February 2020 | Healthcare Financial Management Association www.hfma.org.uk

Caroline Clarke Looking to the future with pride

News Comment Features Features Professional lives Trusts highlight Finance teams must Capital funding: Value roundtable: Technical, events, concerns over stay objective and Leeds rising to the the way forward for training, association blended approach be future-focused HIP challenge measuring outcomes news, job moves

healthcare finance

February 2020 | Healthcare Financial Management Association www.hfma.org.uk

Caroline Clarke Looking to the future with pride

ContentsFebruary 2020

News Comment Features Features Professional lives Trusts highlight Finance teams must Capital funding: Value roundtable: Technical, events, concerns over stay objective and Leeds rising to the the way forward for training, association blended approach be future-focused HIP challenge measuring outcomes news, job moves

Managing editor News 13 Mark Knight 0117 929 4789 [email protected] 03 News Editor Tariff proposals for 2020/21 Steve Brown 015394 88630 [email protected] 06 News review 08 Associate editor A recap of some of the new Seamus Ward 0113 2675855 government’s commitments [email protected] Professional lives 08 HFMA conference 2019 Yuliya Kosharevska 0117 938 8440 Highlights from the annual yuliya.kosharevska@ conference in December hfma.org.uk Advertising Paul Momber Comment 0117 938 8972 [email protected] Subscriptions and membership James Fenwick 10 Back to business 0117 938 8992 [email protected] New HFMA president Caroline Production Clarke calls for finance to Wheal Associates maintain objectivity and clarity 020 8694 9412 [email protected] Getting stuck into value Features Printer 10 Severn Print Steve Brown considers the next steps for value-based healthcare 13 Bright future for Leeds Professional lives What do upcoming capital developments mean for The Leeds HFMA Teaching Hospitals NHS Trust – one of the first to benefit 1 Temple Way, from the Health Infrastructure Plan? Bristol BS2 0BU

Executive team 25 Technical 16 Taking pride in our future Mark Knight Group accounting manual New HFMA president Caroline Clarke hails the NHS’s track Chief executive [email protected] focus, plus technical review record of improvement in the face of huge pressures, and urges Emma Knowles and NICE update staff to be proud of what they have done Policy and research director [email protected] 28 Development 20 The right outcomes Alison Myles Education director Milestone learner Toby Garrood An HFMA Healthcare Costing for Value Institute roundtable [email protected] plus FFF conference news in December looked at progress with measuring the outcomes Ian Turner that are key to understanding value Finance director [email protected] 29 HFMA diary Dates for your 2020 diary and Editorial policy The statements and opinions details of three new webinars in Healthcare Finance are those of the authors and not necessarily those of HFMA. 30 My HFMA No part of this publication may be reported, stored in a Mark Knight on a flying start for retrieval system or transmitted the association in 2020 in any form by any means without permission.Healthcare Financial Management Association (HFMA) is a 31 Appointments registered charity in England Recent job moves, and Claire and Wales, no 1114463 and Scotland, no SCO41994. HFMA Wilson’s new Wirral role (p32) is also a limited company registered in England and Wales, no 5787972. ISSN 1472-3379

healthcare finance | February 2020 01

news

Clarke begins presidency which reflects her belief that people from across the NHS workforce are key to delivering more Caroline Clarke became the HFMA’s president at integrated care models. the association’s annual conference in December, The association made eight industry awards at succeeding Bill Gregory. the conference, including Finance Director of the Ms Clarke, group chief executive of the Royal Year Karen Geoghegan, and honoured 84 students Free London NHS Foundation Trust, has an who gained HFMA intermediate or masters-level extensive background in NHS finance, joining qualifications. Edward Gold, head of costing and the health service in 1991 as a national graduate income at East Suffolk and North Essex NHS finance trainee. She received the chains of Foundation Trust, won the 2019 Tony Whitfield office from Mr Gregory before announcing her Learner of the Year Award.

presidential theme – Taking pride in our future – • See Taking pride in our future, page 16 THEODORE WOOD News Trusts raise concerns with blended payment baselines

By Steve Brown Blended payments combine a fixed payment Support Unit – Establishing fair benchmark levels based on agreed activity with one or more of: an for the blended payment system – suggests that A 1.4% increase to tariff prices and an expansion outcomes-based element; a risk-sharing element; the financial implications of using inappropriate of the blended payments model to more service and a variable payment. Already set as the modelling approaches for setting planned areas are the headline messages from the formal default mechanism for emergency care and adult activity levels within the blended payment consultation on the 2020/21 national tariff. mental health services, this will now be extended system are not trivial. ‘Our analysis showed NHS England and NHS Improvement to outpatients and maternity services, with a that a group of providers could see swings of published their tariff proposals at the end of pilot scheme also run for adult critical care. up to £6m in their payments (for emergency 2019 and the consultation ran until the third NHS Providers backed the one-year admissions alone) depending on the method week of January. timeframe for the tariff as appropriate given the used,’ it said. The report calls for methods to set The tariff has reduced in importance in recent ‘lack of uniformity across payment systems’. benchmarks to be set out in detail. years as many health economies have But policy officer Patrick Garratt Despite the proposed expansion of blended reverted to simpler block contracts “We are said: ‘Over the long term, providers payments, it is not clear how many systems have or introduced caps and collars and concerned about will require more certainty over adopted the approach in 2019/20 for emergency other risk-sharing arrangements. the potential for their baseline allocations. care or mental health. A formal evaluation of However, along with detailed double-counting... NHS England and NHS the emergency care system is promised in the planning guidance, due to be a trust could face Improvement should work consultation paper. However, NHS England published as Healthcare Finance a double penalty towards setting the tariff for and NHS Improvement have suggested that the went to press, the cost uplift on overactivity” a longer period of time after majority of commissioners and providers have and efficiency requirement are Andrew Monahan, 2020/21 to support the long- something in place that follows the spirit of the key details in enabling systems to HFMA term ambitions of the sector as set blended payment policy. agree contracts for 2020/21. out in the long-term plan.’ The HFMA’s response has also raised concerns The guidance proposes a 2.5% inflation The representative body’s response with the process to agree the fixed payment, cost uplift, offset by a 1.1% efficiency factor. to the consultation also raised issues with specifically for outpatients. Price relativities will be rolled over from the the blended payment approach, with trusts ‘We are concerned there is the potential 2019/20 tariff to minimise financial volatility concerned about the difficulty in establishing for double-counting,’ said HFMA policy with the tariff set for just one year. The move baselines. ‘Trusts must be reassured that and research manager Andrew Monahan to new market forces factors – which adjust activity levels will be forecast on previous (pictured). ‘If reductions in face-to-face contacts national prices to take account of unavoidable years’ outturns and continuing trends,’ the are factored into the fixed payment and also local costs incurred in different parts of the response said. ‘Commissioners should not place included as an outcome measure, a trust could country – will continue, with 2020/21 the second unrealistic expectations upon providers by face a double penalty on any overactivity,’ he said. year of a five-year ‘glide path’. setting ambitious forecasts.’ He added that there were also concerns about The consultation document also confirmed A report from The Strategy Unit at the the suitability of a blended payment approach for an expansion of a blended payments approach. Midlands and Lancashire Commissioning specialised services outpatients.

healthcare finance | February 2020 03 news

Carillion costs contained but risks remain

By Seamus Ward It is now predicted to cost more than £1bn. It is expected the taxpayer will pay £739m of this The government has limited the additional costs £1bn – £7m or 1% less than originally planned. to the taxpayer for completing two hospitals The Midland Met is now expected to cost following the collapse of constructor Carillion, £988m to build and run – around £300m more but could have avoided compensation paid to than planned. The taxpayer is currently expected investors, according to the National Audit Office. to pay £709m of this – an increase of 3% (£23m) A report into the efforts to rescue the two on the original plans. However, the NAO hospitals – Royal Liverpool University Hospital believed there was significant risk of further and Midland Metropolitan Hospital – found delays and additional costs. that the new hospitals will open much later than New audit code The NAO estimated the private sector’s planned and with higher costs. total losses on the projects stands at more than Both were being built by Carillion under The final draft of the NAO’s new £600m. However, it added that the government private finance schemes when the constructor Code of audit practice has been paid £42m in compensation to private lenders went into liquidation in January 2018. presented to Parliament. The code, on the Royal Liverpool scheme soon after The Royal Liverpool, which was being which sets out statutory requirements the contract was terminated. Although the built under the private finance initiative, was for relevant public bodies, including compensation was based largely on the estimated originally due to open in July 2017, but is NHS organisations, has a number of cost of completing the hospital, the government now to be completed in 2022. The Midland changes. It proposes the introduction of would have paid nothing once a fuller picture of Metropolitan, which was being built under the a narrative-style commentary on bodies’ the actual cost emerged. PF2 initiative (in which the government took an arrangements for securing value for The Unite union assistant general secretary equity stake), is also due to open in 2022 – just money, together with a greater focus Gail Cartmail called the report ‘grim reading’. under four years later than planned. on supporting financial sustainability, ‘Two desperately needed hospitals are going After several failed attempts to rescue governance and value. Expectations to be years late and in the meantime local the projects, the contracts were terminated on timely and effective audit reporting communities are left with facilities that are in September 2018. The Royal Liverpool have been made clearer. The new code no longer fit for purpose,’ she said. ‘While the was expected to cost £746m to build and will come into effect in April, subject to report notes the financial cost of the projects, run, including maintenance and facilities Parliamentary approval. the human cost of the delays of completing the management costs, as well as construction costs. hospitals has not been recognised.’

Hancock promises permanent pensions solution

The government has promised a clinicians the confidence figure only known at the end of permanent fix for the NHS pensions issue to do their jobs in the the tax year, even those who that has led some clinicians to turn down knowledge they will be earn well below this increased additional shifts, leave the pension fund fairly rewarded,’ he said. threshold would still likely limit or consider early retirement. In January, there were their work to ensure they’re Some senior clinicians face four-, reports that the Treasury is not hit with unexpected five- or six-figure tax bills, according considering increasing the charges.’ to the British Medical Association. This income threshold at which In the short term, is due to rules on tax relief on pension the taper applies to £150,000. NHS England and NHS contributions that include a taper on But the BMA insisted raising Improvement have moved annual allowances for incomes above the threshold would not fix to ease clinicians’ fear of taking on extra £110,000. Senior NHS managers have the problem. work this winter – clinicians will pay any also been affected, though there are no BMA pensions committee chair Vishal tax liability using funds from their pension current plans for them to be covered by Sharma said: ‘The annual allowance is pot and the NHS will be legally bound to new proposals. completely unsuitable for defined benefit cover any resulting shortfall in pension on In December, health and social care schemes. Simply raising the threshold retirement. secretary Matt Hancock (pictured) said he income would not remove any of the NHS England and NHS Improvement was targeting a long-term solution. ‘We’ve complexity of the taper, nor the threat chief financial officer Julian Kelly said the already agreed a short-term solution for of doctors facing a “tax cliff” when their arrangements will incur no extra costs for this winter, but we’re launching an urgent income increases. the employer. Mr Hancock confirmed the review of the annual allowance taper ‘And due to the complexity of the way commitment will be honoured when the so we can fix it permanently and give pension growth is calculated, with a final affected clinicians retire.

