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Road to Recovery

Healthcare commissioners as the driving force for system sustainability

Earlier in 2019 we published our third iteration of Road to Recovery: Achieving financial balance and sustainability in healthcare providers in which we signalled our intent to publish a follow up focused on financial improvement and recovery viewed through a commissioner and system lens.

In this edition we set out our thoughts on commissioner and whole system action.

With the need for greater system working, the drive towards integrated care systems and changes in the regulatory landscape, we think that the role of commissioning is now more challenging and yet more important than ever. As has been experienced by providers over recent years, the amount of financial pressure facing Commissioners has increased and we expect this to continue at least in the short term.

Most recent figures from NHS England show that Clinical Commissioning Groups (CCG) had a year to date deficit of £323m for the 10 months to 31 January 2019.

We have identified six success factors for financial recovery

Clear understanding of the size of the challenge and its causes

  • Agreement on the size of the underlying deficit and the future challenge
  • Obtaining an understanding of the drivers of the challenge (both qualitative and quantitative)
  • Recognition of the elements of the challenge within and outside the CCG’s/Trust’s control

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Effective and cohesive leadership

  • Clarity of roles and responsibilities
  • Collective accountability
  • Scrutiny and challenge
  • Understand of what ‘good’ leadership looks like
  • Effective and cohesive team working
  • An organisational turnaround mindset

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Robust governance

  • Effective Governing Body/Board oversight and assurance
  • Clear committee structures and approaches for escalation
  • Robust high quality information and reporting
  • Focus on the strength and effectiveness of system relationships

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Strong stakeholder engagement

  • Credibility and a track record of delivery
  • Transparency and consistency of actions
  • Clear stakeholder communication plan 

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A clear plan for recovery

  • Development of a clear, realistic but challenging plan
  • Stabilise in-year position
  • QIPP/CIP identified and plan developed
  • Risk to delivery of the plan and mitigations identified
  • Capacity and capability requirements identified and secured

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Rigorous implementation

  • Robust monitoring and tracking of plan
  • Management and resolution of risks and issues
  • Driving accountability and performance management
  • Delivery assurance
  • Driving continuous improvement
  • Collaborative working across the system

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Further support and information

Rapid financial improvement and turnaround often needs the introduction of new skills and capacity to be able to correct and avoid a downward slide on the recovery curve. PwC can support across all areas of financial improvement. As examples, we can:

  • Review the drivers of your deficit and support the CCG/system in identifying the quantum of those within its control and those outside of its control. Work with your executive and leadership team to support them in managing your stakeholders.
  • Develop your QIPP programme both in-year and for next year, identifying new opportunities, stretching current opportunities, and improving delivery.
  • Identify and develop system-wide financial and quality improvement initiatives.

Contact us

Damien Ashford

Damien Ashford

Partner, Government and Health Industries Restructuring Leader, PwC United Kingdom

Tel: +44 (0)7787 120228

Nancy Park

Nancy Park

Partner, PwC United Kingdom

Tel: +44 (0)7725 633066

Josh Walker

Josh Walker

Director, PwC United Kingdom

Tel: +44 (0)7808 035514

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