Modernising NHS Procurement

September 2019 | Healthcare Financial Management Association www.hfma.org.uk

Modernising NHS procurement

News Comment Features Features Professional lives Lack of capital Oversight framework: Diversity: efforts to Mental health: how Technical, events, undermines plans first moves towards make NHS finance to get the data right training, association to transform NHS system focus more inclusive to deliver plan news, job moves

healthcare finance

September 2019 | Healthcare Financial Management Association www.hfma.org.uk

Modernising NHS procurement ContentsSeptember 2019

Managing editor News Mark Knight 0117 929 4789 [email protected] 03 News Editor Fears over impact of capital Steve Brown 015394 88630 constraints on patients [email protected] Associate editor 06 News review Seamus Ward 0113 2675855 A new government, Brexit and [email protected] finance pessimism Professional lives Yuliya Kosharevska 0117 938 8440 08 News analysis yuliya.kosharevska@ Taxing problem: how will the hfma.org.uk government appease clinicians’ Advertising Paul Momber anger over pension tax rules? 0117 938 8972 [email protected] Subscriptions Comment and membership James Fenwick 0117 938 8992 [email protected] Seeing the positives Production 10 Wheal Associates HFMA president Bill Gregory on 020 8694 9412 recent glimmers of good news [email protected] Printer BCQ Group 10 Steps towards system oversight NHS is moving towards system regulation, says Steve Brown Page 20 Achieving the right focus: management HFMA information will play a key role in delivering the 1 Temple Way, long-term plan’s mental health service promises Bristol BS2 0BU Professional lives

Executive team Mark Knight Chief executive Features [email protected] 23 Technical Emma Knowles Capital funding back in the Policy and research director spotlight, plus news round-up [email protected] 13 Balancing up Alison Myles and NICE update Education director NHS finance has started taking action to put behind it a poor [email protected] 26 Development track record on diversity and is taking steps to ensure it is Ian Turner Bitesize training from the HFMA more equal and inclusive Finance director [email protected] and latest FFF developments 16 Modernising move Editorial policy The statements and opinions 27HFMA diary Six months on from the in Healthcare Finance are those of the authors and not Full listing of forthcoming events launch of a central procurement necessarily those of HFMA. scheme, we examine how it No part of this publication may be reported, stored in a 28 My HFMA has progressed and how the retrieval system or transmitted Mark Knight looks ahead, NHS is responding in any form by any means without permission.Healthcare plus member news and West Financial Management Association (HFMA) is a Midlands Branch in focus 30 HFMA key supporters registered charity in England Members honoured at an and Wales, no 1114463 and Scotland, no SCO41994. HFMA 32 Obituary awards ceremony this summer is also a limited company registered in England and In memory of Tony Waite Wales, no 5787972. 13 ISSN 1472-3379

healthcare finance | September 2019 01

news News Capital constraints pose risk “Government to safety and transformation support needs to be translated into urgent By Seamus Ward deliver on the prime minister’s priorities, action because the also about the including health. But it added that Mr risk to patients is availability of Eight in 10 trust leaders in England believe Javid’s announcement would focus on rising every day” capital funding. the current restrictions on capital funding are revenue spending – capital budgets are Chris Hopson, NHS Not all bodies have putting patients at risk and could undermine already in place for 2020/21, it said. Providers internally generated plans to transform the health service, according However, the government has already revised resources to fund capital to NHS Providers. capital funding since Boris Johnson took power projects or the freedom to In a survey, 82% of chief executives and chief in July. In one of his first policy announcements, use them. Many also point at the complexity of finance officers said the limited availability of the prime minister pledged £1.85bn in capital the system for managing capital, which often capital was posing a medium or high risk to for the NHS – £1bn was allocated as a one-off involves bidding for separate pots of funding. patient safety. Almost all of those surveyed capital boost for 2019/20, with the remaining In its 2018 briefing, NHS capital – a system in (97%) said capital constraints were hampering £850m to be spent on 20 capital projects. distress, the HFMA called for a simplification of the delivery of transformed services, as set out in NHS Providers insisted this funding could the system that allows NHS organisations access the NHS long-term plan. The survey received 200 only be considered a first downpayment on the to capital and for the process to be made more responses from 143 trusts. funding required. It called on the government to transparent. NHS Providers called on the government set out a multi-year capital settlement; commit NHS Providers chief executive Chris Hopson to address the issue of capital funding in the to bringing NHS capital budgets up to levels in said a capital funding settlement was needed to forthcoming spending round. comparable countries; and establish an efficient, rebuild the NHS. He highlighted the impact of The NHS had been waiting for the outcome of effective mechanism for prioritising, accessing capital constraints, citing the A&E department the spending review to receive news on capital and spending NHS capital based on need. at Kettering General Hospital NHS Foundation funding over the next five years. However, with Next year, 2020/21, is the final year of the 2015 Trust, which was seeing three times more the uncertainty over Brexit, the Treasury decided spending review period and figures for the final patients than its intended capacity. This was to limit the review to a single year – 2020/21 – year are often revised in a new spending review. compromising care, NHS Providers said. with a multi-year review to take place in 2020. According to the last Budget, the overall capital Mr Hopson added: ‘We know the government Chancellor Sajid Javid was due to announce available to health (the capital departmental shares our aim of a properly funded, well- the results of the one-year spending round on expenditure limit) in 2020/21 – before the recent designed system of capital funding, but this 4 September, but as Healthcare Finance went to boost in funding – was due to be £6.8bn. support needs to be translated into urgent action press, it was unclear what would be announced. HFMA members are not only concerned because the risk to patients is rising every day.’ The Treasury said the spending round would about the overall limit on capital spending, but • See technical news, page 23

Oversight framework moves to greater system focus NHS England and NHS NHS Improvement a merged set of metrics Providers’ director of policy and Improvement have released and NHS England in from the previous strategy, welcomed the moves details of a joint approach relation to providers assessment as providers were concerned to overseeing organisational and commissioners frameworks – regulation was not keeping pace performance in 2019/20 ahead are unchanged, the though more with developments. of introducing a new integrated framework will have regular engagement ‘This framework should help approach from next year. a greater emphasis on will be triggered where to support collaboration,’ she The NHS oversight framework system performance. Where necessary. said. ‘But much will depend replaces the separate provider possible, problems will be Proposals for a new oversight on ways of working and single oversight framework and tackled by ‘working with and framework for 2020 onwards the development of positive clinical commissioning group through system leaders’ with will be worked on during the relationships, particularly improvement and assessment greater autonomy for systems year, focusing on the balance between frontline organisations, framework. It will be used to with a track record of success. between organisational and system leaders and NHS identify support needs. Quarterly system review system oversight and how England/NHS Improvement’s Although the existing statutory meetings will be at the heart of system maturity affects this. new regional teams.’ roles and responsibilities of the new system, with a focus on Miriam Deakin (pictured), NHS • See comment, page 10

healthcare finance | September 2019 03 news

Report says five-year plans will make mental health funding more transparent

By Seamus Ward HFMA offers support to improve NCC Local systems will be required to show in their The HFMA has highlighted issues that need to be addressed in the national cost five-year plans how they intend to meet the NHS collection (NCC) following feedback from costing practitioners. pledge to increase mental health funding at a This summer acute trusts took part in the first mandatory submission of patient-level faster rate than overall funding growth. cost data, using new costing standards and guidance. Following a survey of costing TheNHS long-term plan announced a ring- practitioners, the HFMA has written to NHS England and NHS Improvement director of fenced fund for mental healthcare of at least pricing and costing Chris Walters to offer support to improve the process for next year. £2.3bn a year in real terms by 2023/24. It pledged Practitioners raised concerns in a number of areas, including the standards and that mental health funding will grow faster guidance, the collection process and the impact on costing teams. proportionately than the overall NHS budget, In some trusts, the burden of the NCC submission meant there was not sufficient time while children and young people’s mental health to use the patient-level cost data to support improvement work locally. funding will rise faster than both the overall The letter underlines that the association and its Healthcare Costing for Value Institute funding and total mental health funding. remain strong advocates for robust patient-level cost data. The implementation plan outlines the profile of funding for the next five years that will be – clinical commissioning group baselines and a the overall funding commitments. invested in delivering both the mental health central transformation fund. Draft plans are due at the end of this month, five-year forward view and the long-term plan. The implementation plan said financial with final versions completed by mid-November. Funding for these programmes will rise from transparency will ensure the investment pledges The implementation plan also promises a review £481m in 2018/19 (baseline year) to just over are met. Sustainability and transformation of the current approaches to payment, to develop £3bn in 2023/24. partnerships and integrated care systems must a national payment mechanism for mental Total funding for children and young people’s set out how the mental health investment health services. mental health services will increase from the standard will be achieved across their systems, Mental health providers welcomed the baseline of £289m in 2018/19 to £380m this year, demonstrating this through planned investment implementation plan, but were concerned over rising steadily to £904m in 2023/24. in CCG baselines. Systems will also plan for timescales and workforce. Sean Duggan, chief The funding will be delivered via two streams the use of the transformation funding to deliver executive of the NHS Confederation’s Mental

Budget balanced but NHS must retain finance focus

The NHS balanced its budget and the finances had stabilised, secretary Chris Wormald (pictured) Department of Health and Social Care with the majority said the health and care system delivered a 2018/19 outturn within the ‘demonstrating had achieved financial Parliamentary vote, the Department’s strong, effective and balance due to the focus annual report and accounts states. sustainable financial on financial rigour and However, the report warned that the management’. efficiency. Most providers level of rigour needed to deliver this In 2018/19, early had met their control outturn would have to be maintained action was taken on totals, which contributed to to support long-term financial potential overspends the Department achieving sustainability. in providers and clinical financial balance. He The Department had underspent on commissioning groups, acknowledged 2018/19 had been its resource departmental expenditure helping to deliver financial a difficult year for the NHS, with the limit (RDEL) – day-to-day spending balance across the NHS for the third service failing to hit a range of targets. and administration costs – by £646m, consecutive year. The service continued to seek to mostly due to an underspend in resource Though CCGs reported a cumulative strike the right balance between administration (£605m). overspend of £150m, this was balanced performance, quality and safety, When an underspend in central capital by underspends in other parts of transformation and living within its budgets was taken into account, overall the sector, principally central NHS financial means, he said. capital expenditure was £42m under England budgets (£756m) and direct The report said the new financial budget at £5.94bn. commissioning (£310m). framework would promote financial The report said the tighter financial The NHS England annual report said sustainability, but the level of rigour controls on NHS bodies, introduced that, overall, the commissioning sector seen in 2018/19 ‘will need to continue in 2016 to tackle financial problems, delivered a £916m underspend. in future years to support long-term have been broadly successful. Provider The Department’s permanent financial sustainability’.

04 September 2019 | healthcare finance news

Health leaders warn over social care spending

By Seamus Ward

Pressure is increasing on the new government to fulfil prime minister Boris Johnson’s promise to address the problems facing social care. “With mental health Health Network, said: ‘The timescales are tight As he entered Downing Street, Mr Johnson said he had a services suffering for planning in the first year and we must be clear plan to ‘fix the crisis in social care once and for all’. More from particularly careful, too, about being too prescriptive.’ than 150,000 people signed a petition asking the government high vacancy rates, Local systems would seek to understand their to increase social care funding, suggesting a minimum we will need to see workforce needs to deliver the mental health increase of 3.9% a year. The petition called for access for support from the plan. System plans should include a delivery everyone to the care they need. It said social care cuts had left centre” plan covering workforce as well as finance 1.4 million people without access to the care they required. Sean Duggan, and activity. ‘Workforce remains a worry,’ Mr The petition also called for a long-term plan for social care NHS Confederation, Duggan said. ‘It is good news that local areas will that includes a workforce strategy and support for a diverse pictured be more involved in developing their workforce and stable market of providers. but, with mental health services suffering from Petition organiser the NHS Confederation believes it is the particularly high vacancy rates, we will need to largest of its kind. Separately, it has put together an alliance of see support from the centre. 50 NHS leaders – Health for Care – to write to Mr Johnson. ‘Importantly, investment is needed in the Health for Care said cuts were having a knock-on effect on wider health and care system – including in the NHS and this placed delivery of the NHS long-term plan social care, capital, public health and supported in jeopardy. The Local Government Association said councils housing – if the vision of the long-term plan is to overspent on children’s social care budgets by £770m in be achieved.’ 2018/19 due to demand pressures and lack of funding. • Achieving the right focus, page 20 The letter called for immediate funding increases in the upcoming one-year spending round. It also urged the prime minister to hold cross-party talks to deliver a more sustainable social care system that is backed by a long-term financial BMA calls for fund rise settlement. The new system should be reformed to widen eligibility criteria. Scotland’s NHS budget should efficiency savings Confederation chief executive Niall Dickson said: ‘The level be raised to 10% of GDP and while delivering of distress being experienced by hundreds of thousands of the government should foster a unachievable vulnerable people and their carers is now much greater and more supportive culture where the targets. on a wider scale than at any time in living memory. This is a workforce is valued, according to the BMA Scotland consultants crisis and it has to be urgently addressed. British Medical Association. committee chair Simon Barker said ‘We welcome the prime minister’s early commitment to A BMA Scotland report on the doing nothing meant ministers were find a solution. As our petition shows, the public recognise local service called for urgent action choosing to reduce services, cutting the human cost of inaction and they want this resolved. to put the NHS on a sustainable staff numbers and the motivation of Successive governments have failed to address this issue – the footing, warning that morale among those who remained. new government has a chance to put this right.’ staff was at ‘rock bottom’. ‘The care provided in our Secondary care matters: shaping hospitals suffers from a chronic lack the future of safe, sustainable of coherent planning, substantial hospital-based healthcare in underfunding that forces impossible Scotland set out a 20-point plan prioritisation decisions on frontline for ensuring hospitals can continue clinicians, and undeliverable targets to provide comprehensive care. It that seem to be driven by arbitrary said the government should aim to lengths of time, rather than quality of increase health spending to 10% of care,’ he said. GDP – in 2017/18, this would have ‘For our hospitals and the people swelled the budget by £2.6bn. who depend on them, this simply It said a more supportive culture has to change. If it doesn’t, we would include ending ‘mutually can no longer expect hospitals to incompatible goals’, such as asking provide the kind of comprehensive health boards to make ‘stringent’ care we have always relied on.’ Niall Dickson: ‘This is a crisis’

healthcare finance | September 2019 05 NewsSeamus Ward assesses review the past two months in healthcare finance

