Finance managers are at the sharp end of the health service’s budget squeeze. But all NHS staff need to embrace a collective vision that will support radical change and allow savings targets to be achieved
It is common knowledge that the NHS faces an ‘unprecedented squeeze’ over the next five years, with staff under pressure to make financial savings in all areas.
This is due to a number of well-publicised factors including the burden of an ageing population and real-term cuts in funding year on year. In England alone, it has been estimated that continuing with the current model of care will result in a funding gap between projected spending requirements and resources of around £30bn between 2013/14 and 2020/21 (approximately 22% of projected costs in 2020/21).
The harsh reality facing public finance professionals in the health sector is that, at least for the foreseeable future, there is simply no more money coming into the NHS. Yet the demands on the service continue to increase unabated – as do the costs.
Finance managers are at the sharp end of this squeeze. But they know that savings of this scale cannot be realised by ‘traditional’ approaches to cost improvement, which broadly means doing the same things with less money. And while service delivery models have indeed evolved, much of the way the NHS operates is still dictated by the legacy of the past.
It is clear that a short-term approach isn’t going to build the sustainable NHS we need for the future. We all know that the NHS has needed to transform the way it does business for a long time, and that transforming service provision will be the key to a fit-for-the-future NHS. This is particularly critical given the high-profile failings in organisations such as Mid Staffordshire NHS Foundation Trust.
Additionally, we are all aware that our ageing population is resulting in the balance of diseases shifting ever more towards long-term conditions. These new challenges mean that the trend towards greater clinical specialisation is not going to dissipate and we must all recognise that some services are better delivered from centres of excellence, in order to increase quality of care.
The focus needs to be on the services that are provided and not the buildings they are provided in. In this way, more services can be delivered in the community and better links need to be made with social care services.
But most crucially, as Mid Staffs has taught us, patients must be at the centre. By gaining buy-in from patients and the general public at large, and educating them about the need for responsible changes (and why in certain scenarios difficult decisions have to be made), we can achieve higher quality and safer services.
It’s not just that change needs to happen – the pace of this transformational change must also significantly increase.
We should not be fearful of these wide-reaching changes or the speed at which they are required. Instead, we need to see this as an opportunity. High quality healthcare, valued by patients and the public and achieved through transforming the way services are delivered, will lead to savings that are sustainable and recurrent.
We must now all get behind a collective vision and clear goals, which should be communicated to every member of staff, regardless of their role. Additionally, NHS boards need to lead from the front – working in partnership to agree on how to spend the resources available to best effect, rather than individual organisations making cost savings in isolation.
Finance managers must continue to work hard to engage clinical colleagues to show them how they can best support service transformation and the finance implications of the clinical decisions they make. And with everyone working together, we can all help to make this clinically-led transformation happen.
Paul Briddock is policy and technical director of the Healthcare Financial Management Association
