Comment / Engaging for a new year

As the 2015/16 financial year has drawn to a close, we await with bated breath to see the final figure the NHS lands on for the year. We enter the unknown if we bust the Department of Health’s expenditure limit and find out what impact that has on NHS finances in 2016/17. Throughout the year, we have seen control measures introduced to avoid this worst-case scenario, both innovative and technical, and with varying degrees of success.

Auditors have been watching attentively and I am sure there have been some interesting discussions, with more organisations in danger of not meeting their break-even duty.

Discussions can get even more colourful when non-executives start talking about an organisation’s status as a ‘going concern’. This is where the skills of the finance director come into play as they lead the NEDs through the technicalities of the situation faced.

On a more upbeat note, April saw NHS Improvement launch its draft acute costing standards. And the HFMA costing conference was the best attended yet, with more than 250 finance practitioners and even a couple of clinicians.

Initially, the new standards will only be used in anger by the handful of roadmap partners helping the improvement body and regulator to fine tune its patient-level costing process. But they will be of much wider interest. As NHS Improvement’s director of costing told the HFMA conference, patient-level costing ‘is the future, this is going to happen’.

There are significant challenges ahead – new systems to implement, new data feeds to bring on stream, source data to be improved and staff to be trained. These challenges will differ depending on whether you sit within an acute, mental health, community or ambulance trust.

Where you start from will also have an impact on your own local implementation. One challenge common to all organisations is the need to get clinicians involved. At times it might seem hard to get even finance managers interested in the detail of costing. But if we don’t engage the broader clinical community, we won’t even get robust cost data, let alone achieve the real goals of understanding clinical practice, revising pathways and eliminating unwarranted variation.

Clinicians should be involved in the costing process from the outset. But the need for engagement goes so much wider than costing – it is the fundamental foundation for transformation across the service. Clinicians commit resources – not finance managers – so it is clinical practice that holds the key to changing how those resources are used and improving value.

The number of times I have queried our financial assumptions with clinicians where they have managed to shed a completely different light on it. Or where they haven’t realised how their actions had such a direct influence on finances.

Future-Focused Finance’s ‘Close partnering’ work stream has put clinical engagement at the heart of its development programme (see page 20). It has done great work – with its finance educators’ network, for example – but engagement is a local activity. We need good engagement between individuals. All of us – from finance directors to more junior members of the finance team – have a duty to turn the warm words about closer working into real collaboration on a day-to-day basis.