Comment / Single minded

The NHS must make a forensic assessment of all spending areas to test appropriateness, effectiveness and value for money 

As this will be my last chairman’s comment for Healthcare Finance, I want to return to two of the areas I have covered this year: the impact of the economic downturn and my theme for the year, ‘Building world class finance’, which I hope provides pointers on how to respond to the challenges ahead.

The need to find £15bn-£20bn of savings in the coming years will have a profound effect on the way in which care is delivered across the UK. This challenge cannot be met through our traditional

cost improvement programme approach. Nor will a simple reduction in the number of managers close the gap, whatever some parts of the media might say. Rather, we must forensically assess all spending areas and test their appropriateness, effectiveness and value for money.

In my own strategic health authority area, we have begun the long journey of turning our quality, innovation, productivity and prevention (QIPP) plan into a financial reality. What we are finding is that current levels of performance, while significantly improved over the past 10 years, still lag behind national and international best practice.

For example, the evidence shows that by reducing lengths of stay in secondary care to the levels of the median, savings of more than £200m can be made. Equally, when looking at avoidable emergency admissions, more than £40m of savings could be delivered just through ensuring care is provided in a more appropriate setting or by putting effective admissions avoidance schemes in place.

Before we get too carried away, however, at the relative ease with which these savings can be identified, we must remember that delivery will only take place in a successful way if providers and commissioners work together as a single system. Changes of the magnitude envisaged will require a major realignment in provision. Planning will be crucial if we are to avoid a period where we effectively play ‘pass the deficit’ with the inevitable consequence for the organisation where it finally stops.

And this brings me on to ‘Building world class finance’. As I have travelled around every HFMA branch in the UK, I have been struck by the sense of family within the finance profession that transcends organisational boundaries.

I feel strongly that this is something we must not lose as times become more difficult and relationships inevitably become more strained.

I have tried to build on this by asking the association to highlight areas of good practice, assess how we can support members through a period of unprecedented change and look at ways in which we can encourage accountants in the NHS to gain experience in both provider and commissioning bodies during the course of their careers. Surveys of members will also be increasingly important so we can better understand their fears and motivations as well as gaps we can fill through tailored development programmes.

As we enter our 60th year as an association, I know I leave this organisation in the very capable hands of my successor, Paul Assinder, to whom I pass on my best wishes and confidence for the future.

Our association is now more necessary and relevant than at any time through my career in the NHS and I encourage you all to stay involved, participate and support your staff and colleagues.