Comment / Get Carter

This time of year always gives me the jitters! For finance professionals, the agenda is always huge with so many balls up in the air and the threat of dropping one. One of them looks as if it is about to fall with the Q3 figures published in February. Rising demand, staffing problems and an impossible provider efficiency requirement have continued to broaden the funding and spending gap across the provider sector.

Some providers will be responding better to the pressures than others, but this is undeniably a systemic problem. And the shortfall is growing. Provider forecasts at Q3 indicate a £2.8bn deficit at the year end, albeit reducing to £2.4bn on the back of subsequently identified financial improvement opportunities.

This is £0.6bn out of kilter with what was proposed by system leaders back in January. This, and the fact that reports suggest a third of providers have not agreed to the proposed 2016/17 control totals, may have an impact on the availability of next year’s sustainability and transformation funding.

Minimising this year’s provider overspend is not just a problem for the national bodies. How we land this year will have immediate consequences at the local level next year. We are duty bound to do what we can to deliver the best possible financial position for our own organisations, our health systems and the national service.

But nor can we afford to focus solely on the immediate financial position – we need to keep an eye on planning for next year and those five year system plans.  This demands that systems rethink how they can improve time spent. What doesn’t add value? How much time is being spent in commissioning rounds fighting over the same pound or about where the financial risk will fall?

Wouldn’t time be better spent working together on coherent joined-up plans? Next year’s additional funding in reality buys the service some time. But if we do not use the slight breathing space to transform the way we deliver services, all we will have done is delayed the worsening financial position.

The Carter report, published in February, provides us with some support. Its target of £5bn savings would certainly be welcome. Achieving even a proportion of this savings target will require discipline and action on multiple fronts. However we need to get as much benefit from the work as possible.

The report provides some high level signposts to where savings can be realised. Now we need to do our own local analysis on the areas that will deliver savings most readily locally. In reality, no provider can flip a ‘Carter switch’ that will raise productivity levels across the board.

Instead improved productivity is likely to be delivered service-by-service, department-by-department and ward-by-ward. The data flows envisaged by Carter are fundamental to this – providing an opportunity for increased evidence-based decision making.

Finance staff need to be really active – networking with colleagues across the profession to bring ideas back to their own organisations and engaging with clinical colleagues across their own organisation to help them understand the cause of unnecessary variation where it exists.

A leading commentator recently called for finance departments to be closed in favour of having finance experts ‘embedded in every team and department’.

This misunderstands how finance teams work. Finance already works closely with clinical teams and simply does not work in isolation. But he is right that clinical engagement – and ever increasing engagement – will be the key to success. Let’s step up and make it happen.