"Finance improvement in the NHS shouldn’t mean quality reduction. It’s about modern models of care that deliver more with less waste, done with clinical teams, not to them."
Russell Cake, Co‑founder, The PSC
Contact UsOur Services for NHS Finance Leaders
1. Rapid Diagnostics - Finding the "Why"
We don’t just hand you a data report. We combine deep data analysis with site observations and frontline interviews to pinpoint exactly what is driving the deficit and where the real opportunities for change live.
2. Financial Performance Improvement
We help you strengthen your financial position while protecting quality. By working alongside your finance teams to improve grip and control, alongside your clinical teams to implement the models they already believe in, we remove the friction and accelerate delivery.
3. Redesigning Services for Productivity
We focus on “allocative efficiency”, ensuring patients are seen in the right setting at the right time - either through incremental or transformational change. Once the end-to-end pathway makes sense for the patient, we help you optimise the technical costs to make it sustainable for the system.
4. Financial Planning
From in-year cost recovery to long-term capital decisions, we help you set clear financial guardrails. We focus on devolving decision-making safely so your frontline leaders feel empowered, not restricted.
5. Strategic Commissioning & Contracting
We design strategic commissioning and contracting models that reward good care. We help ICB and system leaders in ensuring that money is spent where there is the greatest impact. We're also helping partners navigate 2026/27 contracting changes across NHS organisations. We support clients in moving away from "lowest unit cost" toward arrangements that support care that is modern, high quality, productive and whole-system orientated.
6. Business Cases for Modern, Affordable Infrastructure
We work collaboratively with NHS leaders to apply rigorous financial and economic modelling, alongside a compelling strategic case, to ensure business cases allow NHS leads to access the right capital and equipment - and in a way that's affordable for your organisation.
7. Smart Procurement
We support NHS leaders understanding and navigating how best to evolve a complex web of existing procurement arrangements and new specification needs. We can support in the upfront design of a specification, in an effective use of frameworks and in an efficient process that drives interest from suppliers and increases the ability to drive value-for-money in work procured to support core needs.
8. Commercial Strategy (Diversification, Joint Ventures, Partnerships & Spin-outs)
We work with NHS organisations, charities, academia, Community Interest Companies (CICs) and industry to design innovative structures to facilitate new models of care that are high quality and financially sustainable. We ensure that you balance opportunities and risks appropriately and bring the best of what public and private sector partners can offer to patients and communities.
The "Right Place" Principle: Why Allocative Efficiency is the Foundation of System Value
The Insight: True sustainability isn't about doing things cheaper; it's about doing them in the right setting. Focusing on "allocative efficiency" (ensuring patients are seen in the setting most appropriate for their needs) yields far greater system-wide value than technical cost-cutting in silos.
The Impact: Working across primary, community, and acute care, we helped a system align its activity for older people. By shifting care to more effective ambulatory settings, the partners reduced acute hospital pressure and improved outcomes for the entire frailty cohort.
High Productivity Through Clinical Co-Design: Doing With, Not To
The Insight: Financial improvement plans often fail because they are perceived as top-down interventions. Lasting productivity gains occur when we work with clinical teams to remove the operational barriers preventing them from delivering the modern models of care they already believe in.
The Impact: We worked directly with theatre and surgical teams to redesign elective pathways. By removing friction in the patient journey, we increased throughput and reduced cancellations, delivering a more reliable service and a more efficient use of hospital resources.
Devolved Grip: Empowering the Frontline to Secure the Bottom Line
The Insight: Centralised financial control can inadvertently slow down necessary change. "Devolved grip" is about setting clear financial guardrails that empower frontline leaders to make decisions. This allows for rapid, high-impact changes while maintaining overall financial stability.
The Impact: Through a combination of rapid diagnostics and hands-on support, we helped an organisation move from reactive financial management to a proactive strategy. This strengthened their permanent workforce arrangements and significantly improved their underlying financial outlook.
Breaking Vicious Cycles: Linking Performance Improvement to Financial Sustainability
The Insight: Health systems do not fail linearly. They are complex systems that can instead be subject to tipping points and vicious cycles. When in financial difficulty, NHS organisations often experience several interconnected vicious cycles, which drive up costs (e.g., through requiring temporary staffing), reduce performance (e.g., when delays in emergency pathways cause patient complications), and reduce leadership bandwidth to deliver change. Delivering financial improvement from such a starting point requires identifying where and how to break the most troublesome vicious cycles, and how to prioritise change that increases leadership team bandwidth.
The Impact: We helped a Trust overhaul its Same Day Emergency Care (SDEC) model. By streamlining front-door processes and improving patient flow, the Trust significantly reduced its need for expensive temporary staffing and created a more stable financial baseline.
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