04 February 2020 | healthcare finance will rise by rise £13mto £700m. will ring-fenced mental funding health improving mental healthcare – a priority and its included focus EvansRebecca said was health mid-December, finance minister government’s draft budget. £8.7bn, according to Welsh the total funding in2020/21to than £400mnext year, taking receivewill an increase of more Health care and inWales social Mental healthapriorityin Welsh draftBudget engagement asapriority.’ country, andurgethemtocontinuethis to us,andclinicaldirectors across the NHS Improvement thattheyare listening the positivesignsfrom NHS Englandand funding forwhatisbeingaskedofthem.’ systems, andgreater clarityaround time, more supportfrom theirlocal directors toldusthattheyneedmore expected ofthem.Inparticular, clinical resourced todeliverwhatisbeing that [PCNs]are farfrom prepared or potential, there isoverwhelmingconcern networks, said:‘Despitethehuge development director forprimarycare years –were adequatelyfunded. requirements ofPCNsoverthenextfour draft servicespecifications–setting were overwhether significantconcerns confused overPCNfunding,there As wellas48%ofrespondents being leaders (clinicaldirectors), mostlyGPs. prescribers directly intopatientcare. and bringpharmacistssocial hospitals tobeoffered inthecommunity, allow more care traditionallycarriedoutin practice attheheartofservices.They the according totheNHSConfederation. available tothemandhowitisallocated, (PCNs) are confusedaboutthefunding Almost halfofprimarycare networks clarity urged PCN funding An additional £421m will be An additional be £421m will Unveiling draft the Budget in However, sheadded:‘We welcome Ruth Rankine,theconfederation’s The confederationsurveyedPCN PCNs have been established under PCNs havebeenestablishedunder NHS long-term plan long-term NHS and put general andputgeneral technologies. transformationin service and new growth, investment be there will pay awards and inflationary cost (£342m) and, as well as funding to allocated NHS the be will capital total £374m. funding will to almost £8.4bn, rise while will Health and care revenue funding and £36mincapital funding. includeswhich £385minrevenue care, toallocated and health social Funding for Public Health Most of revenue extra the financial years. pay parity immediately and over next the two executive, includes which £200mto deliver additional £2bn financialpackage forthe to accept pay the offer. consulted they while with members on whether subsequentlywho suspended industrial action year. Mr Swann quickly met with unions, health to Northern Ireland to restore pay parity this made available from proposed future allocations minister executive. new inthe Some £30mwas January, Robin Swann as health was installed bill –was by rejected unions health inDecember. would have aprojected added 3.1%to pay the staff expectations. One offer which – unable to offer pay rises to meet Departmentthe of Health were for three years, at servants civil levels. With no executive inplace colleagues inEngland and staffing over lack the of pay parity with of Nursing (RCN). for members of Royal the College January, including –afirst strikes industrial action over and December early suspension of action by strike thousands of staff. power-sharing Assembly, has which to led the wake inthe of reformationboost the of local the Northern Ireland received an immediate funding in Health care and services social personal By SeamusWard NI healthandsocialcare Assembly dealboostfor As of part package, the financial further Later, UKgovernment the agreed an However, with Assembly the reinstated on 11 Their main complaints were Staff on Agenda forChange pay took scales start ofstart Assembly this term in 2016.’ Welsh NHSreach £37bn since the investmentplans see will inthe Despite of adecade austerity, our protect future the of our planet. people of Wales and invests to delivers on our promises to the investing inImprovement Cymru. antimicrobial resistance and Health fighting Protection Service, developmentthe of aNational nearly £5mof supporting this Wales increase by will £6.8m,with Ms Evans draft Budget said: ‘This provide care the and treatment required.’ right numbers of nurses right inthe places, to just on pay, but on ensuring that we have the Ireland, dispute said: ‘This always not focused staffing. safe to producing acosted implementation plan for and well.’ doso picket line, can get back to jobsthat the love they great care and health staffcan social come the off (which are(which longest the UK)and inthe to create an actionplan waiting on local times decade, new approach –includes pledges to justice services. shared be education health, will between and a£245mtransformationschool, while fund providedsupport be will for medical anew the delivery of delivery the value for money, it added. governance and structures hampered delivery cost targets. and timescale Cumbersome high-priority capital projects were failing to meet approach as it was needed found major and The Northern Ireland new Audit Office said a Pat Cullen, director of RCN the inNorthern The saidtheRCN minister had committed The deal to The deal reinstatethe Assembly –New healthcare finance enough for time scrutiny. clarity and to give public services 11 March as he wanted to offer He said he could not adate set after present his Budget on 6February. Derek Mackay,secretary will who Budget process, said finance thatScottish has affectedthe March –adecision Budget on 11 deliver his (pictured) will Sajid Javid transform care. and health social implement of reforms aseries to Northern Ireland executive board will oversee service overseeboard will service transformation and keep Chancellor Chancellor under review. healthcare structures delivery funding has now been secured. funding has now secured. been restored. nurses Our and other Pay parity with England can be A joint UKgovernment/ Mr Swann said: ‘Additional |February 2020 news

05

PROFIMAGES NewsSeamus Ward assesses review the past two months in healthcare finance

It may seem like a long time ago, While health and social care secretary this year will receive a non-repayable payment but the Conservatives won the Matt Hancock (pictured) said the of at least £5,000 a year. Additional payments general election, sweeping Boris move would give the NHS certainty of up to £3,000 will be available for students in Johnson back into Downing Street over funding. regions or specialisms struggling to recruit or to with a majority of 80. This will, of help students cover childcare costs. The move is course, affect the NHS – with the The NHS was at the heart of expected to benefit more than 35,000 students UK officially leaving the European the government’s first Queen’s a year and is part of the government’s manifesto Union on 31 January under the deal speech, which set out the measures commitment to increase nurse numbers by brokered by the prime minister before above. It said draft legislation will 50,000 by 2025. the election. NHS staff from European be produced to accelerate the NHS long-term Economic Area countries (except the plan, while the government also plans to seek While much of the government’s priorities Republic of Ireland), resident before the end cross-party consensus on proposals for long- will be welcomed, those involved in health of the year, will have to apply for settled or term reform of social care. To fulfil a manifesto and social care services will also be looking pre-settled status. Those coming in after 1 promise, hospital car parking charges will also to the delayed spending review for long-term January 2021 will need the obtain an NHS be removed for those in greatest need from capital, education and public health allocations. visa, which will be introduced as part of the April. Mr Hancock said people with disabilities, The NHS Confederation said that the government’s promised Australian-style frequent outpatient attendees, parents of government should set a realistic budget in immigration system. The smooth operation children staying overnight in hospital and staff the 2020 spending review to restore investment of both systems will be vital as the NHS working night shifts would be exempt from the in training clinicians and improve recruitment gears up recruitment. charges. As well as looking at capacity and the and retention. Setting out NHS priorities for potential use of technology, the Department the government to focus on, the representative NHS revenue funding will remain as planned, added that it would assess where capital body also called for the pension tapering issue and will be enshrined in law. Published in investment could be used to help improve the to be addressed (see news, page 5). The financial January, the NHS long-term plan funding bill experience of patients and visitors. impact on clinicians has led to doctors turning commits the government to spending an extra down additional shifts and responsibilities, £33.9bn a year in cash terms by 2024. The Another manifesto promise – restoring exacerbating staffing difficulties. And it called legislation includes a legal duty on the Treasury nursing bursaries – was also addressed. The for the creation of an emergency capital and the health and social care secretary to Department of Health and Social Care said that infrastructure fund and increased funding provide this minimum level of revenue funding. all nursing students on courses from September for social care.

The month in quotes

‘This funding bill will empower the NHS and its ‘Andy’s deep knowledge of and commitment ‘We have seen world-class clinicians to deliver our bold plan for to the health service, deriving from many a worrying the NHS. They can do so safe in the knowledge years of public service, is unparalleled. We increase in that this government is giving them the financial continually benefit from his insights and wise the delays certainty and support to revolutionise prevention, counsel and I am very pleased to see his for patients detection and treatment.’ contribution recognised.’ between Health secretary Matt Hancock says the NHS Nuffield Trust chief executive Nigel the decision to admit and long-term plan funding bill demonstrates the Edwards pays tribute to Andy McKeon, admission – more than eight government’s ‘iron-clad’ commitment to the who was appointed a CBE in the new times as many patients waited health service year’s honours over 12 hours this December compared with December ‘We have more than 100,000 vacancies, the NHS needs last year.’ significant investment in buildings, equipment and IT, and Miriam Deakin, NHS Providers everywhere it is struggling to meet waiting times. Our members director of policy and strategy, says have warned this could be the worst winter on record.’ frontline staff are working flat out to NHS Confederation chief executive Niall Dickson sets out the scale of the meet winter pressures challenge facing the government

06 February 2020 | healthcare finance SHUTTERSTOCK on alarger it scale, said. models have delivery new the implemented been residential care, has fund the grown and some of older people independent and out of hospital or establishment in2014/15as ameans of keeping of £59mand £30mof capital funding. Since its report said that it had revenue allocated funding of care and support. The ICF’s 2018/19 annual have potential the to influencefuture patterns of and new innovative ways of working that (ICF) programme had supported range awide government said that its integrated care fund care.social and health between information sharing well as improve for longer, as live independently most vulnerable help will the – these care projects social to develop adult digital authorities given be to local £4.5mwill further on integrating and national local systems. A afocus access be permissions, there will while to ensure seek will staff havethe appropriate couldwhich compromise security. Trusts multiple passwords or same the use password, ins, Department the said, and had to remember fingerprintSome access. staff have up to15log- logins or provide multi-factor logins, such as to work with suppliersservice to standardise computer systems. allow the funding The will staff time the into logging spend work it would allocate £40mto reduce unveiled.Department The said manifestoin the was also Away from Westminster, Welsh the One measure not included hospital car parking charges willalsobe manifesto promise, removed forthose in greatest need To fulfila Tory management, respectively. to healthcare and to public financial sector Rob Whiteman were awarded CBEs for services chair Andy McKeon and CIPFA chief executive to governmentservices finances. Nuffield Trust officer Department, the at received an OBE for director general, finance, and chief operating Lancashire and South Cumbria. David Williams, awarded to NHSin anthe MBE for services CommissioningBay Clinical Group, was officer and governance director at Morecambe Parkinson, was who previously chief finance for many people associated with NHS.Kevin the being postponed,being were they not cancelled. being care system and, though some operations were there was pressure across whole the and health Wales, minister health Vaughan said Gething by 6%compared with November 2018.In 12 months earlier. The waiting list had increased elective care increased by 2.9%compared with 12monthsin the to December. In November, four hours, with A&Eattendances up 4.8% admitted, transferred or discharged within in December. Just 79.8%of A&Epatients were reported that demand on systems health grew was £10mlast winter). pressure funding has now reached £13.4m(it the waitingthe improvement times plan. Winter will be drawn be from asidewill for £815mset the Finally, year’s new the honours saw awards NHS as it faceswinter pressures. funding The provided £3.4mto support afurther the care they need. The Scottishcare need.The they government Significant numbers continued the to access NHS performance. NHSEngland norovirus, have which hampered have outbreaks been of flu and relatively far, so mild there Thoughthewinter been has www.hfma.org.uk/news/blogs both theNHSandBermuda. conference andtheimpactofBrexit on returning totheUKfor HFMAannual islands. Inhislatestblog,hereflects on working onthe blog serieson – continueshis finance director former NHS (pictured) –a officer BillShields chief financial Hospitals Board Bermuda professionals. finance and meetingtheneedsofyounger reduction, greater systemworking technology, finance’s role incarbon of topics,includingtheimpact panel discussionlookedatarange its future, says profession isbeginningtomapout the systemtransforms,and Finance staff willhavetoadaptas outpatients cameasasurprise. the inclusionofsomespecialisedservices outpatient appointmentsbyathird, but the long-termplanambitiontoreduce blended paymentstooutpatientsfitswith and commissioners.Theextensionof putting toogreat aburden onproviders systems introduce newcare modelsand aims tostrikeabalancebetweenhelping the consultationon2020/21tariff on theassociation’s website,hesays policy andresearch manager. Inablog according toAndrew Monahan,HFMA 2020/21 tariff istosupporttransition, It feelslikethepurposeofproposed from thehfma the report, was heldagainstthebackdrop of function –andtheskillsrequired – about thefuture shapeofthefinance annual conference saiddebate wrapping upeventsattheHFMA editor SteveBrown. Hisblog better decisions, better health better decisions, better healthcare finance Designing our future: future: our Designing Healthcare Finance Finance Healthcare |February 2020 . A . A news

07 University HospitalsBirmingham’s ClaraDay Leeds Teaching Hospitals’ David Berridge Outgoing president BillGregory

HFMA AWARDS 2019 December 2019 | Healthcare Finance supplement Karen Geoghegan named top director

Page 1-2 Finance Director of the Year Page 3 Qualifications/FFF stop ordodifferently. Apanelsessiondiscussedtheneedforfinance staff tothinkcreatively, and Finance LeadershipCouncil,saiditwasanattempttothinkabout whatthefunctionneededtostart, Worthington, director offinanceatLeeds Teaching HospitalsNHS Trust andamember ofthe for their contribution to delivering good patient outcomes. for theircontributiontodeliveringgoodpatientoutcomes. finance staff, where diversityhelpstodriveinnovationandwhere financestaff are widely recognised launched attheconference –imaginesafuture where theNHSisseenasbestplacetoworkfor ways theirdepartmentsoperate.Anewreport from Future-Focused Finance,theHFMAandPwC– technology, devisingnewmodelsofcare andusingstaff indifferent ways. KPMG intheUK.Solvingglobalworkforce crisisinhealthcare, hesaid,wouldmeanharnessing challenge. ThiswasathemepickedupbyMarkBritnell,globalchairmanandseniorpartnerfor careful supplyanddemandprojections fortheservicegoingforward. required standard. Shetrailedplansbythefoundationtoestablishacentre thatwoulddevelop to takealonger-term viewoftheresources neededtodeliverservicessustainablyandthe social care. However, shealsomadeamore emerged generalargumentforwhichevergovernment of themainparties’keypromises onhealth–focusinginfundingfortheNHSandall-important inside andoutsidethemainconference room. the different offers onthetablefrom thevariouspoliticalpartieswere stillprominent indiscussions to makepresentations duetopre-election sensitivity. However, thecountry’s votingintentionsand did justaweekbefore thecountrywenttopolls.Anumberofseniorcivilservantswere unable The generalelectionloomedlargeovertheHFMAannualconference inDecember–comingasit Highlights from theconference inDecember HFMA 2019 Introducing thedocument– Finance staff willthemselvesneedtoadaptnewroles infuture astechnologyalsochangesthe She addedthatthere didappeartobeconsensusthatstaffingnow represented the central Jennifer Dixon,chiefexecutiveofthinktankTheHealthFoundation,provided ahelpfulreminder

