Comment / A public duty

A public debate is needed on the scale of the financial challenge – and finance staff have a key role to play in that discussion

In October, NHS confederation chief executive Mike Farrar called for an ‘honest public debate’ about NHS finances. He argued that politics – for example, the claims and counter-claims around private finance initiative costs – focused attention on issues that were relatively minor in the scheme of things and tended to ‘obscure the real scale of the problem’.

We in the NHS finance profession need no convincing about the size of the challenge we face. Meeting the combined pressures of increasing demand, improving technology and rising costs, all within static resources, will not be achieved by incremental changes to the cost base. Maintaining quality and, most importantly, safety for our patients will only be achieved by a fundamental change in the way we deliver services. 

This will inevitably mean the centralisation of services in specialised centres and the closure of acute beds and it will have an impact on jobs. We cannot deliver the transformed services we need without these things. In this issue we look at telemedicine.  Early signs are that this can deliver wins all round – better support for patients, fewer admissions (and so reduced expenditure for commissioners) and, if delivered at scale, the opportunity for acute providers to close beds and reduce costs.

However, experience tells us that, with these kinds of changes, it is the closures that grab the attention. And it is public reaction that often presents the biggest barrier to changing service provision. Many of us will be able to cite local examples of public opposition to accident and emergency departments or maternity centres, whatever the clinical and cost-effectiveness arguments.

It is crucial that the public understands the size of the financial dilemma faced by the NHS and is involved right from the start in planning the creative solutions that will ensure a strong NHS for the future.

This, of course, is easier said than done. The messages can be complex and difficult to translate for our own staff, never mind a public informed by a media with a preference for shock and awe.

So how do we move past the notion that transparency in healthcare affairs can be achieved by holding board meetings in public? There are examples of organisations doing good things in this area, but there is definitely more that could be done.

We need patients and the public not only to understand and support future changes to health services, but to actually shape and own the changes.  The degree of transformational change will be much more powerful with public involvement.

The starting point has to be a good understanding of the problem. And this is where finance professionals have an important role.  Our reporting and communication has traditionally been largely inwardly focused in our organisations, with the exception of the statutory annual report and accounts and the annual general meeting. 

We need to consider how we can translate the financial context very simply so that everybody can understand the challenges we face. We need to avoid jargon and technical language and be clear in our messages. We need to make the financial links across the wider health economy and accurately model the consequences of proposed changes in services.

The HFMA also has an important part to play in getting  a clear message about the finances across nationally. But crucially, we need to think about how we echo this locally across our own communities.