Radical financial leadership – 4 ways to accelerate the left shift in health and care

The NHS 10-Year Plan sets out a clear ambition: we need a fundamental shift in how health and care is delivered. From sickness to prevention, hospitals to communities, late intervention to early help. 

Yet, despite previous efforts – pooled budgets, care trusts, rapid response teams – acute spend continues to rise. With revenue gaps of up to 15% forecast over the next three years, the need for innovation has never been greater. 

At the HFMA Annual Conference, we convened a brilliant panel of finance and system leaders who are helping to reshape how health and care is funded and delivered: 

• Dinah McLannahan, Chief Financial Officer, NHS South West London ICB – championing community investment to reduce acute spend and improve outcomes. 

• Laura Foster, Director Operational Finance, Nottingham University Hospitals – leading neighbourhood-based integration and dismantling funding barriers. 

• Stephanie Elsy, Former Chair, Bath and North East Somerset, Swindon and Wiltshire ICB – building trust and partnerships to enable system transformation. 

The key message from the panel was clear: finance leaders are the catalysts for system change. 

This is one of the toughest financial environments in the history of the NHS – but also the clearest case for acting now. Finance directors are uniquely positioned to lead beyond the numbers. 

Increasingly, they are stepping into the role of system integrators – working across organisations to align incentives, develop joint business cases, and support teams to deliver population level outcomes. This is not just technical finance work, it is about enabling clinical and operational colleagues to work differently and more effectively. 

Our panel highlighted four practical tips on how to accelerate the left shift: 

1) Start small – but start 

Perfect conditions won’t arrive. The most effective systems pick one pathway or neighbourhood, invest modestly, show impact, then scale. 

How to get going: 

• Choose a high-impact cohort (e.g., frailty, heart failure, diabetes). 

• Stand up a multidisciplinary team with clear goals: reduced non-elective hospital admissions for people aged 65 and over, shorter length of stay, more care at home. 

• Track three metrics from day one: avoided admissions, patient-reported outcomes, and net financial impact. 

2) Learn by doing – together 

One theme that came through strongly in the panel discussion was the importance of learning through delivery, not just through meetings. 

Formal governance has its place, but what shifts behaviour is shared accountability, strong local relationships, and teams solving problems side by side. 

Key enablers: 

• Establish a single accountable delivery group for pilot areas. 

• Use common reporting dashboards to stay focused on outcomes. 

• Develop joint evaluation plans to build a clear, shared story of benefits.

3) Start with the patient, not the organisation 

Successful left shift models work because they begin with what individuals and communities need – not organisational charts or historic funding routes. 

When services are designed this way, pathways become simpler, delivery becomes more coherent, and the business case becomes stronger. 

Principles for success: 

• Fund the pathway, not the silo – money flows to integrated models. 

• Agree a shared outcomes framework and align budgets to it. 

• Commission neighbourhood leadership across health and social care. 

4) Back models where the left shift is already working 

There is already strong evidence that the left shift delivers better outcomes at lower cost when the right models are in place. Examples include: 

• Frailty and integrated care centres: reducing non-elective admissions and improving wellbeing. 

• Community cardiology: Local diagnostics and rehabilitation reducing emergency admissions. 

• Virtual wards / hospital at home: freeing acute beds whilst offering safer, specialist support at home. 

If systems put these principles into action, the left shift becomes tangible – not just a strategic ambition but a practical route to improving lives, strengthening services, and reducing overall cost. 

If you want to accelerate your system’s left shift, get in touch to discuss how IMPOWER can support you.