Page 4 Deputy Finance Director Page 6 Finance Team

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Page 13 Clinician Page 14 Governance

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Page 16 Havelock Training Page 17 Past winners ways toimprove staff mobilityacross different partsofthe system. was sofundamentaltoit,BBCEurope editorKatyaAdlerreflected on the politicallandscapeduring2019. appearance of Jax Kennedy and her amazing assistance dog, appearance ofJaxKennedyandheramazingassistancedog, Bringing theconference backtotheelectionandBrexit issuethat Kingston, onthemainstage.fundedfrom apersonal health budget, helps Jax manage her physical disabilities and has health budget,helpsJaxmanageherphysicaldisabilitiesandhas Designing our future: better decisions, better health better decisions, better future: our Designing transformed her life. Kingston is estimated to have saved the NHS transformed herlife.Kingstonisestimated tohavesavedtheNHS However, astand-out momentformanydelegateswasthe nearly £1m over the last few years and was a major hit with the nearly £1moverthelastfewyears andwasamajorhitwiththe conference audience. recognising Eightawards thebestinNHSfinanceandgovernance. were presented, withKarenat Geoghegan,chieffinanceofficer Brighton andSussex UniversityHospitalsNHSTrust andWestern Sussex Hospitals NHSFoundationTrust, namedHFMAFinance The conference alsohostedtheannualHFMAawards, Director oftheYear. Designing ourfuture panelsession – Simon –Simon

CONFERENCE PHOTOGRAPHY: THEODORE WOOD conference 2019

Jax Kennedy and Kingston

The Health Foundation’s Jennifer Dixon HFMA qualifications graduates

KPMG’s Mark Britnell US HFMA’s Michael Allen

BBC’s Katya Adler

HFMA chief executive Mark Knight

Leeds Teaching Hospitals’ Simon Worthington NHS England’s Tony Young Broadcaster Matthew Syed CommentFebruary 2020

Like many people, I’m government struggled with. plan. I’m a pretty optimistic Back to relieved to have got the I was struck by the person, and there’s plenty in election out of the way, performance data the NHS the plan to be cheerful about so we can at least return released in January. It was – a focus on integrated, business to business in the public pretty grim reading, with digital and personalised services. Whatever you less than 80% of patients care, action on inequalities We need to be honest think of the result, we now treated within four hours, and prevention, some great about how much have a government with a rising waiting lists (6% commitments about some of recovery is needed before working majority that will higher than last year, with the biggest killer conditions, transformation be able to enact policy in 4.6 million people waiting and a return to financial a way that the previous for treatment), more patients balance. What’s not to like? staying longer in hospital, But we’ve got to be honest away from their families and about current performance familiar places of care, and and how much recovery pressures across the mental we have to do before we HFMA health system showing huge transform. We are going to president increases in demand. need both cash and time to Caroline Clarke This data was published a clear waiting lists and treat year after the NHS long-term our patients.

Value-based healthcare needs to across the whole of the NHS. That’s easier said Getting move into the practical delivery phase and than done, but finance teams have a major finance teams need to be at the heart of this. role in making it happen. December’s vision paper for NHS finance – An HFMA Healthcare Costing for Value stuck into Designing our future: better decisions, better Institute roundtable in December (see page health, published by the HFMA, Future- 20) explored progress in the collection and value Focused Finance and PwC – is littered with use of outcome data to inform value-based references to value being central to finance decision-making. It is clear that the service Finance teams have a teams’ future role. has made a lot of progress in addressing the key role in moving value It talks about the finance function ‘leading cost side of the value equation – with an the way in developing a system-wide ongoing programme to get all NHS providers to the next level understanding of value’ and of adopting costing at the patient-level. business partnering roles ‘to focus more But there has been far less co-ordination closely on value-adding activities’. in terms of outcomes. There is no shortage It also suggests that the profession needs of data collected in the NHS – for outcomes to recognise the importance of moving to frameworks, clinical audits or to fill various an outcome-driven approach rather than a registries – but little finds its way back into cost-focused system. There is wide-ranging acknowledgement that making decisions based on the value delivered – both in terms of outcomes and costs – makes sense. And there are growing examples of value-based approaches delivering real benefits in terms of improved Healthcare patient pathways, better patient outcomes and Finance savings that help services stay within budget editor or be reassigned to other patient care. Steve Brown But value-based healthcare needs to grow its base and become the way of doing business

10 February 2020 | healthcare finance comment

PRESIDENT’S PLAYLIST

BOOK Radical Help, Hilary Cottam This has some interesting examples of new ways of working, and challenges to historic notions of how the state should provide care. It’s an optimistic reinvention of the welfare state, based on how humans work together. PODCAST Brexitcast (back after election) I love hearing political journalists let off steam and get underneath what’s really going on. With a 10-year old daughter, I’m also listening to a distressing number of boy bands. Any tips on how to divert away from Lewis Capaldi and Justin Bieber and how to avoid Radio 6 being retuned to Radio 1? • Send your suggestions to [email protected]

“Our job is to ensure we in an increasingly digital worry that the focus on unwarranted variation in maintain objectivity and clarity, environment – the NHS has ever more complex pricing cost and quality to add value. and to grow a focus on the been astonishingly slow to mechanisms is in danger Whatever happens, 2020 balance sheet” adopt new technologies. of missing the point that – international year of the These are all pretty systems need to concentrate nurse and midwife as well as general concerns, but our on reducing system cost and the HFMA’s 70th anniversary job as finance professionals on integrating, rather than – will be a year to remember. We also need to be super is to ensure we maintain passing money around. The NHS will be high on the clear on how we think objectivity and clarity, and to Perhaps that’s naive, but government’s agenda, and current concerns on ailing grow a focus on the balance we have limited bandwidth we will have an opportunity physical infrastructure sheet, the medium to longer and our intellectual to shape the service for (across the care system) term future, as well as the endeavour needs to be on the future generations. And I should be addressed, as well here and now. We must be big health issues in front of think the HFMA and finance as the well documented crisis more future focused. us rather than transactions. professionals have a massive in social care. And we need I note there’s been tariff For me, as a taxpayer and part to play in that. Happy to be much more explicit action, with a consultation a patient, those issues are new year everyone. about how we grow and on blended payments and reducing the overall cost develop a workforce that is fit some further complexities of care, increasing quality Contact the president on for the future and can work that left me a bit cold. I do of care, and reducing [email protected]

clinicians’ hands to inform care decisions or “There is no shortage of data to rethink pathways. collected in the NHS, but little There is an argument for a more centrally finds its way back into clinicians’ co-ordinated approach to the collection of hands to inform care decisions or outcomes or to the use of outcome sets that to rethink pathways” have already been defined and developed. It is true that more of this outcome data needs to reflect the outcomes that patients professionals have good skills working with want – a measure of improved mobility, for large data sets and good objectivity. And example, rather than logging a ‘successful’ hip they often have a view of the whole patient replacement. pathway in an organisation, as well as But NHS bodies cannot afford to sit back contacts with many of the key stakeholders. and wait for a centrally driven solution. Experience in a number of trusts shows Getting started – systematically looking at that most clinicians like to engage with outcomes alongside costs – is the key. Trusts value once they are presented with the data that have made progress urge others to look on outcomes and costs. But they need help at the outcome data they already collect – getting there. They need the data presented to whether clinical outcomes or patient reported them in ways they can understand quickly – outcomes. They are likely to be surprised at and again this is where finance comes in. what they already have access to. Finance directors and boards have another There will be gaps in the data and metrics role. Value-based healthcare won’t be that aren’t currently collected that they wish delivered without an organisation-wide – and were – but there will be enough to start ultimately system-wide – approach. This will making more informed decisions. And it will need senior backing and investment. help map out how a more comprehensive data That is difficult in the current financial set can be pulled together. climate. But in reality this is the solution You might ask what the finance role is to the current challenges – and not finding in all of this. Surely outcomes need to be the funding will only exacerbate the

defined by clinicians? That’s true, but finance current problems. SHUTTERSTOCK

healthcare finance | February 2020 11

capital investment

Bright future for Leeds The Leeds Teaching Hospitals NHS Trust is one of the first six to benefit from the Health Infrastructure Plan and associated funding. Seamus Ward explores what the publicly funded development means for the trust, both clinically and financially

When your chief executive calls on a Saturday afternoon, it’s rarely good has grown as new buildings have been added, piecemeal, over the years. news. So, when Simon Worthington picked up a call from his chief The listed Victorian buildings that formed the original LGI – designed executive Julian Hartley on a September Saturday last year, he feared by Sir George Gilbert Scott (who also designed the St Pancras station the worst. But the chief exec was overjoyed – he had just been told and hotel) – are no longer suitable for healthcare delivery. The art that the trust would be awarded public funding for its planned £600m deco-inspired Brotherton Wing from the 1940s is also no longer fit for hospital development. Mr Worthington was, of course, delighted, but his purpose. Both will be retained, but repurposed as accommodation for thoughts soon turned to making sure the scheme is a success. the new Leeds innovation district (see box overleaf). The scheme is one of the first six projects to come forward under Mr Worthington says a lot of the estate is not being fully used and the government’s Health Infrastructure Plan (HIP) – a five-year rolling when low utilisation rates are coupled with backlog maintenance, the capital investment programme that has funding totalling £2.7bn over annual cost is high – running to millions of pounds. One of the wings at the first five years. The £1.3bn-turnover Leeds trust has a number of the LGI sits partly on a bridge over the city’s inner ring road, and within sites, including two major hospitals – Leeds General Infirmary (LGI) 20 years the concrete will no longer be able to support the NHS building and St James University Hospital. Most of the development under the – the opportunity must be taken to move the accommodation away from HIP funding will take place at the former site – delivering new adult and the bridge and increase utilisation. children’s hospitals – though the project also includes a new pathology The new hospitals will also facilitate the consolidation of maternity unit on the St James’ site. and neonatal services on a single site at the LGI, although this is subject The LGI redevelopment (pictured), known as Hospitals of the future, to a public consultation, currently under way. These services will be has become essential because of a number of issues, including under- housed in the new purpose-built children’s hospital. utilisation at the city centre site. As with many NHS hospitals, the estate The current split of maternity and neonatal services between the