Summer brought a change in personnel at from April this year. According to the King’s latest performance figures for England reflected the top of government in Westminster, with Fund’s Quarterly monitoring report, 27% of trust sustained increases in demand, particularly from Boris Johnson now prime minister, though finance leaders expect their trust to be in deficit older and frail people. The NHS England figures Matt Hancock remained health secretary at the end of this financial year. Most of them showed attendances at A&E up by 4% on those in the ruthless reshuffle that followed. But predict that the NHS will fail to achieve targets in July 2018, while emergency admissions were that did not mean all was quiet at the health set out in the NHS long-term plan, including 4.6% higher than a year earlier. The number department, as the new administration for the sector to be in balance in 2020/21 and of patients waiting to start elective treatment seemed to move into election mode, making the aim for deficits in NHS organisations to be also increased – at the end of June there were announcements on capital funding and the eradicated by 2023/24. 4.4 million people on the waiting list, also 4.6% NHS pension tax issue (see p10). more than in June 2018. NHS Providers said Around half of the that, unlike previous years, trusts had not been A general election could be the ultimate population believe it able to use lower emergency demand in the outcome of the Brexit debate, but leaving the is difficult to get a GP summer months to clear waiting lists. European Union by 31 October and preparing appointment, while most for a no-deal exit are the government’s prime (86%) say too many people Many senior doctors are reportedly angry focus. The Department of Health and Social Care use A&E departments over potential pension tax bills, though they is at the forefront of preparations and in August unnecessarily, according did receive some good news as consultants invited bids for a £25m contract to set up an to the latest British Social and dentists were handed a 2.5% pay rise, express air freight service for urgent medicines Attitudes Survey. While 17% backdated to April. The Department of Health and medical products post-Brexit. The contract prefer A&E to GPs because they can get tests and Social Care said the award was worth allows for small parcels of urgent medicines or done more quickly, the preference rises to 29% between £1,940 and £2,630 for consultants. products to arrive within 24 hours. Larger pallet among people from the most deprived areas. The value of clinical excellence awards is goods would arrive within two to four days. And though 11% said they have no confidence in being frozen. Specialist doctors and associate GPs, this rises to 18% in the most deprived areas specialists will in addition receive an extra 1% in Mr Johnson has famously called for a and 20% among those with children under 5. 2020/21 conditional on contract form, through can-do spirit and positivity on Brexit, but at a multi-year deal. The deal follows the June the beginning of the summer finance directors’ July saw the highest number of people announcement of a four-year deal for doctors outlook remained pessimistic despite the seeking emergency and urgent care since records and dentists in training, which guarantees an additional funding that is going into the NHS began, according to NHS Providers. It said the uplift of 2% a year.

The month in quotes

‘This express freight service ‘These figures show the health service is still struggling ‘Despite the funding sends a clear message to the to climb out of the morass created by a decade of boost, unrelenting public that our plans should austerity. Year on year, the demands made on frontline financial and ensure supply of medical goods services continue to grow, with attendances at A&E operational pressures remains uninterrupted as we significantly higher than at this time last year. Our suggest patients are leave the EU.’ dedicated staff do all they can for patients, but they are not going to see improvements in Health minister Chris Skidmore being stretched to breaking point.’ care for some time yet. Thanks to on the Department stepping up The NHS is struggling to escape the effects of the hard work of staff, the NHS is preparations for Brexit austerity, says Nick Ville, director of membership and treating more patients than ever. policy at the NHS Confederation But without a concerted effort to address staff shortages and more investment, ambitions to improve ‘There is a clear need for the NHS to make a broader contribution to patient care will remain more people’s lives, leveraging its considerable resources to improve the aspirational than realistic.’ economic and social conditions that so fundamentally affect our health.’ King’s Fund chief analyst Siva Anandaciva Dominique Allwood, Health Foundation assistant director of improvement, says the NHS says its latest QMR offers a reality check must contribute to the wider determinants of health

06 September 2019 | healthcare finance SHUTTERSTOCK and midwifery is single biggestand the midwifery group (34%). staff make up 19% the of workforce – nursing staff are women. Administration and clerical Agenda for Change bands 1to 4,and 79%of found that 38%of HSCstaff are employed at equivalents or 31%of staff. all The census also employer with almost 18,000whole-time staff.Belfastof local The Trust the is largest 2010 and 2019,according to latest the census in Northern Ireland increased by 12%between decision-making process should trusts adopt. a few exceptions and flowchart the sets outthe shifts ratherthan using agency staff. Thereare contracts administration to fill and estates required be will to or bank trusts use substantive orpost shift. from rules, this Under month new for adminand or clerical estates and facilities chart setting out process the for avacancy filling 14.3% to report 13.4%,the said. staff clinical health turnoverfrom has decreased fromhas fallen 12.5%to 11.9%and mental retention initiatives. National nursing turnover knowledge and expertise’ to develop staff years ago, said it has given ‘tools, the trusts of programme, the was which launched two encourage staff to remainthe NHS.A in review step forward insupporting to trusts programme amajor has been that national the staff retention The health and social care The health social (HSC) and workforce NHSImprovement published also aflow NHSImprovement claimed air freight servicefor has invited bids for has invitedbidsfor a £25m contract to a £25mcontractto set upanexpress medical products The Department The Department post-Brexit environmental sustainability. land for community benefit; and leading on to quality employment; leveraging assetsand bythis means, several including widening access institution communities: the role of the NHSasan anchor people’, it healthier said. The Building report, and indoing so, advance welfare the of local community wealth building and development, with sizeable assets that to support used could be institution is ‘a large, public organisation sector institutions’ for areas. local An anchor should ‘anchor be bodies foundation proposed NHS Foundation. In areport, the according to Health the area, people local intheir economic conditions for to improving and social a greater contribution health as well as secondary and tertiary care. and ashealth well tertiary as secondary working and include prevention and population at and on system focus will pace. They scale carevalue-based and quality improvement pathways on prudent based be healthcare, will national pathways clinical out set plan. in the The He to work said expected clinicians be to will The NHS should make social services minister Vaughan services social Gething. , said NHSorganisations could achieve a written statement from and health under development, according to specialist services inWales services specialist is Anational plan clinical for healthcare finance for more • Visit www.hfma.org.uk/news/blogs delivered bycommunityservices. dashboards demonstratingthevalue to developingcomprehensive benchmarking –thefirststep allow robust andtransparent of activitydata,whichwill services. Theseincludetherelease transformation ofcommunity at thecentre willlikelydrivethe says significantdevelopments (Community HealthImprovement), NHS Improvement senioradviser Michael Dimov,NHSEnglandand In thefinalbloginseries, data, headds. public trustovertheuseoftheirpersonal self-care, butthe NHS mustalsogain clinicians’ timeandsupportpatientsto Technological advances can free up director ofstrategy(AI)atNHSDigital. in healthcare, saysJamesHawkins, gained from new digital technologies Safer andmore efficient care canbe new multidisciplinaryteams. collaboration betweenpracticesand PCNs will offer greater coverage, with help meettheconsequentdemand– the populationages,primarycare will of primarycare networks(PCNs).As primary care, outlinesthebenefits deputy nationalmedicaldirector of In hisblog,RajPatel,NHSEngland the fundinggapislikelytowiden. becoming imperativeasprojections show prevention asa‘mustdo’isfast prevention ofillhealth.Embedding the NHSmustshiftspendingtowards chief economistBrianFergusonsays In thefirstblog,PublicHealthEngland of blogs. in the issues, challengesandopportunities commentators toexaminethekey Over thesummerHFMAinvited from thehfma NHS long-term plan long-term NHS |September 2019 in a series inaseries news

07 NewsHeadline issues in the analysisspotlight Taxing problem Clinicians are angry about the impact of pension tax rules that could leave them facing large bills. The government has promised to solve the problem, but what is it proposing? Seamus Ward reports

Pension tax has been the NHS issue of the service would not wish to see it devalued. May’s government proposed a scheme where summer. It has been blamed for senior doctors The issue has sprung from the introduction of employers and employees reduced their leaving the NHS, considering retirement, an annual allowance to limit the amount of tax contributions to 50%. In exchange for this reducing their hours or refusing to take on relief received by higher earners. The value of 50:50 option, clinicians would cut their rate of additional work – to reduce waiting times, for the allowance rose steadily from its introduction pension growth in half. A consultation paper example – because they fear being saddled in 2006 to £250,000 in 2010/11, but fell sharply was published, but the proposal was rejected with significant tax bills. The issue is regarded under austerity measures and stood at £40,000 immediately by the British Medical Association, as so serious that, over the course of 16 days for the 2018/19 tax year. the doctors’ trade union. this summer, the government moved twice to While this means more people are facing Shortly after Mr Johnson took the keys settle the issue. tax bills, the allowance can be tapered down to number 10, it became clear that the 50:50 The problem has arisen due to the tax further, potentially increasing the size of the option was to be abandoned in favour of a more policies set by the Treasury, but both the health bills. If a doctor, for example, earns less than flexible proposal that will allow, from April 2020, department and Treasury accept the need to £110,000, they keep the full £40,000 allowance. clinicians to set their contribution rates to limit resolve the issue. It affects a relatively small For those earning more, there is a further test. their chances of having to pay pension tax. number of highly paid staff. Some will find it Their income – from all sources – is added to the Exactly what the government is now difficult to sympathise, but it is important to growth in their pension over the year – this is proposing is unclear – it has promised a new remember how vital they are to patient services. known as their adjusted income. If this totals less consultation, but this had yet to be published as There is evidence that the problem is having than £150,000, they retain the £40,000 allowance. Healthcare Finance went to press. What is clear an impact on the delivery of services and trusts’ If it’s more than £150,000, the allowance is is that it will apply only to senior clinicians – financial position (see box). But the NHS tapered, falling to £10,000 for adjusted incomes chiefly doctors and nurses – but not to managers. pension is also a key element in recruitment of £210,000 and above. There is no flexibility in the current and retention of staff. And, though the pension Tackling the issue is now high on ministers’ scheme – staff are either opted in (paying scheme remains generous even when the agendas. Just before Boris Johnson took 100% contribution) or opted out (paying no pension tax issue is taken into account, the over as prime minister, on 22 July Theresa contribution) of the pension scheme, but the new proposal would allow greater variation in contribution rates. A Department of Health and Social Care Finance concern press release gives an example of a senior Senior finance staff are reducing their hours, their financial clinician giving ‘30% contributions for a worried about the impact refusing to work extra hours position or 30% accrual rate, or any other percentage in of the pension tax issue, or take new responsibilities – both. 10% increments depending on their financial according to a recent including waiting list work – There situation’. HFMA survey. or taking early retirement. were similar This would mean the senior clinician The survey received 74 While around a quarter responses to questions reducing their pension contribution to 30%, but responses from a range reported that staff had on the impact of reduced it would also mean their pension on retirement of NHS bodies. While taken early retirement but hours. would be reduced commensurately. In the case 54% of finance staff were they had not yet seen an Finance staff said the of a clinician earning more than £111,377, their very concerned, 34% impact on patients, their solution lay in reform of the contribution is currently 14.5%, so their new were ‘quite concerned’. financial position or both, a annual allowance. It affected contribution would be 4.35% (30% of 14.5%). A fifth said clinicians had similar proportion said they managers as well as senior The cut in employee contributions can be already taken action that is knew staff were planning clinicians and any reforms tailored in 10% increments to suit their personal affecting patient care and to take early retirement should apply to all affected. circumstance and ensure they do not fall foul their organisation’s financial and they expected this to • Visit hfma.to/9x for the of the pension tax rule or, for very high earners, position. This included have an impact on patients, HFMA briefing reduce their exposure. By reducing the potential tax bill – or

08 September 2019 | healthcare finance news analysis

listen carefully to the views of those affected – for example, there is a strong argument that income for extra work beyond normal contracted issues should not be counted in annual allowance taper calculations.’

