Balancing act: supporting finance leaders to deliver on short- and long-term priorities 11
The Healthcare Value Institute 13 has further resources to support how value-based healthcare can encourage multidisciplinary system-wide approaches to deliver financially sustainable outcomes. Examples include A value-based healthcare approach to driving improved productivity 14 and The vital role of outcome measurement in maximising healthcare value 15 . The One NHS Finance Best possible value toolkit 16 is another source of support in making value-based decisions for healthcare services. Partnership working and integration Participants reflected that it does feel like real progress has been made in partnership working and integration, with much more consideration of impacts in both health and social care and across organisational interfaces such as the community provider and acute hospital. Several examples of this were shared, such as considering what happens if a local authority is financially challenged and drives more demand into the health system. Or, where work in a single organisation effectively ‘squeezes the balloon’ and moves pressure elsewhere in the system – for example, a focus on prompt discharge in acute beds achieved through using additional beds in the community with inadequate therapy support, leading to reduced independence for people and associated social care costs. Some participants did emphasise there was further room for improvement – an increase in transparency and openness between partners; more consideration of not just health and social care, but the interdependencies between primary and secondary care; and the relationship between elective care backlogs and urgent and emergency care demand. It was discussed that protectionism can raise its head at times. Everyone acknowledges they would ideally move the right care to the right place, but that funding to make the transformation happen, and the changing of commissioned contracts around this is not flexible and able to keep pace. Often systems don’t have the financial headroom, whether capital budgets or revenue funding, to pump prime or double run initiatives. This leads to a dissonance between the ultimate goal being entirely logical and high-value for patients and the system, but the resources required to get there being unavailable. This is explored in the HFMA briefings, Moving money around the system 17 and Bringing it together: financial strategies that address health inequalities 18 .
If organisations are in stalemate because no one wants to ‘lose out’, then it is the pace of change and ultimately the positive impact on patients which suffers. The use of block- based contracts was raised as having cut through some of the activity and tariff-based challenges in making changes or cooperating to respond to pressure. Protectionism can also be found in operational constraints put in place by partners or deep rooted in commissioning agreements. Some of these constraints are in place for good reason, but others are in place as that is the way things have always been done – not necessarily because that is how things need to be done going forwards. To operate in a system leadership capacity, organisational leaders have to both embrace transparency and openness, and a willingness to collaborate for the greater good. But they also have to be willing to be potentially vulnerable and held to account by system partners for performance and improvement. A toolkit for leaders and individuals engaged in the design and delivery of integrated care at a local level can be found in Integration at place: from ambition to delivery , published by NHS Providers and Newton 19 . Value – mindset, measurement, and realisation What do finance functions need to do to be able to think in these value terms and influence others? Participants shared that there are undoubtedly opportunities to develop new skills, or recruit new roles which bring complementarity and diversity of thought into the finance team. It may also be time to look at business partnering models and support finance business partners (FBPs) to rebalance their activity from the ‘churn of reporting’ to more transformational support. One roundtable group discussed how as senior finance leaders, their support of other functions should be a key evaluator of performance – the acid test being how often colleagues come to them for advice or help.
13 Healthcare Value Institute, webpage 14 Healthcare Value Institute, A value-based healthcare approach to driving improved productivity , December 2024 15 Healthcare Value Institute, The vital role of outcome measurement in maximising value , November 2024 16 One NHS Finance, Best possible value: decision toolkit , webpage 17 HFMA, Moving money around the system , January 2025 18 HFMA, Bringing it all together: financial strategies that address health inequalities , August 2024 19 NHS Providers and Newton, Integration at place: from ambition to delivery , January 2024
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