Comment / A time for grit

The weather may have turned milder, but finance directors continue to be snowed under by the challenges of stormy years to come 

January’s sustained and heavy snowfall added to the country’s challenges. But after reading the pre-Budget report and operating framework, it appears that whatever the weather outlook, finance directors will continue to be snowed under as Lean working road maps and transformational project plans fall on their desks.

The King’s Fund’s cheery pre-Christmas offering, How cold will it get?, suggests that as the service approaches the new financial year, the financial thermometer will continue to fall. And just as the nation seemed ill prepared for January’s big freeze (with shortages of salt and grit and panic buying of bread and toilet rolls), so we may come to regret the lack of concerted effort over the past 12 months to reduce collective spending in many health economies.

Indeed, Monitor has indicated that a number of foundation trusts are still targeting significant volume increases to offset real cuts to provider funding next year!

For most NHS organisations, however, the tariff has been modelled and the operating framework digested sufficiently for all to be in no doubt that collective action can be delayed no longer.  And while health secretary Andy Burnham was right to warn against unfocused ‘slash and burn’, this must not be an excuse for inaction. 

It all boils down to reducing collective recurrent spending by around £20bn over the next four years to meet the rising ‘Wanless’ demographic, patient expectation pressures and the soon to be reawakened inflation beast. While service-wide numbers remain comfortably abstract to the non-accountant, the good news is that the replaying of the numbers at a local organisational or health economy level is a much more sobering experience for chief executives and other board members.  

Most appear to agree with my own analysis that savings of this level can only be achieved by reducing the frontline clinical, as well as the back office, pay bill and through a hitherto  unprecedented degree of clinical engagement across the entire patient pathway.

I would commend to all HFMA members the joint statement of intent agreed between the Audit Commission, the HFMA and the Academy of Medical  Royal Colleges and other clinical representatives.  This states: ‘Money will only be used well if clinicians are fully engaged in managing it. Ultimately it is clinicians who are responsible for the way in which services are delivered to individual patients and it is they who commit the necessary resources.’

All finance staff should learn this mantra by heart and quote it often in the next few months.  Our aim must be to urge and cajole our clinical colleagues into designing new clinical pathways for their services that are safer, faster, deliver an improved patient experience and are also cheaper.

The role of finance is not ‘to do’ but ‘to guide and support’ the change. But while finance staff will have a pivotal role in the process, getting the organisation into clinical shape in a financially more challenging environment cannot be left to the finance team.

It is our duty to understand the numbers, to have the courage to put our heads above the parapet when required, and make sure our boards are well briefed on the scale of the challenge ahead. You could say we mustn’t run out of grit and determination.