Comment / Reasons to be cheerful?

That's a tough ask. Health economist and research director at the Health Foundation, Anita Charlesworth, offered few reasons to look on the bright side in the current financial climate. No prospect of additional funding (speaking before the government raised the possibility of allowing councils to further increase council tax to boost social care budgets) and a productivity improvement that no other health system has achieved was her bleak conclusion.

Pay restraint was in part to blame for the current agency staffing challenge, she asserted, and with concerns about staff morale, workforce was 'the number one finance risk.'

It was NHS Improvement chief executive Jim Mackey who wanted positivity in the face ; of this hostile economic reality. Finance directors - while resisting all pressure to do anything other than report the financial truth – should sidestep their tendency to be 'borderline negative' and ensure discussions were framed around the art of the possible.

Providers £650m year-to-date deficit represented a huge result and the service was on course to take an 'incredible' £1bn out of agency spending. Next year's control total-driven planned provider balance might require heroics, but would put the service back into earned autonomy territory.

Easier to say than to do, you might argue. But Mr Mackey had some thoughts on where NHS bodies should look for these heroic improvements in efficiency – variation.  Variation, he said, was how politicians challenged calls for additional healthcare funding and the level of variation, across the provider sector and within organisations, was significant. Even the most efficient organisation had services that were seriously inefficient, he said.

Few in the finance community would argue with the value of addressing clinical variation – both from the point of view of improving service consistency and increasing value. But making it happen – or influencing clinicians to make the changes themselves – is no easy thing.

Here then are three reasons to be cheerful that emerged from the HFMA annual conference . 

1. Help is at hand. Professor Tim Briggs has been championing the elimination of unwarranted variation in orthopaedic surgery for several years. His Getting it right first time (GIRFT) initiative – which is clinically led – has exposed major differences across the country. Surgeons performing fewer procedures annually than recommended. Continued use of unnecessarily expensive approaches and implants for some patients, despite accepted evidence of better (or as good), more cost-effective approaches. Wild differences in prices paid for common implants and bits of kit – and the highest volume users not getting the lowest prices.

Some organisations have not yet changed practice in response to their own data, but Lord Carter’s backing for the programme should change this. And the news that the programme is being expanded to 30 specialties has to be good news. With the GIRFT team offering to help trusts make the case locally, here is a practical tool to help organisations understand variation better and eliminate it where appropriate.

2. Better data is on its way. The key to unlocking variation and driving improvement generally is robust data. It has been too easy for clinicians to dismiss both activity and cost data in the past on the grounds of inaccuracy or claiming it doesn’t reflect actual practice. But data is getting better. The acceleration of the Costing Transformation Programme, announced ahead of conference and reported in the conference issue of Healthcare Finance, promises to provide a robust and granular makeover to the value equation’s crucial denominator. The importance of the initiative and the need for finance directors to back it was highlighted in a question and answer session at conference. And while the NHS could do with simply switching this data on right now –at least it is on the road towards it. NHS Improvement’s model hospital programme also promises wide ranging comparative data on everything from staffing to procurement.

3. Financial enthusiasm. Okay perhaps the conference shows the finance function in its most positive light – but there was bags of enthusiasm, pragmatism and can-do attitude on show at the conference. Perhaps the characteristic ‘border-line negativity’ was set to kick in when managers returned to their day jobs, but for a couple of days at least, the function seemed up for the challenge. Workshops highlighted really interesting progress with new models of care and moves towards outcome-based commissioning – all essential for sustainable future services and being taken forward while still driving hard to improve in-year financial positions.

Finance staff are too often viewed as a mere overhead to frontline services – a support service that should be minimized at all costs. But the function knows its own value. And the HFMA annual awards, held during the annual conference, demonstrate this in spades. The awards grow bigger and more competitive each year and show case real examples of how the finance function continues to deliver in important areas such as governance, financial management and reporting. The pride finance managers take in their role was obvious to anyone in attendance. And this is surely a reason to be cheerful all on its own.