healthcare finance | February 2020 13 capital investment

LGI and St James’ Hospital increases the pressure for workforce and prevents the trust from meeting its priority (and that of its commissioner) – to provide a bigger midwife-led maternity unit and ensure closer alignment with children’s services. Mr Worthington believes the creation of the new children’s hospital is an important step for the trust – not just for the potential to improve the quality of care or reduce waste, but also to enhance its reputation. ‘Of course, we already have a children’s hospital, but it is spread across the site,’ he says. ‘It’s at least as big as some of the more famous children’s hospitals across the country. The clinicians want this, and the community want it too.’ The LGI redevelopment has been long planned. ‘Since he arrived here about six years’ ago, Julian Hartley had been developing the Leeds Way,’ Above: the atrium at the Mr Worthington says. ‘The new hospitals are a big thing for us and new-look LGI an essential part of the Leeds Way – the development programme is Inset: the new pathology called Building the Leeds Way. All our financial strategy is built around unit at St James’ Hospital achieving the outcome of getting the new hospitals.’ the Leeds Way. A lot of banks were prepared to lend us the money, so Financing options the issue was not about access to finance; the issue was about controls on When he became the trust’s finance director in 2017, planning work capital spending.’ was already under way, but the big question was financing it. Though The arrival of the HIP means the trust will have access to public there was a brief flurry of activity in the early 2010s around using the finance within the government’s capital spending limits. PF2 model of private finance to build other hospitals, this funding This does not mean the drive to maintain its financial performance mechanism has since moved off the table. For a while, there was no will recede. ‘Our financial plan was that, over five years, we would obvious source of funds for big capital schemes. generate sufficient surpluses to pay for the revenue consequences of Yet trusts still put forward their capital plans – most recently through Building the Leeds Way before the new developments open. That’s still the sustainability and transformation partnership prioritisation process. our plan. There’s wiggle room now, because the scale of the surpluses we Last April, the trust published an outline business case (OBC) and need is less. But our objective is still to overachieve on our trajectory.’ strategic outline case (SOC), which assumed that funding would be He adds: ‘A £30m surplus is needed – around 0.5% or £6m a year over found through a private finance scheme. Both the OBC and SOC are five years. We are making progress on that.’ now being rewritten to reflect funding via the HIP. The trust made a surplus of £18.9m in 2017/18, followed by £53m in In the original documents, the trust assumed it would take another 2018/19, through overachieving on its control totals and with the benefit four or five years to get through the approval and funding processes of provider sustainability fund (PSF) support. before builders broke ground. ‘At the time, capital was so constrained ‘This year we are aiming for a surplus of £16m because of the changes and the approvals process difficult and lengthy,’ Mr Worthington says. to the PSF, but our underlying financial position is better than it was But the HIP has changed this for the Leeds trust. And, with the last year. Our plan is to have a £1.5m surplus next year – our underlying emphasis now on getting the hospitals built quickly – but with robust position will again be better, but we won’t have PSF. governance – Leeds plans to open the new hospitals in five years. Under ‘We are looking at our approach to depreciation, which will lead to a the previous proposals, building work would have begun in 2024/25. significant increase. This will mean our future surpluses aren’t as large The HIP has injected new impetus into the LGI development, but as we had previously targeted but the “buying power” in terms of capital another key feature is public funding and the raising of the Department of Health and Social Care’s capital spending envelope. Overall, the trust’s five-year plan proposes capital spending of just under £1bn, including Capital roundtable investment the HIP developments. The trust will receive the HIP funding as public A recent HFMA roundtable discussed the capital Capital challenge dividend capital (PDC), on which a dividend – currently 3.5% – will be It was a big summer for capital investment in the NHS. First, instructions for all providers to cut capital plans by 20% were dropped when The health service £1bn was added to this year’s capital spending must modernise to next year’s long-term spending limit. This was then followed up with news that its estate if it is review to deliver a multi-year numerous hospital rebuilds would be funded, to realise the culminating in the unveiling of further funding HFMA capital settlement for the NHS. as part of a new long-term, rolling programme of ambitions of the But changes are also needed capital investment. NHS long-term ROUND to the current processes used to But the capital challenge facing the NHS is plan prioritise and approve projects challenges faced by the NHS as it seeks to implement . That means TABLE for investment. In November, the far from over. The vision set out in the NHS new buildings in some paid each year. Mr Worthington says the revenue costs of PDC are due HFMA – supported by health and long-term plan will need a transformation of places, while addressing care property development company the NHS estate. Existing facilities will need to significant levels of backlog Prime – brought together finance leaders have the capacity and quality to meet current and capital project experts to explore the current and future demands, and new infrastructure – maintenance. A recent capital challenges and discuss possible solutions. including digital infrastructure – will be essential HFMA roundtable discussed ‘While the summer announcements are to support integrated models of care. the challenges ahead. welcome and the release of funds is helpful, there More funding is needed as a minimum – a Steve Brown reports still remains a significant amount of uncertainty point that was recognised in some of the party and there is a lot to do to implement the long- manifestos published ahead of December’s term plan,’ said Ian Moston, chief finance officer the NHS long-term plan. The roundtable discussion – general election. The Conservatives made no of Northern Care Alliance NHS Group and chair estimates suggest the total cost of the rebuilding earlier than the unitary charge potentially due under a private finance new specific pledges on capital as part of their for the roundtable discussion. ‘All of us are living programme could be over £20bn. campaign, sticking to pre-election commitments with huge backlog maintenance issues. At a While addressing some very specific needs to build 40 hospitals. However, only £2.7bn has national level, the latest figure is £6.5bn and it is for new facilities, this in no way covers the so far been awarded for six projects, and some growing quicker than we can erode the issue. On service’s wider capital needs. With the election top of this, private finance [or at least the private out of the way, the service will now be looking finance initiative] is no longer an option.’ initiative (PFI). When this is taken into account, the revenue cost of the supported by health and care property development He added that lead times for major capital

Jane Cole company Prime – is detailed in a Healthcare Finance Ian Moston publicly funded HIP scheme is around £25m a year – but this is still Tim Morgan

healthcare finance | December 2019 £20m a year less than under PFI. supplement. The topics explored include developing 1 Mr Worthington says: ‘In our finance and sustainability plan we have system plans to meet the requirements of the strategy, and said we want to deliver a sustainable surplus by becoming the most the health infrastructure plan. The supplement is available efficient teaching hospital in England. Our financial strategy is geared to download from the HFMA website at hfma.to/xpp to achieving a surplus to pay for the revenue consequences of Building

14 February 2020 | healthcare finance capital investment

Innovation hub The new hospitals at the Leeds General healthcare challenges. The aim is to support and we’ve had significant interest from the Infirmary will leave the trust with buildings innovation, improve health outcomes business community and our staff.’ and land – over 5 hectares – that are surplus and lower cost, and contribute to the city The trust is a key national player in NHS to requirements. To realise the potential of economy. hospital-based research and the Leeds city this site, the trust is working with two of the ‘We are at the start of the journey, but our region is already a thriving centre for health city’s universities and the local council on a initial economic analysis suggests that we technology companies. ‘There are about scheme that could boost the city’s economy could see economic benefits in the region 400 companies in the city region – from by more than £1.5bn. of £1.6bn,’ says Mr Goodyear. ‘It sits well large firms such as Johnson & Johnson ‘We have some fantastic heritage assets with the Northern Powerhouse agenda. to medium and small companies,’ Mr for the city, but they are no longer fit for The government has been supportive, Goodyear says. ‘Also, 22% of digital health purpose in terms of modern healthcare jobs in the UK are in Leeds, including at delivery. We want to regenerate these great NHS Digital, EMIS and TPP.’ buildings and secure their future in the city,’ Working in partnership with the says James Goodyear, director of strategy. universities and the city council is key to the The trust plans that the iconic Gilbert success of the scheme. ‘Each of us brings Scott (pictured) and Brotherton buildings, something different to the partnership – be together with the old medical school and it academic strength, the ability to translate Clarendon Wing, will become part of a ideas into clinical practice or planning health innovation hub where universities, expertise. That partnership is fundamental to the NHS and industry collaborate to solve what we’re trying to achieve.’

spend remains the same. This is partly in response to the issues there and improve patient experience and outcomes by harnessing the ideas were about spending retained surpluses when the NHS was looking at and enthusiasm of its staff. capital spending controls earlier in the year.’ Mr Worthington says the overall plan is for no significant increase Hitting the £30m efficiencies needed means the trust must refocus on in bed numbers in the new hospitals, though there will be a little more waste reduction – Leeds has rejected the notion of cost improvement in capacity in critical care. However, the LIM will support changes to bring favour of waste reduction – targeting 2.7% a year. Mr Worthington says services together, so patients do not have to move around the hospital to this will move the trust’s reference costs from 103 to 94. ‘There’s a lot of receive care. Outpatients will be redesigned, bearing in mind the NHS good work going into making sure that happens,’ he says. long-term plan ambition of reducing follow-up appointments by a third. Fewer waiting areas will be required in outpatients, but there will be a Project risks greater need for video calling and other digital technologies. There are risks related to large, public sector schemes. These can include A small Kaizen promotion office (KPO) is supporting work to ensure financial difficulties in a private sector partner, seen recently in the NHS the new hospitals’ workspaces suit clinician and patient needs. The and other parts of the public sector with the collapse of Carillion, and in emphasis will be on engaging staff to develop and make the changes Scotland building defects in hospitals and schools. Mr Worthington, the themselves, according to Rachel Bickerdike, KPO specialist. One method project’s senior responsible officer, says new procurement arrangements used is a rapid process improvement workshop, where, over the course must be developed as it’s a few years since such a large publicly funded of a week, around seven or eight staff work with the KPO to make their scheme was tendered in the English NHS. There is also the risk that services better, more effective and with enhanced patient experience. expertise – ranging from project advisers to builders – could be in short Staff engagement through the workshops has already proved effective, supply with so many schemes coming forward at the same time. according to Natasha Bissett, KPO facilitator. They have increased With the trust having so many sites, the HIP development will not capacity in cardiac care and ensured ophthalmic outpatient clinics address all of the capital needs at Leeds. As mentioned earlier, the HIP start on time, for example, with little to no extra cost. The continuous funding will support part of an estates strategy totalling around £940m improvement philosophy of Kaizen will ensure the new hospitals have a over five years, including plans to relocate the ophthalmology unit. strong, patient-centred culture that focuses on efficiency. ‘We are looking for cost improvement or waste reduction in the ‘It makes for a more engaging place to work,’ says Ms Bickerdike. context of the Leeds Improvement Method and we are making clear to ‘People want to be there and feel they have control over their workplace people that if we achieve all that we are planning to achieve, we will be and their ideas are valued.’ able to sort out our capital issues,’ Mr Worthington says. ‘People will be Mr Worthington adds: ‘It builds confidence in our staff to meet the significantly motivated. We are already doing this – we’ve said if we can change challenge we face to make the new hospitals work.’ achieve our financial plan, we will invest back £7m a year in medical The building of two major hospitals in Leeds is a major undertaking equipment. We have done this. Putting in a clear level of investment for the trust and – in the wider context of the HIP as a whole – the NHS. is important, and you get better results if you engage with clinicians. Not only must the developments meet the needs of local people, but Improvement is at the core of what we are.’ they must be delivered at pace. While PDC funding means the Mr Worthington’s mention of the Leeds Improvement Method (LIM) complexities of private finance are not in play, there are other pressures, – the trust’s approach to continuous improvement – is timely, as it will including the need to generate year-on-year surpluses. But the Leeds play a central role in much of the next phase of development as the trust trust is hoping its thorough approach, including early and ongoing staff finalises plans for the new hospitals. Based on learning from the Virginia engagement, will help it achieve its plans and deliver modern and Mason Institute in Seattle, the LIM seeks to promote greater efficiency efficient facilities geared to patients’ needs.

healthcare finance | February 2020 15 hfma president Taking pride in our future

Caroline Clarke became group chief executive of the Royal Free London New HFMA president Caroline Clarke NHS Foundation Trust in February last year, capping an NHS finance believes the real story in the NHS is one of career that has spanned nearly three decades. But as she takes on the role of the health finance profession’s leader, as HFMA president for 2020, improvement in the face of unprecedented she still sees finance as her ‘tribe’. pressure. Staff remain key to success, but And it’s a tribe that she wants to take a bigger role in meeting the she insists the service should be proud of challenges facing the NHS – challenges that remain significant despite what it has done and optimistic about what increased funding to support the NHS long-term plan. it can achieve going forward ‘The finance community can help with improving operational performance because it understands data and that measuring performance does matter,’ she says. ‘Colleagues look to us for objectivity and facts and to help make decisions. ‘You need to be able to quantify as well as narrate your way through a reflects her view that people (clinical and non-clinical) are the key to situation. Finance professionals have all sorts of professional capabilities meeting the service’s goals of developing more integrated care models. and we should be using these skills in other parts of the service.’ She recognises that the current context for the NHS is tough, with the This call for finance to take on a broader role forms part of Ms Clarke’s service facing extreme challenges. Demand continues to rise and there theme for her year in office – Taking pride in our future – a theme that remain significant staffing shortages – along with the money to pay for

16 February 2020 | healthcare finance THEODORE WOOD meant it didnot receive sustainability funding and reported adeficit of thirdthe quarter of year, this compared with atarget of 95%. performance, with just 79.5%of patients all within four seen hours in from to trust the requires good improvement. It with A&E is struggling Carethe Commission Quality downgraded its overall assessment of position. faceof Onthe it, has some trust the major challenges. year Last might able be tosome shift the of workforce issues.’ NHS andthe develop of asense optimism about future. the That way, we – and it is term pressures, it hard can be to market NHSas the a fantastic career should optimistic be about service the its future. ‘Because of short- the about improvement faceof inthe unprecedented pressure and believes targets –is gloomy. But despite MsClarke this, is real the story believes music –with record underperformance on performance Stafffunctionsthem. all in are hard pressed theand mood In 2018/19,it was not inaposition to agree acontrol total. This TheRoyal LondonFree provides example a good thewider NHS of afantastic career. We should really proud be of what we doin these skillsinotherparts professional capabilities and weshouldbeusing “Finance professionals have allsortsof of theservice” Caroline Clarke overall costs to reduce. system the will more appropriate settings, and with more efficientmean thatprocesses, of working. Significant reductions indemandpatients as aretreated in of carer for maternity services. replacements,knee for example, and major improvements on continuity real benefits been forpatients – reducingthe length of stay for hip and numbers of its staff aretrained inimprovementscience thereand have were up set last year and there are plans to expand to this 60.Increasing unwarranted variation. clinical Twenty pathway clinical groups (CPG) a systematic approach to patient reviewing pathways to reduce withpartners Institute the of Health Improvement, it has introduced borrowing of £170mrepayable over next the few years. reliant on loans to maintain positive cash balances–with cumulative an underlying carrying deficitstill of morethan £70m. also It remains strip out sustainability the funding and non-recurrent savings and it is £67m. This year, it is on course to hit a£30mdeficit control total. But costs for years –has reduced by some £50minjust acouple of years. deficit –largeas as below set fuelled it tariff is, by a providers’actual consistentlybeen below national the average. And that underlying decision support for clinicians. its flagship hospitals. This underpins the CPG programme, providing revolution digital wider too, with an electronic patient record intwo of most advanced digitally hospitals. has And embraced trust the the Farm Hospital on budget and on time. This provides one the country’sof NHS(Trackwider record, page £200mChase new opened the 18)–also which – trust is effectivelyThe testing a groupmodel behalf on the of Digital role model we’re going to doit together, and we when back, we’re look going to business roles partnering for –critical delivering value the agenda. transactional processing, more finance be free to will staff move into to support transforming the NHS.As fewer people are for needed process automation, and it at looks how roles to need change will cloud computing, blockchain, intelligence artificial (AI) and robotic final later report this year. that is now under way with finance staff, to view a with publishing a Finance, December 2019)is at of heart the consultation awide exercise out avision for NHSfinance the Healthcarefunction. This (see report future, our consultancy published PwC Designing area.in this In December, Future-Focused Finance, HFMAand the absolutely on right the track and current inthe context, we have to Importantly, is done this being at and way as anew embedded scale Despite is doing trust the this, lots of right the things. Strategic ‘The story internally story is ‘The one of improvement,’says Clarke. Ms ‘We are On finance,there positives.are trust’salso The reference costs have ‘We are going to make acareer inNHSfinancetherebestthe is, and It explores impact the of embraces as function the technology new Her future theme –Taking our in pride that efforts their are a making difference.real describe the journey around journey the describe relative improvements as well as has on to be supporting and developing staff beingand clear binary targets.binary are key requests the from MsClarke. But locally, focus the care budgets and better on policies long-term financing this improvementthis message across. Staff are working term funding care, for social merged and health social Leaders acrossLeaders NHShave the amajor role ingetting extremely hard and efforts their be to need recognised service remain significant,service believes. she and celebrated, eventhough pressures the on the There are roles forthe centre too. Increased long- healthcare finance – is focused completely –is focused hfma president which starts to set to starts which set |February 2020

