NHS “Missing in Action” – what happened to ministerial accountability?

What Thatcher attempted in the 1980/90’s was to restrict ministerial responsibility to “policy decisions”, leaving responsibility for delivery or “operations” to semi-autonomous agencies.

Under this policy ministers are no longer responsible when things go wrong with delivery of essential services.

The present state we are in shows that this is an unsustainable fig-leaf.

Time for ministers to stop hiding. – Owl

[Currently, a total of 410 agencies and other public bodies form part of the UK government’s sprawling structure. These agencies and public bodies are service delivery units that support ministerial departments, but do so whilst operating at arm’s length from ministerial control. In effect, this means that those whom we elect to power look as though they are in charge, but in practice have scant direct power (and accordingly, accountability) over governmental operations. The democratic core of government has been hollowed out by radical structural reform began under the Thatcher government. blogs.lse.ac.uk]

BMA condemns ‘political choice’ not to tackle ‘intolerable’ pressure on NHS


The pressure on the NHS is “intolerable and unsustainable”, medics have said, amid warnings that the deaths of up to 500 people each week could be caused by delays in emergency care.

It comes after more than a dozen NHS trusts and ambulance services declared critical incidents over the festive period, with officials citing rising flu cases and the impact of the Covid-19 pandemic among the reasons for the pressure on the health service.

Prof Phil Banfield, chair of the British Medical Association (BMA) council, hit out at both the prime minister and the health secretary. Highlighting the scale of the crisis facing healthcare workers, he called the government’s decision not to negotiate with medics a “political choice” that is leading to patients “dying unnecessarily”.

“The current situation in the NHS is intolerable and unsustainable, both for our patients and the hardworking staff desperately trying to keep up with incredibly high levels of demand,” he said.

“The BMA has repeatedly invited the government to sit down and talk about the pressures on our health service, but their silence is deafening.

“It is disingenuous for the prime minister to talk about ‘backing the NHS’ in his new year message, when his own health secretary is failing to discuss how this crisis can be fixed.” He called on the government to “step up and take immediate action” to solve the crisis.

The Royal College of Emergency Medicine also doubled down on its claim that somewhere between 300 and 500 people are dying each week as a result of delays and problems with urgent and emergency care, as it warned against any attempt to “discredit” the figure.

Ian Higginson, vice-president of the Royal College of Emergency Medicine, told BBC Radio 4’s Today programme: “What we’ve been hearing over the last few days is that the current problems are all due to Covid or they’re all due to flu, or that this is complex, you mustn’t jump to conclusions – all that sort of stuff.

“If you’re at the frontline, you know that this is a longstanding problem. This isn’t a short-term thing. The sort of things we’re seeing happen every winter, and it still seems to come as a surprise to the NHS.”

Last week, one in five ambulance patients in England waited more than an hour to be handed over to A&E teams. NHS trusts have a target of 95% of ambulance handovers to be completed within 30 minutes, and 100% within 60 minutes.

In November, 37,837 patients waited more than 12 hours in A&E for a decision to be admitted to a hospital department, according to figures from NHS England. This is an increase of almost 355% compared with the previous November, when the figure was 10,646.

Higginson added that the Royal College of Emergency Medicine figures on deaths caused by delays were more than a “guesstimate”. “These are real figures, and I worry that we’re going to hear attempts to spin and manipulate this data and discredit it. I think if we hear that, we’ve got to say, ‘No, that is spin.’”

The figure was questioned by some health chiefs, with NHS England’s chief strategy officer, Chris Hopson, claiming not to “recognise” that estimate.

“We need to be very careful about jumping to conclusions about excess mortality numbers and their cause without a full and detailed look at the evidence, which is now under way,” he told BBC Radio 4’s World at One programme.

On Monday morning, the education minister, Robert Halfon, said Rishi Sunak was treating the issue as a “top priority”, but admitted that more needed to be done.

