Comment / Reality check

The resignation of both the chief executive and finance director of Cambridge University Hospitals NHS Foundation Trust certainly raised eyebrows last month. Coupled with the current level of vacancies in similar posts across the country and comments from existing chief executives about the growing complexity of their jobs, we seem to be in a difficult place. The pressure on senior staff and management is now immense as the NHS grapples with the current financial difficulties.

There have been a number of such resignations in recent times. But these are the same managers that have led their organisations well in the past. They’ve certainly not learned new behaviours or lost these skills. It is the context that has changed. Financial problems are now widespread, with about 80% of acute providers forecasting a deficit this year.

The financial picture is similar in the devolved nations and there appears to be no quick fix to this situation. All eyes, then, are on chancellor George Osborne’s spending review in November, when the sequencing of the promised £8bn new investment comes into sharp focus. The sooner this additional funding is released in this parliamentary cycle, the more chance the NHS will have of putting in place sustainable solutions to some of its challenges.

HFMA policy and technical director Paul Briddock and I are going to meetings every week where the increasing unaffordability of the current regime, particularly in England, is high on the agenda. There are always savings opportunities and chances to do things better and more cost-effectively. But we need hard-nosed reality about what is achievable and in what timescales, not blind optimism.

In his interim report on productivity, Lord Carter was reluctant to set detailed targets but said that up to £5bn of savings could be achieved per year by 2019/20. But crucially he said this was assuming ‘there is political and managerial commitment to take the necessary steps and funding to achieve these efficiencies’. Simply assuming the service can deliver these savings or, worse still, working on the basis that these savings are already banked, will lead the service into more trouble.

The HFMA is undertaking a piece of work planning to test some of the Carter review assumptions. We are fully supportive of the aim to improve productivity and spread best practice and think that any help in identifying these opportunities and achieving them is to be welcomed. However, we need to be realistic about the practicalities in delivering these savings and their contribution to the over-arching financial challenge.

We will be publishing our next NHS financial temperature check in November and the underpinning survey is already under way. We would encourage all finance directors to complete a return if you’ve not already done so.

A key role for the HFMA is to ensure the NHS finance voice is heard as policy is developed or put into practice. We have practical relationships with key stakeholders – providing support and robust challenge where necessary.

This survey means we can undertake this work from a foundation of solid evidence rather than anecdote.