National Audit Office slams NHS ” transformation” plans

Owl’s summary: you haven’t done your homework, your models are untested, you don’t understand what you are doing and the NHS is underfunded NOT overspent!

Some quotes:

17. Plans to close the estimated £22 billion gap have not been fully tested.

“The Department, NHS England and NHS Improvement used a financial model to estimate the gap between patients’ needs and resources by 2020-21, and the savings their programmes need to achieve to close this gap. We found limited testing by the Department, NHS England and NHS Improvement of their estimates of how much they expect to generate from their savings programmes.

This raises concerns about whether planned savings can be achieved. For example, plans assume that growth in trusts’ acute activity (including specialised acute services) will be reduced from 2.9% to 1.3% through transformation and efficiency programmes such as Right Care, new care models and the Urgent and Emergency Care programme. However, NHS statistics show this will be challenging as hospital admissions, a key driver of activity, grew by 2.8% a year between 2013-14 and 2014-15 (paragraphs 2.4 to 2.7).”

18. The NHS is implementing its plans to make the NHS financially sustainable from a worse than expected starting point.

Plans to achieve financial sustainability were based on trusts ending 2015-16 with a combined deficit of £1.8 billion. The fact that trusts ended the year with an even larger deficit means that the level of deficit to be recovered is significantly greater than expected. This means that the trusts affected will need to catch-up by making more savings than planned to reach the intended starting position. For example, trusts with deficits greater than expected at the end of 2015-16 will need to make operational efficiencies above the 2% savings level applied to all providers of healthcare services in 2016-17 or subsequent years (paragraphs 1.8 and 2.8).

19. National bodies have not assessed the impact of all the wider cost pressures faced by local NHS organisations in plans for achieving financial sustainability.

The Department, NHS England and NHS Improvement expect trusts and commissioners to invest in transformation programmes. But they do not yet know what level of investment is required or whether local bodies will be able to make the changes at the scale and pace needed.

Furthermore, the government has made a commitment that the health and social care system in England will be fully joined together by 2020. We have previously reported that local authority spending on adult social care fell by 10% in real terms between 2009-10 (£16.3 billion) and 2014-15 (£14.6 billion). The accounting officer for NHS England told the Committee of Public Accounts that “over the next two or three years, there is likely to be a widening gap between the availability of adult social care and the need for social care. That, will, inevitably show up as delayed discharges and extra pressure on hospitals.” However, in our review of the plans for financial sustainability, we did not see any estimate of the impact of pressures on social care spending on NHS bodies (paragraphs 2.6 to 2.13).

24. The National Audit Office (NAO) perceives differences in the position articulated by the Department – which views the funding for the NHS as having been adequate over the last few years, and in line with what NHS England set out it would need to deliver the NHS Five Year Forward View – and NHS England itself. Confronted as NHS England is by the pressures of rising demand for services, these signs of differences do not help build a confident feel about the future of the NHS.

Japan: commit crimes to get the ultimate social care – special prisons for elderly

Japan has the largest population of people over 65 (25%). All sorts of theories about why the elderly are committing more major and minor crimes but an interesting point made about those imprisoned for their crimes:

Thousands of [elderly people] are winding up in prisons. National police figures for 2015 show the number of people age 65 and older arrested for criminal offenses makes up 20 percent of all arrests, which totals nearly 48,000.

The Japanese government is spending tens of millions on constructing prison wards specifically designed to cater to a growing number of elderly inmates. But Shinko warns that nicer prison facilities might have the opposite effect of deterring crime.

If you steal and get away with it, you end up with free groceries or money.
But “If you are arrested, you still get a roof over your head, you’re fed three times a day and you get health checkups. So it’s sort of a win-win situation either way,” says Shinko.

It’s a vexing policy problem for Japan, and a glimpse of yet another difficult challenge as more and more of its population ages past retirement.”

Exmouth Regeneration Board has not discussed council overspend

Strange that! You might think they would need to know what is happening, what has been spent so far and what is to be spent in future.

Yet no mention of funding changes at their last meeting in September

Click to access 150916erpbcombinedagenda.pdf

when officers and senior councillors were almost certainly aware of the problem. Or was that the ” more thoughtful approach” mentioned in the minutes!

Perhaps EDDC just has an open chequebook approach.

Here is what they DID report about Queen’s Drive:

RC (Richard Cohen) gave an update on the Queens Drive development. It was noted that agreement had now been reached with tenants. There was a meeting next month with Grenadier and there was enthusiasm that the project was moving forward. It was hoped that planning permission would be in place for Phase 2 of the project by the end of the calendar year.

