Financial control

01 March 2023

Like a cliff edge emerging through the fog, next year’s daunting financial challenge is becoming clearer – why does principal consultant David Cryer see this as an opportunity?

This might sound strange, but I do wonder if the operational challenges facing integrated care systems, providers, commissioners and partners might also present an opportunity.

While all are struggling with the level of urgent and emergency care, ambulance handovers and response times and managing the planned care backlog, the financial challenge ahead is rapidly becoming clearer. Like a cliff edge emerging through the fog, the scale of the ‘savings’ to be made next year are becoming clearer and more daunting.

Why might this be an opportunity? Well, we have been here before. We have been through ‘difficult choices’ and ‘success regimes’, we have plucked the low-hanging fruit and seized the quick wins. A lot has already been achieved, so now the opportunity is to focus on the longer-term changes in clinical practice and patient management that will help a system to become more sustainable in the longer term. This isn’t necessarily about finding solutions that will ‘fix’ the problem, but identifying those that might make it better.

Good governance helps

It will always be necessary, and helpful, to be comprehensive. The HFMA checklist will help. GGI has a checklist that will help and there are others. Benchmark prescribing, compare Continuing Healthcare, and properly interrogate the Model System and other data sources to identify the opportunities for improving the quality of care, the experience of patients and the costs in the system.

If your governance processes are working well, you will have all of this already. We can certainly help you in enhancing and improving these processes through review and recommendations, supported by coaching of non-executives and executives alike. As our CEO, Professor Andrew Corbett-Nolan, says: ‘good governance makes it really difficult to do the wrong thing and really easy to do the right thing’. Good governance processes are of course central to an effective financial recovery programme.

If your programme is not comprehensive, then GGI can help you with that detailed analysis where you have gaps. We can help you to interrogate the data and identify where your system has opportunities to improve the triple aim of patient experience, outcome and value for money.

Analysis, then engagement

However, analysis is the easy bit. The next step is more challenging: engaging across the system, with clinicians and allied health professionals, with the public and executives at trusts and in the integrated care board, and agreeing the right focus for action.

We can support you here too, helping to build the consensus you will need to take action. Analysis will give you a large part of the answer, but engagement across the system will help to refine it. There will need to be a focus for improvement and change while holding all else stable. That comprehensive approach will be needed to enable a system to move towards sustainability.

You will also need a best-in-class finance function – one that operates across the system in an open and transparent way. Robust financial analysis will need to be incorporated into the way teams across the system work, into how improvement methodologies drive change and how decisions are made in a consistent manner.

When you have a well-focused and governed financial recovery programme in place the last aspect to consider is how you communicate that programme. How you get clinicians and trusts and the public engaged to support the drive for continuous improvement will be critical for a successful programme.

While focus is important to achieve the change that makes the system more financially robust, that needs to be communicated clearly to the thousands of clinicians and allied health professionals whose behaviour you are trying to change a little each day.

If you can manage and execute effectively and communicate that to key stakeholders – including NHS England – then you may be able to improve both the long-term sustainability of your system and the patient experience and outcomes as well.

Our programme for financial control and recovery has four stages:

  • Review of existing financial governance arrangements
  • Detailed review of existing data and financial recovery programme
  • Developing system capabilities to support financial sustainability
  • Communication and engagement in financial recovery and sustainability

Let’s talk about how GGI can help to support your financial sustainability.

Prepared by GGI Development and Research LLP for the Good Governance Institute.

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