Road to Recovery - Healthcare commissioners as the driving force for system sustainability

11 April 2019

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by Damien Ashford Partner

Email +44 (0)7787 120228

by Nancy Park Director

Email +44 (0)7725 633066

The NHS Long Term Plan highlights the need to accelerate the redesign of patient care to future-proof the NHS for the decade ahead. To achieve joined-up care at the right time in the right setting, with more options and improved support for patients, an infrastructure of integrated care systems (ICSs) and greater system working will be required.

Progress has been made towards ICSs and single system control totals, but there are great differences across the country in levels of maturity in sharing data and joint working, and much work still to be done. For now, commissioners will remain accountable for the procurement of healthcare services to meet the needs of their population within their allocated financial resources. In this environment the role of commissioning is more challenging and yet more important than ever.

The amount of financial pressure facing commissioners is increasing. Most recent figures from NHS England show that Clinical Commissioning Groups (CCGs) had a year to date deficit of £323m for the 10 months to 31 January 2019. This trend is likely to continue, at least in the short term, as new funding is invested in system reform and priority delivery areas. In this context there is a clear need to recognise the signs of financial stress and take action to mitigate a deterioration in the financial health of local systems and organisations, and ultimately to ensure the financial sustainability of the system.

For the current financial year, commissioners’ QIPP and providers’ CIP remain a source of multi-million financial improvement plans to drive up efficiency. However, in many parts of the country, the distinction between QIPP and CIP is blurring with an increased focus on the system’s financial health. When we launched our recent publication on achieving financial balance and sustainability in healthcare providers, we signalled our intention to publish a follow up focused on financial improvement and recovery viewed through a commissioner and system lens. Drawing on our experience of working with commissioners and integrated care systems across the country to help them get onto a more sound financial footing, we have now released a new publication looking at financial improvement through the lens of a commissioner, where we set out what commissioning organisations can do when faced with growing financial challenge.

In particular our framework identifies the six success factors for financial recovery:

  1. getting a clear understanding of the size of the challenge and its causes;
  2. effective and cohesive leadership;
  3. robust governance;
  4. strong stakeholder engagement;
  5. a clear plan for recovery;
  6. rigorous implementation.

Additionally we explain the indicators of financial stress including the metrics which can be used to identify early warning signs of financial deterioration and use the Recovery Curve to show how an organisation goes through in its journey back to financial sustainability.

We hope this report is helpful in supporting the NHS to achieve its goals. We would be delighted to hear your own reflections and learnings from dealing with financial recovery. Please, do get in touch.

by Damien Ashford Partner

Email +44 (0)7787 120228

by Nancy Park Director

Email +44 (0)7725 633066