A picture is worth a thousand words – owl

Grant Thornton implicated in allegations of “Blame Deflection” – Owl

A critical report into how a mental health trust mismanaged its mortality figures was edited to remove criticism of its leadership, the BBC has found.

By Nikki Fox & Matt Precey www.bbc.co.uk

In June, auditors Grant Thornton revealed how the Norfolk and Suffolk NHS Foundation Trust (NSFT) had lost track of patient deaths.

But earlier drafts included language around governance failures that were missing in the final version.

NSFT and Grant Thornton said the changes were due to fact-checking.

A number of drafts of the report were produced, with the first dated 23 February this year.

The first version described “poor governance” in the way deaths data was managed, with governance also being called “weak” and “inadequate”.

But many of these critical words were missing from the report released to the public, with “governance” also being replaced with “controls”, according to leaked documents.

NSFT said: “We responded to requests from the auditors to check the factual accuracy of their early draft report and to provide further information. This is a standard process to make sure that such reports are evidence-based.”

Grant Thornton said: “It is not uncommon for findings and language to be refined before being finalised.

“After the initial draft the engagement team at the trust changed, who then provided further information around controls and internal processes of which we were previously unaware.”

But campaigners have described this as blame deflection.

After losing her son Tim in 2014, Caroline Aldridge has been highlighting what she and others claimed had been the trust’s undercounting of deaths.

“I think people need to know what was removed and what was changed, because I suspect that the first report is a lot nearer to the truth,” she said.

Ms Aldridge added: “It takes all responsibility from governance, removing the words ‘inadequate’, ‘poor’, ‘weak’ governance, removing significant pieces of information that’s not factual accuracy.

“We cannot have people watering it [the report] down when it’s about deaths.”

Another section that did not make the final version highlighted a “culture of fear” among some staff, who reported anxiety around how the data was used.

It is understood this was removed after the trust challenged the number of clinicians Grant Thornton had spoken to.

The auditor said the trust had demonstrated its governance was “in line with national expectations”.

‘Single truth’

The review was launched at the behest of local NHS commissioners in October over confusion about the number of people in contact with the trust who had died.

In August last year, Norwich South Labour MP Clive Lewis cited claims from local mental health campaigners that there could have been as many as “1,000 avoidable mental illness-related deaths” – a figure the trust said it did not recognise.

Deputy chief executive at the trust, Cath Byford, told a local health scrutiny panel that Grant Thornton’s review had been established to find a “single truth” regarding the number of deaths.

But the review instead looked at the trust’s mortality data processes, finding that it could not provide assurance over the trust’s figures.

‘Demand just exceeds capacity’

Referrals to mental health crisis teams across the country were up 30% since before the pandemic, according to NHS England.

The number of people aged under 17 receiving NHS-funded support had increased to 702,000 since 2019.

NSFT’s most recent annual report stated referrals to its children and young people’s services had more than doubled in the same period.

Two NSFT clinicians, who asked for their identities to be protected, described how there were not enough staff to deal with demand.

“The service I work for, we’re just not able to support as many people as we’d like to. We’re only supporting around 66-65% of the people that are contacting us,” one said.

They added: “One of my managers came up to me and said, ‘Don’t complete the patient incident forms,’ and they were actively encouraging us to not do that, because they’d have to do more work and it looked badly on them as a team.”

The other said: “Services have always been under pressure, but now it feels like demand just exceeds any capacity available.

“Staff don’t have time to be recording things as they would want to so they might not record every incident on the patient safety records, which should be highlighting any risk incidents up the chain to more senior management.”

Stuart Richardson, NSFT’s chief executive officer, said: “Over the last year we have introduced safer ways of working and supported colleagues to raise concerns or ask questions so that we can address and help resolve them at the time.”

The BBC showed the different versions of the report, and the responses from the trust and Grant Thornton, to the Parliamentary and Health Services Ombudsman.

Rob Behrens said: “I’m concerned at the difference between the draft report and the published reports, and because the differences in the texts at key points are so huge that this is not just a bureaucratic drafting issue.”

