Our clients ask, how do we…

  • Get our organisation out of the red and still deliver high quality care?
  • Understand what is driving our finances and how we improve?
  • Establish the right payment model for the outcomes we want?
  • Balance the organisations needs with the wider system?
  • Model service changes robustly and risk assess plans?
  • Maximise the effectiveness of our finance function?
  • Gain stakeholder buy-in?

The strength and capability of a finance function is intrinsically linked to quality health and care. We work with finance functions and leaders when they need to:

  • Deliver financial sustainability
  • Create high-performing teams
  • Strengthen executive finance teams
  • Build relationships within and between departments
  • Qualify and introduce new payment models
  • Maximise resources to deliver quality care and outcomes for patients


Common challenges include navigating regulation and accounting standards, delivering change when it conflicts with policy, adapting to personnel changes, and making change happen within the limits of financial constraints.

Our offer

  • Financial strategy Utilising a whole system approach that connects all key components of effective financial systems and provides a “single version of the truth” for all parties to collaborate on
  • Financial and economic modelling Evaluating the effectiveness of models and building new models, to support investment and business plans and risk testing using scenario and sensitivity testing
  • Costing and pricing and contracting Advising on payment models, contractual options and relative pros and cons to achieve desired outcomes
  • Financial improvement Assessing drivers of financial position and the underlying run rate, identifying realistic opportunities and how they can be delivered combined with securing stakeholder buy-in and ownership
  • Financial assurance Completing due diligence to assess the financial implications of proposed transactions
  • Finance team development Assessing capacity and capability, reviewing governance and reporting lines to optimise effective delivery and wider impact
  • Capital development Delivering end to end business cases at SOC, OBC and FBC stages. Supporting services ranging in value from <£1m up to £500m to build capital cases for hospital/service redevelopments


Speak to one of our specialists for advice


The work that Carnall Farrar did with us was designed to provide a framework and methodology for service and financial recovery on a whole-system basis. Throughout this time, however, their advice and expertise on how to best present our case and manage the inevitable tension between the commissioner and provider viewpoints, including those of the respective regulators when working outside the boundaries of the normal rules of engagement, was of huge benefit in ensuring our system progress was not derailed.”

John Dowell
Chief Finance Officer, Devon CCGs


Financial improvement from planning to delivery requires engagement and ownership of the challenge

We were commissioned by a hospital Trust in the south-west of England to understand two areas of significant challenge for their £40m cost improvement programme. The Trust needed a more detailed understanding of the issues affecting medical workforce productivity and the financial implications of providing specialist services in a region with a much lower population outside of peak holiday season.

To understand medical workforce productivity, we investigated a representative sample of specialities and reviewed: Consultant job plans compared to actual delivery; start times, end times and cancellations of theatre sessions; patient appointments made, missed and kept, and efficacy of forward-based activities.

To understand the profile of subscale services, we created a methodology with Trust leaders involving activity and workforce indicators. Six services were highlighted for a deep dive. In both areas of work, we maintained close engagement with personnel, to enable continuous reality checking of findings with clinicians, service line leads and Trust executives.

A £12m+ opportunity was identified for medical workforce productivity, through changes to job planning, theatre utilisation, and outpatient utilisation. An additional opportunity was established based on the improvement of ward-based activity. An £8m opportunity was identified for subscale services. In both areas, we developed clinical buy-in to the key themes and actions required to address poor productivity and improve financial performance.