Comment / Future vision, short term focus

Alex Gild (pictured), chief financial officer of Berkshire Healthcare NHS Foundation Trust, became the association’s new president on the final day of the conference. As he unveiled his theme for his year in office – Our NHS, your HFMA, brighter together – he told delegates that the service’s 70^th anniversary in 2018 was a good opportunity to look forward 30 years to ensure services could continue to meet demand within budget.

The HFMA is due to work with other organisations, including accountancy body CIPFA, on a series of collaborative reviews. These will look at topics such as the future NHS offer, funding models, health economics and the role of technology. 

Mr Gild’s predecessor as HFMA president, Mark Orchard (pictured), had trailed the work in his speech opening the conference. ‘The NHS will celebrate its 70^th anniversary next year, so surely we need to start laying the foundations now for its 100^th birthday by starting with a meaningful review of how we might take steps to ensure that the NHS remains fit for the next generation and the generation beyond that.’

Turning his attention to the current pressures, Mr Orchard said the finance profession had a major part to play in providing the right financial platform for service delivery and transformation. He urged colleagues to ‘keep going’ and to continue to support each other. ‘There is no-one else – no army of accountants or alternative group of finance leaders with a better plan nor greater experience than we have in this room today,’ he said.

Setting the scene for the conference, BBC political editor Laura Kuenssberg warned delegates not to expect big political changes in the NHS in the short-term to address some of its challenges. The government’s focus was elsewhere, mostly on plans to exit the European Union, and the ‘political bandwidth’ was not available.

NHS Improvement director of resources and deputy chief executive Bob Alexander (pictured) linked future and current challenges. Landing this year’s position in the ‘best shape possible’ would be the best starting point for continuing the drive for sustainable services, he said. While he praised the finance function for the work they had done to deliver financial plans in recent years, more needed to be done. There was still a ‘significant reliance on non-recurrent measures’ and too many financial improvements ‘skewed to the back end of the year’, he said.

Mr Alexander acknowledged that the extra money announced in this year’s Budget would not address all the risks in their financial positions. But he called on organisations to deal with the risks in their control and to work with system partners on ‘the issues between organisations’.

Systems were also prominent in an address by Matthew Style (pictured), director of strategic finance at NHS England. Mr Style said that all new accountable care systems (ACSs) would be given the opportunity to ‘operate within a shared system control total from next year’. However while systems have long identified this as an enabler for pathway reform, delegates said there were still concerns. These centred around how this would work in practice given regulators were still focused on organisational performance and provider funding from the sustainability and transformation fund was linked to individual provider performance against control totals.

However Mr Style said that co-design work was underway on how shared control totals will work in practice and that areas not formally part of ACS arrangements should also think about applying the same principles locally.

New payment systems may be needed to underpin new models of care pursued by ACSs. But Mr Style called for systems not to simply adopt block contracts. While payment by results may not be appropriate for all service areas, the NHS should not lose all the benefits associated with the approach.

While greater system working is seen as a key building block for more integrated care, the service is also being encouraged to move towards value-based healthcare. This seeks to target the best value from all decisions taking account of outcomes that matter to patients and cost. And while it is often seen as supporting long-term sustainability, there are examples of value-based approaches also delivering short-term benefits in terms of improved outcomes and costs.

NHS Improvement’s Costing Transformation Programme aims to ensure the service has robust cost data to inform value assessments and costing awards were handed out by the oversight body to recognise work by trusts in the programme to date. NHS Improvement’s chief pricing officer Monique Duffy-Brogan (pictured) said that modern companies understood that ‘good data is key to delivering an efficient service’.

Value-based healthcare is delivering results for local health systems across the world. Jason Helgerson, Medicaid director for the New York Department of Health, has already blogged for the HFMA about how a commitment to value following major financial pressures was already delivering improvements in outcomes and costs across the state.

He used a session at the annual conference to underline this message, highlighting an example in New York Montefiore Health System where healthcare purchasers were fitting air conditioning units in homes of patients with chronic obstructive pulmonary disease after spotting the link between extreme hot weather and increased attendance at emergency departments. This was value in action, he said – better results for patients at reduced costs.

In the UK, Aneurin Bevan University Health Board is one of the organisations leading the way on value-based healthcare. Paul Buss, the board’s medical director and winner of the HFMA’s 2017 Working with Finance – Clinician of the Year Award, said there needed to be much wider adoption of the value-based approach. Cost data could reveal patterns in clinical practice that could help clinicians to understand current practice, identify variation and change behaviours where appropriate.

He called for every foundation trust or integrated health board to have a chief value officer and said that medical directors were the perfect candidates for these roles.

The conference also showcased the best in NHS finance and governance as it hosted the annual HFMA Awards. Eight awards were handed out to individuals and teams covering categories such as costing, governance, training and innovation. Manchester finance director Adrian Roberts claimed the overall Finance Director of the Year Award. You can read more about their winning entries in this year’s HFMA Awards 2017 supplement.

Full coverage of the HFMA annual conference 2017 

Association to collaborate on NHS future

Manchester director wins FD of the Year

Medical directors should lead on value

Good financial progress, but more to be done

ACSs urged to use control total flexibility

Costing excellence

LEAN institute announced

Orchard calls for long-term review

FFF outlines accreditation benefits

More trusts need to realise potential of PPIB

Colour scheme supports flow improvement

FIP using Model Hospital

HFMA Awards 2017