30 September 2022 – NED webinar – Provider trusts role in delivering population health

This week’s session opened in conversation with Rob Whiteman CBE, chief executive of CIPFA, the Chartered Institute of Public Finance and Accountancy and previously chief executive of the UK Border Agency. Rob is also currently chair of University Hospitals Dorset Foundation Trust.

Reflecting on the role provider trusts should play in delivering population health, Rob said: “There’s no such thing as a perfect policy. All policies have unintended consequences, and the job is to manage them. If you look back on the wonderful history of the NHS, an unintended consequence at its inception was that, to some extent, it dislocated the local state.

“That causes a policy problem because there are generally two types of productivity: technical productivity (how do we produce more widgets with the same resources?) and allocative productivity (how do we spend money in the right place to get overall value for money for each tax pound?) The UK state is very good at getting technical productivity gains but poor at allocative productivity – shifting money around systems in order to spend it in the right place to get overall value for money.

“If you think about the UK, having a nationalised health service free at the point of use means that it is relatively macro-economically cheap. But if you look at how we cut our pie, we do spend differently to other systems, which generally spend more on prevention, public health, aspects of mental health, aspects of social care which are preventative. So, the UK state is macroeconomically cheap in a technical productivity way but we’re not good on allocative productivity because the local state is dislocated. And really, population health, ICBs, ICPs is the latest iteration of trying to deal with that problem.

“I find it quite interesting having swapped from chairing an STP to chairing an FT. My background is running large public services, so I quite enjoy being at the front line on the board, working with the executive to think through how we improve performance. But there’s always a risk with that that we can become a little bit insular and think we’re a factory – a business based on numbers rather than people. When I was chairing a system, I was very conscious of being a people-based business, but you didn’t feel quite as close to the front line and able to work with people and help them solve knotty problems.

“I passionately think that it’s not a top-down approach. We’re all members of the system, we don’t wait for things to come down from on-high, but we also grow things that we can feed into that strategy ourselves. We are looking at our board and committee structure at the moment. People are tired and under pressure and we’re looking at how to streamline our committee structure, we think maybe it's a burden that there’s so much governance so we’re looking to streamline that. But I think we probably will create a population health committee or a population and system committee. Because we’re interested in how we focus more on health inequalities and understand the demography of our area and get clinical input into the implications of that.

“What’s interesting about areas is that they genuinely vary – all areas have their strengths in their DNA and also things they want to work on. I think Dorset is a nice place where people want to work together so the feel of the ICB is quite collaborative and not top-down. But I don’t think it’s just something we wait for the ICP to do. We’re a relatively big trust – the 14^th biggest in the country – whether the system is going to be a success or a failure, we want to make a contribution to that.

“I think we’ve got to go into this with our eyes open to the fact that it’s getting tougher and tougher to do this. That’s not to say we don’t do it, we’ve just got to reflect that the government is probably also going to have a very heavy performance agenda, it’s going to have a heavy efficiency agenda that will lend itself to technical productivity because that’s the way we’ve always done it in the past. And at the same time we’ll be squeezed for more technical productivity while being told we’ve got to create more allocative productivity through system working – and these two things are going to clash.

“Those of us charged with the oversight of public bodies have to know how to deal with both. So there are things we need to do by five o’clock today but at the same time there are seeds or acorns we’re going to plant where others will benefit from the shade of that tree in generations to come."

These meetings are by invitation and are open to all NHS non-executives directors, chairs and associate non-executive directors of NHS providers. Others may attend by special invitation.

If you have any comments, questions or suggestions about these webinars, please contact: events@good-governance.org.uk