Comment / Strategy and tactics

I attended the North West HFMA conference in January and had the privilege of listening to General Sir Richard Shirreff, a really thought-provoking speaker who had spent time as the deputy supreme allied commander in Europe.

He spoke at length about planning military campaigns and shared
with the audience a quote from Sun Tzu, the Chinese general and philosopher responsible for writing The art of war 2,500 years ago.

I have reflected on this quote a lot as we have been going through the NHS planning process this year. He said: ‘Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before defeat.’

Finance staff across the country might be forgiven for being somewhat confused as to where strategies and tactics fit together in this planning round. 2014/15 was a challenging year, to say the least. From early on in the year, provider organisations, particularly in the acute sector, have been forecasting significant deficits.

These have grown, along with the number of organisations affected, and there have been distinct challenges in meeting some service standards – perhaps most clearly in accident and emergency department waiting times.

We now have the Five-year forward view setting out options for the future. It is fair to say that a consensus has been developed behind this vision.

There is agreement about the challenges and the broad things that will need to happen, over time, to meet them – greater prevention and new models of care.

More recently Devo Manc has been unveiled and will set the direction for the people of Greater Manchester. They both provide compelling visions of the future, but it’s not really clear yet what the read-across is to addressing the day-to-day challenges we are continuing to experience

The safe staffing agenda was introduced partly in response to the service failings exposed at Mid Staffs. But without the benefit of a strategy to increase staff in training, and with limited funding to support the growth in numbers, the result is massive growth in staffing overspends.

Coupled with the long-term strategy to transfer funding from hospital care to the community – and the resulting cost efficiency requirement – and providers are left with more cost, less income and the ability to drive efficiencies from only a proportion of their cost base.

Meanwhile, commissioners are required to plan for surpluses while handing over funding to the better care fund and agree contracts with providers that support sufficient activity and resilience to achieve service standards.

They are now going to be dealing with two tariffs and running CQUIN schemes with some providers and not with others.

We NHS finance staff pride ourselves on our personal resilience and how we handle the challenges and contradictions in the system. Now more than ever, we need to make huge efforts to understand each other’s positions and work together across health economies to link the strategies with the tactics in the best way we can to deliver plans for safe, sustainable services.

We need to take the NHS to victory and we can’t contemplate defeat.

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