion panels, briefing papers and benchmarking support.


As part of its Finance the Leeds Way initiative, Leeds Teaching Hospitals NHS Trust redesigned its internal audit and counter fraud service into a co-sourced model with partner PwC. The approach blends external expertise with the internal team’s vast corporate understanding. The model has strengthened resources and enabled the establishment of a dedicated internal counter fraud service staffed by two whole-time equivalents. It has also helped extend internal audit focus into specific governance risks.