SHUTTERSTOCK It is important the government recognises that the issue affects managers too, he said. eradicating it totally – it is hoped the clinicians “The government has listened Some providers have taken steps locally to will maintain or return to the additional hours to us on offering full flexibility – mitigate the tax allowance issue. Three types they have worked previously. meaning doctors can choose the of scheme are most common, according to The proposal has a number of other potential amount they and their employer NHS Providers. One scheme pays staff who benefits. It could keep senior clinicians in the wish to put away” have opted out of the NHS pension scheme the NHS pension scheme – any significant outflow Chaand Nagpaul, BMA equivalent of the locally administered employer of contributors could undermine the scheme. pension contribution (14.3%). Additionally, by remaining in the scheme, when it launched that the earlier consultation Staff would not be subject to pension tax even with reduced contributions, clinicians on the 50:50 model – whereby doctors and unless they join an alternative pension scheme. can continue to take advantage of some of employers halve what they put into their pension A higher proportion of an affected employee’s the attractive add-ons to the pension scheme, pots – was not fit-for-purpose and we are pleased pay could be made non-pensionable, possibly such as life and ill-health insurance, which are that the government has heeded the BMA’s by splitting their role into two assignments with important in recruitment and retention. concerns by ditching it. This method is overly separate employment contracts (one where the What is less clear is how reduced employee restrictive and can leave doctors putting either pay is non-pensionable). In a third scheme, staff contributions would affect employers. Though too much or too little into their pensions. could be given additional leave in return for not confirmed, it appears that employer ‘The government has listened to us on working more than their contracted hours. contributions could decrease, either by an offering full flexibility – meaning doctors can But all three approaches could be problematic. amount agreed with the clinician or to match the choose the amount they and their employer For example, while the first option may be a employee’s reduced rate. wish to put away – and we note the assurance relatively simple and potentially cost-neutral It is not a given that an employer’s that this will not mean doctors “losing out on option, there are concerns that it could be contributions will align with their employee’s. the value of unused employer contributions”. discriminatory, and risks being seen as an For example, in the local government scheme, This must mean full recycling of the entire inducement to opt out of the pension scheme. employees can reduce their contributions to employer’s contribution being paid back into A handful of trusts have explored the idea of 50%, but employers are still required to pay the doctors’ salaries.’ paying for services from consultants who have full contribution. Dr Nagpaul insisted the proposed flexibilities formed a limited liability partnership. It is possible that employers will have to were a short-term measure and tackling the The trusts believe this arrangement could maintain a level of contribution to fund other underlying problem meant tax reform. In allow more flexibility for the staff to manage benefits, such as the insurance safety nets particular, changing the annual allowance taper their pension savings. But these could fall foul of mentioned above. was imperative. IR35 tax rules. Any funds not paid as an employer’s The Treasury has committed to reviewing how Clearly, there is an appetite at trust level to sort contribution could be paid to the employee as the allowance operates with a view to supporting out the issue. Surveys from the HFMA (see box) salary, though the clinician should be keeping the delivery of public services. and NHS Providers have both found that trusts one eye on how increased earnings – fuelled by Guidance will also be given to employers, have developed or are considering local schemes reduced employee pension contributions and setting out how they can use existing local – a signal of the importance of affected clinicians recycled employer contributions – might affect flexibilities to address the pension tax issue. to trusts’ performance. But most providers their exposure to pension tax. NHS Providers welcomed the government’s would prefer a national solution and will be BMA council chair Chaand Nagpaul said the ‘pace and focus’ on the issue. Chief executive looking in detail at the consultation and eagerly proposal was a step forward. ‘We said clearly Chris Hopson added: ’The government needs to awaiting the review of the taper.

healthcare finance | September 2019 09 CommentSeptember 2019

I hope you managed to activity under way in the current position once the Seeing fit in a bit of down time developing system plans for process has been completed. during the summer period. discussion with regulators Those of you who have However, we all know that during the early autumn. seen economic cycles the this is never a quiet period, With the change in before, will not be surprised despite the need to take government leadership, we to see that capital constraints positives summer holidays. are starting to see decisions are the first area that get a This year has been no being made on some of the look-in, as government starts While different, with plenty of things that are inhibiting to prioritise for the future. challenges progress in improving The one-off nature of this services for patients. type of spend makes it an remain, recent The recognition of the attractive way of making an changes help problems created by the way impact in the NHS. to address the NHS pension scheme Critics will say it’s not new some difficult HFMA interacts with the tax regime money, or too little too late. issues president is welcome. And I am sure But let’s not look a gift horse Bill Gregory the process of consultation in the mouth. We badly will yield an improvement on need investment to address

NHS England and NHS Improvement’s Steps new oversight framework is a good statement of intent, but changes very little in the short term. The framework continues the ongoing towards alignment between the two bodies that have been acting as a single organisation system since April. It also makes a move towards addressing one of NHS practitioners’ biggest concerns over the move to integrated working oversight – how can we work as systems if you continue to regulate us as separate organisations? New framework makes At this point, the NHS remains well small moves towards short of a regulatory system that is focused on systems not organisations. This is system-level regulation understandable. Systems have no statutory basis and so NHS England and NHS Improvement’s respective regulatory focus has to be on clinical commissioning groups and providers. Their formal powers to intervene to improve local performance is firmly at the organisational level. This position would only change with the creation of new system-level bodies, and the appetite for further structural change is minimal both inside the NHS and at the Healthcare political level. Finance So, the changes have to be looked at in in the pre-existing sector-specific oversight editor this context. On the one hand, the ‘new’ frameworks – the single oversight framework Steve Brown oversight framework looks like little more for providers and the improvement and than a stitching together of the metrics used assessment framework for CCGs.

10 September 2019 | healthcare finance comment

“We badly need investment to or integrated care systems individuals with fellowships the technical work of the address backlog maintenance have a strategic case for of the association. association. issues in our hospitals, capital investment to It was particularly pleasing As we head into the and the previous capital transform service provision, for me that this included autumn, a quick look in my constraints have made this and we now have an Tim Crowley and Jonathan diary suggests that I’m going very difficult” opportunity to pursue the Stevens. to be clocking a fair number ones that offer best value. Tim retired from his of miles over the next few In July, HFMA chief role as managing director months. Nine of the 13 executive Mark Knight and of Mersey Internal Audit HFMA branch conferences I hosted HFMA’s annual key Agency earlier this year – a take place during this period. supporter’s event in London role in which he has made I hope to see as many of backlog maintenance issues (see page 30), which is an a significant contribution you as possible supporting in our hospitals, and the opportunity to acknowledge to the development of your branch event, and also previous capital constraints the contribution made to the governance in the NHS. at the national conference in have made this very difficult. association by individuals Jonathan, now the north early December. In addition, most and organisations. west regional director of sustainability and As is tradition, we also finance, was recognised Contact the president on transformation partnerships acknowledged a number of for his contribution to [email protected]

staff survey metrics for providers. But there “There is a hint of a greater are no major departures in terms of what is system focus and there is a being looked at and the focus is firmly on promise for this to increase in organisations. subsequent years” On the other hand, it demonstrates that the powers-that-be do recognise the importance of moving regulation to a system level alongside the continued development in subsequent years. Recognising that of sustainability and transformation the 2019/20 approach – which has been partnerships and integrated care systems. published without consultation and nearly And there are some small, but important half-way through the year – effectively changes of emphasis. NHS England and combines current approaches, NHS England NHS Improvement say they intend to work and NHS Improvement say they will use ‘with and through’ system leaders wherever this year to develop proposals for a new possible to tackle problems and to provide framework starting from 2020 onwards. greater autonomy for systems with ‘evidenced Crucially, the document introducing the capability for collective working’. new framework says the design of the 2020 At the heart of the new framework will be framework will involve partners at key stages. quarterly system review meetings – bringing This will include a consideration of the the regulators’ regional teams together purpose of the framework and the balance with system leaders. These meetings and between organisational and system oversight. performance data will inform decisions about It will be important that these changes are what support might be needed. subject to full consultation and that finance Organisational-level information flows practitioners – as those arguably most remain in place, in part so that the centre can aware of the importance of governance and SHUTTERSTOCK spot where good system performance might regulation and how it works – are at the heart There are a few new oversight metrics. For otherwise mask emerging problems at the of this process. example, metrics have been introduced on local level. Regulation that is appropriate and in tune the overall size of the waiting list and patients So there is a hint of a greater system focus with the move to system working will be waiting over 52 weeks for CCGs, and a set of and there is a promise for this to increase crucial to delivering the long-term plan goals.

healthcare finance | September 2019 11

diversity

It’s been made clear from finance departments up and the Finance Mr Hancock continued: ‘However, it’s not just a question of fairness Leadership Council (FLC) down that NHS finance must address and justice. Diversity of leadership is a diversity of experience, a diversity diversity in the workplace. Indeed, the FLC has encouraged initiatives to of perspectives. Different ways of thinking, fresh ideas, new solutions to tackle the issue in England. There is little doubt there is a problem, but old and seemingly insurmountable problems. how should the finance function go about addressing it? ‘Diversity of thought is essential to the future of the NHS. It is A recent Future-Focused Finance conference looked at practical essential to make the best, and most intelligent use, of the £20bn a year steps to bring greater equality to employment and promotion decisions. extra we’re putting into the NHS.’ They included recognising and eliminating unconscious bias, reverse mentoring (see box overleaf) and how to measure progress. New goals published Equality is not new to the wider NHS – there have been measures In July, NHS England and NHS Improvement published guidance going back years – but it seems its time has truly come. Health and outlining goals for health service organisations to reduce the social care secretary Matt Hancock is committed to moving the disproportionate rates of disciplinary action taken against BAME staff diversity agenda forward. Last year, he set a new target of eliminating compared with white staff by 2022. the ethnicity pay gap, with black, Asian and minority ethnic (BAME) The position in NHS finance is similar to that in the wider NHS. representation in senior roles matching that across the rest of the NHS, In the 2017 NHS finance function census, women outnumbered their by 2028. BAME representation among the non-medical NHS workforce male colleagues in every grade up to and including band 8b. Women stands at 17%, but only 11% of senior managers are from a BAME accounted for 61% of the finance workforce, but only 28% of finance background. This falls to 6.4% at very senior level. directors. Two-thirds of women working in NHS finance were at band 6 Mr Hancock told the King’s Fund in November that 40% of hospital and below, compared with 46% of men. doctors and 20% of nurses in the NHS are from a BAME background, While 70% of the NHS finance workforce in England said they yet BAME representation on NHS trust boards is only 7%. More than were white British, some 86% of finance directors were white British. half of all NHS trusts in England have no black or ethnic minority staff However, it should be noted that 11% of organisations did not disclose at the very senior manager (VSM) level. their employees’ ethnicity. ‘Over 75% of the NHS workforce are women, yet at board level that Success in promoting diversity and inclusion could be measured by figure is just 40%,’ he said. ‘We need 500 more women on boards to whether organisational, cultural and personal beliefs had been shifted, make them gender balanced,’ he said – a message he has since reiterated. Edward John, FFF’s diversity programme lead, told the conference. Of Balancing up

