Jonathan Lee, assistant director for business and finance at Digital Notts, shares his insights on the benefits of closer links between digital and finance in healthcare in this blog for HTN. A qualified accountant, Jonathan brings a wealth of experience gained from working at a senior level in a number of organisations, mostly in the NHS.
Digital Notts is the Nottingham and Nottinghamshire ICS digital transformation team, working across the system to coordinate and enable the delivery of the ICS digital strategic priorities alongside experts and professionals in each of our partner organisations. I joined the team during the pandemic, when I started a secondment opportunity working in the ICS on a variety of transformation projects. Over a period of time, the work I was doing with the digital team grew and grew. The rest, as they say, is history…
I believe that we are in a world of rapid digital transformation that will enable new models of service delivery to improve how we care for our population. This all has to align, be delivered through a value-based approach with robust financial governance that supports a sustainable change.
With the ICS still developing, we have been building and shaping the ICS Digital Programme Management Office (PMO) approach as the Digital Notts team continues to mature. There was already (and still is) a well-established Digital Collaborative Group and Digital, Analytics and IT stakeholder group within Nottingham and Nottinghamshire which was a strong starting point. We’ve not rushed into making hasty changes, rather working with partners to mature and evolve, learning what works well or not, and stealing the bits we like from elsewhere (with recognition of course).
We have also ensured that we remain aligned to the seven pillars of What Good Looks Like as well as national and local system priorities. Our governance arrangements continue to evolve and, bit by bit, we are seeing digital become more embedded into people’s mindsets. We promote an operationally-led, digitally-enabled approach in everything we do. There’s still a long way to go but we are making good progress.
It’s all about finding the right hybrid blend of strong governance whilst remaining agile; responsive but in control.
I think it’s important to emphasise that Digital Notts is a fantastic multi-disciplinary team. We are surrounded by people with a wealth of knowledge and experience from across the system who all have a strong belief in working together. That’s a great place to be when I think back to the days of internal market competition and the commissioner/provider divide.
In terms of the benefits of this work, I developed a financial model to enable the Digital Notts team to become established on a permanent basis. Hosted by a local trust on behalf of the system, we are self-funded through additional income streams with a system-wide risk share agreement signed by the ICS finance directors. This means, rather than trying to lead significant system-wide transformation with a team made up of people on secondments and fixed term contracts, we have a stable team to call upon.
The biggest benefits always come from working together. The PMO is designed to underpin an approach where we engage with the right people, in the right ways. Through our performance reporting, we provide assurance as well as holding people to account through a supportive escalation process if necessary.
Having a blend of skills in the team has led to success in securing funding and then managing the funding more appropriately to support delivery against sensible timelines. We’ve only had the team in place for a relatively short time and we are already starting to see the results.
I believe that the NHS can really stand to benefit in general from stronger links between digital and finance. In 2014, One NHS Finance launched the Value Makers Network, and it felt like a real step in the right direction to support finance colleagues develop a deeper understanding of value. Being a key member of a wider team, finance staff can add value into the healthcare system. The Healthcare Financial Management Association (HFMA) gives a similar message in its strategy and provides networks, articles, training, webinars and events to help drive this approach. When finance professionals embrace working alongside clinical and operational colleagues, providing patient level intelligence, modelling and benchmarking data, you can see the added value of working together.
Whilst finance folk are the gatekeepers to unlocking investment, it’s also our duty to help our colleagues unlock those opportunities. We can help by developing robust, evidence-based approaches to deliver real transformation knowing that it was the right thing to do. This includes looking at the art of the possible, the value digital transformation can add and not just focusing on the familiar, same old approaches. As finance experts we can apply our skills to help our colleagues write better bids, business cases, financial plans and model and measure benefits. We can listen to their ideas and help develop them.
What does the future hold? Part of my role includes co-ordinating the Digital Maturity Assessment (DMA) locally. One question in 2024/25 is:
To what extent do you agree or disagree with the following statement in relation to your organisation: “Executive Board members feel comfortable taking measured risks in digital and data investments across the ICS?”
I don’t think many ICS Boards currently have the freedom to consider taking any risks about any investments. This could stifle ambitious system transformation as the focus becomes more about quick financial fixes. Many ICSs are in financial recovery and this means investment is even harder to justify unless it guarantees a quick return. There is also a risk that transformation funding gets sucked into financial recovery plans.
Because most digital funding is ring-fenced, albeit non-recurrently, it gives us the opportunity to ensure that everyone gets behind proving the benefits. This means that when we do need to put the case forward for recurrent, local investment we can demonstrate that it’s money well spent.
Two important ambitions for 2024/25 that I will be working on with colleagues on are:
- During a recent reflective session with senior digital leads, we realised that lots of great work has happened but all too often we’ve not captured it anywhere. We will be changing that starting with an annual report.
- We will also be developing a longer term financially sustainable model for digital transformation. To do this we must start by taking our approach to evidencing benefits up several notches. We must also ensure that we dedicate the time and resources to write some really strong business cases that include these benefits.
I’d like to conclude with my five “top tips” for colleagues working in digital transformation from a finance person’s point of view.
- From the outset have one eye on the long term financial sustainability. Start thinking about your business case from the outset.
- Have good financial plans. It keeps the oversight groups, NHSE and finance happy, helps with recruitment and importantly, gives you piece of mind by having clarity from seeing your plan nicely laid out in numbers.
- Make sure your local priorities are well aligned to the national ones. That’s where the funding will be!
- Have a finance digital champion – someone who understands the NHS finance regime, has contacts and understands how funding can be safely managed across financial years and across partners. They will help write bids, business cases and spend funding in the right way, at the right time, linking you in with the right finance people. This will hopefully reduce your stress levels.
- Don’t scrimp and scrape by not putting in the necessary resource to do the business analysis, benefits and evaluation work properly. Reflecting on projects I’ve worked on in the in the past I don’t think we fully appreciated this at the time and it made moving things past the pilot phase difficult.
Many thanks to Jonathan for sharing his insights.
