4 Balancing act: supporting finance leaders to deliver on short- and long-term priorities
The aims of this project Practical support for finance leaders in balancing work across three transformation horizons.
To achieve the ask of an NHS that delivers long-term operational and financial sustainability requires significant change across short-, medium- and long-term horizons. However, the current focus on agreeing, and then delivering on, a tight 2025/26 financial plan (including a plethora of returns), along with the immediate workload and distraction of the abolition of NHS England and delivery of local running cost reductions, leaves little (or no) management capacity to think about anything other than the short-term. This sentiment was strongly felt by many of the finance leaders engaged throughout this project. As set out in the HFMA’s statement on the role of the NHS chief finance officer (CFO), the CFO in today’s NHS is at the heart of an organisation’s management structure and plays a key role in both corporate decision-making and leadership 9 . Working closely with board members and clinicians, finance leaders are required to balance quality and finance targets within year for their own organisation, in addition to delivering quality and finance targets across multiple years across multiple organisations. However, for many in the finance community, the focus on in-year initiatives leaves no headroom to come together as leaders to discuss and progress multi-year schemes.
In response, the HFMA and Newton have together undertaken a series of engagements with NHS leaders. These engagements have sought to identify practical approaches that can create headroom (both in terms of time and money) for longer-term change, helping to avoid getting caught in the short-term only. The methodology is set out in appendix A . This paper summarises the common barriers and success criteria identified in balancing work across three transformation horizons: • horizon 1: optimising the current system • horizon 2: designing, testing and scaling new service delivery models • horizon 3: fundamental service redesign and normalising new operating models. It provides practical tools and resources that we hope will support finance leaders today, including links to existing resources as well as case studies to share the methods and mindsets being applied across the country. The messages are applicable across the four nations of the United Kingdom.
The aims of this project • Create headroom: provide practical approaches that can create headroom – both in terms of time and money – to plan and deliver multi-year structural change and avoid getting caught in the short-term only. • Provide a framework for planning: support finance leaders to develop plans for long-term financial sustainability and improved outcomes, at the same time as operationalising current plans. • Clarify the role of finance leaders: set out the role of finance leaders within multi-year, multi-organisational system change. • Share experiences and tools: summarise the common barriers and success criteria identified in balancing work across different change horizons, sharing examples, practical tools and resources that can support finance leaders today. • Inform strategy discussions: provide the basis for further discussion on the role of the finance profession within wider NHS plans, including the 10-year health plan.
9 HFMA, The role of the NHS chief finance officer , October 2024
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