NHS finance has a diversity problem, but it is taking steps to ensure it is more equal and inclusive. Seamus Ward reports SHUTTERSTOCK

healthcare finance | September 2019 13 diversity

Reversing the trend Many finance managers will have experience diversity and inclusion. I’m so pleased to be here [at this event].’ of mentoring, but not so many will have ReMEDI has been operating across She highlighted Guy’s and St Thomas’ experienced reverse mentoring, whereby around 15 NHS organisations. It is being NHS Foundation Trust chief financial officer they are mentee to a more junior member evaluated, though Ms Johnson recognised Martin Shaw who filmed a video (available of staff. A new project aims to use the latter that individual organisations are at various on YouTube) with his reverse mentor – no- to help address issues of diversity and stages in their development of reverse one else had done this, she added. inclusion in the NHS. mentoring to improve diversity and inclusion. The programme aims to disrupt the ReMEDI (reverse mentoring for The programme has been welcomed, traditional power dynamic by giving lower equality, diversity and inclusion) expands she said. One board member had told her band staff an opportunity to speak up reverse mentoring to include mentors to that being a reverse mentee was the most without consequence. But, to be successful, people with less (perceived) power, in a important piece of work they had done in 30 reverse mentoring had to go beyond cosy more disadvantaged position or under- years in the NHS. chats about cultural differences, she added. represented group or from a marginalised or Finance leaders were particularly keen ‘If you want inclusion, you can’t limit the oppressed group. to be involved, she added. ‘I believed the conversation just to culture. And you can’t Stacy Johnson (pictured below), finance professionals would be the hardest just pick two people and hope for the best programme lead and University of nut to crack but my stereotypes are so not when you are pairing mentor and mentee. Nottingham associate professor, told the borne out.’ We want to facilitate different conversations event that there was growing evidence Her assumption was that finance staff – not just about culture. You want that reverse mentoring can stop individuals would be cynical and uncaring about conversations that are uncomfortable.’ acting in a discriminatory way, change patients. ‘But finance organisational culture in gender and race directors have been a equality, and contribute to organisational revelation – that’s why

these, cultural changes would be the trickiest, he added. Targets could be set and reached, but people in “I believed the finance protected groups had to feel welcome and included. professionals would be They must be supported. ‘We can set targets – great,’ the hardest nut to crack Mr John said. ‘But what about the softer stuff? What but my stereotypes are makes somebody lack confidence because they think so not borne out” they don’t talk or look the right way?’ Stacy Johnson, University of He praised the introduction of a BAME representative Nottingham on interview panels in some trusts – something he believes should be rolled out across the NHS. But he added: ‘In NHS finance, we are behind the curve and need to make an impact. It’s taking a bigger priority and we all need to be behind that.’ Paul Deemer, head of diversity and inclusion at NHS Employers, told the conference about how Australian airline Qantas had turned a AU$2.8bn deficit in 2013 to an AU$850m surplus in 2017. The airline’s chief executive believed this was largely due to the introduction of a culture of inclusivity and diversity. Business benefits It’s a bold statement and it attracted the attention of Deloitte, which looked into the business benefits related to diversity and inclusion. It spoke to 50 of its biggest global customers and reported there are eight ‘powerful truths’ on diversity and inclusion. These included: • Diversity of thinking, rather than in numbers and demographics, was the most significant factor in a lot of the organisations’ success • Diversity had to be more holistic that just meeting targets – it had to be inclusive too and see if there’s any way to integrate some of your work with their work • Inclusive leaders cast a long shadow – committed senior board to get cross-fertilisation of ideas, which I find really exciting,’ he said. members makes a huge difference In a session on unconscious bias, delegates heard that everyone holds • Middle managers matter – Mr Deemer said this was often forgotten. unconscious prejudice or stereotypes. The key to addressing these is first This layer of management implements strategy, so their buy-in can to pay attention to your reactions to people, news or social media posts determine success or failure and have the courage to be honest that you hold these biases, according • Tangible goals must be set. to consultant Desiree Silverstone. Asked what finance departments should be doing now, Mr Deemer These thoughts can be countered using a range of strategies, including said they should make equality impact assessments of their recruitment avoiding generalisations; being more positive about people you have processes. ‘I would also encourage you to speak to your HR colleagues stigmatised; putting yourself in someone else’s shoes; and increasing

14 September 2019 | healthcare finance diversity

“Diversity of thought is essential to the future of the NHS. It opportunities for contact with a diverse range of is essential to make the While much of the attention has been on people, she added. best use of the £20bn a discrimination on the grounds of sex and race, the Speakers shared their own experience of year extra we’re putting event included a welcome focus on discrimination discrimination. Arnold Palmer, a coach and mentor, into the NHS” against people with disabilities. The conference heard and former NHS finance director, said: ‘I remember Matt Hancock, that though only 3% of NHS staff declare a disability going to my first finance directors’ meeting in London health secretary on their electronic staff record, around five times more and being the only black face there. It’s not like that now and said they are disabled in the (anonymous) NHS staff survey. I am really pleased the NHS is moving in the right way.’ It appears that many staff with a disability fear discrimination if Many speakers and delegates spoke of imposter syndrome – a feeling they notify their employer officially. of inadequacy based on looking or being different from peers, despite Hayley Ringrose, Stockport NHS Foundation Trust chief financial doing the same job just as well. Lei Wei, deputy chief financial officer at analyst, said being invited to speak at a HFMA costing event gave her North West London Collaboration of CCGs, spoke of her discomfort at confidence to take the podium at this and other events. ‘I got an email her first regional meeting. ‘I looked around and thought, “I don’t think I asking me to lead a workshop and I replied, “You do realise I have a belong here” as I was surrounded by middle-aged men in grey suits. At speech impediment?” They said they did know and wanted me to lead first, I wanted to run out but then one of the speakers called me over.’ the workshop.’ But instead of words of encouragement, he was asking for help Referring to the gap between those who declare a disability in ESR as he thought she was one of the conference support team. The key and the staff survey, she said. ‘Some of us don’t have a choice and was to draw strength from these difficult situations, she said. ‘It was because of that I feel I have to be seen as a role model – to promote quite difficult at first, but it is important to remind yourself that this is and challenge, not through what I say; not through going to the board something you really want to do. If it is what you want, keep going and and saying, “We don’t have enough disabled representatives or BAME don’t let some bad experiences scare you away. representatives”, but just by being the best you can be in every role. We ‘We need to set a good example; speak up and challenge bad will break through those barriers, but it will take time.’ behaviour and put diversity and inclusion in our day-to-day work. The promotion of diversity and inclusion is now at the top of finance We must listen to the views and good ideas of people from diverse departments’ agendas – as it is in the wider NHS – and finance leaders backgrounds. Gradually, people will listen, and the culture of the will seek to use some of the tips provided at the conference to find a organisation will change.’ better balance.

Going beyond

The London-based Going beyond to influence and make an impact, programme continues to evolve and grow, negotiation and leadership with strong support from London regional • Understanding the environment – finance director Ann Johnson. change management project, system The programme aims to support and leadership, working with partners and expand the number of women and BAME engaging with the private sector finance staff at senior levels. It focuses on • The interview – CV review, simulated supporting these staff in bands 8c and interview, recruitment agency support and above to step up to finance director posts. feedback Going beyond is now part of a new • Lived experience – delivered by chief umbrella structure, explains Central and finance officers, candidates look at ‘what North West London NHS Foundation it takes’ to do senior jobs and they gain Trust chief finance officer, Hardev Virdee shadow experience. (pictured), who, along with Chelsea and ‘We are working with the HFMA branch Westminster NHS Foundation Trust and with FFF to help people understand chief financial officer Sandra Easton, is what we are doing and how we can best leading the programme. support them in terms of diversity and An overarching London finance talent Six modules have been developed for inclusion,’ Mr Virdee says. board has been established to bring Going beyond and approved by the talent ‘I think we are seeing more good together several workstreams on diversity board. The modules, which are due to be practice as a result of what we are doing. and inclusion, as well as those supporting launched shortly, are designed to help staff It seems more commonplace to have more talent development in general. In addition take a step up. They include: diverse interview panels at senior level to Going beyond, the workstreams include • Understanding yourself – defining and shortlisted candidates from a wider projects from the HFMA London Branch, the career goals, understanding skills gaps background, so we must ensure that we NHS Leadership Academy and FFF. and addressing confidence issues build on this.’ Mr Virdee chairs the talent board, with • Understanding the organisation – Though focused on London for now, Ms Easton providing representation at a relationship management, working with other regions have shown interest in Going national level. Both are due to move to new peers and non-executives and managing beyond. ‘It is designed so it can be easily roles shortly, but will continue their work with poor performance in others replicated. I expect it will be rolled out across Going beyond and the talent board. • Understanding the role – how the country as good practice,’ he adds.

healthcare finance | September 2019 15 procurement Modernising

Almost six months after the formal launch of a central procurementmove scheme, Seamus Ward asks how it has progressed and how the NHS has reacted

For years, the NHS has talked about leveraging Alan Wain, SCCL’s chief operating officer. its buying power when it comes to goods and NHS Supply Chain has been moving to services. And with an estimated £9bn annual the new system for the last year, gradually spend on goods and services – £6.5bn on transferring in-house a £3bn business from clinical and general items – it would appear the DHL. Back-office functions were the final potential for savings is significant. activities to move over before the programme Lord Carter thought so in his 2016 review launched in full on 1 April. of acute trust productivity and efficiency – he The new organisation’s work has also believed savings of at least £700m a year on included letting contracts to new partners that clinical items and general supplies could be provide logistics and IT and establishing the 11 realised. And now a national bulk buying category towers and their providers. scheme seeks to address his recommendations. ‘All trusts have contributed in some way to Though many of the elements of the new the cost of our operation,’ Mr Wain says. ‘As strategy were established last year, Supply a result, we have removed the margin from Chain Co-ordination Limited (SCCL) was the price paid for products. Under the old only formally launched in April. It replaces the operating model, DHL funded its operation contract operated by logistics firm DHL, which using the margin – a bit like a retail model delivered about £300m in savings since 2015. – but in this model there are variables in SCCL is the management function of the margins and it is not transparent. That NHS Supply Chain and aims to lower prices transparency is there now because the price we and drive efficiencies through product buy at equals the sale price.’ rationalisation and economies of scale. It has divided goods into 11 procurement towers Early successes and three enabling services (logistics, IT and Mr Wain says SCCL has achieved some early down the prices – on average we achieved transactional services), each operated by successes. The business case setting out the around 22% savings. We have embedded the companies such as DHL and Unipart, as well as rationale behind the new operating model was NCP principles in all of our category towers,’ some public sector bodies. that there would be a £68m annual saving. Mr Wain says. The procurement tower operators are But in the last financial year, savings of £286m ‘We are also looking at deals of more than incentivised to deliver lower prices but SCCL is were achieved by elements of the new model one year. Typically, the NHS operates on a funded through an adjustment to the national that were up and running, such as the category one-year cycle, but we are moving to three-year tariff (see box overleaf), prompting complaints towers, plus the old DHL model. deals to get better value for money.’ from some trusts. ‘Our target is to deliver cumulative He believes the new model is a step The adjustment of the national tariff is one savings of £2.4bn by 2022/23. Currently, our forward compared with previous attempts obvious difference from previous attempts to cumulative savings are standing at £800m – a to save money on NHS procurement. The get national purchasing off the ground, but third of the way to the target and way above procurement towers mean buying teams are there are others. our trajectory.’ focused on particular types of related products SCCL has a single shareholder – the health He says the NCP (nationally contracted – under the old model, expertise was spread secretary – and its board draws representatives products) procurement initiative – an NHS across all categories of products. from the Department of Health and Social Supply Chain and NHS Improvement pilot Previously, central procurement competed Care and NHS Improvement, together with project that sought to aggregate demand with the regional NHS procurement hubs. four non-executive directors. This makes it at national level – offered proof of concept Many are now part of the new system, with more accountable than previous attempts to for the new operating model. ‘We did some four of the old hubs coming together as CPP, save on procurement spending, according to rationalisation and at the same time drove which manages three clinical category towers.

