Comment / Keep it simple

I did my first HFMA branch conference towards the end of February. The HFMA Eastern Branch had a great event, packed with a mix of technical and softer skills-type presentations.

The highlight for me was listening to an incredibly courageous lady who has battled with a disability for 52 years and is now at a place in her life where she doesn’t care what others think.

She has reached a kind of inner peace that many of us strive for and has a work-life balance that seems out of reach to many of us – an inspiration to us all. So thank you to the HFMA’s Hayley Ringrose!   

The conference was full of discussion about the recent draft plan submissions and the various levels of deficit that each integrated care system plan appeared to be reporting at the time.

I was approached on more than one occasion and asked whether the HFMA was going to be saying anything at a national level about some of the more interesting policy directives that have materialised in this year’s planning round. The rules around the elective recovery fund came up a lot in conversation!

It would appear that no matter where you sit on this spectrum, whether you are a trust tasked with getting to 103% of 2019/20 activity or aiming for 113%, there is a particular reason for you to feel aggrieved.

I’m not sure what the right answer is to this, but it is clear that nothing will make everyone happy.

Is the solution to reinstate some arbitrary target that is equally applicable to everyone – a bit like telling us all to get to 76% with the emergency department standard or have no patients waiting longer than 65 weeks? Or should we continue with differential target baselines that don’t, on the  face of it, seem terribly intuitive or logical in their creation?

I don’t envy the team at NHS England tasked with developing these financial systems, and I would never dream of telling them what to do. My only advice would be to make it simple.

The level of complexity we are wrestling with and the numerous ways that the system rules are being interpreted are not helpful.

I get the sense from talking to colleagues that we just want the rules to be clear and unambiguous, which is arguably something that we haven’t got quite right so far this year?

What is certain is that there is a lot of work needed to reduce deficits.

The question bothering me as a chief finance officer is what happens when we can’t get the numbers down any further?

At what point do we need to talk about what is actually deliverable, as a national health service, if we are to remain within this resource envelope?

That said, there is clearly more we can do, particularly on productivity, and all organisations must be looking to reduce unit costs over the coming period.

But it’s not just waiting lists and the ERF that are causing concern. Most systems are also wrestling with the challenges of urgent care and ever increasing lengths of stay in hospitals as out-of-hospital services continue to recover from the pandemic, the economic downturn, and even Brexit.

The push on virtual wards is a good example. These initiatives operate on a simple premise – care closer to home is safer and better for the patient and, in the long run, could be more cost effective too.

This is definitely a work in progress, and not without its challenges – working with stakeholder partners in a way that many of us haven’t done previously. And learning to be reliant on the system acting in concert is a real ask, especially with the workforce pressures that many of us are also trying to juggle on a daily basis.

The temptation to abandon initiatives such as these before they have time to mature and flourish is a real one. However, I think it is a temptation we need to resist as we try to change decades of consumer custom and practice through the use of technology and virtual medicine. These approaches offer real hope in terms of freeing up physical beds that will help with recovery.

Lee Bond is chief finance officer at Hull University Teaching Hospitals NHS Trust and Northern Lincolnshire and Goole NHS Foundation Trust. This blog also appers in the March issue of Healthcare Finance.