Speaking notes for Healthcare Financial Management Association

Date published: 24 November 2023

Thank you for the invitation to speak at this conference today.

Department of Health Permanent Secretary Peter May
Department of Health Permanent Secretary Peter May

Thank you for the invitation to speak at this conference today.

I know that the HFMA, both locally and in terms of the work it does nationally, is a great source of support to our finance staff.

This support is very much valued, not least at this time of severe budgetary pressure and uncertainty.

I also want to place on record my deep appreciation of the work finance professionals undertake across the health and social care system. This work is not often headline-grabbing or heralded, but I certainly know as overall accounting officer just how important it is.

Financial stability and efficiency are foundation stones that make everything else in health care possible. Never lose sight of this fact and please accept my personal thanks for the contribution each of you make.

The drive to secure greater efficiencies has been very much at the forefront of our minds, given the current financial position.

To use a seasonal quote, efficiencies like dogs are not just for Christmas – or even just for a single accounting period.

There will be an ongoing and pressing need in the years ahead to make the best use of every single pound we are allocated as a system.

There is ongoing speculation about whether or not the Executive will return and whether this will include additional funding for public services in Northern Ireland.

We will have to wait and see but I do not anticipate that any financial settlement could conceivably resolve all our challenges. If extra funding does come, it is expected to be mostly consumed by pay and overspend pressures.

The reality is that in health and social care, we will never have enough money to do everything that we want. The competing demands for extra funding cannot all be met, not now and not in the foreseeable future.

There will inevitably be limits on what we can do. Choices will have to be made and priorities agreed.

That’s a central reason why we need political leadership, mature public debate and collective decision making.

Efficiency and productivity savings, delivered on the ground by operational teams, will be a core requirement for the long term.

I want to be clear that I do not believe that efficiencies alone will completely bridge the widening gap between demand and capacity.

Additional investment will be absolutely crucial to address unmet need and help transform health and social care services to make them fit for the future.

Priority areas for investment include waiting lists, workforce, social care, technology and the ongoing roll-out of Multi Disciplinary Teams in primary care.

The need for health and social care provision in our society will undoubtedly continue to grow, as more people live longer lives. In addition, incredible advances in life saving and life changing drugs will inevitably come with a price tag.

But efficiency gains help us do more with what we have.  And importantly they also strengthen our case for additional funding. The more we can demonstrate to an Executive that we are making the best use of existing resources, the better our bids for much-needed further investment will land.

This is without doubt a very tough time for health and social care and I cannot promise you that this will lessen any time soon.

However, there are still grounds for real hope.

I get inspired every day by the commitment to excellence and innovation I see across Northern Ireland.

I have no doubt the next Minister will too.

And real change is happening right now. We see it with the game-changing encompass programme, which has gone live at South Eastern Trust in recent weeks. That is one of the most ambitious initiatives in the history of our health service.

Reconfiguration of hospital services is also underway. We see that with the development of standalone elective care centres.

Day Procedure Centres are now up and running at Lagan Valley and Omagh Hospital sites, while Elective Overnight Stay Centres are treating patients at the Mater, Daisy Hill and South West Acute Hospital sites.

These centres cover a range of specialities including General Surgery, Urology, Gynaecology, ENT, Breast and Endoscopy.  In addition, we have cataracts centres at Downe, South Tyrone and Mid Ulster Hospital and an orthopaedic hub at Musgrave Park Hospital which includes the Duke of Connaught Unit - a dedicated orthopaedic Day Procedure Centre.

This is all part of what will be an ongoing focus on developing specialised hubs of care.

This means working with the grain of modern medicine and not against it and accepting that every hospital cannot provide every service. Establishing specialised hubs makes sense in efficiency terms. Most importantly, it provides safer and better care.

We have also seen this year the decision to locate all births in the Northern Trust area at Antrim Hospital; and the concentration of minor injury unit services at Ulster Hospital.

Important progress is also being made on the goal of controlling and reducing agency spend. Time has been called on off contract agency use in nursing and midwifery; while all agency use in social care has been ended. This is progress.

Change is happening elsewhere too. Work continues on the development of the new Integrated Care System, another gamechanger.

It will seek to create a culture both inside and outside the system where those who want to make our population healthier feel more empowered and are provided with the means to do so. It will look to establish and cultivate relationships across the community landscape where our population will feel more informed and involved in decisions that will improve their health and wellbeing and that of the community they live in.

Empowering and enabling people to improve their health will be an essential component of what we do in future.

I would also encourage each of you to try to ensure that you take some time to care for your own wellbeing.  Work can be all consuming, particularly at times of heightened service pressures.

Those pressures are not going to ease overnight, but we can get through them. Too much is at stake to walk away from the challenge.

Let me conclude by again thanking each of you for your work.

It is and will remain absolutely vital to the entire health and care system, as it addresses current pressures and future opportunities. 

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