16 September 2019 | healthcare finance procurement

“All trusts have contributed in some way to the cost of our operation. As a result, we have removed the margin from the price paid for products” Alan Wain, SCCL

Mr Wain explains that clinical and product products identified as best for patients. though switching could be delayed where assurance is one of SCCL’s driving forces. ‘One Anecdotally, Healthcare Finance has heard trusts still have a contract with other suppliers. of the ways we are driving value for the NHS that some trusts have complained about the ‘They might be complaining about specific is by regular rationalisation of products. But to new arrangements. For one trust, question items, but they are moving their activity to us be able to rationalise, you must be sure those marks over switching to SCCL are primarily more generally,’ he says. ‘Last year’s savings that are remaining are clinically sound, fit for over the accuracy and timeliness of the receipt were three times the business case target, purpose, high quality and fit for the NHS.’ of goods. which is higher than in any year with DHL. In SCCL uses its clinical and product assurance ‘At a hospital level, our first priority is our first quarter, we are already two-thirds of (CAPA) process to follow the Carter principles product availability. Long delivery lead times the way towards our target this year.’ of reducing variation. ‘It’s good to assure and variable fill rate performance remain a Mr Wain adds that SCCL’s customer ourselves in the NHS that these are the right barrier to giving growth to the new model,’ says satisfaction index is high – in one month since products. The CAPA team sits within SCCL one procurement lead. April the index hit 8.5 out of 10, matching the and sets the framework for how we expect the Others say they can find supplies offered previous high under the old system. tower service providers to work.’ through the new tower system at lower prices, He believes some trusts are being offered SCCL is also working closely with other even when the suppliers’ margin is factored in. lower prices for a number of reasons. Suppliers national programmes, such as Getting it right Mr Wain accepts that some trusts have taken that have not won contracts under the new first time (GIRFT), as well as the national this position on prices, but he also points out system – or do not want to contract with SCCL wound care and excellence in continence care that DHL had about 38% of the market share, – may be offering attractive deals to offload strategies. The intention is to ensure best while SCCL has 53%. This shows that trusts are excess stock, he says. ‘I would anticipate that

SHUTTERSTOCK value and to check that towers focus on the moving their purchasing to SCCL, he insists, when we are doing national level procurement,

healthcare finance | September 2019 17 procurement Funding overheads

The funding of NHS Supply reimbursed through the Chain overheads via the national tariff. there will be opportunities for trusts to get tariff rather than a margin The tariff adjustment has better deals. But I have a message for finance on goods is a step forward, been achieved by reducing directors: they must take a system-wide view. according to Mr Wain. ‘It the cost uplift factor, ‘If you take these spot deals, it may work gives trusts an incentive to reflecting the reduced for your trust, but it is undermining the whole use us as they have already cost of SCCL products. system at national level. If we commit to a paid for it,’ he adds. For nationally determined volume of goods at national level and we can’t Some trusts see the tariff prices, the adjustment is deliver it because trusts are taking spot deals, reform as a reduction in funded from central funds. 0.36%. maybe next time we won’t be able to commit to their income that applies With the mark-up The adjustment has the same volume.’ whether they source removed from product been varied, reflecting the Lower amounts of goods equals lower supplies from SCCL, are prices, the direct cost to likely use of SCCL between savings, he says. tied into a contract with providers should fall if they acute, mental health, Are some types of trust, such as major another supplier or can find choose to procure supplies community and ambulance teaching hospitals, more likely to take local the supplies at a lower price from SCCL. trusts. For both national and deals than that offered by SCCL? Mr Wain says elsewhere. To reflect the new funding local prices, the reduction teaching hospitals will be able to leverage the Under tariff changes for arrangements prices under in tariff for acute trusts is volumes of supplies they use, although these 2019/20, SCCL’s overhead the national tariff have been 0.36%; for mental health volumes are not as big as national levels, and costs (estimated at £253m adjusted, removing around 0.1%; ambulance 0.08%; some suppliers will sell at lower prices to have in 2019/20), will mostly be £204m from the amount and community 0.05%. their name associated with a particular trust. However, a supplier could also offer a district general a good deal for the volumes they use – “I have a ensure they are getting the best deal.’ it could happen at all levels, he argues. message Mr Wain’s second message is to raise ‘We have got to get all trusts behind the awareness of the potential for value-based principle at national level so we can get better for finance contracting with suppliers, which would deals for the whole system.’ directors: include an element for patient outcomes. ‘This Looking ahead two or three years, Mr take a is something for finance directors to think Wain says value-based procurement will be system-wide about – how will we do this? How do we realise important to the NHS, increasing value and that value? quality. ‘We are looking at whether we can view. If you ‘If it comes down to reductions in beds or contract for outcomes – this could mean fewer take spot deals, it may fewer interventions, it may be challenging but days before discharge, for example. This is work for your trust, but how does that affect a department’s budget?’ important to us because if you keep driving it is undermining the His third point is for finance directors to be prices down, you come to a point where a system at national level” aware new medical device regulations come supplier can’t do any more.’ At this point, value into force at the end of May 2020. These place can be driven by increasing productivity. Alan Wain, SCCL greater emphasis on traceability through a Supply Chain is also looking at asset unique device identification system and new utilisation. ‘For an asset such as an MRI standards for clinical evidence. If products are scanner you will pay £600,000 to £1m, so we variable margin model in the old model, and non-compliant, the Medicines and Healthcare want to get better information to the NHS on margins as high as 25%, savings opportunities products Regulatory Agency can prevent how they can utilise assets to get more out of were expected in all trusts. But only 60% of them being used, potentially leading to longer them and get better throughput,’ says Mr Wain. trusts filled out demand capture forms to the waiting times and loss of income. Asset use evaluations are being carried out value of around £100m. The opportunity to redeploy procurement at trust level, though increasingly system-level This indicates that either the other 40% had staff to value-generating work is Mr Wain’s use across integrated care systems will be more no savings opportunities from margin removal fourth message to finance directors. ‘It makes important. ‘It could be about sharing assets and or had not looked closely enough at the pricing no sense to duplicate services you’ve already reconfiguring the system to utilise the assets information and are leaving savings on the paid for through the tariff. They could look better. It could mean replacing an asset less table, he adds. at other procurement areas where resources frequently or not having to replace them at all.’ By July, almost half of the £100m of demand have not been there to focus on them in the capture had been moved to NHS Supply Chain, past. “Evergreen” contracts have always been Five finance messages but that means 50% of the savings available there. Or you could redeploy staff into the As well as insisting trusts do not undermine through demand capture have not been taken, management of service contracts.’ national savings efforts by taking spot deals, Mr Wain says. Further savings may have been Finally, he adds that Supply Chain will be Mr Wain has a further five messages for available if all trusts had filled in their demand investing in upgrading its IT to ensure all finance teams. The first is not to miss out on capture forms. processes are carried out online. easy savings. At the beginning of the year trusts ‘I know there are legitimate reasons SCCL is bullish about its prospects, buoyed were provided with a list of margin-free prices why some trusts can’t move across, such as by its early savings successes. Its overriding on all products and were asked to indicate commitments in contracts, but the overriding message to trusts is that national procurement which products from NHS Supply Chain message to finance directors is that they must releases savings, but the NHS must think they would like to switch to. This was called check with their procurement staff that they collaboratively to get even better value from demand capture. Mr Wain says that with the have cross-checked with Supply Chain to purchases and existing assets.

18 September 2019 | healthcare finance

pressures. SteveBrown reports account ofsignificantservice data andtimescalesneedtotake goals, butitneedstobetheright will playakeyrole indeliveringthese services. Managementinformation supported expansionofmentalhealth The long-termplanprioritisesawidely mental health 20 Health Finance Steering Group, debate the has long centred on the affordable.be data, requirements the achievable to need be and to needs collection the However, practitioners right the say collecting to needs sector be the andIAPT providing services comprehensive crisiscare. people’s and community services mental healthcare, expanding access to goals –includingthese delivering amajor to children boost and young challenges inmeeting plan’s the goals. terms for mental by health facesignificant 2023/24,mental bodies health out plan. inthe However, despite apromised increase of £2.3bn inreal Mental clinicians health and support leaders fully ambitions the set ambitious transformation of mental healthcare England has everseen. NHSlong-termThe plan renews acommitment to pursue most the right focus According to Suzanne Robinson, chair of HFMA’s the Mental Data and management information key to sector’s the be will success. say on deliveringThey do is they focused that it vital is everything

September 2019| healthcare finance achieving the implement an agreed way forward.session The framed was around five how should sector the navigate to provide these aclear roadmap to different the discussed data and informationsources available and alternative designs that adopted. could be understand why there hasn’t universal appetite been for and this possible data.groupgood The looking been has currentat to uptake trying and looking athas been development, tariff which is underpinned by having we direct our resources? It can often depend who on you ask.’ on.goes Which one adds most value? And how dowe prioritise where Outcome HoNoS) Scales, patient-level costing, reference costs… list the standard (MHIS),outcomes measures (such as Health the of Nation the data (MHSDS), set Model the Hospital, mental the investment health implementation of clustering. But it is much than wider that. Finance practitioners and clinicians at an HFMAworkshop inJuly A task and finishgroup led by NHSEngland and NHS Improvement ‘It can get confusing,’ she says. ‘Clustering, mental the service health

SHUTTERSTOCK mental health

principles. The data and information framework: standardised through use of an algorithm and clusters are used to 1. Needs to be simple understand patient severity and risk. Another provider has developed a 2. Needs to be clinically engaging needs-based currency approach, grouping patients based on their team/ 3. Needs to be meaningful for commissioner and providers setting and their needs and engagement with their care. 4. Must deliver value for money from any investment in infrastructure The review has noted that all the local approaches work well when 5. Must utilise the expertise of highly skilled costing practitioners and the organisation is committed to them and use the information that information specialists. underpins the currency model for other purposes. This includes the clusters. NHS England and NHS Improvement plan further testing to Cluster focus identify the most appropriate approach. One area receiving attention is the currency built around mental For many finance practitioners at the HFMA workshop, the need for health clusters. Introduced around 2012, the 21 clusters group patients a national currency is inextricably tied up with payment by results and by their characteristics and requirements, rather than the individual the context has changed. If integrated care systems develop as many interventions they receive or their diagnosis. Providers have had to commentators suggest they should, the service could be moving towards submit cluster-based costs for much of the last decade as part of their capitated budgets covering whole populations rather than paying for reference cost submissions. individual episodes of care. The original key driver for the cluster currency was to support the Helen Todman, NHS England and NHS Improvement mental health development of a payment system amid concerns that the lack of a link infrastructure programme manager, says there is a consensus at the between payment and activity was disadvantaging the mental health centre on the need for a currency. ‘A national currency model supports sector. In some providers, use of clusters has been embedded well – with effective investment, by improving the transparency of funding flows clusters providing the initial way to separate out different pathways and through the mental health payment system, which works alongside the explore variation within them. But this is not the case everywhere. mental health investment standard (MHIS) to ensure that long-term One deputy medical director at the workshop said clustering at his plan priorities have sufficient investment,’ she says. trust was seen as a bureaucratic exercise – with a system based on And she insists that whatever payment system is used – locally or diagnosis and condition complexity likely to have more resonance nationally – needs to be informed by a currency (see box). ‘We have to with clinicians. However, there appears to be broader acceptance of the have a currency as a building block for any funding system,’ she says, HoNoS scales that are used as a core part of the clustering process. ‘whether that is blended payment or population-based.’ A finance director said clusters were not being universally used and A currency also enables services to demonstrate how much safe and were not well understood outside mental health secondary care. To effective care costs, she adds. ‘Currency allows understanding of whether really be useful in developing mental health services, GPs and social care services are delivering value to patients; by providing comparison would need to be familiar with their use, he said. The fact that this wasn’t between the cost of service delivery with quality, safety and effectiveness the case undermined moves to system working and integrated care. for specific patient groups,’ she says. Practitioners said the world had moved on from activity-based Costing – and in particular the move to patient-level costing – is one payment approaches. With capitated budgets now seen as the future, was of the other issues challenging mental health finance managers. There a payment currency even relevant? are different views around the introduction of patient-level costing Recognising that the current currency approach is not working as for mental health providers. Some organisations have been pursuing well as it could for the sector, NHS England and NHS Improvement patient-level costing for years, despite typically having fewer resources have been reviewing the suitability of clusters. As part of this review, the dedicated to costing than acute providers. organisations have looked at a number of options to develop a currency North Staffordshire Combined Healthcare NHS Trust implemented model that suits service delivery and incentivises high-quality care. This patient-level costing in 2015 and has been an early implementer of the has included a review of existing local approaches. new national costing standards. Its work was recognised with the HFMA One trust has been implementing a system where clinicians assign Costing Award in 2016. patients to condition-specific pathways. Cluster allocation has been But not all mental health trusts have made this sort of progress and

Payment plan July’s NHS mental health implementation components. A fixed element is based on basis for the blended payment approach’. plan states clearly that NHS England and the agreed forecast level of activity required However, use of an alternative currency NHS Improvement remain committed to to meet planning objectives. A variable is possible. Clusters have been the set developing national payment approaches element is based on an estimate of the currency for years, yet uptake in contracts for adult and older, perinatal and children’s incremental cost of activity increasing or has been limited or tokenistic. mental health services. ‘This will involve decreasing. The third element links payment The 2017/19 tariff guidance, for example, review of current approaches to develop to locally agreed outcomes. called for mental health contracts to use a national currency model, piloting of This has been introduced to ensure episodes of care based on care cluster models with mental health systems, and activity is rewarded and that systems are currencies or capitation ‘having regard to the implementation from 2020/21.’ incentivised to deliver improved outcomes. It care cluster currencies’. As a starting point, a blended payment is expected that further development of this Despite this, most contracts up until system has been issued this year as a approach will take place over the coming this year have remained on a block basis default mechanism for mental health service years, including to the underlying currency. – simply rolling forward the previous year’s contracting. According to the blended payment contract values updated for new investment The new system splits payment into three guidance, ‘mental health clusters are the and price increases.

