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NHS leaders are being asked to do more with less while changing how services are configured

Waiting lists and workforce pressures land on the same leadership teams that have to hold a tight budget. Our healthcare specialists work alongside Trust teams to close financial gaps and improve services, with the long term in view.

NHS financial improvement and turnaround: closing the gap through delivery not diagnosis

Many NHS organisations face financial challenges and efficiency programmes they can’t deliver on their own. NHS England asked for our support as part of a different approach to help financially distressed hospitals. Supported by regulators, we work with challenged NHS organisations across the UK to put visible and experienced NHS senior leaders and managers (financial, operational, clinical, workforce and programme management) to work alongside teams providing hands-on support and coaching to drive financial improvement and sustainability. We act as a genuine delivery partner taking accountability and ownership for results, improving governance and accountability and equipping local teams to deliver at pace.

What we’ve learnt

Across the organisations above, starting points differ but the challenges and opportunities are often similar.

Challenges we see

Workforce costs growing faster than activity and not funded, driven by temporary and variable pay and poor productivity
Reporting that gives different answers to different people, with schemes overstated until they’re tested
Governance and programme management that’s disjointed and ineffective in holding Executives and Senior Leaders to account
Lack of understanding, knowledge and capacity across financial, operational and clinical teams on financial drivers and controls that deliver reductions in run-rates
Plans that do not provide time, capacity and pace to reflect transformation and digitally enabled opportunities to support medium-term financial and operational sustainability

Opportunities we’ve found

Improvement in governance, reporting and structure to provide accountability, rhythm, drum beat and consistency on recovery actions
Variable pay, through bank-first working, tighter agency rates, less overtime and consistent controls on temporary staffing
Productivity and flow, from length of stay and delayed discharges to outpatient follow-up
Non-pay and corporate costs that sit above those of peers and do not maximise scale, supply and digital/automation solutions

Six lessons for leadership teams

Numbers first

Reconcile and test every scheme before building the plan. Savings may fall, but the plan will be reliable. Triangulate workforce, activity and finance plans so they tell one story.

Workforce spend is owned

Variable pay falls when someone is accountable and controls apply organisation-wide. Service leaders should own workforce plans that build in productivity and digital, so vacancies reflect reality.

Clinicians lead delivery

Each division needs clear accountability for its own schemes. Clinician-led savings are more likely to deliver and last.

Renew the pipeline often

Plans built on one-off items and second-half delivery leave little room to recover. Identify the pipeline continuously, not annually. Move value into sustainable change early for full-year effect.

Flex governance, keep control

Strong leadership, governance and accountability form the base. If a process isn’t working, change it, so it stays effective without becoming burdensome.

Make it business as usual

Coach and train staff so these practices become part of the day job. If this sounds familiar, we can help. Talk to Peter Saunders or one of our experts below.

Why Grant Thornton

We provide advisory and audit services to the NHS, covering transactions, projects, performance improvement, workforce, analytics, data quality, digital and clinical strategy. Our teams bring together experienced health and care leaders alongside technical specialists.

Financial improvement and turnaround

If your organisation faces a difficult financial position, we can work with you to:

test your savings plan and establish a single, ledger-based view of the numbers
set up the governance and ownership that get schemes delivered
address workforce costs and variable pay, non-pay spend and productivity
turn one-off savings into recurrent ones
build the skills in your own team to sustain the gains.
Our financial improvement and turnaround work also helps you understand your position and its main risks and present it clearly.

In addition, our healthcare advisory team can support with

Data and analytics to inform decision making

Every financial improvement programme depends on numbers people can trust. The NHS holds some of the richest data in public services, and as care becomes more integrated, data from different organisations has to be reliable and analysed consistently. Our team has direct NHS experience at regional and national level. We check that clinical data reflects the care delivered, turn it into usable insight, explain complex analysis in plain terms and manage large datasets across organisations to support planning and care delivery.

Infrastructure projects, business cases and transactions

Capital is tight across the NHS. But investment in assets such as community diagnostic centres, elective recovery hubs, new equipment and digital capability can make services more efficient.

We help organisations find the right funding structure and build HM Treasury business cases, whether for a new hospital or for a digital solution when a private finance initiative (PFI) contract ends, helping them build the benefits case and then realise them. We also support infrastructure projects, mergers and acquisitions, and contracting issues.

Our experience spans the first PFI deals through to the latest community diagnostic schemes.

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