17 hfma president

Track record An economics graduate from the London School of Economics, new HFMA president Caroline Clarke joined the NHS on the national finance training scheme in 1991. Her NHS career to date is bookended by the Royal Free London NHS Trust. In an early placement on the training scheme at Hampstead Health Authority, she was involved with work to establish the hospital as a freestanding NHS trust. She was to return to the organisation (by now a foundation trust) as finance director some 20 years later. She got an early insight into the role of HFMA leader in her first substantive job at Kensington, Chelsea and Westminster Health Authority. She worked under finance Inset: Caroline director Keith Ford, who himself spent a year Clarke winning as HFMA national chairman during her time the 2012 HFMA at the authority. Naming Mr Ford as a major Director of the influence, she was impressed with his ability Year award (top) to influence policymakers and his readiness and at Homerton hospital in 2004 to take informed risks, with a credibility that was based on delivering in his day job. Chase Farm Hospitals NHS Trust. The Royal was not about control and power, but about Deputy and assistant finance director Free London group was then established getting the best from other people. roles at Camden and Islington Health in 2017, with North Middlesex University Ms Clarke loves working in the system she Authority and the Royal Brompton Hospital Hospital NHS Trust as a first clinical partner lives in – something that has always been NHS Trust were followed by a first director- – followed in 2018 by West Hertfordshire important for her – and enjoys the breadth level position at the new City and Hackney Hospitals NHS Trust. of opportunities and the complexity of Primary Care Trust. Ms Clarke continued to Ms Clarke was appointed group chief issues that her role offers. She is also big on pursue her career in north and east London executive at the beginning of 2019. work-life balance. As a mum with a 10-year with a first provider finance director position She has been a long-time supporter of old daughter, she says she has a ‘real moral at Homerton hospital in 2003, taking it to the HFMA – a former London branch chair obligation’ to get that right. foundation trust status the following year. and a key figure in Future-Focused Finance, She is also open about living with After five successful years at the trust, Ms where she led the programme’s Best multiple sclerosis (she is a trustee of charity Clarke took a break from the NHS, moving to Possible Value workstream. She was named Overcoming MS). ‘My condition is very KPMG to help build the health practice. But HFMA Finance Director of the Year in 2012. stable. I have had to think about how I just two years later, she was back in the fold, A self-proclaimed extrovert, she says she manage it in a way that enables me to do at the North Central London Commissioning is a team player who likes people. She claims my job effectively. Like many long-term Agency. The move to the private sector City and Hackney PCT chief executive Laura conditions there are things you can do to had taught her a lot, she says, but ‘didn’t fit Sharp taught her that good management control it – I practice mindfulness to manage entirely with who I am’. stress, I exercise and I manage my diet. Then, in 2011, she returned to the Royal ‘I hope that is a good message for other Free – now a foundation trust – as finance people with long-term conditions. I had a director, subsequently adding the role of wake-up call, but the overall message is that deputy chief executive. The trust expanded “We are going to we all need to look after ourselves, and each in 2014 through a merger with Barnet and make a career in NHS other, in order to achieve our potential.’ finance the best there is, and we’re going to be proud of what we’ve done,’ she told December’s do it together, and we’re She takes issue with the portrayal of finance HFMA annual conference. Mapping out what the going to be proud of only as a support function. ‘There is a whole raft of future could look like within finance teams will be what we’ve done” people, who because they’ve gone into a technical Caroline Clarke essential if finance teams are to be in the best possible profession, don’t see themselves as leaders. But we condition to add value. ‘We have people working for us are leaders. You only need to look around at the HFMA now who will be finance directors in 30 years’ time,’ she says. annual conference to see the capability in the room. We have ‘We need to think about what the world will look like for them and something really special in the finance community.’ how we get people ready for that. But she adds that finance will need to embrace changes in its own ‘Finance staff need to be on top of the idea of using multiple sources operation, which will involve adopting technology for transactional of data and being really clear about what data is telling us,’ she continues. processing and sharing services where that makes sense. Letting go of ‘They need to be guiding decision making in organisations – right there transactional responsibilities will free up time to provide more analysis at the table and often leading it.’ and understanding of what is happening in the business.

18 February 2020 | healthcare finance hfma president

‘So we need to make ourselves invaluable – and we do this by being a case for diversity is really strong. When you have cognitive diversity, bit broader,’ she says. ‘There is definitely room for centres of excellence which comes from having people around the table who don’t look the and people being experts at tax or the capitation formula or whatever. same or haven’t grown up in the same way, you get better solutions. I am But for business partners and the vast majority of finance managers, completely sold on that.’ you have to have a broader outlook, be able to use multiple data sets and The challenge is making this happen. Future-Focused Finance is think about data science and technology. And you will need to have a leading work to improve diversity in senior finance leadership roles. new set of skills – even if we don’t yet know what all those skills will be!’ The last finance staff census, due to be updated shortly, revealed that Ms Clarke wants finance to be fully engaged in helping the NHS women account for 61% of the finance function, but just 28% of finance meet its wider people challenge too. ‘In the next 10 years, the NHS will directors. And 18% of the finance workforce are from a black, Asian and potentially need 250,000 new members of staff if we do nothing,’ she minority ethnic (BAME) background, while only 4% of director level says, suggesting that the solution will lie in innovative thinking as much positions are held by BAME employees. as straightforward recruitment. ‘We need to use the diversity of our populations to bring diversity of thought and approach to our problems,’ says Ms Clarke. ‘If we continue Attracting staff to look at things in the old ways, we will miss the new solutions.’ There Attracting new staff and retaining existing workers is clearly the ‘number is no one single solution. Instead, improving diversity will take lots one priority’ and ‘the most important part of the long-term plan’. of small steps – more targeted recruitment and more work getting Technology will provide part of the solution. For example, a recent study people ready for senior roles, for example. And in many cases it will be involving researchers from Google Health and Imperial College London something that organisations have to do for themselves. showed that an AI model was as good as the current two-doctor system ‘A lot of this has to be done locally as it is about local culture,’ she says, of reading mammograms and better than using a single doctor to spot but adds that the centre’s role could be to showcase departments that cancer. With an estimated shortage of more than 1,000 radiologists have made themselves more inclusive. across the UK, this could help increase capacity by a different route. Ms Clarke’s year as president also coincides with the HFMA’s 70th Ms Clarke believes that finance staff have a big part to play in asking anniversary – a birthday she is keen to point out the association shares hard questions about why things are done in a particular way, or with NATO, Stevie Wonder and Snoopy. However, she is determinedly sometimes why things are done at all. And she is clear that the more looking forward with her presidential theme. She wants finance staff to diverse the finance function becomes, the better able it will be to meet fulfil their potential, broaden their role and take pride in their this challenge. contribution to delivering high-quality, sustainable healthcare. That has ‘The function needs to reflect the population,’ she says. ‘The business to be something worth celebrating. outcomes The right

HFMA ROUND TABLE

Understanding the value of services means understanding the outcomes that are important to patients. An HFMA Healthcare Costing for Value Institute roundtable in December explored progress in measurement and the use of outcomes to inform decision-making. Steve Brown reports

There is increasing support for she said. ‘But we also need to think policy and practice in ways that cut with the value-based healthcare. There about patient-reported outcome grain of wider changes in society and public has been a lot of work in the measures (PROMs) and expectations,’ said James McGowan, specialty NHS on improving data experience measures registrar in public health medicine at Public on costing – one half (PREMs) – for example, Health England. ‘As people become more of the value equation. have we reduced empowered to make their own decisions in But the other key patients’ pain, can they respect of using services, including health factor in assessing the now perform their services, the NHS has a principled and value of any decision daily activities or are practical need to respond to this.’ or intervention is the they sleeping better?’ Simon Kenny, paediatric surgeon and outcome. And there There is growing clinical lead for the national Getting it Right has been far less done recognition that, while First Time programme, and former clinical to put outcomes alongside the NHS collects a mass director at Alder Hey Children’s Hospital cost data or to make sure the of clinical data, many of the NHS Foundation Trust, said that outcome outcomes monitored are the ones measures focus on processes or data could inform both the immediate care that are most important for patients. outputs, not outcomes. being provided, while also supporting broader ‘You can’t address the value equation until And, where there are outcome measures, decisions about interventions that deliver the you’ve decided what outcomes you are trying they don’t necessarily reflect the outcomes that best outcomes for patients. to deliver,’ Sally Lewis told a roundtable patients most want to achieve. ‘Big data can help us do that, but it will only organised by the HFMA’s Healthcare Costing happen if we’ve got the outcomes for Value Institute in December. Collection question embedded,’ he said. Talking The roundtable, supported by Johnson The roundtable kicked specifically about PROMs, & Johnson Medical Devices Companies, off by discussing why he added that it was a was convened to discuss where different health services should key way to ‘measure organisations are in terms of their collection be collecting patient- outcomes that are and use of outcome measures. It also aimed to defined outcomes important to patients’. identify challenges to the wider use of outcome at all. For some, it Glyn Jones, finance measures and to understand the specific role was about the NHS director at Aneurin finance practitioners should play in moving catching up with other Bevan University this agenda forward. areas of people’s lives Health Board, agreed, Dr Lewis, GP and national clinical director and meeting public suggesting that outcomes for value-based healthcare for NHS Wales, and expectation. also provided a common chair for the roundtable, said that outcome ‘Other industries and language to improve measures came in different guises. ‘We are services are modernising their engagement between clinicians talking about clinical outcomes that you might and finance staff on deciding how find in national clinical audits and registries,’ Pictured: Sally Lewis and Simon Kenny resources should be used. PROMs also helped

20 February 2020 | healthcare finance outcomes

clinicians have more Acknowledging support consultant appraisal. The NCIP, which meaningful discussions these different uses runs as part of the GIRFT programme, has to with patients about for outcome data, date been implemented across eight surgical the right next steps in Clara Day, nephrology specialties and is being initially rolled out to their care. A ‘successful’ consultant and five trusts to pilot its use. surgical intervention, associate medical This programme has been set up to use for example, might not director for finance data that already exists, either in the national address psychological at University Hospitals hospital episode statistics data set or from or social issues affecting a Birmingham NHS audit or registry data. Dr (Jenny) Lewis said patient and a PROM can help to Foundation Trust, that existing data should be the starting inform patient-clinician discussions. stressed that it was point for outcomes. Duncan Orme, operational director of important to be clear about ‘There is a vast amount of finance at Nottingham University Hospitals the reasons for collecting data collected and pitifully NHS Trust, stressed the importance of PROMs data in advance. small amounts of it that understanding patients’ own views of ‘If you want the actually gets out into the healthcare interactions. ‘Work by the Royal patient to fill something hands of clinicians,’ she College of Physicians found that 20% in, they need to know said. While there were of pensioners who attend an outpatient why they are doing it,’ issues that needed to appointment reported feeling worse afterwards she said. ‘Is it to help be addressed in terms because of the stress involved in getting there,’ inform their care now of using or sharing he said. ‘When you add this into the climate or to support population some of the data, there impact – with nearly 5% of road traffic in health? Both are fine, but was certainly no shortage England being NHS-related – then arguments you need to be clear and get of it. ‘It is amazing what you start to build up for doing something the balance right. [As a clinician] can get out of it if you throw the differently with how we work with it can also be frustrating if a right analytical resource at it,’ she said, patients, starting with allowing patient reports on something adding that analytical expertise was an area of patients to report their own and you receive a report six major underinvestment across the NHS. outcomes.’ months later showing how Picking up the issue of data quantity, Dr PROMs data is a patient had a bad time, McGowan called for data collection to be essential to realise these but you didn’t know rationalised. He emphasised the importance social and economic about it at a point when of clinical leadership in this process, but benefits. you could have done said there also needed to be greater focus on Bill Gregory, chief something about it.’ building the evidence base to support high- finance officer and Dr Lewis underlined quality measurement in the NHS. deputy chief executive the importance ‘Many measures and indicators are used in of Lancashire Care NHS of embedding the healthcare,’ he said. ‘But too small a proportion Foundation Trust, and measurement in direct of them are patient-based or patient- immediate past president of patient care. ‘A PROM focused and an even smaller the HFMA, underlined this key is essentially a structured proportion are supported role for PROMs. ‘It is only when you communication from the patient,’ she by evidence. Addressing are in an outpatients department as a patient said. ‘They are telling us what they need, not this imbalance should be a HFMA that you see it with their eyes,’ he said. ‘Only just the result of a treatment.’ priority for clinical leaders, ROUND the patient travels through the whole pathway researchers and and they see the disjoins – and if you don’t ask What to collect policymakers.’ TABLE the patient, you won’t find out about them.’ The roundtable next turned So, make better The reason to collect outcome data also its attention to the question use of existing changes depending on what you want to of what to collect. It data an agreed starting do with the data. Chris Graham, chief started by discussing point. But there was executive officer of Picker, which specialises the data already also recognition that in undertaking surveys of patient experience, collected in the NHS. this may need to be suggested there are ‘many different whys’. Jenny Lewis is the supplemented with ‘These are often in opposition to each other analytics and content PROMs to get a more and there may not be a single approach that lead for the National rounded view. meets every need,’ he said. ‘If you want to have Clinical Improvement NHS Wales’ Dr person-centred care, you need to recognise Programme, which is (Sally) Lewis asked the that what matters to individual patients differs developing a secure online participants how agreement – so one-size-fits-all won’t work. portal to enable (initially) could be gained among clinicians ‘You might need something different for surgeons to view outcome data and to about what to collect. ‘For example, clinical practice, something for local service if respiratory physicians have a view on what improvement work and then something Pictured, top to bottom: Glyn Jones, Duncan PROMs should be used in asthma, how do we different again for national collections.’ Orme, Bill Gregory and Clara Day get them to a real consensus?’