healthcare finance | September 2019 21 mental health

some managers at the workshop said it was hard to make a business case affordability of the framework for mental health trusts. Ms Robinson locally for the investment of time and money needed to meet next year’s believes there is a danger that next year’s costing submission could end mandatory patient-level cost submission deadline. (Acute trusts faced up as a tick-box exercise producing data of little value. their first mandatory collection this year.) One finance director at the workshop was concerned there would be Ms Robinson says the sector is committed to ensuring all services no return on patient-level costing if it was just an annual submission add value and make a difference and that it maximises the value of the that disappeared into a central black hole. It has to add value. Simply mental health pound. ‘But there is concern that clustering and a tariff- cranking the handle to make the submission would consume all a typical based system may not answer this question from a system perspective, at mental health trust costing team’s time, when these teams could be more least not in the short/medium term,’ she says. usefully supporting clinical teams to improve service costs, he said. It was highlighted that a huge amount of detailed data is needed to deliver a patient-level cost submission. Some at the workshop said this Improving transparency was difficult to deliver with current information systems and would Ms Robinson believes improving transparency around the mental health provide uncertain benefits – especially given the existence of other investment standard (MHIS) should be top of the agenda. This should benchmarking tools such as the Model Hospital. (The plan is for the focus on helping to demonstrate that the standard is being met and that Model Hospital to draw information direct from patient-level cost data, additional investment from the forward view and the long-term plan is but it currently uses a bespoke collection for workforce cost submission.) reaching its intended areas. Beyond that, she says, agreeing a common, For some, the key issue is timescale and prioritising the initiatives that well-defined set of service lines would improve the sector’s ability to will best support the delivery of the long-term plan goals. compare and contrast and provide better assurance across systems (and ‘There may be more value in focusing in the short term on the key multiple providers) that they are making a difference. data sets,’ says Ms Robinson, although there is some recognition around There is broad support for the goals set out for mental health in the the service that the overall goal of developing a deeper understanding NHS long-term plan. Management information will be vital in helping to of patient costs is valuable. And the demanding deadlines for patient- deliver these goals and demonstrating their achievement. But the clear level costing have encouraged some trusts to make steps towards being message from July’s HFMA workshop was that current initiatives should compliant, even if many are still some way off being able to produce be working together to ensure they support these goals. And timescales meaningful patient-level costs. must take into account the sector’s starting point and existing pressures. Mental health trusts are often less well advanced in terms of costing The HFMA Mental Health Finance Faculty is working with NHS than acute colleagues, a position created by the introduction of tariff- England and NHS Improvement to set out some principles and key based systems in the acute sector many years ago. This has driven up milestones that might support a clearer roadmap for mental health the data quality for acute trusts, but there are questionmarks around the providers to work to on their costing journey. professional lives: technical

hfma professionalEvents, people and support for finance practitioners lives

Page 23-25 Page 26-27 Page 28-30 Page 31-32 Technical Development My HFMA People

Increased spending limit reduces capital concerns, but better forecasting needed

Capital funding may have taken a Providers’ capital spending Technical back seat in recent years with an all-consuming focus on limiting Plan Actual (Underspend)/ Available (Underspend)/ providers’ revenue deficit, writes £m £m overspend CDEL overspend against against plan £m available CDEL Steve Brown. But it moved firmly back to centre £m £m stage, dominating discussions in finance circles in the early summer. Julian Kelly gave up a 2016/17 4,071 2,900 (1,171) 2,774 126 good proportion of his first major speech to the 2017/18 4,334 3,063 (1,271) 3,330 (267) profession since becoming chief financial officer 2018/19 4,644 3,932 (712) 3,555 377 at NHS England and NHS Improvement to it. There was a specific problem this year. NHS Plan figures taken from NHS Improvement quarter 4 figures. Actual, available CDEL and providers’ initial plans for spending on capital for underspend against CDEL from Department of Health/Department of Health and Social Care annual accounts. Underspend/overspend against plan is calculated 2019/20 would have breached the Department of Health and Social Care’s capital departmental expenditure limit (CDEL). need for capital projects to address backlog their own savings. Yes, insisted the government, In fact, this is not that unusual. Take 2018/19 maintenance and underpin new models of care; pointing to a real increase in the departmental – providers started the year planning to spend and crucially, in some organisations, the cash spending limit. £4.64bn, despite just £3.46bn of capital being available to fund these schemes. It is easy to see both sides. The cash will available in their initial allocation from CDEL. This cash has been built up thanks to the indeed, at least in part, come from trust reserves. They ended the year with actual spend of Provider Sustainability Fund, which has But is this really smoke and mirrors? This is the £3.93bn – an underspend of £712m compared rewarded trusts that were able to improve their case every year. The CDEL sets the limit for all with plan, but still nearly £400m over their financial position compared to control totals. capital spending, irrespective of whether it is final allocation. In many cases, this revenue belt-tightening was financed by public dividend capital, a loan from The DHSC accounts – published in July – sold to clinicians with an explicit promise that it the Department or internally generated funds confirmed this overspend against CDEL by would enable capital investment this year. including depreciation charges and previously providers was compensated for by underspends Calls on the service by Mr Kelly’s department made surpluses. in central capital budgets, giving an underspend to voluntarily reduce these capital plans – by a But back to the issue of planned capital against the overall CDEL of £42m. reported 20% – did not appear to be delivering spending and limits. The real difficulty for the Providers also overspent their CDEL the required reduction. It was looking as though Department is knowing how actual capital allocation in 2016/17 (see table). cuts and capital control totals might be imposed. spending will turn out. Hoping previous years’ It is curious that in 2018/19, providers set But the increased capital funding announced underspending against plan will materialise off the year planning to spend £1.2bn or 35% by Boris Johnson as part of the new prime again is being judged as too risky and Mr Kelly more than was available – but triggered no minister’s spending spree in August has now wants to see capital forecasting improve. central crackdown. The DHSC has traditionally removed this specific tension. Of the £1.8bn cash In an August letter, providing details of the been able to rely on providers significantly injection, £850m is tied to specific projects, but increased spending limit, he called for the NHS underspending against their capital plans – by £1bn is being used to enable increased capital to ‘collectively improve our forecasts and provide more than £1bn in 2016/17 and 2017/18 and by spending this year – removing the need for the a taut and realistic view of the forecast outturn more than £700m in 2018/19. 20% cut in planned spending. for your organisations in September’. But 2019/20 was seen as providing something This led to an interesting debate on whether More specifically, Mr Kelly previously told of a perfect storm, meaning that actual spending the £1bn actually represented new money. No, the HFMA summer conference that he wanted would get a lot closer to planned levels. Limited said the respected Nuffield Trust, arguing that trusts’ mid-year forecasts to be within 1% of capital (CDEL) for the service overall; a growing providers were merely being allowed to spend their outturn spend.

healthcare finance | September 2019 23 professional lives: technical

Technical review The past two months’ key technical developments

The Department of Health and Social Care will produce The key points in the NHS mental health Technical additional guidance as part of the finalisation of the IFRS implementation plan 2019/20-2023/24 are set out 16 guidance and this will flow into the 2020/21 Group in a new summary briefing from the HFMA. The accounting manual. The Department’s response to the implementation plan explains how a £2.3bn local consultation on the 2019/20 manual, which included a consultation on an investment fund will be used to build upon the IFRS 16 supplement, said the public sector approach to the new leasing work of the Five-year forward view for mental standard remained a work-in-progress. Respondents requested additional health. It also describes how the ambitions guidance on the use of IFRS 16 to measure liabilities arising from service for mental health fit with the system planning concession arrangements and on how recognition and derecognition approach and other sections of the NHS long-term plan. hfma.to/mhip will work in accounting for subleases. With the Treasury finalising the accounting and budgeting approach, this will enable robust guidance A personalised care handbook covers the finance, commissioning to be developed in the manual around all of the proposed public sector and contracting aspects of implementing personalised care locally. interpretations and adaptions of IFRS 16, the Department said. The The guidance aims to help staff understand what the expansion of the HFMA also updated its Accounting for leases – application of IFRS 16 programmes means for their areas of work, the support available, and the briefing at the end of July.hfma.to/9t impact on current processes. The guidance covers methods for funding personalised care but stresses that it is crucial to maintain stability of the Newly published guidance from NHS England and NHS Improvement provider sector. hfma.to/9v aims to support commissioners looking to develop an integrated budget as part of the integrated care provider (ICP) contract. The guidance The first clinical service benchmarking metrics have been launched introduces the whole population budget (WPB) approach and as part of the Model Community Health Services. The metrics cover 10 summarises the steps involved in designing a pooled budget. key areas and are based on organisations’ submissions to the A whole population budget represents the total payment For the community services data set. The range of services covered amount available to the ICP for all services in-scope for latest will be expanded over the next year. model.nhs.uk/ the whole population, which could include general technical practice, NHS and potentially local authority services. guidance NHS Improvement has published trust accounts Key steps in developing a WPB include: calculating download consolidation (TAC) data for 2018/19. The the myHFMA the WPB baseline; estimating WPB values for app from the information is drawn from the information trusts future years; and converting estimated WPB values are required to include in their annual accounts. Apple store to contract values for each year in a contract. A However, the data does not include all consolidation question and answer document has also been or Google adjustments made by NHS Improvement, such as published on the ICP contract, covering issues Play those to eliminate income and expenditure between such as the impact for the voluntary sector and NHS providers. This means it may not agree with the VAT recovery. hfma.to/9u consolidated provider accounts. hfma.to/9w

Treatment for SMA patients gets go-ahead

NICE published nine technology the age of two. Without nusinersen, the has the potential to be cost-effective, and Technical: appraisals, one public health condition is managed with supportive care recommended it for use in the Cancer Drugs NICE guideline and one diagnostics to minimise the impact of disability, tackle Fund. This will allow more evidence to be guidance item this summer. complications and improve quality of life. collected to address the uncertainties around Under guidance TA588, Nusinersen for A further technology appraisal, TA593, overall survival and cost-effectiveness. treating spinal muscular atrophy, more recommends ribociclib used with fulvestrant Elsewhere, guideline NG135, Alcohol children with the rare genetic disorder spinal as an option for people with hormone interventions in secondary and further muscular atrophy (SMA) can be treated. This receptor-positive, human epidermal growth education, replaces NICE public health followed a proposal to extend the terms of factor receptor 2 (HER2)-negative, locally guideline PH7 (November 2007). The the managed access agreement between advanced or metastatic breast cancer who interventions aim to prevent and reduce NHS England and Biogen for funding it. have had previous endocrine therapy. alcohol use among those aged 11 to 18. SMA affects the nerves in the spinal cord The positive recommendation follows It also covers people aged 11 to 25 with controlling movement, causing muscle an improved patient access scheme by special educational needs or disabilities in weakness, progressive movement loss and the company as part of a commercial full-time education. Costs associated with difficulty breathing and swallowing. Those arrangement. The appraisal committee implementing the guideline are not expected with the most severe forms usually die before recognised that ribociclib with fulvestrant to be significant.

24 September 2019 | healthcare finance professional lives: technical NHS in numbers A closer look at the data behind NHS finance

Providers

We may be moving towards system The acute sector was also primarily responsible There were a total of 124 trusts that made a Technical working, but providers – both for the sector’s overspend. Acute providers’ surplus or broke even. NHS trusts and foundation trusts £1.3bn deficit was offset by a net surplus of The overall financial position of the sector – remain major players in the £416m across mental health trusts, £209m benefited from £2.45bn of funding from the achievement of the NHS long-term plan. for specialist trusts and a combined £78m for Provider Sustainability Fund (PSF). Access to The service ended 2018/19 with 227 providers ambulance and community trusts. In total, this the fund depended on providers accepting and in total and twice as many foundation trusts delivered a £575m overall provider sector deficit. achieving a financial control total, 92 of which (150) as trusts (77). This followed some minor Not all acute providers made a deficit and were set below break-even (after PSF). reconfiguration during the year with the not all non-acutes were in surplus. Of 106 Some 201 providers accepted their control dissolution of two trusts and one foundation providers reporting a deficit for the year (before totals in 2018/19, and 149 of these met or trust, following acquisitions by foundation trusts. impairments and transfers), 88 were acute, seven exceeded their full-year control total and received So, NHS Improvement’s Consolidated NHS mental health, three each for ambulance and their full entitlement of PSF income. A further provider accounts 2018/19 reports that there were community and five specialist. 43 providers received part of their initial PSF 230 NHS providers in existence during the year. The gross deficit of all providers in deficit allocation and eight providers didn’t meet their Of these 230 providers, 133 acutes accounted was £2.7bn – up from the £2.4bn recorded by control total at any point in the year but benefited for 75% of the overall sector’s £85bn turnover (up 101 deficit trusts in 2017/18. Ten of the most from a general distribution of the fund. from £81bn the previous year). Some 53 mental financially challenged trusts are in the financial In addition, three providers received PSF health trusts shared a further 15%, with the special measures programme and made up 26% funding where their integrated care system remainder split across 10 ambulance trusts, 17 of the reported gross deficit. (See figure below for exceeded its system plan, but the providers did specialist trusts and 17 community trusts. trusts with deficits greater than £30m.) not accept an individual control total.

