Allow service to focus on delivery, not returns, says HFMA

In evidence to the Commons Health and Social Care Committee’s inquiry into ICS autonomy and accountability, the association said  a permissive regulatory framework provided a real opportunity to provide care in a different way that met the needs of local populations. But there should be clarity about delivery expectation and resources available.

‘NHS England should be clear on “what” needs to be delivered, while allowing local ICSs to determine the “how”,’ said Emma Knowles (pictured), the HFMA director of policy and research.

This should be supported by a transparent mechanism for monitoring delivery with measures agreed up front, she added. An outcomes-based accountability model would strike the right balance.

The association also called for a sensible approach to required submissions. While enough detail was required to ensure accountability, this should not be overly onerous. Finance staff were keen to focus on delivery rather than on completing increasingly detailed returns and plans. Finance staff’s representative body also called for recognition of the significant demands being placed on the NHS financially – delivering more activity with reduced purchasing power as inflation and pay awards eroded the national settlement.

‘NHS England must also allow systems and trusts time to develop their arrangements,’ the HFMA submission said, ‘recognising that solutions will need to be tried and lessons learnt to enable these arrangements to evolve over time. It called on NHS England to reduce the burden on the NHS by minimising submission requirements, supporting multi-year planning, ensuring collected measures are driving the right behaviours, and enabling greater sharing of data.

Finance practitioners are insistent that the integrated care boards (ICBs) must be part of systems and not viewed as regulators. ICBs must also be seen as more than a continuation of the former clinical commissioning groups. Their wider role should be highlighted and clarity was needed over the functions that will transfer from NHS England.

The association said systems were keen to prioritise prevention, but were concerned that opportunities would be missed with the understandable focus on elective recovery. Allowing time to deliver longer term outcomes and better use of shared data would help ICSs to promote the prevention agenda.

In its response to the inquiry, the NHS Confederation said there had been a tendency in the NHS to measure what is measurable, rather than what will drive improvement in the longer term. ‘There is therefore a risk of defaulting to existing performance metrics such as waiting lists and finances, especially as integrated care can be hard to define and measure,’ it said.