Developing system finance and governance arrangements: key considerations for 2021/22
11 March 2021
The need for collaborative system working is clear but the finance and governance arrangements to enable it can be complex. As recognised in the white paper, legislation is just one part of the change and much relies on having the right workforce, good leadership and getting the incentives and financial flows right.
While recognising that there is no one size fits all for an ICS, there are a number of common enablers, as well as challenges, in establishing agreed and effective system-wide finance and governance arrangements. Most importantly, the pre-requisites for any arrangement are a shared vision, trust and transparency.
Conversations are needed both within and across systems. As NHS systems, and their constituent organisations, formalise and develop arrangements for 2021/22, the aim of this paper is to provide material to feed into discussions. It focuses on:
- System approach: building collaborative relationships, the role of the ICS, shared vision and strategy and working with partners
- Financial framework: financial arrangements and sharing financial information
- System governance: governance framework and the role of non-executive directors (NEDs).
For each area, it includes a brief context; signposting of existing guidance; and shared experiences from across the country including challenges and suggestions of what might work well to address those challenges. The paper aims to provide a reference point for developing arrangements and it is expected that much more will be learnt over the coming year. The HFMA will continue to share lessons from across the country via events, webinars and briefings.
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