Executive summary

 

• The signal: September 2025 Board papers confirm ICSs are under sharper scrutiny on financial variance to plan, productivity, and reliance on premium staffing.
• Why this matters: The old model of offering volume capacity at premium cost is no longer viable. ICSs will demand proof of value, outcomes per £, productivity gains, and equity benefits.
• What to do now: Partners must redesign offers around cost-effectiveness, outcome-linked KPIs, and bank-first models that support system savings.

 

Context & system signals

• The Financial Performance Update (Sept 2025) confirmed tighter NHSE oversight on planned surplus/deficit, YTD variance, implied productivity, and reliance on agency or premium staffing routes.
• The NHS Oversight Framework points to a future where ICSs are measured not just on finances, but on life expectancy gaps, CV mortality, maternity outcomes, and productivity ratios.
• This reframes financial management as inseparable from outcomes and inequalities.

Strategic implications

1. Outcomes are the new currency: Partners must evidence £ per RTT week reduced, £ per LoS day avoided, or £ per DRD day cut.
2. Productivity is the accountability lever: ICSs are being judged on throughput per WTE and avoided waste, making productivity impact non-negotiable.
3. Equity is now financial: Gaps in prevention and care uptake create avoidable costs; tackling them is part of fiscal discipline.
4. Green compliance is a gateway: The 2027/28 supplier roadmap means non-compliant suppliers risk exclusion regardless of price.

Blueprint: engaging with the new rules

1. Redesign value cases
   • Link every proposal to at least one NHSOF metric (RTT, DRD, LoS, inequalities).
   • Proof point: case studies showing £ saved per outcome achieved.
2. Adopt bank-first flexible staffing
   • MSP/rostering solutions to reduce agency reliance.
   • Proof point: % agency shifts avoided, £ saved annually.
3. Provide live dashboards
   • Real-time performance and spend vs outcome reporting.
   • Proof point: system leaders can track savings month by month.
4. Evidence green compliance
   • Publish supplier net-zero pathways aligned to NHS deadlines.
   • Proof point: emissions reporting by 2027, product-level by 2028.

Inequalities lens

• Financial risk and equity risk converge: deprived communities experience higher avoidable costs through preventable admissions and late-stage conditions.
• ICSs will increasingly commission interventions that both save money and close gaps.

Final word — Altin Biba, MBA, AMBA

“Finance and productivity are no longer background concerns, they’re the frontline of NHS decision-making. The test for partners is simple: prove value with outcomes per pound, or risk irrelevance. At ProMedical, we are committed to demonstrating that productivity and equity can go hand in hand.”

References

• NHS England. Financial Performance Update, September 2025 (Item 4.2)
• NHS England. NHS Oversight Framework metrics list, September 2025 (Item 4.1.1)
• NHS England. Healthcare Inequalities Improvement Programme & Race and Health Observatory report, September 2025 (Item 6)