Grant Thornton said: “Whilst the overall findings of the report did not change, the new evidence did adjust our assessment of significance in some areas. In addition, wording changed in some areas to highlight areas of good practice that were brought to our attention and which we believed could be broadened out to help resolve issues.

“We maintain that the final public report is an entirely independent, robust and thorough assessment of the historic matters at the trust.”

Mr Richardson, from the trust, added: “We have been open and honest about the failings highlighted in this report, and are committed to bringing about the improvements that our service users and staff deserve.”

“Let’s get on and get the job done,” councillors in Teignbridge said this week as they agreed more changes to decision-making in order to speed up delivery of a £9-million project to transform Newton Abbot’s high street.

Alison Stephenson, local democracy reporter www.radioexe.co.uk

Dogged by delays after the government awarded cash from its Future High Street Fund four years ago , Teignbridge District Council has decided now it will delegate decisions to officers but that the executive committee will keep overall control.

Liberal Democrat council leader Martin Wrigley (Dawlish North East) proposed that ‘delegated authority’ to be given to the head of place and commercial services so they can make decisions provided they have obtained approval from an executive member and that all decisions are reported to the executive.

He said decisions can be made effectively by officers but it is important to remember the executive was “making the bigger decisions on this project”.

Cllr Wrigley, who had previously put forward a motion for the executive to make all decisions alone – leading to an accusation of “control freakery” by Cllr Andrew MacGregor (South Devon Alliance Independent, Bishopsteignton) – said progress on the market hall regeneration and the cinema had been disappointingly slow.

It was likely that changes to these projects may be required because of inflation and economic changes since 2019 and delays since last November.

“The cinema has yet to obtain planning permission after nearly four years of the project. The council is concerned that the projects are progressing without detailed oversight,” he said.

Councillors were told this week that the whole scheme could be in jeopardy if decisions were made solely at executive committee meetings.

They also heard that there was now some flexibility in how the money could be spent after Michael Govem secretary of state for levelling up, housing and communities, announced that changes  of up to 30 per cent could be approved locally.

Cllr Huw Cox (Lib Dem, Ashburton and Buckfastleigh) said: “I agree with the move to give officers authority to move things on a bit quicker but it’s been going on forever. We need to stop chattering about it and get the job done. We need to get it finished one way or another or we could still be here talking about it in ten years’ time.

Cllr Daws (South Devon Alliance, Ambrook) said the new flexibility was welcome. “I think now we need to grasp the nettle, reform the cinema application size and scale, since the demise of Cineworld, Empire cinemas going into administration and the lack of interest by local operator Scott Cinemas,” he said. “If there is one company that should have the handle on the viability of cinema in Newton Abbot, it is Scott Cinemas.”

“Let’s take this forward with a transformational plan which is in the community interest of the district. The Queen Street development can move forward, but it does not have the support of the retailers and we need to address that if there is to be a lively town centre.”

Cllr Jackie Hook (Lib Dems, Bushell) said plans to change Queen Street, including widening pavements , improving crossing, more planting and public seating and an introduction of a 20 mph speed limit between The Avenue and Courtenay Street, went through three stages of public consultation.

“The last one was close, but ultimately the residents of our town and district support that and they will be the people spending the money in Queen Street and that is what we have to remember.”

Cllr Gary Taylor (Lib Dem, Kenton and Starcross) said he is positive:  “I am looking forward to transformational change within Newton Abbot town centre and I am am confident we will see it, albeit with some changes to the original plans. I am pleased we have flexibility now, with the economic conditions we have floating around us it is  important we have that flexibility.”

But he added that the closure of Wilko was a blow. “I am very sad we will be losing one of major anchor stores, not least because it’s a tenant of ours, also because it provides a very good service to people of the town.

“It’s a huge shame to be losing them and whilst it does give us another opportunity, I do hope somebody comes along and continues to do something similar to what Wilko did for our high street as it took over from Woolworths when it came.”

Cllr Wrigley agreed it was a sad loss to the high street: “No doubt we will have decisions to make in the future regarding what happens there,” he said.

Four years on and no “Prime Contractor” yet appointed, only 5 of the 40 are actually new builds anyway, and in “most of the schemes the issue of affordability had not yet been considered” (NAO).

