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Financial reform as an enabler of change in Bradford
Partners across the six places within the West Yorkshire and Harrogate Health and Care Partnership integrated care system (ICS) agreed to use fixed-income contracts as a way of maintaining control over annual healthcare spending. This was one aspect of their aim to close the financial gap across the ICS and at the same time meet the system control total.
Fixed-income contracts are fixed payments agreed by commissioners and providers, based on planned activity. These annual contracts provide a degree of certainty around income received by providers and the money commissioners spend. The fixed-income amount relates to inflation, efficiency savings, system plans for transformation and changes in demand and delivery of the system control total.
Five key lessons can be drawn from Bradford’s experience, which will be of note to system leaders looking to develop a similar approach:
- Get the system fundamentals right: strengthen local partnerships, spend time setting and demonstrating a new culture, and prioritise what you will do together, for example by focusing on a small number of priorities you want to work on together and developing an agreed memorandum of understanding.
- Optimise the principles and behaviours for cross-organisational working, for example by being authentic and honest in conversations – contract as a group of senior leaders and stand by the Strategic Partnering Agreement avoiding a ‘winners and losers’ approach.
- Use system governance to support shared accountability and to create space for joint problem-solving, by sharing data, for instance, and build a shared picture of financial issues.
- Maximise the benefits of using fixed income contracts whilst protecting against their limitations, for example the need to understand that this approach does not eliminate underlying deficits; rather, it encourages partners to decide how best to use the available resources.
- Recognise that the NHS, on its own, does not have the scope or the levers to achieve the local ambition for change, for example working more closely with local authority and voluntary sector in the development of future financial mechanisms.