Left Shift, Right Funds? The Battle to Move NHS Money Where It Matters

The Challenge of Moving Money Around the NHS: Breaking Barriers to Enable the Left Shift

The NHS is full of bold ambitions, but few are more talked about—and harder to achieve—than shifting care from hospitals to the community. Everyone agrees that the so-called ‘left shift’ makes sense. More care closer to home, fewer hospital admissions, better preventative strategies—the benefits are clear. And yet, despite the rhetoric, moving money around the system to make it happen remains frustratingly difficult.

As Chair of the HFMA roundtable discussion, I had the privilege of guiding a conversation that laid bare the challenges of shifting resources to where they can have the biggest long-term impact. The key takeaway? We all want it, but structural, financial, and cultural barriers mean we’re not making the progress we need.

The Financial Conundrum: Everyone Wants Change, But No One Wants to Lose Out

As Helen Dempsey of Staffordshire and Stoke-on-Trent Integrated Care Board (ICB) put it, “So much of the NHS is in deficit situations. Trying to carve out existing resources and put them into an area where there isn’t necessarily a positive return on investment in the current year is creating real headaches.”

In other words, the case for investment in community-based services is clear, but when acute hospitals are drowning in waiting lists, financial deficits, and operational pressures, it’s no surprise that resources remain locked into the status quo. The NHS is stuck in a loop: we know moving money upstream will help in the long run, but short-term pressures make it nearly impossible to justify.

Power Imbalances and Organisational Self-Interest

Ben Galbraith of the Greater Manchester Primary Care Provider Board highlighted another fundamental issue: power. Large acute providers naturally hold more influence than smaller community services, voluntary organisations, and primary care networks (PCNs). This imbalance can reinforce the status quo, as hospital providers prioritise their own financial stability rather than taking a system-wide view.

Samantha Newcomb from University Hospitals Plymouth NHS Trust was frank about the reality of how many organisations operate. “We expand our services internally to make sure we have control and oversight. Then if there’s any return to be made, we have it. But it just means what we are offering is growing and growing, and we can end up duplicating work done elsewhere.”

The Need for a Strategic Approach to Investment

So how do we actually make progress? The roundtable discussion highlighted several key actions to help break the cycle:

• A Clearer Definition of ‘Left Shift’ – As Ashley King of Mid and South Essex ICB pointed out, is the left shift about moving activity out of hospitals, or is it about proactive, preventative care? The answer is both, but they require different approaches.

• Better Financial Modelling – Systems must take a whole-patient pathway approach rather than looking at individual organisations in isolation. This means measuring value beyond simple activity reductions.

• Multi-Year Planning – One-year financial cycles are a major obstacle to meaningful transformation. A longer-term view is essential to unlocking investment in prevention and community services.

• Shifting the Narrative on Cost Savings – As Debbie Griggs of Hertfordshire and West Essex ICB noted, reducing A&E activity is positive, but unless we can translate that into actual cost reductions—such as redeploying staff or closing beds—savings remain theoretical.

Real-World Examples of Change

Despite the barriers, there are examples of organisations successfully shifting resources.

• Housing and Health Interventions: In some areas, investment in tackling damp housing is reducing respiratory admissions—demonstrating how cross-sector collaboration can pay dividends.

• Federated Optometry Services in Manchester: A long-running model that takes referrals from GPs and hospitals, reducing demand on acute eye services.

• Investment in End-of-Life Care in Oxfordshire: A social investment-backed approach that has successfully reduced unplanned hospital admissions for people in their last year of life.

These examples prove that moving money is possible—but they remain the exception, not the norm.

Bridging the Gap Between Data and Action: HEU’s Work on the Left Shift

Although not covered in detail during the roundtable, the Health Economics Unit (HEU) has been actively working with ICSs to enable the left shift using data-driven decision-making. Through the Smarter Spending in Population Health (SSPH) programme, the HEU has collaborated with multiple ICSs to identify the most impactful places to direct resources using the Socio-technical Allocation of Resources (STAR) methodology.

The HEU’s approach combines stakeholder engagement, intelligent modelling, and real-world data insights to help decision-makers shift resources effectively. This method has already been applied across five ICSs—Coventry Place, Northamptonshire, Nottingham and Nottinghamshire, Gloucestershire, and Birmingham and Solihull—to identify high-impact opportunities within existing budgets.

For example, the HEU’s work in COPD pathway redesign has engaged over 100 stakeholders—including patients, clinicians, and finance leads—to model real-world costs and benefits. This has led to actionable insights such as expanding virtual ward capacity, implementing risk-based screening, and improving patient education, all aimed at reducing avoidable hospital admissions.

By blending data, analytics, and expert consultation, the HEU is helping systems make tangible progress toward a left shift, proving that with the right tools, moving money isn’t just possible—it’s essential.

The Bottom Line

There is no shortage of passion, creativity, or great ideas in the NHS. But until we get serious about the financial and structural barriers preventing money from moving where it’s needed, we’ll keep having the same conversations. We need bolder decision-making, greater trust between organisations, and a fundamental shift in how we measure val