Comment / Taking control

The finance function as a whole faces huge challenges, but support and development for individual practitioners is on hand.

January can be a quiet time of the year, except for over-crowded gyms as new year’s resolutions get under way. But ‘quiet’ is not an adjective that could be applied to the NHS this year. Having faced significant flu-driven winter pressures – to which I personally added with a bout of pneumonia – the service has been hectic. It has been road-testing the new tariff, published in December alongside the new operating framework, and coming to terms with the reform programme spelled out in January’s health bill.

No one in the healthcare finance community is in any doubt about the challenges we face – both in maintaining financial control while delivering huge efficiencies and in supporting the move to the new structure. But the bill and the various business rules for 2011/12 have helped crystallise this challenge.

We are moving towards a very different system that will be far more rules based. The media focus has been on GPs and the commissioning consortia, but the changes for providers are just as profound, if not more so – a point underlined by NHS chief executive Sir David Nicholson when he addressed the HFMA FT Finance directors’ forum recently (see page 8).

A definite deadline for trusts to become foundation trusts – April 2014 – is one of the bill’s headlines. But the changes around economic regulation, any willing provider, pricing and greater independence (and a ‘freedom’ to fail) provide risks and opportunities. A 4% efficiency requirement in tariff is perhaps slightly lower than many had anticipated. But the impact of zero reimbursement for emergency readmissions, penalties for mixed sex accommodation and tweaks to trim points for long-stay patients are likely to add to the financial pressure for many organisations.

Primary care trusts face their own challenges. Greater integration with social services, producing robust and deliverable QIPP plans, creating non-recurrent headroom and dealing with legacy debt.  And beyond the short term, we have a major reform programme.

On this front, clearer pathways for transition are starting to emerge. The move to create PCT clusters by June 2011 under single executive teams makes practical sense and improves certainty. But it will also present its own workload and potential diversions.

The healthcare finance function will retain a key role through and beyond the transition. We know we hold the key to much of the success of the system. Financial management responsibilities stretch well beyond the finance department. But it will be finance professionals who will help clinicians identify opportunities for service and cost improvement – for instance, by using patient level costing data – and continue to deliver many of the routine but vital components of governance and accountability. The service will increasingly rely on our imagination and creativity to help redefine the healthcare business.

Knowing finance’s role is assured within the system is not the same as having personal job security. Many face uncertainty over their futures. Some perhaps feel exhausted at the prospect of yet further reform.

That is where the HFMA’s ‘Take control’ initiative comes in – a series of free events and workshops for finance staff supported by the Department of Health. They aim to help finance professionals take stock, think about opportunities and personal challenges and brush up on key skills.

Feedback from the early sessions has been excellent. The benefits are wide ranging and, for me at least, infinitely more useful than an unused gym membership.