Deficit before impairments and absorption transfers greater than £30m † ø KINGS ø CAMBRIDGE † ø UNITED LINCS † ø BARTS ø MORECAMBE BAY ø WORCESTERSHIRE FREE ø ROYAL ø PENNINE ACUTE ø DERBY † ø NORTH MIDLANDS ø MID ESSEX ø NORFOLK & NORWICH † ø BARKING † ø N LINCS AND GOOLE LIVERPOOL Δ ø ROYAL ø LANCASHIRE TEACH ø NW ANGLIA ø WEST HERTS ø BRIGHTON † ø ST GEORGE’S ø LEICESTER † ø EAST SUSSEX ø CALDERDALE † ø EAST KENT ø WYE VALLEY ø PORTSMOUTH ø KINGS LYNN ø WIRRAL ø NOTTINGHAM BROMPTON ROYAL ø BASILDON ø BUCKINGHAMSHIRE UH BIRMINGHAM ø LEWISHAM † ø ISLE OF WIGHT £m 60

(20)

(60)

(100)

2018/19 surplus/(deficit) (140) 2017/18 surplus/(deficit)

(180)

† Receiving intensive support through the financial special measures programme as at 31 March 2019 ø In receipt of interim revenue support funding from DHSC during 2018/19 Δ Excludes gain recognised on part-constructed PFI asset following liquidation of Carillion Source: NHS Improvement

healthcare finance | September 2019 25 professional lives: development

Bitesize learning

By Alison Myles, HFMA director of education News and views from the HFMA Academy

Around 500 learners have now capital, and integration – to name just a few. Training achieved a qualification from These new bitesize courses will not feature the HFMA Academy, helping the live elements that characterise the studying to improve these individuals’ approach used for the intermediate and knowledge and career prospects. Some of them advanced diplomas. So there will be no tutor-led are even continuing their studies by moving sessions or discussions. on to the MBA programme with our partner However, students will benefit from much university BPP. greater flexibility and will be able to start a However, following completion of all the courses Studying while working in a highly pressured course whenever they want, rather than wait for that make up a module, certificate or award, environment requires real commitment, and the the next cohort start date. a student would be free to pay an additional academic route is not for everyone. Recognising They will be encouraged to complete the fee and complete the qualification module this, the HFMA Academy is developing new course in a set time period, although access to assessment, giving them a chance to gain the bitesize continuing professional development the material will last for longer than this. relevant certificate, award or diploma. (CPD) courses. There is no formal application/acceptance As well as appealing to individuals from all The new CPD courses will be based on the and paying on a course-by-course basis may be disciplines within the NHS and social care, the same subjects that make up the qualifications more suitable for individuals and organisations courses should also be of interest to department and draw on much of the same content. in some cases. managers. Feedback suggests that there is a Available from the end of 2019, each diploma The courses themselves will not lead to level demand for affordable training that could be module will be broken down into at least 10 4 or level 7 qualifications and do not include offered more broadly to staff to fill training needs different courses. support for the development of academic skills. identified in the appraisal process. All three of the intermediate (level 4) modules Each bitesize CPD course will take around are being given the bitesize treatment – How six to 10 hours on average to complete and will finance works in the NHS; Governance and “As well as appealing include in-built opportunities for students to test risk management; and Management skills. The to individuals from all their understanding of the subject. advanced (level 7) module Tools to support disciplines within the NHS The new bitesize courses sit neatly between decision making will also be made available as the association’s existing e-learning offerings and CPD programmes. and social care, the new higher level qualifications – both in terms of the For example, the level 4 How finance works bitesize courses should also detail provided and the commitment needed. in the NHS module will include separate We think they will prove a popular way bitesize courses covering healthcare financing, be of interest to department to enable more people to access the growing commissioning, providing services, revenue and managers” educational resources provided by the Academy.

Finance Leadership Council changes Following recent changes to the Development Network to ensure consistent, Sustainability and Transformation Future structure of NHS England and high-quality finance development across the Partnership (SRO) focused finance NHS Improvement, members of NHS in England. • Claire Yarwood, chief finance officer, the Finance Leadership Council The FLC’s membership now includes the Manchester Health and Care (FLC) have been changed so that the senior following leaders: Commissioning (SRO) responsible officers (SROs) leading Future- • Julian Kelly, NHS chief financial officer • Simon Worthington, director of Focused Finance’s five themes and the chair (chair) finance, The Leeds Teaching Hospitals of the Finance Development Foundation • Chris Young, finance director, NHS Trust (SRO) (FDF) become full voting members. Department of Health and Social Care • Adrian Snarr, director of financial control, This will ensure a broad spectrum of • Calum Pallister, director of finance, NHS England and NHS Improvement finance staff is represented at meetings, with Health Education England (SRO) members having a detailed understanding • Alex Gild, HFMA representative, and • Richard Alexander, chief finance officer, of day-to-day issues that affect colleagues chief financial officer, Berkshire Healthcare Imperial Healthcare NHS Trust (SRO) working in trusts, CCGs and national bodies. NHS Foundation Trust • Andrea McGee, director of finance and The FLC was set up in 2014 to support • Jill Robinson, finance director, commercial development, Warrington and FFF programmes and the Finance Staff Shrewsbury and Telford and Wrekin Halton NHS Foundation Trust (FDF chair).

26 September 2019 | healthcare finance professional lives: development

Diary Events in focus

September 23 N Could the Government Estates and facilities forum 12-13 B South Central: annual Digital Service and GOV.UK 7 November, London conference Pay help my trust? webinar 18 I NHS capital funding has been high on the news agenda this Institute: introduction to 24 B Wales: VAT training day, summer, with the prime minister giving the service access costing, London Cardiff to additional funds this year and pledging £850m for 20 19-20 B Wales: conference, The 24-25 B Scotland: conference capital projects (see p23). The Naylor review of 2017 set the Vale resort 30 B London: annual conference, 23-24 N CEO forum and dinner, direction of travel for NHS London estates in England, estimating London F 31 Chair, Non-executive that total sustainability and 25 F Provider/Commissioning Director and Lay Member: transformation partnership Finance: technical forum, harnessing the power of capital requirements could London internal audit, webinar reach £10bn, but also 26-27 B South West: conference, highlighted opportunities to Bristol November release capital funding by 7 N Estates forum, London October selling surplus estate. STPs now have estates plans with 7-8 B Northern: conference proposals for capital investment to support the transformation 1 F Provider Finance: NHS as 12 N Charitable funds, London of services across their systems, though the long-term funding an anchor institution, webinar 13 F Audit conference, London picture remains unclear. 3 I Institute: international 14-15 B East Midlands: This conference – aimed at senior finance and facilities symposium, London conference staff – will explore how capital can be financed, as well as 10 F Chair, Non-executive 14 F Commissioning Finance: considering strategic estate planning at a system-wide level. Director and Lay Member: forum, London It will look at how to maximise estate productivity, ensure forum, London 21 B London: VAT level 2 construction and maintainance is sustainable and increase 11-12 B Kent Surrey Sussex: 21-22 B Northern Ireland: energy efficiency. The event is free to all HFMA members and conference conference is open to non-HFMA members. 15 I Institute: costing with 27 I Institute: technical costing • For more details, email [email protected] informatics, webinar update 17 I Institute: costing together (North), Manchester December 17 N Mental Health Finance: HFMA annual conference 4-6 N HFMA annual conference, conference, London 4-6 December, London London 18 B Eastern: conference, The highlight of the NHS finance year Newmarket is fast approaching, with less than three months until the HFMA annual conference. Finance staff from across For more information on any key B Branch N National the UK will gather under the theme of of these events please email F Faculty I Institute 2019 HFMA president, Bill Gregory – Value the opportunity – [email protected] in London at the beginning of December. It is a time of significant transformation and ambitious plans across the UK as nations seek to address challenges such as staff shortages, an ageing population, rising demand CPD accredited events and webinars and increasing costs. At the same time, the NHS must face external challenges, such as the UK’s exit from the EU. The HFMA is pleased to announce it has achieved accredited continuing The annual conference offers an unparalleled opportunity professional development (CPD) status with the CPD Standards Office for to hear from the leading thinkers on healthcare finance its national and network events and webinars. from home and abroad, learn about best practice, see Delegates who attend one of these events or webinars will be issued different approaches to common issues and to network with with an accredited CPD certificate of attendance for inclusion in their CPD colleagues. There will also be a chance to celebrate the best records for their professional body, institute, regulator or employer. of NHS finance at the annual HFMA Awards ceremony, held Previous attendance at HFMA events and webinars counted towards during the conference. Conference speakers include NHS CPD, but these would have been ‘unaccredited hours’. Several professional England and NHS Improvement chief financial officer Julian bodies are now insisting that up to 50% of CPD should be accredited hours Kelly (pictured), NHS productivity and efficiency leader Lord – where members are taking part in accredited activities. Carter and BBC Europe editor Katya Adler. Now that the HFMA’s national and network events have achieved this • Email [email protected] or visit the HFMA accreditation, the association is committed to working hard to maintain, website for details and exceed, the excellent standard it has already set. The HFMA’s e-learning modules and NHS operating game also have CPD accreditation.

healthcare finance | September 2019 27 professional lives: my HFMA

New term time

Association view from Mark Knight, HFMA chief executive To contact the chief executive, email [email protected] ‘

We are now emerging from the as well as continuing to provide valuable My summer holiday period and I hope feedback to central bodies. I’d like to thank all HFMA that, if you managed to get some those involved in the development of this work. It’s important we provide services for all our time off during July or August, it was September is a busy month for the association member groups and twice a year we invite chief relaxing and enjoyable. as we start our autumn term leading up to the executives along for a finance-related briefing. It has been an eventful couple of months annual conference in December. There are also quite a number of chief in the life of our nation, with the accession of We have three branch conferences during the executives who are former finance directors, new prime minister Boris Johnson. It will be month – South Central, South West and Wales so for them it’s a chance to keep in touch with fascinating to see how the Brexit issue is resolved – all of which are usually very well attended. The friends and colleagues. over the coming months with his hardening contributions made by the local committees are In early October, the Healthcare Costing for stance over leaving the EU. invaluable, whether in programme design and Value Institute hosts its annual international A spin-off from his appointment has been delivery, turning up on the day to volunteer or symposium. Experts from across the globe will announcements around transport, full-fibre supporting sponsorship. come to the UK to talk about what’s going on in broadband and, of more direct relevance to While there is some paid help, it is the energy their country in terms of value-based healthcare. those of us working in the health service, a much and enthusiasm of volunteers that makes our With a couple of member webinars and a few needed injection of capital into the NHS. operation tick in these and other places. other national meetings, it all adds up to a The ensuing debate about whether money As far as national events go, we will be hosting packed line-up for this month. was really new or not is possibly the first time another chief executive forum in September. The autumn will also see the usual round of that the mechanics of the capital departmental committees. The HFMA has an extensive list of expenditure limit and how this spending groups and committees in areas such as policy, allowance is funded have been discussed in the governance and accounting. We’re often looking mainstream media (see technical page 23). HFMA chief for new faces for these groups, so look out for There is a more important debate needed executive notifications of vacancies or contact me directly around how far this goes towards meeting the Mark Knight at [email protected] service’s capital investment needs. Enjoy the rest of the summer and I hope to see It is an issue the HFMA continues to promote, you at one of our autumn events.

