When Doing Nothing Is the Bigger Risk: Reflections from the HFMA – IMPOWER Roundtable

Health systems across the UK are facing a shared dilemma: how to move towards prevention and care in the community while managing unprecedented demand, stretched budgets and operational pressure. From my perspective, the challenge for many finance leaders is not a lack of ambition, but the difficulty of creating space for long‑term change in the face of immediate risk.

In April 2026, I joined senior finance leaders from across all four UK nations at an HFMA roundtable discussion sponsored by IMPOWER. The conversation explored what transformation really means in today’s context – and what it will take to move beyond pilots and good intentions into sustained system change.

Despite differences in system structures, the discussion surfaced common barriers: limited headroom to invest, misaligned incentives, and the challenge of shifting resources upstream without undermining acute services. There was also a strong focus on the role finance leaders can play in enabling change -through partnership working, informed risk‑taking, and supporting robust business cases for prevention. Crucially, we reflected on the reality that inaction carries consequences of its own.

The roundtable closed with a shared recognition that transformation is complex and difficult, but that the status quo is no longer sustainable.

Download the full HFMA IMPOWER Roundtable 2026 write‑up to explore the discussion in full and hear directly from finance leaders shaping the future of health and care systems.