Comment / A problem shared

The HFMA’s July Convergence conference concentrated on the shift towards local system working as health and social care work together to provide patient-centred care efficiently and affordably. There was a lot of discussion about legal forms, governance, structures and a whole raft of new acronyms to grapple with. However, a common message from speakers was that successful changes to working practices often only happen when they are driven by key individuals who are engaged and enthusiastic. 

Enthusiasm and engagement will not, on their own, result in positive changes to the system.  The changes need to be made within the complex framework of legislation and governance that the NHS and their partners - inside and outside of the public-sector – already work with. This means making changes while meeting the complexities of the Health and Social Care Act 2012. While legislative changes may well be needed at some point – there won’t be any new legislation any time soon.

The engaged and enthusiastic people need to understand the systems that they are working in and we’ve produced a number of publications, some more technical than others, looking at partnership and integrated working.

Our briefings on pooled budgets and the integration agenda and the better care fund – the full year experience  set out the legislative basis for pooled budgets and also look at the first year of the better care fund to identify good practice and lessons learnt.

Working in systems means finance staff trying to affect change need to be comfortable working together and understand each other’s worlds.  We are working with CIPFA to try to close the cultural and language divide which seems to exist between NHS bodies and their local authority colleagues – we have recently refreshed our glossary of NHS and local government finance to reflect the development of sustainability and transformation partnerships (STPs) and accountable care systems and organisations (ACSs and ACOs).  We have also worked with CIPFA on how local authorities and NHS bodies can work together to fund capital projects.

It was perhaps unsurprising to hear at the summer conference that it is the finance community that is well placed to make changes happen – we are used to networking, we speak a common language and like to learn lessons from one another.  However, we also have the business acumen to think around of all of the implications of a new arrangement.

One of our very technical briefings is on accounting for joint working.  This briefing tries to tease out the questions that need to be asked about an emerging new working relationship in order to determine the accounting treatment.  These questions are also a good basis for understanding the governance arrangements for the new arrangements and for identifying some potential pitfalls.

Partnerships are absolutely fundamental to the transformation agenda and to taking a system-wide approach to meeting current challenges. That means partnerships between, sectors – health and social care in particular. It means partnerships between NHS bodies – both commissioners and providers. It means partnerships between different professionals – especially clinical staff and finance staff. And it means partnerships between finance practitioners from all parts of the health and social care sector.

Understanding what works and what doesn’t and what is possible and what isn’t within current rules and financial frameworks will be further important ingredients. Guidance and shared best practice will be play an important supporting role. You can expect the guidance and briefings in this area from the HFMA and partner organisations to keep coming.