Member news On the hottest day in June, Stuart Wayment cycled 45 miles Team HFMA, taking on in the New Forest as part of the the Three peaks challenge in Wiggle New Forest Sportive. It October, has already raised over is the latest in his fundraising £5,150 for mental health charity efforts for PLANETS Cancer Member Mind. This includes more than Charity, which helps patients £950 from a raffle at the HFMA with pancreatic, liver, colorectal, benefits Summer conference and £636 abdominal and neuroendocrine in a raffle at the West Midlands communication with finance cancer by funding patient Membership benefits Branch annual conference. colleagues in the region. HFMA support groups, treatments include a subscription to Team HFMA went on a practice champions in each organisation and research. Support him at: Healthcare Finance walk in the Brecon Beacons in the area will promote HFMA uk.virginmoneygiving.com/ and full access to (pictured) to prepare for the opportunities in their finance StuartWayment the HFMA news alert challenge and are planning teams, ensure people are aware service. Our membership further fundraising activities to of mentorship opportunities, Do you have any news about rate is £65, with reach their goal. Support them and motivate them to submit you, your team or a colleague, reductions for more at hfma.to/3peaks nominations for the annual that you would like to see junior staff and retired branch awards and the national in our membership news or members. For more The HFMA Northern Branch HFMA Awards. For further appointments sections? Please information, go to has introduced an initiative information, please email email yuliya.kosharevska@ www.hfma.org.uk to improve engagement and [email protected] hfma.org.uk with the details. or email membership@ hfma.org.uk

28 September 2019 | healthcare finance

professional lives: my HFMA

Key supporters recognised

The HFMA honoured members who have made a significant contribution to the association at a key supporters dinner in London this summer

The association awarded four honorary fellowships and five The association made three bronze and two silver key contributor awards. awards key contributor awards. The winners received their awards The bronze awards went to: from HFMA president Bill Gregory during a ceremony at the Institution of Civil Engineers in London. Mike Townsend A stalwart of both local and national Chief executive Mark Knight said the HFMA would not be as HFMA activities, Mr Townsend (left) was nominated successful without its key supporters, who work hard for the by the Kent, Surrey and Sussex Branch. As well association. ‘Thank you to all our award winners and to all of our as playing a key role in the branch for at least 12 members, our key contributors, our corporate partners and all the years, he is also a member of the national HFMA staff at HFMA. We really do depend on your support and loyalty Governance and Audit Committee. He single- and it is you that make us unique.’ handedly organises one of the branch’s largest events each year, the annual accounting standards Honorary fellowships, which recognise members who have made a update, and turns what some think as a dry topic into sustained contribution to the life and work of the association, went to: an entertaining informative session.

Pam Hobbs Nominated by the HFMA South Neil Kemsley Mr Kemsley (right) was honoured Central Branch and the Skills Development for his work with the South West Branch, Network, Ms Hobbs (left) has been an advocate which he chaired. Described as having a calm of finance staff development throughout and welcoming manner, his leadership skills her career. She cares deeply about providing invigorated the branch and brought together an opportunities for school leavers, graduates excellent, proactive committee. Those who have and those in roles to progress in their careers worked with him will have benefited from his through learning. focus and commitment.

Ros Preen Ms Preen (right) has Sheila Stenson Mr Knight paid tribute to Ms Stenson’s been an HFMA member throughout her career commitment to the HFMA. She is currently in the NHS, spanning more than 20 years. She Kent, Surrey and Sussex Branch chair and is recently stepped down from the association’s passionate about staff development, the branch board of trustees and the fellowship is an and its members. She won the HFMA Deputy acknowledgment of her service. (Ms Preen Finance Director of the Year Award in 2016 was unable to attend the presentation and and was the first member of the national talent received her award later in the summer.) development pool to secure a finance director post. (Ms Stenson, right, was unable to attend the presentation.) Tim Crowley The HFMA North-West Branch nominated Mr Crowley (left) to acknowledge his The silver award is given to bronze award winners who continue to commitment to local NHS finance over many contribute to the association. This year’s winners were: years. The award is a mark of its appreciation of his work and the fact that his input will Kavita Gnanaolivu Ms Gnanaolivu (left) has be greatly missed now that he has stepped played an active role in the Wales Branch for down from the Mersey Internal Audit more than 10 years and is the driving force Agency. behind its research and development work. She has led and contributed to projects that have benefited the NHS in Wales and the UK. Jonathan Stephens Nominated by the HFMA Payment Systems and Specialised Services Group, Phil Foster Mr Foster Mr Stephens (left) previously took an active (right) was nominated by the role in the association’s Prescribed Specialised Provider Finance Faculty Technical Issues Services Commissioning Group. He continued Group. A supporter of the HFMA for years, to chair the group when it merged and has he is the faculty’s vice chair. His experience only recently stepped down. The group said his and knowledge are greatly valued by the vast knowledge and a level head have been great group. He can be relied upon to comment assets and he has always ensured detailed and often on any issues that arise and often brings new difficult discussions are kept focused. issues to the committee’s attention.

30 September 2019 | healthcare finance professional lives: people

Branch focus Appointments

My James Drury is the new interim director of finance at HFMA West Midlands Shrewsbury and Telford Hospital NHS Trust. Mr Drury has nearly 15 years’ experience working in the NHS, as well as 15 years at KPMG. He will remain in the position while the substantive director of finance Neil Nisbet is on The NHS people plan encourages secondment to NHS Improvement. collaborative working throughout the NHS, including between finance John Williams (pictured) has been and human resources professionals. appointed executive director of finance ‘We can’t continue to work in silos, we work now, the smoother this at Sheffield Children’s NHS Foundation as disjointed working has an impact transition will be,’ says Ms Li. ‘We Trust. He joins after six years at Chesterfield on expenditure and efficiencies,’ are moving from competition to Royal NHS Foundation Trust, where he says Kim Li (pictured), director of collaboration and this will require a was deputy director of finance and most finance at South Warwickshire NHS different skillset and more soft skills.’ recently managing director of its wholly Foundation Trust and chair of the The NHS people plan aims to owned subsidiary, Derbyshire Support and Facilities Services. HFMA West Midlands Branch. make the NHS an employer of Mr Williams has been part of the Future Focused Finance To empower finance professionals excellence and to improve the national talent pool. He takes over from Mark Smith, who to appreciate working with HR leadership culture. The HFMA has a remains at the trust as associate director of finance. colleagues, the branch is hosting key part in supporting its members a joint event with the Healthcare in achieving these objectives. Two directors of finance have taken up charity trustee People Management Association The need for finance professionals positions. Rob Pickup (pictured), interim director of finance, (HPMA) on 18 October to highlight to develop soft skills was also the procurement and information management the NHS people plan and the value driver for the branch to organise four and technology at Dudley and Walsall Mental of working in collaboration. workshops focused on coaching Health Partnership NHS Trust, is now also Speakers include NHS England for resilience and performance a trustee at John Taylor Hospice. The charity and NHS Improvement director management. They aimed to provides specialist support for people living of workforce and organisational develop participants’ coaching skills with a terminal illness and their families. development Steve Morrison, who to support themselves and their Tracey Cotterill, interim director of finance will explore the opportunities for teams. Ms Li, a strong advocate at Kingston Hospital NHS Foundation Trust, has become effectiveness and efficiency involved of coaching, says the HFMA can a trustee at Sustainability First, an environment think-tank in the NHS people plan. provide technical knowledge and with a focus on practical policy development in the areas of ‘No organisation has all the focus on skills. sustainable energy, waste and water. She is also a primary answers,’ says Ms Li. If people The coaching events were so school governor. come together, she says, they will well-received by branch members have the chance to exchange and that the committee is looking to Steve Warburton (pictured) has been develop ideas. make this support available in the named chief executive of the organisation ‘The role of commissioning is upcoming year. to be created from the merger of Royal changing, and providers will take on • For more on the branch, Liverpool and Broadgreen University more of the tactical commissioning visit hfma.to/westmids or email Hospitals NHS Trust and Aintree University currently managed by clinical [email protected] to Hospital NHS Foundation Trust. The commissioning groups. The closer share your views new organisation will be called Liverpool University Hospitals NHS Foundation Trust and the merger is scheduled to complete in October 2019. Mr Warburton is Eastern [email protected] currently chief executive at Aintree University Hospital NHS East Midlands [email protected] branch Foundation Trust. He first joined the organisation as director contacts Kent, Surrey and [email protected] of finance and business services and deputy chief executive London [email protected] in 2006 and became chief executive in 2015. Mr Warburton Northern Ireland [email protected] started his NHS career in 1989 as a graduate finance trainee in Northern [email protected] Mersey Regional Health Authority. North West [email protected] Scotland [email protected] Hardev Virdee has been appointed group chief finance South West [email protected] officer at Barts Health NHS Trust. He is currently the chief South Central [email protected] finance officer at Central and North West London NHS Wales [email protected] Foundation Trust. Mr Virdee who first began his NHS career West Midlands [email protected] as part of the national graduate training scheme, will be Yorkshire and Humber [email protected] joining Barts Health in November, where he will take over from interim Bill Boa.

healthcare finance | September 2019 31 professional lives: people

Obituary: Tony Waite

It was with great sadness that the ‘The PFI was a mammoth job for him. Obituary HFMA learned of the passing of Tony Waite, a leading NHS finance He worked really hard on director and enthusiastic contributor it and was instrumental in to the life of the association. bringing the hospitals to the Two years’ ago, he was diagnosed with a patients and populations of brain tumour, which was removed. Following Wakefield and Pontefract. I Left: Tony Waite at the 2008 treatment, he was hoping to use his expertise and don’t think we would have HFMA Awards, when he experience in a non-executive role. However, these hospitals without him.’ was shortlisted for Finance his cancer returned, and he died peacefully on Mr Waite is still fondly Director of the Year 2 August at the Wakefield Hospice. He is remembered in his former survived by his wife Lynn and two daughters. finance team in Wakefield. A native of Wakefield, Mr Waite spent almost ‘One of my heads of finance eight years as finance director of the local Mid said he encouraged them to Yorkshire Hospitals NHS Trust. When he joined qualify and was so supportive where it was a positive in 2003, the trust was in deep financial difficulty. in getting them there. Clinicians thing,’ Mr Johnson added. In 2003/04, it reported an £18.6m deficit, the here also speak highly of him. Mr Waite’s work on the trust’s largest of any single organisation in the English He was a really nice person – I spoke with him financial turnaround and the PFI led him to be NHS that year. frequently and he always gave me good advice.’ shortlisted for the HFMA Finance Director of As a result of ongoing financial difficulties, Mark Johnson worked with Mr Waite at the Year Award in 2008. the trust was placed in special measures in the Mid Yorkshire trust while it was in special In 2011, he became finance director and 2007 – under the new financially challenged measures, having first met him through the deputy chief executive of Burton Hospitals trusts regime. However, Mr Waite successfully HFMA. ‘He was a really easy person to work NHS Foundation Trust and then joined led the trust out of special measures in 2009, with and led by example. He used to get Sandwell and West Birmingham NHS Trust in partly by taking a system-wide approach everybody involved to produce a collaborative 2014 as finance director. involving the local primary care trusts and solution. He kept a stack of books where he’d Toby Lewis, the Sandwell trust’s chief strategic health authority. write down the numbers and he’d refer to them executive, said: ‘Tony was a valued colleague and Andrew Pepper, who worked with Mr Waite during meetings. You knew you could never pull leader in our organisation, with a wide circle at the Mid Yorkshire trust and has known him the wool over his eyes.’ of friends both inside and outside the trust. As for 16 years, said: ‘One of his main achievements He encouraged finance staff to join the HFMA one of the principal architects of our work on at Mid Yorkshire was organising the new – as well as chairing the HFMA Yorkshire and long-term finance, on new estate including the hospitals at Pinderfields and Pontefract. The Humber Branch for many years, Mr Waite was Midland Met, and on public health, Tony was time and effort, strategic thinking and resilience also a member of the association’s Provider passionate about the NHS and placed the highest needed to deliver that was significant. I spoke Finance Faculty. He was always keen to support value on improving the quality of patient care. to him a month or two ago and he said it was staff who wanted to add to their skills. ‘Getting ‘I know that he remained fiercely proud of always his aim to get the doors open on the new training was never an issue. He didn’t force this organisation, clinically and in terms of our hospitals, and he achieved that.’ anyone to train, but he created an atmosphere ambitious vision, and will be missed in all the ‘I got to know him personally and he was organisations he served over a career with more kind, generous and he had a brilliant strategic than 30 years as a director, including his five brain. Added to that, he had integrity, he had “The PFI was a mammoth years with us. Our aim going forward in his wisdom and he was fiercely loyal.’ job. Tony was instrumental memory will be to continue to try and deliver Jane Hazelgrave, the current finance director in bringing the hospitals to our 2020 Vision – reporting back next year to at the Mid Yorkshire trust, also speaks warmly of local residents as we promised we would. Mr Waite. ‘I was at the strategic health authority the patients and populations ‘Trust was such an important part of how when Tony was at Mid Yorkshire and we did a lot of Wakefield and Pontefract. Tony worked, and who he was, and I know of work together, particularly on the new private I don’t think we would have he would want to try and build even more finance initiative hospitals and because the trust confidence from local people in the honesty with was financially challenged. these hospitals without him” which we deliver change and improve care.’

32 September 2019 | healthcare finance