Balancing act: supporting finance leaders to deliver on short- and long-term priorities 7
Figure 2: the three horizon model
across existing service or pathway interfaces, and identifying opportunities for better service provision. Specific examples ranged from integrating several community services into a single team, through to new models for urgent response to mental health crises. These were seen to have generally supported both shifts from acute to community and from treatment to prevention. Key discussion points included the challenges in designing and funding new services alongside day-to-day running, the need to design with overall system value in mind and the importance of engagement and alignment with system partners throughout. Horizon 3: Fundamental system redesign Participants shared aspirations to work on the longer-term elements which would lead to a more personalised, sustainable approach to health and care in the UK. This included examples ranging from funding models which align incentives, through to more blue-sky discussions on potential future models of care (for example accountable care organisations). By their nature these often seem outside of the current grasp of any one organisation, but in applying a multi-year approach and recognising the different improvement horizons within the change journey, it was felt that many of these ideas would become accessible. However, it was agreed that there is a risk that without any headspace and capacity to begin working on these, they remain several years away.
Horizon 1: Making what exists today as productive and efficient as possible Some leaders shared examples of embracing the ‘brilliant basics’ ethos in their ways of working within horizon 1. While often these examples were openly shared as not leading the way with innovation, a focus on ‘brilliant basics’ in some areas has potential for large scale impact. Examples shared included having a refreshed focus on length of stay and quality board rounds; standardising rotas; and having a coordinated push on agency and bank usage. In several cases, leaders called out the importance of the cultural change that took place alongside any technical change, and the need to engage teams on patient and operational value rather than specifically money. Another consideration raised was where opportunities exist for finance teams (or wider support services) to improve their own efficiency and lead by example on the productivity challenge. Further examples of horizon 1 opportunities are included in additional HFMA resources 10 . Horizon 2: Designing, testing, and scaling new service delivery models Roundtable participants shared examples of designing, testing, and scaling new service delivery models. These included working in a more integrated manner
10 HFMA, Common themes from the investigation and intervention regime reports , February 2025 and HFMA, The NHS productivity challenge , November 2024
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