healthcare finance | February 2020 21 outcomes

Mr Gregory said undertaken as part of “Google may not be there was a precedent the COMET initiative, doing this in a way we with the work on started in Liverpool, to costing and tariff develop core outcome would want in the NHS development. There sets to support clinical but they have lots of was wide-ranging input studies, audits and experience to learn from” from clinicians into the research. Chris Graham, Picker (left) development of the HRG4 But Lee Outhwaite, currency, which was the first director of finance and healthcare resource group currency contracting at Chesterfield Royal be key to any future development. Professor designed to be used for payment purposes. Hospital NHS Foundation Trust, raised Kenny suggested the NCIP offered this. Dr (Jenny) Lewis agreed that clinical concerns about the scope of PROMs. ‘What Mr Graham said the NHS was still a long ownership was important and that the NCIP does a PROM actually tell us?’ he asked. ‘If it is way off a comprehensive, single system to had used a similar approach of involving the for a patient in end-stage renal failure receiving collect and analyse outcomes. ‘To build a royal colleges and professional bodies to get a new kidney, they are likely to be quite pleased future-proof system of measurement, you’d endorsement for the metrics it uses. ‘Once with the outcome. But if someone has multiple need a mechanism to aggregate lots of different you’ve got that endorsement, there is a degree comorbidities and is socially isolated, what you types of data and structure it around patients of ownership, which is helpful,’ she said. find out from an episodic treatment so that patients become the However, she warned that it didn’t might have little to do with the organising point in the data set necessarily last, as clinicians out in the field intervention.’ and the data follows them,’ often had different ideas. And getting a patient Mr Outhwaite said the he said. ‘That’s really perspective was a continuing challenge. ‘There service needs to start important because most has been little patient involvement in measuring broader current mechanisms our contact with the professional health and wellbeing are focused on single bodies,’ she said. metrics for the local services, illnesses Su Rollason, chief finance population. ‘That or conditions and HFMA officer of University Hospitals will help us see the don’t take account ROUND Coventry and Warwickshire impact of upstream of individual patient NHS Trust, suggested that interventions around complexity and wider TABLE outcome standards from social exclusion and determinants of health. the International Consortium isolation,’ he said. You need as much data in one for Health Outcomes Management There was a lot of discussion place as possible.’ (ICHOM) provided a good place to start. around the benefits of standardising These outcome sets – including clinical outcome measures rather than allowing Tech sector outcomes and PROMS – have built-in clinical different organisations to do their own There were lots of obstacles to developing such input, having been pulled together by teams thing. Using bespoke outcome measures in an approach, including public confidence, of clinicians, and are being adopted by a single organisation may help with information governance and consent. But to increasing numbers of health direct care locally, but if multiple move forward, the NHS needed to harness the bodies across the globe, organisations collect the expertise from other sectors and especially opening up the potential same outcome measure, it technology companies. ‘The likes of Google for benchmarking. opens up the potential may not be doing this in a way we would want The trust has done to compare and in the NHS but they have lots of experience to pioneering work on identify best practice learn from,’ said Mr Graham. collecting prostate and opportunities to Neil Davis, director of commercial and cancer outcomes – improve. strategic capabilities at Johnson & Johnson looking particularly at Professor Kenny Medical Devices Companies, said there was a the outcomes delivered went further: not rich volume of data, but to gain value from it, using robotic surgery. only did organisations digital systems were needed to support its use. ‘We went to ICHOM need to collect the same ‘We need systems that allow for better because we needed clinically outcome measures – ask the data analysis, segmentation and best practice recognised outcomes that gave same question – but the data sharing to drive better outcomes for patients us the patient perspective,’ said Ms needed to be widely accessible. ‘The and bring more value across the NHS. This Rollason. However, having decided what days of the standalone outcomes database provides a real opportunity and an important outcomes they wanted to collect, the next job are dying,’ he said. ‘Data needs to sit centrally role for industry to use our resources to was to work out what data they already had. and be available to the public, commissioners, innovate and create the artificial intelligence ‘We were amazed at the amount of data we providers and clinicians,’ he said. Such a system (AI) capability for the health sector,’ he said. capture and submit,’ she said. ‘However, it is should be built on solid foundations, so the Johnson & Johnson, for example, already completely siloed, isolated and in most cases NHS number and the GMC number would works in partnership with Google on AI and not used for any other purposes.’ use of data. ‘The nature of our organisation Offering another ‘off-the-shelf’ solution, Pictured, top to bottom: Chris Graham, Jenny means we’re embedded in hospitals and Professor Kenny also highlighted the work Lewis and Lee Outhwaite theatres, not just across the country, but

22 February 2020 | healthcare finance outcomes

globally. So we’re in a very Mr Orme described Two principles of design should be adopted strong position to use the Nottinghamshire’s view for any system of outcomes collection, insights we gain from of ‘at scale’ which had according to Mr Graham. ‘First, you have to this to successfully focused within the minimise the burden of administration,’ he partner with the NHS county boundaries. said. ‘Otherwise it will be unbearable on the to bring a meaningful ‘Our key challenge system – and that suggests a digital approach. solution to this was the need to engage Second, measure as rarely as possible and use opportunity,’ he added. with primary care,’ he as often as you can. At the moment, the system ‘Of course, with any said. ‘The project required tends to measure frequently and then not use new approach, regulation their data to understand the information as much as we should. We and protecting patient data is complex comorbidities, when need a total reversal of this situation.’ fundamental and something we examining outcomes for patients Mr Jones said clinician and patient buy-in would support developing in collaboration with type two diabetes.’ were also essential to ramping up outcome with regulators and authorities.’ Developing trust and offering win-win collection. ‘You need to work with patients Mr Jones felt a more organic approach to arrangements with primary care were essential to convince them that this is not just an measuring and collecting outcomes was more in gaining access to the insights from other Amazon after-sales survey but an important realistic. ‘How do you design a big theoretical providers’ data sets. part of their care – allowing them to take model that involves everyone and gets their Mr Gregory said the service should explore control of how their care is delivered,’ he said. buy-in and then collects a consistent set existing events where people interact with And he said that once buy-in was in place, of outcomes?’ he asked. ‘My perspective is health services – such as repeat prescriptions. organisations needed to make it convenient that you should start at the ground level – at ‘Is that an opportunity to ask simple for patients to complete the essential the front line – and build on this involving questions?’ he asked, recognising information – via a smart app different people and different groups.’ that these questions while waiting to go into a This has been the approach at Aneurin couldn’t be too detailed clinic, for example. Bevan University Health Board, which began or intrusive. And he Dr Day again its value-based journey five years ago. ‘We said that supporting underlined the started at a simple level by just trying it in one people to become more importance of clinical or two areas, such as Parkinson’s disease,’ he activated in terms buy-in in any scale-up. said. ‘We were manually collecting outcomes of their wellbeing ‘We have a national and working with clinicians to see how we and condition would renal PREM and we’ve could better design services.’ The health board also provide a better started collecting knew that, to collect and use outcomes at scale, foundation for greater some PROM data as it needed an IT system, and the ‘start small’ collection of PROMs data. well,’ she said. ‘It can be approach encouraged clinical buy-in and Digital solutions are likely looked at as a curiosity, as demonstrated positive results. to play a major role. Professor something that is interesting. One of the next areas it is considering is Kenny referenced a patient portal But it should be used to improve and working with social care – aiming to collect a being developed at Alder Hey as part of its guide care at an individual and unit level, not wider set of care outcomes. global digital exemplar programme. While simply to compare between patients or units.’ Mr Jones said adopting a big bang approach this would provide opportunities to deliver Patient outcome data must be used to drive – or waiting for a service-wide system – would routine communications to patients, it also transformation. have likely meant the organisation making opens up the potential for collecting clinical At Aneurin Bevan, the health board’s little or no progress. ‘The answer is probably outcomes. Dr (Sally) Lewis said the portal’s investment in an outcomes reporting system somewhere in between: some bottom up work two-way communication would also put the is helping it to scale up – although Mr Jones along with a top down approach that enables patient in charge of governance, untying some warned that this alone would not solve all collection and use of outcomes at a system of the knots the health service has found itself issues. There was still a need to ensure that level, enabling it to be used with individual embroiled in over information governance and different systems could talk to each other. By patients, along a range of care pathways and to consent. The NHS app was also mentioned as a solving this, it is possible to develop single inform decisions at a population level.’ possible way of collecting outcome data. dashboards for clinicians, enabling them to Perhaps the real challenge is implementing easily access all the relevant data to discuss the PROMs and outcome measurement at scale. Pictured: Su Rollason and Neil Davis patient’s care and inform decision-making.

HFMA ROUND TABLE

healthcare finance | February 2020 23 outcomes

The roundtable “Many measures are used in healthcare also discussed how but too small a proportion are patient- data from outcome measures could be focused and an even smaller proportion turned into useful are supported by evidence” information to inform James McGowan (left) decision-making. Dr (Jenny) Lewis said there was ‘Finance people have experience Finance leaders will also have a major a role for digital design agencies with very large data sets,’ she said. influence on the development of the to feed back information in a way that ‘They are objective in looking at data and they outcomes agenda as they have a leading role directly supports the decision to be taken. have a privileged view over the whole pathway in investment decisions. Will they support ‘In the NHS, we have a tendency to build a in an organisation and already engage with investment in outcomes? Mr Gregory said dashboard for one purpose and then use it many of the key stakeholders.’ some would be in the vanguard and the HFMA for 10 other things,’ she said. This doesn’t Mr Orme said the finance function also Healthcare Costing for Value Institute work and can discredit the data and put had a role in ensuring future payment systems had a role in encouraging others to people off using it. supported the collection of robust data. The follow them rather than wait to Mr Graham agreed that visualisation was payment by results (PBR) system had led to a see benefits emerging. However, HFMA important, with boards wanting information in major increase in coding and data quality, even he added that the focus needed a totally different format to the frontline. While though there are now plans to move towards to shift towards system value and ROUND boards want detailed reports and benchmark population-based payment approaches. system outcomes, rather than TABLE data, clinicians often prefer narrative feedback ‘While the finance profession has recognised the narrower focus on individual and infographics that engage them more. what was wrong with PBR, it has provided an organisational value. This brought the roundtable to its final enormously valuable data set and we mustn’t Overall the roundtable agreed that more question of the day. What is the role of finance throw the baby out with the bathwater,’ he said. needed to be done to demonstrate the value of teams in mainstreaming the collection and ‘There is real value to developing the collecting and using outcomes to improve use of patient-defined outcome data in the contract data into an outcome-focused data pathways. They called for more case studies to NHS? Ms Rollason said finance professionals’ set, and finance professionals are in a unique be shared and suggested more peer-reviewed training meant they were well suited to support position to help develop our understanding of evidence would help demonstrate this as good the roll-out of outcomes. outcomes and value.’ value for citizens, patients and clinicians. professional lives: technical

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Page 25-26 Page 28-29 Page 30-31 Page 31-32 Technical Development My HFMA People

