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Unlocking System Finance a Framework to Support Integration

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Unlocking System Finance a Framework to Support Integration June 2021 | Healthcare Financial Management Association www.hfma.org.uk Unlocking system finance A framework to support integration News Comment Features Features Professional lives System oversight, Discharge support: Specialist hospitals: Supply Chain goals: Technical, events, ISFE developments it’s time to make invaluable role in efficient, resilient training, association and GP funding funding recurrent NHS Covid response and sustainable news, job moves healthcare finance June 2021 | Healthcare Financial Management Association www.hfma.org.uk Unlocking system finance A framework to support integration ContentsJune 2021 News Comment Features Features Professional lives System oversight, Discharge support: Specialist hospitals: Supply Chain goals: Technical, events, ISFE developments it’s time to make invaluable role in efficient, resilient training, association and GP funding funding recurrent NHS Covid response and sustainable news, job moves News Managing editor 13 Mark Knight 0117 929 4789 [email protected] 03 News Editor Call for more detail on system Steve Brown oversight 015394 88630 23 [email protected] Associate editor 06 News review Seamus Ward A round-up of recent healthcare 0113 2675855 [email protected] finance developments Advertising Paul Momber 0117 938 8972 Comment [email protected] Production Wheal Associates 020 8694 9412 [email protected] 08 Discharge duty Printer Caroline Clarke calls for Seacourt recurrent funding to support patient discharge 08 Financial designs The financial framework must Features support system working Professional lives HFMA 11 Getting connected 1 Temple Way, Nottinghamshire costing accountant Clare Speed and clinical Bristol BS2 0BU analyst Lori Edwards Suarez on the gains of working together Executive team 29 Technical Mark Knight Financial reporting under the 13 Special delivery Chief executive [email protected] new integrated care system, plus The indispensable role of specialist hospitals during Covid-19, Emma Knowles recent technical developments and how they can help the service recover Policy and communications director [email protected] 31 Development 17 The missing link Ian Turner Focus on tutors, and introducing Roundtable participants discuss the importance of the Finance director One NHS Finance financial framework needed to support the introduction of [email protected] integrated care systems 32 HFMA diary Local and national events and 23 Covid lessons learnt dates for your diary NHS Supply Chain’s interim chief executive, Colin McCready, on the challenges posed by the Covid-19 pandemic Editorial policy 33 My HFMA The statements and opinions Support plans in Healthcare Finance are Mark Knight on cautious return 27 those of the authors and not to face-to-face events Emma Knowles spells out the association’s work programme necessarily those of HFMA. No part of this publication for the coming year may be reported, stored in a Key contributor awards retrieval system or transmitted 34 in any form by any means HFMA members recognised The HFMA is further committed without permission. Healthcare to reducing our impact on the Financial Management environment. This magazine was Association (HFMA) is a 35 People registered charity in England printed using a waterless and and Wales, no 1114463 and Who’s moving where in NHS chemical free process, using only Scotland, no SCO41994. HFMA 100% renewable energies. We is also a limited company finance, and Alan Brace to retire directed zero waste to landfill and registered in England and (page 36) had no negative carbon impact. Wales, no 5787972. ISSN 1472-3379 healthcare finance | June 2021 01 news News NHS calls for more details on system oversight plan By Seamus Ward organisations will be allocated to segment 2. NHS organisations in need of significant Details of a new, integrated system oversight support will be placed in segments 3 or 4 and framework are due to be published this month, be subject to enhanced oversight by the national but NHS organisations have called for greater regulators, and could face additional reporting greater flexibility, basing the annual performance clarity on how the framework will operate and requirements and financial controls. assessment against the oversight metrics; specific details on measurement of system performance. Bodies will be considered for mandated key lines of enquiry, including breaking even A consultation, which closed last month, support and moved to segment 3 if, for example, and contributing to the reduction of system- said the new oversight framework will assess they are reporting a negative variance against level deficits; and an evaluation of how well the integrated care systems (ICSs), trusts and clinical an agreed financial plan or are forecasting they CCG works with others to improve quality and commissioning groups against five themes, will not meet their plan at year-end. Those in outcomes for patients. This will inform an end- including: finance and use of resources; quality segment 4 will have long-standing, complex of-year meeting with their regional team. of care, access and outcomes; preventing ill needs and previously been in special measures. While welcoming a more system-focused health and reducing inequalities; people; and The current system of special measures, support programme, the HFMA consultation leadership and capability. including financial special measures, will be response warned that it could lead to a greater A sixth theme for 2021/22 will replaced by an integrated recovery need for resources in bodies that have not in the focus on local strategic priorities, support programme (RSP), which past needed support, but are located in a system recognising the unique “We need more will apply to systems, trusts and that does need intervention. HFMA policy and circumstances faced by each details on what clinical commissioning groups communications director Emma Knowles said ICS, and the ‘renewed support will be in segment 4. clarification was needed on a number of points. ambition’ to support greater provided from the SID An integrated approach ‘For example, we need more details on what collaboration, accelerate and NHS England and was needed to fit the new support will be provided from the SID and NHS progress in overcoming the NHS Improvement landscape, the consultation England and NHS Improvement team. Will this most critical challenges, and team” said. The RSP will differ be asking for information, providing challenge, support broader social and Emma Knowles, from the special measures providing more money, or providing advice on economic development. HFMA (above) programmes in several ways. how to use data to make improvements? As a ICSs, trusts and CCGs will be The RSP will focus on systems joint appointment: who will pay for the SID; who allocated to one of four segments. Bodies while also providing support to individual will employ the SID; how does the SID fit with in segment 1 will earn the right to have the organisations. It will be led by an experienced the organisational board and the ICS board?’ lightest level of oversight, including the ability system improvement director (SID), who In its response, NHS Providers warned that to request devolution of programme funding, will co-ordinate an expert multidisciplinary using quartiles as part of the allocation into removing the requirement to account for support team. segments could be arbitrary and ‘potentially resource deployment in exchange for agreed Assistance could include: financial recovery unhelpful as it is relative to other trusts. This outcomes. They will have greater control over support (for example, specialist help to reduce may lead to scenarios where, for example, a the deployment of improvement resources made agency use or implement cost controls); a trust sitting just outside of the upper quartile is available through regional improvement hubs. governance or drivers of deficit review; or penalised for an effectively arbitrary banding. It Trusts and CCGs in segment 1 will also: intensive support for emergency/elective care. would be useful to understand further how these • Be able to request access to funding to provide Legally, NHS England must assess CCG criteria will be weighted against the additional peer support to other organisations performance annually. Currently, this is via the judgements made to identify the correct • Be exempt from the consultancy controls or NHS oversight framework, which examines segmentation for a trust.’ relevant running cost limits leadership, financial management, and The provider body welcomed the commitment • Benefit from streamlined business case performance in priority areas. For 2020/21, to use discretion and flexibility where possible approval. the assessment will be simplified as a result of in identifying the correct segment, particularly Segmentation will be phased in during 2021/22 Covid-19. A narrative assessment, based on as finance metrics could affect many trusts – and reflect the approach to operational and performance, leadership and finance, will replace only half of trusts met their control total in financial planning set out in the planning the ratings system previously used for CCGs. 2019/20, for example, and could be pulled into guidance. Segmentation decisions will be based The consultation proposed the 2020/21 segment 3 without a nuanced assessment of their on the assessed support needed and, by default, approach be adapted for 2021/22 to ensure performance and support needs.
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