It was reported that a more thoughtful approach could be taken towards Phase 3 of the project and take steps to take this to the market. There was a need to go out to public consultation on Phase 3 o the works and also go out to tender.

Agreement had been reached with the tenants of Harbour View Cafe to end the formal lease and they were currently on licence until the end of September. A request had been made to leave the tenant in situ until the Council needed the site for redevelopment works. The Board members were keen that the building was not left vacant and the tenant remains in situ.
TW (Tim Wood) expressed his disappointment that a cafe/restaurant had not been established at Orcombe Point.

JME (Councillor Elson) raised the issue of having a Master Planning meeting of all /Exmouth District Councillors on Monday 12 September at 6.00pm.”

And what is Hugo Swire worried about this week? Burma and traffic noise

Politics in Burma:

Still can’t accept that he was fired from the Foreign Office it seems

and traffic noise:

Written Answers – Department for Transport: Motor Vehicles: Noise (21
Nov 2016)

Hugo Swire: To ask the Secretary of State for Transport, what steps his
Department is taking to reduce noise emissions from (a) motorcycles, (b)
cars and (c) commercial vehicles; and what targets he has set to reduce
each such type of noise emission.

Maybe boy racers outside his Mid-Devon home or all those HGV’s for the construction traffic for basement conversions near his Central London home?

About ….. turn! Councillors doing contortions?

With the proposal to severely cut community hospital beds and totally close some community hospitals (Owl STILL insists a ” community health hub” with no beds is NOT a hospital) comes some interesting behaviour from majority party councillors in East Devon.

For example”

Suddenly, they have become “experts” on consultation, loudly stating that the CCG consultation is “flawed” because users of NHS services were not consulted.

They check numbers and find some don’t add up and some are missing.

They ask for “more evidence” on some of the CCG’s wilder claims.

They suddenly discover their voices and some, who have been mute for many a long month or even years, decry the whole project – even though their own party is 100% responsible for it.

They complain bitterly about the amount of money spent on so-called consultants who seem ready to tell the CCG what it wants to hear – for a price.

Well, councillors, welcome to our world – the world of residents battling some of YOUR sillier decisions (so many of them) and profligate spending. Now YOU know how WE feel – if only for a fleeting moment and because it is YOUR health and YOUR families that will suffer from these decisions. Especially as so many of our majority councillors are of the age and lifestyle that often makes most demand on community hospital services.

Just one caveat: Councillor Leader Diviani HAS stayed true to his principles and has tacitly agreed to CCG proposals to close Honiton hospital – having not spoken out AND voting against the motion from Councillor Claire Wright at DCC to “stop the clock” on the plans until Honiton and Okehampton hospitals (both due to close under CCG proposals) could have their viability assessments checked and included in the plans.

Expect some rousing speeches when the head of the CCG comes before the EDDC Scrutiny Committee on Thursday this week at 6 pm. But do watch out for any majority councillors crossing their fingers behind their backs.

Yes, welcome to our world indeed – if only for a very short time.

Save Clyst St Mary update – November 2016


A big thank you for all the emails of support that we have received in the last few days regarding the latest planning application for development proposals for the Friends Provident site. We are currently working our way through this latest planning application. Although we remain open minded to the eventual solution to the site, we currently have grave reservations regarding these proposals for Winslade Manor and the Stables because the developer hasn’t offered any solution to a number of key National Planning policies such as :

-The loss of the leisure facilities (Stables Club) that were closed down at the end of 2015

-The flooding that has continued to occur at the site and the proposals to build houses and industrial buildings in the areas that frequently flood. (As I am writing this email I have just been advised of the closure of the A376 due to flooding!)

-The fact that our village remains unsustainable for such a significant population increase, having only one shop and a pub

-Lack of public transport links and the scale of congestion that already occurs on a daily basis (set to be exacerbated by the poorly considered location to the entrance by our Village Hall)

-The proposed site sits outside of the current approved Built Up Area Boundary

These are just a few of the examples and valid reasons why the proposals won’t enhance our village; worryingly, the proposed scheme has many other areas where we have serious concerns.

We have started writing some template letters of objection which you may want to use. We hope to be able to email them to you within the next week. Moreover, we understand that the Parish Council may be arranging a Public Meeting at the beginning of December to further discuss the planning application. As soon as we get a date and time, you will be informed.


East Devon District Council’s Environment Department is currently conducting a survey of households within our neighbourhood regarding the odours that were omitted from Enfield Farm and the anaerobic digester. Hopefully, since the last major problem five weeks ago, things have considerably improved. We have been told that this should finally solve the ‘odour issue’ that has annoyed residents for so long.