Group accounting manual firms up expectations in run-up to year-end

It’s the time of year table; require a link to be Technical that guidance is issued included to the gender pay gap thick and fast as we report; and require disclosure on run up to the year- the FT’s compliance with guidance end. This year, the Department of on managing conflicts of interest Health and Social Care’s Christmas in the NHS. present of the updated Group The NHS Business Services accounting manual was late and Authority has also issued its arrived in time for Hogmanay Greenbury guidance. There are instead, writes Debbie Paterson. few changes – the deadline for There are seven FAQs – the submissions for information is 28 usual update on discounts and the February; there is now a reference injury cost recovery rate, as well to the General Data Protection as some tidying up of terminology Regulation (GDPR); there has and reflecting the updates to the been a change to the method Treasury’s Financial reporting used to calculate cash equivalent manual (FReM). transfer values (CETVs) to remove The more substantial changes are: manual 2019/20 has also been published. There the adjustment for guaranteed minimum • An update to the public dividend capital are very few amendments this year, so they were pension; and a change in the inflation rate to (PDC) dividend policy that removes not subject to consultation. Most of the changes 2.4% (3.0% last year). terminology relating to grant accounting reflect changes to other guidance: The December pensions newsletter makes it that is no longer relevant. It also adds • TheUK corporate governance code means clear that the NHS Business Services Authority instruction on what should happen when a changes to the disclosure of key issues and will not be able to provide revised calculations provider demises or is involved in a merger or risks in the performance report and disclosure once final pay figures are known. acquisition of policies on diversity and inclusion in the Finally, the Agreement of balances guidance • Guidance on how transfers of property from staff report has been issued for 2019/20. It has been NHS Property Services to NHS providers • UK auditing standards have required changes revised to make it easier to read and to ensure should be accounted for to the wording used in relation to ‘going that it is internally consistent. It is worth • An initial indication of the accounting concern’ noting that the word ‘variance’ has been treatment for the element of the employers’ • Guidance issued by the Tax Centre of replaced with ‘mismatch’ to better reflect pension contribution that is being paid for Excellence in relation to highly paid off- differences highlighted by the agreement of by NHS England. The FAQ makes it clear payroll workers balances exercise. that NHS bodies will be required to account • The new name of the NHS oversight The guidance has been substantially for the full employer contribution of 20.68%, framework has required changes to references amended to reflect the changes made to NHS with an offsetting entry to reflect the funding to framework disclosures England’s structure – notably, paragraph 7.1 for the part of the contribution being paid • To reflect the FReM, disclosures around and Appendices 1 and 3 of the NHS England by NHS England. Further guidance on how information to auditors has now been moved appendices. Other changes reflect the revised this will work in practice, including how the to the statement of accounting officer’s approach to the Provider Sustainability Fund, amounts being paid by NHS England will responsibility. Financial Recovery Fund and the marginal rate be calculated, will be provided before the Further changes – not related to other guidance emergency tariff. year-end. – have been made. These help foundation trusts Debbie Paterson is HFMA policy and technical

SHUTTERSTOCK The NHS foundation trust Annual reporting to explain the single total figure of remuneration manager

healthcare finance | February 2020 25 professional lives: technical

Technical review For the latest The past two months’ key technical developments technical guidance download the myHFMA Getting it Right First Time (GIRFT) has launched a series this to identify opportunities for app from the Technical of questionnaires in support of its work on paediatric critical improvement. It has also started Apple store care. This includes a questionnaire on finance, which seeks to map service user pathways and or Google to gain an understanding of how the service is commissioned link these to patient outcomes. The and funded; the information gathered in providers; and the data reported briefing is available to all institute Play outside the organisation. GIRFT said it expected a senior member of the partner organisations. hfma.to/qj6 finance team would be best placed to provide the information, though it may also require input from contracting teams. hfma.to/68t NHS Improvement has published a guide on good governance for audit and assurance for providers and A new HFMA briefing looks at the accounting and valuation commissioners. The guide looks at best practice in appointing and issues related to property, plant and equipment. The guide managing external audit contracts, as well as external audit findings and covers the initial measurement of purchased assets as well as reporting. It sets out expectations for good governance over audit and when subsequent expenditure can be capitalised. It goes on to assurance and seeks to help NHS bodies understand their responsibilities. explore depreciation, including component depreciation, and hfma.to/86m looks at the revaluation model for measuring asset value in the NHS after initial recognition. A simple table summarises The HFMA updated its efficiency map the valuation basis used depending on the asset type and in December. The map – developed by the reason it is being held. The guide goes on to cover the role of the HFMA in partnership with NHS England NHS efficiency map A tool that promotes best practice in identifying, delivering and monitoring cost improvement programmes (CIPs) and quality, innovation, production and prevention (QIPP) auditor, impairment and disposal of property and equipment. hfma.to/r75 and NHS Improvement – promotes best schemes in the NHS

practice in identifying, delivering and Updated December 2019 The existing reference costs grouper, as used in 2019 (relating to the monitoring cost improvement programmes financial year 2018/19), is being retained for use with the 2020 collection. and quality, innovation, productivity and The decision follows a review by NHS England, NHS Improvement and prevention schemes. It links to a range of tools and guidance and is split NHS Digital of the options for developing the grouper. It was decided that into three sections: enablers for efficiency; service efficiency; and system the existing grouper continues to meet the requirements of stakeholders and efficiency. The map supports the delivery of efficiency in the 10 priority has the added benefit of being immediately accessible. A January costing areas identified in the NHS long-term plan. A new case study explores how newsletter also reminded providers that the deadline for the voluntary one sustainability and transformation partnership is embracing the use of education and training cost collection had been extended to 17 February. costing data to drive its efficiency programme.hfma.to/c4z hfma.to/qit Commissioning for quality and innovation guidance has been North Staffordshire Combined Healthcare NHS Trust implemented published for 2020/21 by NHS England, covering both the clinical a patient-level information and costing system (PLICS) for its mental commissioning group and prescribed specialised services schemes. Selected health services in 2014/15. Now a new briefing from the HFMA Healthcare indicators are aligned to four key areas: prevention of ill health; mental Costing for Value Institute describes how the trust has worked hard to health; patient safety; and best practice pathways. Applicable indicators turn the large amounts of data generated by the system into information depend on the type of provider and payment rules continue to promote that is useful for clinical and operational services. The trust has developed simplicity, with lower and upper adoption goals for each intervention an information dashboard in-house and clinical teams are starting to use chosen to ensure CQUIN funding is fully earnable. hfma.to/ovn

CDF approval for breast cancer treatment

During December and January, All seven technology appraisals had stage of treatment. Taken once-daily in pill Technical: NICE published a further seven positive recommendations, with Palbociclib form, palbociclib is a type of drug called a NICE technology appraisals, one with fulvestrant for treating hormone cyclin-dependent kinase 4 and 6 (CDK4/6) medical technology and two receptor-positive, HER2-negative, advanced inhibitor. These work by inhibiting proteins guidelines, writes Gary Shield. breast cancer (TA619 ) being recommended in cancer cells, thereby preventing the cells The guidelines – Acute kidney injury: for use with the Cancer Drugs Fund (CDF). from dividing and growing. prevention, detection and management It is estimated that up to 3,300 women per Implementing the medical technology (NG148) and Indoor air quality at home year will be eligible for this treatment, which guidance GammaCore for cluster headache (NG149) – are supported by resource impact is for those who have already had endocrine (MTG46) is not expected to lead to a statements that detail why implementing therapy. significant resource impact. the guidelines are not expected to lead to a Palbociclib joins two other NICE-approved Gary Shield is resource impact significant resource impact. drugs – ribociclib and abemaciclib – at this assessment manager at NICE

26 February 2020 | healthcare finance

professional lives: development

Diploma shows clinical appeal

News and views from the HFMA Academy

When Toby Garrood signed up Dr Garrood completed his first module – he says, admitting that he had expected it to Training to study for the HFMA Advanced Managing the healthcare business – in January be drier. ‘It is very well written and it is good higher diploma in healthcare business and has now started on the second of three relevant content. I wouldn’t have time to learn and finance last September, little modules that make up this diploma. things that aren’t relevant – I couldn’t just be did he know that he was passing a significant This term he will be studying Making finance learning for the sake of learning – but this is all landmark for the association, writes Steve Brown. work in the NHS – before moving on to Creating very pertinent to my job.’ Dr Garrood (pictured) was, in fact, the HFMA and delivering value in UK healthcare. He singles out coverage of forecasting, Academy’s 500th learner to start one of its However, he hopes to move beyond this and, accounts and ratio analysis as being useful. ‘It programmes. upon successful completion of the diploma, was all really interesting, but the content on the As a clinician, he is also one of an increasing wants to sign up for the MBA in healthcare accounting side was particularly helpful,’ he says. number of frontline staff keen to improve their finance, delivered by the HFMA Academy’s Dr Garrood says he would recommend the grasp of NHS finance. In fact, across all the partner, BPP University. programme for other clinicians going into academy’s programmes – covering both the ‘The content has been surprisingly enjoyable,’ management or leadership positions. ‘The NHS HFMA’s intermediate and advanced healthcare is not great at providing this kind of support for business and finance qualifications and the clinicians, but it is definitely what they should be diploma in advanced primary care management, doing,’ he adds. delivered on behalf of the National Association He also highlights the value of the tutor-led for Primary Care – about one in six learners has sessions run by Paul Dillon-Robinson, who a clinical background. spent 17 years in the NHS and nine as director Dr Garrood is a consultant rheumatologist of internal audit at the House of Commons. ‘The and clinical director for specialist ambulatory tutorials were brilliant,’ he says. ‘They kept it all services at Guy’s and St Thomas’ NHS moving and interesting.’ Foundation Trust. So, what attracted him to Dr Garrood admits that the level 7 modules supplement his already extensive clinical training are a lot of work – each one taking up to 200 with a business oriented programme? hours according to guidance. ‘It is a significant ‘I’m a clinical director at Guy’s, so it is really commitment and you do need to be prepared for to fill the gaps around finance,’ he says. ‘As it,’ he says. ‘I have done a PhD in the past, so I doctors we don’t get any formal training in knew what to expect from a postgraduate degree, finance and we may find ourselves in senior but people need to believe it when they are told it management positions without specific is a significant amount of work. And experience expertise in these areas.’ with writing is definitely helpful.’

Value maker conference announced

Bookings are now open some of the biggest achievements FFF has Future for NHS Future-Focused made. In particular, the number of NHS focused finance Finance’s fourth Value Maker organisations reaching at least level one Annual Conference (VMAC) in on the Towards Excellence accreditation London on 24 September. VMAC 2020 will programme is now in excess of 100. bring together finance professionals from The much sought-after value maker across the country to: share best practice awards (pictured) will also be taking place from their organisations; network and build again this year at the conference and details on their professional connections; and will be shared soon. The event is open to all celebrate the success of the network, NHS colleagues: those already a part of the which is currently made up of over 1,450 value maker network and those who aren’t people – and growing. yet but are interested in learning more. The network has grown dramatically If you would like to hear more about the over the past 12 months, with increased network and how it can benefit you, join engagement across the regions. Value FFF at this free networking-based event. makers have been the driving force behind Bookings can be made at hfma.to/ytj

28 February 2020 | healthcare finance professional lives: development

Events in focus Diary Integration forum 6 February, London January 26 N Value and Innovation With the new government throwing 29 N Pre-accounts planning, Award 2019 winner (webinar), its weight behind the NHS long- Leeds 12.30pm term plan, health and social care 30 N Pre-accounts planning, 27 I Institute: costing together organisations throughout England London (south), London will be carrying on with their efforts 30 B Northern: social evening to implement its ambitions on 31 B Yorkshire and Humber: March integrated care. A year on from branch conference, Scunthorpe 4 I Institute: the next step – how the publication of the plan, the HFMA’s fifth annual integration to use PLICS to benefit your summit will focus on the implementation of integrated care February trust (webinar), 11am systems (ICSs) and the progress made towards national 6 F 5 N Integration summit, London Driving workforce savings – coverage (due by April 2021). N 10-11 CEO forum, London staff bank best practice The event will be useful for those with an interest in 11 B Kent Surrey and Sussex: (webinar), 11am integrated finance and governance, particularly those from I accounting standards, Gatwick 11 Institute: value masterclass, health and local authorities working in integrated systems. F 12 Provider Finance: technical London The programme, chaired by Kathy Roe (pictured), finance forum director at Tameside and Glossop Clinical Commissioning 13 B Wales: VAT training level 3, April Group and Tameside Metropolitan Borough Council, will I Cardiff 8 Institute: costing conference, hear from Jacquie White, director of system development for 14 B Kent Surrey and Sussex: London primary care and system transformation, NHS England and introduction to NHS finance, 24 B North West: golf event NHS Improvement. There will also be speakers from local Wroxham Heath government and ICSs. 20 N Clinical coding If you are affiliated with a HFMA partner organisation, you transformation at North Bristol can attend this event for free. Limited free places are also NHS Trust (webinar), 12 noon available for members of the Local Government Association. • To book a place, email [email protected] For more information on any key B Branch N National of these events please email Save the date: the HFMA annual summer conference F Faculty I Institute [email protected] (2-3 July) will focus on ICSs and the transition to system-wide working in the NHS, how the aims of the long-term plan can be delivered and how finance teams can work together across organisational boundaries. HFMA webinars Mental Health Finance Faculty technical Three new webinars will be available to HFMA members over the forum/Provider Finance Faculty coming month, focusing on clinical coding, patient-level costing technical forum (PLICS) and finance business partnering: 12 February, London • At North Bristol NHS Trust, Clinical coding transformation (20 February, 12 noon) will look at how the trust significantly Each year, the HFMA mental health and provider finance improved its coding in three pilot specialties in 2018/19. It will faculties run technical events, each focusing on a single topic. also examine the trust’s standardisation of its improvement This year, the events will be held on the same day, with the methodology and look in detail at improvements in mental health faculty hosting the morning neurology coding. session. This will look at digitisation and will • Costing practitioners, as well as those focusing on include an update from NHS X director for improving internal PLICS reporting and the use of data, will find technology and data strategy Kathy Hall. The next step – how to use PLICS to benefit your trust Delegates are welcome to attend both useful. The webinar (4 March, 11am) will examine how to move sessions – the Provider Finance Faculty’s from generating annual PLICS data to reporting quarterly and afternoon forum will examine system finance monthly. management. There will be updates from national bodies, and • A third webinar, Exploring the role of the NHS finance speakers include John McLoughlin, senior finance lead for business partner, was held on 23 January and is available on financial accounting and services at NHS England and NHS demand via www.brighttalk.com (search for HFMA), together Improvement (pictured). with a range of previously held webinars. • To book a place, email [email protected]

