Providers and commissioners should end the escalating “arms race” that threatens the sustainability of their health systems, the NHS Trust Development Authority finance director has warned.

Bob Alexander told the Healthcare Financial Management Association’s conference last week he had seen “too many examples” of providers and commissioners blaming each other for their problems.

Bob Alexander

Bob Alexander said he accepeted national bodies had not always been the best role models for collaborative working

“It would be all too easy, in the difficulties that we have at the moment, to get into what might look like an arms race,” he said. “With providers tracking down every last opportunity to charge and commissioners following a strategy… fundamentally based on finding ways not to pay for stuff.

“I still encounter too many examples where… provider teams [are] too quick to blame all their ills on commissioners, and commissioners [are] too keen to issue fines and to criticise providers than to get alongside and work with them.”

Mr Alexander said he could see how such blame cultures could improve “bottom lines today” but warned they would not “help your health system tomorrow”.

“Pursuing strategies like that is a game that I have called ‘who fails first’,” he added.

He said it was crucial for providers and commissioners to align demand, capacity and together agree what had to be done.

Mr Alexander acknowledged that national regulators and commissioners, including the TDA, had not always been the best role models for collaborative working.

“I accept that as national bodies we haven’t always been good at role-modelling consistent close working.

“But the work we have recently done in trying to get to grips with the five year forward view [together with Monitor and NHS England], signals a shift to that closer working.

“It’s something we are going to need to see a lot more of everywhere if we are going get through this next period.”

Mr Alexander said the health service’s planning guidance, due later this month, could help by providing clear “aligned business rules”.

These would help NHS bodies implement the proposals set out in the NHS Five Year Forward View.

 “There needs to be a set of aligned business rules that commissioners and providers understand, and that are utterly consistent with addressing the urgent issues for 2015-16,” he added.

“We need to have a set of aligned levers that support the start of the journey of the five [forward] year view.”

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