Comment / HFMA 2019: Finance function starts to map out future role

In particular, the conference was asked to consider how the finance function itself will need to change as the service adapts to working more as systems and to using new technology. The discussion came on the back of a new report – launched at the conference by the HFMA, Future-Focused Finance and PwC.

Designing our future: better decisions, better health imagines a future where the NHS is seen as the best place to work for finance staff, where diversity helps to drive innovation and where finance staff are widely recognised for their contribution to delivering good patient outcomes. Introducing the report, Simon Worthington, director of finance at Leeds Teaching Hospitals NHS Trust and a member of the Finance Leadership Council, said it was an attempt to think about what the function needed to start, stop or do differently.

There are plans to consult widely on this vision – involving as many of the NHS finance function as possible – before finalising next year. A panel discussion covered numerous topics including the impact of new technology taking on more transactional processing within finance teams,  finance’s role in carbon reduction and the importance of meeting the needs of younger finance professionals.

As the NHS moves towards greater system working, there should be opportunities to improve patient pathways and potentially improve value. Finance will need to take a leading role in this work, working with clinicians and frontline teams as business partners. And it will be important for finance staff to get opportunities to work in different parts of the service to develop a rounded perspective.

Mr Worthington called on NHS bodies to ‘start making small steps now’ rather than wait for structural changes or to be told to do it. ‘[Providers] have you invited your commissioning finance team to your finance time out for instance?’ he asked. ‘We can all do things to get to know each other in the system.’

Chief executive of the Royal Free London NHS Foundation Trust Caroline Clarke – and the new president of the HFMA – agreed with this approach, wondering if shared apprentice schemes could replicate the cook’s tour approach used by the national graduate training schemes. ‘Find a few things you can work on collectively with other organisations and build up trust and relationships while doing this,’ she said.

The need for finance staff to work more closely with clinicians was also picked up by David Berridge (pictured), deputy chief medical officer of Leeds Teaching Hospitals NHS Trust in an earlier session. The trust’s focus on waste reduction – rather than cost improvement – has helped to engage clinicians as has the trust’s Scan4Safety programme.

The trust’s theatres all now have trackable items – enhancing patient safety and enabling rapid location of items subject to manufacturer recall – and barcoded bracelets mean that patients can be tracked as they move around the hospital, opening up the possibility of live bed availability data.

Working together to implement Lean processes, staff identified significant amounts of out-of-date stock and theatre implements on trays being regularly re-sterilised despite the fact that the surgeons who used them had now retired.

All the information gathered is now feeding the trust’s patient-level information and costing system (PLICS), enabling clinicians to drill down to specialty and healthcare resource group level to identify where variations are arising.

Clara Day (pictured), nephrology consultant and associate medical director for finance at the University Hospitals Birmingham NHS Foundation Trust, picked up a similar theme as she briefed the conference on the trust’s experience piloting the Engagement Value Outcome (EVO) framework being delivered by the HFMA Healthcare Costing for Value Institute and Future-Focused Finance. The framework looks to support trusts in use of PLICS data to deliver value in terms of outcomes and costs.

She walked the conference through a patient journey highlighting aspects that didn’t work well for the patient. She said the EVO programme was a way of trying to address this sub-optimality by engaging around the data.

In terms of finance-clinical interaction, she urged finance practitioners to think about presentation – clinicians like pictures not pivot tables, she said. ‘Proper time’ together should not be underestimated and she said clinicians needed to understand that costing data might not be as accurate as data they are used to in research, but it was good enough to inform decisions.

Matthew Syed (pictured), author and broadcaster, was also looking to the future as he called on NHS leaders to develop a growth mindset and to learn from mistakes. In organisations with a fixed mindset everyone wanted to look the smartest and saw errors as a threat to their self-image. Organisations with a growth mindset were full of ‘learn it alls’ rather than ‘know it alls’ and this was the best way to address sub-optimality and improve.

The conference took place just a week before the general election and this had an impact, with a number of civil servant and national body representatives unable to address delegates because of pre-election sensitivity rules. However, the election was never far from discussions given its inevitable impact on the NHS and social care.

Jennifer Dixon (pictured), chief executive of the Health Foundation, provided some financial context to the election, setting out how current healthcare funding compared with historical settlements and with international health systems. And she compared the various offers contained with the main parties’ manifestos.

However she also highlighted the need for a long-term view to be taken of the resources needed by the NHS. Current short-termism was ‘absolutely astonishing’, she said.

The House of Lords Committee on the Long-term Sustainability of the NHS two years ago called for an Office for Budget Responsibility-type body for health as a solution to this short-termism. However, this was never picked up by the government.

Dr Dixon said The Health Foundation had decided to fill the gap and will establish a centre in 2020. This will aim to develop supply and demand projections for the NHS. This might mean that in future elections, different parties’ proposals for NHS funding, demand and staffing numbers can be compared with an authoritative assessment of what is needed.

It is hard to imagine an election where the NHS isn’t centre stage, but perhaps this might help to shift the discussion in future away from the size of funding promises and towards how the money is used.