Comment / A new way

A new approach to developing and implementing NHS policy will place new demands on a more enabling and engaged finance profession

At this time of year, when many of our colleagues are more concerned with parties and presents, we NHS accountants tend to spend most of our time poring over the new operating framework, trying to discern what it will bring to the financial fortunes of the NHS in the New Year. 

Many column inches have been filled with stories about the delay in producing this document and the delay in receipt of primary care trust allocations following the implementation of the new formula by the Advisory Committee on Resource Allocation (ACRA). These reports have also raised concerns about the potential volatility created by changing the healthcare resource groups used in the tariff, switching from HRG version 3.5 to HRG4. 

But are these criticisms justified?  Do we fare less well than other sectors?  The evidence suggests not.

Several recent media stories have speculated that the health service in England will only be able to draw down £400m of the £1.7bn accumulated surplus in 2009/10.  While this has been greeted with howls of disapproval, how many of our private and public sector colleagues would relish the opportunity of working out what to do with this kind of resource?

Turning to HRG4, there have undeniably been delays in producing information and informing the NHS of the likely impact.  But what is the alternative?  Produce a system without road testing?  Issue a tariff and then withdraw it as we have seen in the recent past?  Engage clinicians in the development of the new tariff and then change this when we don’t like the results?  None of these outcomes is desirable.

The direction of travel in the English NHS is clear.  The NHS Next Stage Review has heralded a focus on clinical engagement and quality.  And given the business we are in, who would argue with this?

The NHS in?England: the operating framework for  2009/10 makes it clear that these actions will be delivered by adopting techniques and approaches we have not always seen evident in the NHS.  We will do business based on four principles:

l co-production: solutions need to be jointly produced with the local NHS and not merely imposed from the centrt

l subsidiarity: while the centre will play an enabling role, the details of implementation should be determined locally, where possible.

l clinical ownership and leadership: NHS staff must be active participants and leaders as the Next Stage Review is implemented.

l system alignment: the NHS is a system, not a single organisation and therefore, the wider system must be aligned to the same goal, enabling quality to be improved through the system’s combined leverage.

This marks a very different approach to development and implementation of policy in the NHS.  One where involvement, participation and consideration are much more evident than we have ever witnessed before.  And this new agenda will require us, as finance professionals, to move from our traditional performance management role to one where we become more engaged and enabling.  The programme which has now commenced within the HFMA to investigate and learn what world class finance looks like will, hopefully, go some way towards helping us on this journey.