“The government is putting [in] a lot of funding and doing everything possible. We know, of course, that many of these problems have been caused by the pandemic and the pressures on the NHS that we’ve seen over the past few years.”

But Banfield warned that patients would die due to the current state of the health service. “The government should deliver on its obligations to the public. It is just not true that the cost of resolving this mess cannot be afforded by this country. This is a political choice and patients are dying unnecessarily because of that choice.”

The Liberal Democrats called on the government to recall parliament over the crisis. The party’s health spokesperson, Daisy Cooper, said: “This is a life-or-death situation for huge numbers of patients. The NHS is collapsing in front of our eyes whilst the prime minister and health secretary are nowhere to be seen.

“This is a national crisis and the country will never forgive the government if they refuse to recall parliament whilst hundreds of people die in parked ambulances or hospital corridors. Nobody should lose a loved one because the government was asleep on the job.”

Tim Cooksley, president of the Society for Acute Medicine, said the current situation in emergency departments was “unbearable” and would remain that way without significant changes.

“Unless we engender a belief for both NHS staff and for our patients that things will improve, and unless we are able to retain and then attract colleagues back and recruit new colleagues, then our situation will remain unbearable for a long time.”

Plan to power thousands of new homes in Exeter’s extension

There is currently insufficient electricity capacity in the area to support the full planned development of 2,500 houses around Matford.

Devon County Council and National Grid have now put forward a detailed joint planning application that would see the substation operational in 2026. 

An example of development plans running ahead of infrastructure. – Owl

Paul Greaves www.devonlive.com

Plans have been submitted for a new electricity substation to power thousands of new houses on the outskirts of Exeter. Devon County Council says the bulk supply point at Matford Home Farm is essential to support the large housing extension to the city between Alphington and Exminster.

Housing development in the area has been taking shape off the A379 for several years. Hundreds of houses have already been built and many more are in the pipeline. But there is currently insufficient electricity capacity in the area to support the full planned development of 2,500 houses around Matford.

Devon County Council and National Grid have now put forward a detailed joint planning application that would see the substation operational in 2026. The proposed scheme is for the construction of a 132kV-33kV -11kV bulk supply point electricity substation, operational electricity plant, substation access road and surface water drainage. A planning application document sets out the principles of the plan which can be viewed online.

It says: “The proposed scheme would be located in Teignbridge district and Exeter City and forms part of the SWE urban extension which would provide 2,500 homes across Exeter (500) and Teignbridge (2,000) and well as five hectares of employment land.

“The scheme would provide key infrastructure which would enable the building of homes and employment space in the urban extension area and would help enable the delivery of the objectives set out in the Teignbridge Local Plan and Exeter Local Plan.

“The substation is required as it is understood that there is insufficient electricity capacity in the area to support the full development of SWE. This would also impact future development proposals, such as Exeter City Council’s ‘Liveable Exeter’ project. Therefore, this development is essential in providing the infrastructure to enable the development of SWE and delivering the policies and aims of the Teignbridge Local Plan and Exeter Local Plan.”

The proposed site near Old Matford Lane extends to nearly three hectares over an extensive yard area currently occupied by with a range of agricultural buildings and a farm shop. Much of the farmland surrounding the plot is currently being transformed by different housing developers as part of the wider SWE scheme. Existing power supply equipment is reaching the limits of its capability and will not cope with the expansion, says the National Grid.

The council says: “Future demand for electricity is expected to increase from 2025, when it is expected that new homes will no longer be able to have gas boilers, with the alternative likely to be heat pumps powered by electricity.

“Similarly, from 2030 new petrol and diesel cars will not be sold resulting in additional electricity required for charging. A new bulk supply point is expected to provide sufficient capacity to meet future demands. The scale of the proposed substation accords with other locations in Devon, where similar upgrades are required to meet future need.

