Elective Recovery Financial Advice and Assurance

NHS commissioners and commissioning support partners traditionally contain few individuals who are qualified accountants and have patient level SUS knowledge and access. Aggregated data, used in commissioning software, is the norm. This was the case before ICBs, and now that non-provider staff are fewer in number it remains common.

The NHS Elective Recovery Fund (ERF) was launched in the pandemic while the ICBs were in shadow form. ERF required ICB-wide patient level data analysis to ensure income was not under-recovered materially. Trusts needed the grip to understand their elective recovery and how to maximise this in a financially affordable manner. The need was twofold.

In-Form Solutions were asked by MIAA to partner them in providing specialist advice and assurance to Lancashire and South Cumbria’s Elective Recovery Programme Board (ERPB) for both of the above aspects, provider grip and commissioner income recovery and distribution. The need was both technical and strategic, with a need to advise many directors and an ability to speak “truth to power” based on granular insights, so a consultant who is a senior qualified accountant was used who had decades of strong experience in these fields in both providers and commissioners.

The project lasted 2 years and was extended multiple times, given the strong success it delivered, with a significant net financial benefit to the system. Much of this came from the granular analysis at patient level that ERF needed, picking up inadvertent issues in the guidance and SUS quirks that led to no income for some patients.

We designed a model that would work with the CSU to take patient level data from SUS, agree it with the trusts, and calculate and reconcile the funding that should result from NHS England (and to each provider including the independent sector). Our consultant gave regular advice both verbally and in writing to the ERPB and other groups such as the Chief Operating Officer’s collaborative and the working group of provider accountants and informatics staff. We led the negotiations with NHS England to correct errors and increase funding levels where appropriate.

All output from this multi-year project has been formally signed off and the client is very happy with the results.

The outcomes:     

• £20m attributable increase to funding from issues identified by In-Form Solutions and remedying advice (variety of baseline adjustments, independent sector negotiations and SUS data issues missed by NHSE). Some of this benefit will recur in future years. The project can thus be evidenced to be a large net benefit.
• Evidence that LSC were one of the highest performing ICBs for elective recovery during this period.
• A granular model and method of populating that was retained by the CSU and trusts after the project.
• Benefit from 2 years of advice to directors and other stakeholders from multiple NHS organisations.
• Detailed handover plan at project end enabling a smooth transition to an in-house “business as usual” solution.
• Identification of a financial risk for the year following our input with advice how to monitor and mitigate, so that progress was maintained.