A flogging offence or a hanging offence? The financial dilemma facing NHS trusts
I recently facilitated an eye-opening focus group with eight finance directors from hospital trusts across the NHS. What became clear was that the NHS is now in such a precarious financial position that the internal mantra driving decision-making around scarce resource has become, “is it a hanging offence or a flogging offence?” In other words, are the Government/regulators likely to shout at them or sack them for not meeting a particular national priority. They will accept a flogging every time.
Working with NHS trusts is increasingly about identifying where their priorities lie and ensuring yours align. Currently these priorities are workforce, finance and quality (with a specific focus on A&E). For everything else, such as the Government manifesto pledge of delivering seven-day hospital services (providing the same high standards at the weekend as in the week, to 90% of patients), it’s a nice to have. Many trusts will take a board decision that 70% of patients having access to full weekend services is good enough and, after all, not meeting this target is just a flogging offence.
NHS finances are in a perilous state and so trusts are taking short-term fixes now with long-term consequences that will see finances worsen. For example, one trust in the North West is selling off its car park to a private company. This income stream will no longer be available after the immediate windfall is sunk into helping reduce the current deficit, the first due to be posted in this trust’s history.
This sort of decision making is taking place against the backdrop of a shift toward longer-term planning and restructuring through the 44 Sustainable Transformation Partnerships (STPs) or Integrated Care Systems (ICS). STPs and ICSs have a shot at being successful if they can get trusts to lift their heads up from their increasingly pressing priorities and look forward. Equally NHS Improvement, NHS England and the Department of Health and Social Care need to reduce the threat of a flogging, or even, a hanging, and encourage longer-term thinking instead.
The Lexington Health team – in both Manchester and London – is currently working with a number of healthcare companies, helping them navigate the newly-evolving NHS landscape and helping them work strategically with STPs and ICSs at a regional level.
Andy Kliman, Lexington Health’s new director, is based in our Manchester office. If you are interested in finding out more about these topics, please email Andy at Andy.Kliman@Lexcomm.co.uk or Emily Cook in London, at Emily.Cook@Lexcomm.co.uk.