“The proposed electricity substation aims to be operational by 2026, to serve the SWE development and future growth. In summary, the capacity of existing electricity infrastructure has been fully utilised and this, in combination with the expected future electricity need, requires significant scale upgrades to the electricity network.”

A public consultation has already taken place on the plans, which have been submitted to Devon County Council for determination. Concerns have been raised by residents living in established homes nearby about noise and light pollution. One resident said he was ‘astonished’ the site is considered suitable considering its history of flooding.

He added: “This planned substation is quite simply in the wrong location. It may be the cheapest option for Devon County Council, but it’s clearly not the best option for the hundreds of residents living in the area.”

Sidmouth no closer to getting protection for crumbling cliffs

Sidmouth remains in limbo as to when it the town will eventually get new and improved vital coastal defences – but not for another two years at least. Protection is needed for the East Devon seaside town to stop the crumbling cliffs from falling into the sea.

Will the cliffs fall victim to austerity 2.0? – Owl

Daniel Clark www.devonlive.com

Over the last several years, cliff falls have been a regular occurrence. Time and time again, landslides have taken place, seeing large red dust clouds engulf part of the cliffs and the beach – including in August, when four cliff falls happened in the space of a day.

It was hoped that by the end of 2022, the funding case for approval for the latest iteration of the scheme would have been granted by the Environment Agency. This however is yet to have happened – putting the latest anticipated timeline in doubt. No details as to how long, or the reasons for the delay, are known at this stage.

Already the costs of the vital sea defences to save Sidmouth’s crumbling coastline and protect the Esplanade have gone up by £5million in the past year, taking the estimated costs to a total of £19million. The Sidmouth and East Beach Beach Management Plan Project Advisory Group have previously approved ‘bigger and better’ Sidmouth sea defences.

In 2018, plans for a coastal defence scheme which would involve beach replenishment, periodic beach recycling, a new rock groyne on East Beach and modifications to the River Sid training wall were agreed. They would also include raising the height of the splash wall along the seafront slightly, and then topping it up with temporary storm barriers or strong glass panels when needed.

But in 2021, extra funding for the scheme is available, alternative schemes that had been ruled out due to the cost could be made on the table. This meant that options, such as additional offshore breakwater, which had previously been discussed and would have presented a more robust solution technically, were ruled out on financial grounds.

It meant that the council was able to start work on plans for a new ‘hybrid option’ to replace the former 2018 ‘preferred option’. This option includes at least one additional rock island, which may reduce the need to raise the splash wall along The Esplanade and could lower the long-term costs of recharging the beach with new material, which will be needed in the future. The hybrid option still includes a 120m rock-groyne at East Beach and requires a beach recharge on both East Beach and the town beach.

An outline business case was prepared for the Sidmouth Beach Management Scheme (BMS) in the summer for readying it for submission to the Environment Agency (EA) for funding. That however has yet to happen – putting the timeline of the scheme in doubt.

To allow the scheme to progress, then authority will submit a report to EDDC’s cabinet and full council, seeking approval for the additional funds from the capital budget as a temporary loan until further money can be secured from elsewhere.

The previously anticipated timeline:

  • Late summer 2022 – Submit the funding case for approval to EA, which if successful, secures the funding in principle. Approval should be granted by autumn 2022.
  • Late autumn 2022 – Work on the scope of the detailed design stage with a sub group made from members of the Sidmouth and East Beach BMP Project Advisory Group. They will help represent Sidmouth residents, providing guidance on what the town needs from the scheme, what it looks like, how it will work and how it will be designed and built. This will include discussions on the number and position of additional rock breakwaters.
  • Early 2023 – Finalise the scope for the detailed design.
  • Followed by – Appointing an engineering consultant to manage the detailed design process and prepare for construction.
  • Summer 2023 – autumn 2024 – Public consultation on the detailed design and propose a planning application.
  • Autumn 2024 – Early 2025 – Appoint a contractor to build the scheme.
  • Spring 2025 – Start construction.