healthcare finance | February 2020 29 professional lives: my HFMA

New opportunities

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

A very belated happy new year. I are excited to have Caroline Clarke at the helm will be sending out further details shortly. My trust you had a good break over for 2020. Her theme, Taking pride in the future, is In April, we launch our new hub concept. HFMA Christmas. The short days and cold a powerful rallying call in the association’s 70th Most of the face-to-face networking at HFMA weather don’t entice us back to work year of existence. She wants NHS finance to take in England takes place via our faculties, which but, for many of us, it is the belief we are doing pride in what it does well and play a key role in have been astonishingly successful. But we must something worthwhile that motivates us. securing the future success of the NHS. move with the times. The HFMA’s longstanding For the HFMA, the work continues. Thank Those of you who have met Caroline will partner programme and faculty offering will you to all who attended the annual conference have been struck by her energy and charisma. evolve into the HFMA hub partner programme in December. Apart from a pretty shockingly We look forward to helping her deliver her to mirror moves towards system working. bad dinner, for which I apologise, I felt the event objectives. There is a different dimension in Partnership with the hub will allow organisations was one of the best we had run, with a variety of having a CEO as president and it’s great to have and systems to come together, network with interesting and stimulating speakers present. someone from London – the first since 2000. peers, share expertise, and influence policy and For the association, it was a piece of crisis The association used the annual conference to decision-making. The aim is to support wider management four weeks out, when the general launch our HFMA bitesize portfolio of courses, finance teams working across organisational election date was set for the week after our with three levels to meet the learning needs of a boundaries for integrated service delivery. flagship event. Several NHS leaders scheduled to wide range of NHS staff. We are exploring how The HFMA faculties will continue as networks speak had to withdraw because of pre-election we can make these courses much more accessible and keep their strong identities. But there will be sensitivities. But HFMA staff were able to turn across all four UK nations. The product will be more focus on integration and picking up new a potential disaster into a triumph. And many available to purchase from early March and we methods of delivery. Hub partners can select the of our colleagues from NHS England and NHS events and familiar benefits from their faculties. Improvement, who were unable to address the But they will also be encouraged to access the conference, will be delivering webinars on the broader hub programme. You’ll hear more from HFMA platform in the coming weeks. HFMA chief us in the coming months and weeks, so look out For those who like to plan early, the early executive for further details on the hub. booker rate for our 70th anniversary conference Mark Knight 2020 has got off to a flying start already for the in December will be out soon. association. Perhaps this is the year you will get

The new year means a new president and we more closely involved with the HFMA! SHUTTERSTOCK

Member news The Northern Branch • Small Team – financial celebrated the best in local management community Sussex Community NHS NHS finance at its recent annual team, Co Durham and Foundation Trust’s finance team conference. The winners were: Darlington NHS FT has donated a £100 voucher • Large Team – financial • Unsung Hero – Ritchie Barron to Brighton Food Bank. The management team, • Chair’s Award – Moya Member team won the Training Award at Northumbria Healthcare NHS Mearman, Lynne Hodgson, the Kent, Surrey and Sussex FT (pictured) Samantha Hebdon, Louise benefits Branch awards and received • Accountant – Lis Dunning Ferguson and Anne Dinsley the voucher to recognise the • Student – Arran Scott and • Graeme Smart Award – Membership benefits achievement. The Brighton Georgia Carter (joint winners) Lynne Hartley include a subscription to charity supports families and • Apprentice – Lewis Chater, Healthcare Finance individuals going through times Aiden Watson, Connor Hundreds of HFMA members and full access to of crisis. hfma.to/foodbank Buckley and James Davison took part in an end-of-year quiz the HFMA news alert (joint winners) that asked members to match service. Our membership Meanwhile, Sheila Stenson, • Accounting Technician – Josh dogs with their NHS finance- rate is £65, with chair of the Kent, Surrey and Lowes related owners. Tameside and reductions for more Sussex Branch, and committee Glossop Integrated Care NHS junior staff and retired member Stuart Wayment Foundation Trust’s Michelle members. For more visited St Catherine’s Hospice Hurst was randomly selected information, go to to hand over £1,300 that the from a small number of entries www.hfma.org.uk branch raised during its annual that got all the pairings correct. or email membership@ conference. She won an HFMA goodie bag. hfma.org.uk

30 February 2020 | healthcare finance professional lives: people

Network focus Appointments Environmental Steve Wilson (pictured) is now My Sustainability Special HFMA treasurer at Greater Manchester Combined Interest Group Authority. He was previously executive lead, finance and investment at Greater Manchester Health and Social Care As one of the biggest employers in be expertly managed.’ Partnership. Mr Wilson started his NHS the world, the NHS plays a key role Environmental sustainability is finance career as a finance trainee on in the environmental sustainability everyone’s business, and this is the NHS financial management training agenda. From reducing single use why the group is keen to reach a scheme in 1996. plastic in canteens and in clinical wide audience across the NHS. practice to redesigning processes to To achieve this, the SIG shares University Hospitals Birmingham NHS Foundation reduce carbon emissions, the scope case studies and information to Trust has named Claire Finn director of operational finance. for improvement and culture change illustrate the impact of NHS activity Previously, she was head of productivity and financial is vast (see Healthcare Finance, on environmental sustainability. It improvement at the trust. Ms Finn has over 15 years’ December 2019). helps to identify resources available experience in NHS finance. By building on the work of the to NHS finance staff to address the NHS Sustainable Development environmental sustainability agenda Mark Axcell (pictured) has been Unit and taking the advice of other at a professional and personal level. appointed chief executive at Black Country experts in the field, the HFMA ‘There are a lot of good case Partnership NHS Foundation Trust, in Environmental Sustainability Special studies to show what NHS addition to his position of chief executive Interest Group (SIG) aims to support organisations have already at Dudley and Walsall Mental Health its commitment to embed significant done to enable sustainability in Partnership NHS Trust. Mr Axcell has over and effective sustainability strategies their local communities and to 25 years’ experience in the NHS, most of it into all aspects of the NHS. The address the wide variety of issues in finance. He is also a trustee at A Child of group facilitates the sharing of best identified in the UN Sustainable Mine, a charity supporting grieving families. practice and urges the NHS finance Development Goals (SDGs) – from function to take steps to reduce the waste management to improving Chelsea and Westminster Hospital NHS Foundation Trust negative environmental impact of procurement processes or reducing has appointed Virginia Massaro acting chief financial officer. NHS activity as a whole. the impact of NHS-related travel. Ms Massaro joined the trust in 2010 as head of financial ‘We want to develop the But there is still a huge amount left planning before progressing to assistant director of finance capabilities of the NHS finance to be done,’ says Mrs Dyson. and deputy director of finance, having worked in finance function in terms of how to plan ‘As an NHS finance function, teams across NHS organisations in North West London. for, manage, analyse and report we’re very capable of addressing She takes over from Sandra Easton, who is now director of on the sustainability issues of the “big issues”. Environmental operational finance and performance at NHS England and NHS,’ says Pam Dyson (pictured), a sustainability and the survival of the NHS Improvement. longstanding member of the group. planet needs everyone’s attention ‘Everything that happens in the NHS now. It’s the biggest problem we Peter Holt (pictured), former finance involves a financial demand on the have ever faced, and we only have director of Health Education England for public purse as well as an impact on one shot at it,’ adds Mrs Dyson. London and the South East, is now chief the global environment. Both need • To get involved, please visit finance officer at GambleAware, a charity constant professional focus and to hfma.to/environmentSIG committed to minimising gambling- related harm. Mr Holt has 12 years’ experience in public finance. Eastern [email protected] East Midlands [email protected] branch Peter Munday has been named lay member for contacts Kent, Surrey and [email protected] governance and audit for Cheshire Clinical Commissioning London [email protected] Group, to be formed by the merger of Eastern Cheshire, Northern Ireland [email protected] South Cheshire, Vale Royal and West Cheshire clinical Northern [email protected] commissioning groups on 1 April. Mr Munday has held the North West [email protected] same post at Eastern Cheshire CCG. He previously worked in Scotland [email protected] finance for Salford Royal and Mersey Care trusts. South West [email protected] South Central [email protected] Frankie Morris has been named acting chief finance Wales [email protected] officer at Liverpool Heart and Chest Hospital NHS West Midlands [email protected] Foundation Trust. She has been deputy chief finance officer at Yorkshire and Humber [email protected] the organisation. Ms Morris joined the NHS in 2006 and has held senior positions in organisations in the North West.

healthcare finance | February 2020 31 professional lives: people

Get in touch Have you moved job or been promoted? Do you have other news to share with fellow “There are lots of opportunities to go at – members? Send the and if we make the right changes, we will details to seamus.ward@ be up there with the very best” hfma.org.uk Claire Wilson, Wirral University Teaching Hospital NHS Foundation Trust Wilson makes chief finance move to Wirral

Claire Wilson has been appointed ambitious vision for the hospital, including a working together around the shared financial On the chief financial officer at Wirral determination to address the financial challenges challenge. That’s a positive and one of my move University Teaching Hospital NHS faced by the trust and the wider Wirral system,’ objectives for the coming year is to build on that.’ Foundation Trust. She joins from she says. ‘As a finance director, that was a strong She is optimistic that this will deliver better the Liverpool Heart and Chest Hospital NHS draw for me.’ care for patients. ‘Looking at the benchmarking, Foundation Trust, where she has been chief In 2018/19, the trust ended the financial year Model Hospital and RightCare data, there are financial officer since 2016. Previously, she has with a deficit of £31m, which was £6m more lots of opportunities to go at – and if we make worked in a clinical commissioning group and at than planned. Provider sustainability funding the right changes, we will be up there with the regional and national level. was not available to the trust in 2018/19, as it did very best.’ ‘The move was a natural next step from a not agree to its control total. A strong finance team that is supported personal perspective,’ she says. ‘Wirral is a ‘Geographically, Wirral has the right to reach its potential will play a vital role in teaching hospital with a broad range of services ingredients to make integrated care work – a facilitating these improvements. To this end, and a busy emergency department. The trust has single CCG, a community trust, acute trust, Ms Wilson will focus on developing her team. been on a journey of improvement for the last mental health services and a single local ‘This year, I want to look at how we are 18 months and has built strong foundations to authority. We are at the start of the journey, but supporting and engaging with staff at every improve quality and governance. there’s a will to work together across the system level in the hospital. We need to find the best ‘Like many others, the trust is facing and there’s a great opportunity to develop a ways to make the financial challenge meaningful considerable financial challenges, but there are successful integrated care system.’ to the people who are delivering care every opportunities for improvement and a strong Ms Wilson continues: ‘There are some big day and to support them to help us to turn commitment to tackle them,’ she adds. ‘It is an financial challenges across the health economy, this around.’ exciting time to join the team, the foundations but the partners in health and care are now She wants to ensure that finance staff have are there, and we can build on this now to focus the skills, capability and capacity to provide on wider system sustainability.’ this support to frontline carers. This will mean The trust is focusing on a number of “Geographically, Wirral has developing business partnership arrangements developments, including acting as a global digital the right ingredients to make for the next phase of the journey. She praises exemplar and delivering an £18m upgrade to integrated care work – a the recent report, Exploring the role of the its urgent treatment centre, and it is moving NHS finance business partner, published by the forward on population health. single CCG, a community HFMA, Future-Focused Finance and ACCA. Meeting the new management team – trust, acute trust, mental She is keen to use the support offered by the appointed following some instability at the trust health services and a single HFMA to develop her team. ‘The HFMA is a – confirmed her feeling that Wirral was the right strong community for finance colleagues in choice. ‘The board of directors has a clear and local authority” tough times, offering insights into best practice.’