Place no credence on a Tory “pledge”. – Owl

Ben Gartside, Hugo Gye inews.co.uk

The Government’s flagship ’40 hospitals’ project is set to face further delays, piling further pressure on Rishi Sunak over missed Tory pledges.

An industry insider told i the Government appears to have “abandoned hope” of making significant progress before the general election next year.

The fresh delays raise the prospect that a future Labour administration will have to decide whether to continue with the project, or to abandon it and draw up new plans for hospital construction and upgrades.

The pledge to build 40 new hospitals by 2030, originally promised by Boris Johnson in the 2019 Tory manifesto, has been beset by delays and claims that some of the ‘new’ sites are just extensions to existing healthcare centres.

i has been told the latest delay relates to the appointment of a building firm to serve as the ‘delivery manager’ – a construction industry term to describe the lead contractor responsible for the overall progress and completion of a major project.

Insiders on the project told i that this crucial appointment has been delayed twice, with firms recently being told a hiring process will not begin until the new year. They fear little progress will be made before the next election if it is held in October or November 2024.

One told i: “It feels like the Government has abandoned any hope of moving the project on any time soon. Hiring a delivery manager has been delayed, and it feels like all big projects have been put on ice.

“We have a full team ready to work on the project, but we keep being told of delays to the procurement. We can’t keep waiting for the Government to start forever.”

Another company told i: “There’s no way the process will be completed much before October next year, by which point we might be dealing with a new Government.”

The next general election must be held no later than 24 January 2025.

Labour is committed to continuing with the construction of dozens of new hospitals if it wins the election, but insiders say the party may need to review the way the project works. Shadow Health Secretary Wes Streeting said: “The programme is already over-budget and behind schedule. Many are not ‘new’, others are not ‘hospitals’, and there aren’t 40 of them.

“If Rishi Sunak has now abandoned the Conservatives’ promise to build 40 new hospitals, then it is further proof there is no point of him or his government.” Labour is understood to be concerned about whether enough funding is available. A party source said: “It is about making it work, rather than ripping it up and starting again or allowing it to continue how it has. We’ve got to see what state it is in at that point.”

The Department of Health and Social Care said it is “on track” with appointing the lead contractor. Ministers admitted in May that eight of the “new hospitals” they pledged to build by 2030 would be delayed into the next decade.

At the time, Health Secretary Stephen Barclay stressed that they were still committed to meeting the pledge, highlighting how the refurbishment of five hospitals in urgent need of repairs and the building of three mental health hospitals would be added to the programme and prioritised instead.

In July, the National Audit Office warned that the New Hospitals Programme (NHP), the project’s official title, is “highly dependent upon [delivery] partners outside the direct control of the NHP, including the construction industry”.

Despite this, little progress has been made on appointing a lead contractor nearly four years after Mr Johnson first made the pledge, with two firms currently acting as interims.

The appointments process was set to begin in September but insiders said this has now been delayed until the new year.

The Government faced a stern rebuke from spending watchdog the National Audit Office earlier this summer, as it was revealed at least eight hospitals were expected to be completed after the initial 2030 goal.

The report stated that under Mr Johnson, in “most of the schemes the issue of affordability had not yet been considered”. i reported in October that cheaper prefab construction would need to be used for parts of the scheme due to a potential budget shortfall under the Liz Truss government.

Gareth Davies, the head of the NAO, warned in the report that progress had been slower than expected and that the Government had failed to achieve good value for money. He said that cost-cutting and inaccurate modelling could also mean new hospitals are too small.

The Department for Health and Social Care said: “We are on track with the appointment of a programme delivery partner, and remain committed to building 40 new hospitals in England by 2030, which is now expected to be backed by over £20 billion of investment.”

The ’40 hospitals’ plan: a timeline

30th September 2019: Boris Johnson pledges to build 40 “new” hospitals during the 2019 election campaign, pledging £13bn in spending, with £2.7bn in the first 5 years.

However, initial praise for Boris Johnson’s landmark 40 hospitals pledge quickly became sceptical scrutiny due to the definition of ‘new hospitals’ used by the Government.

1st December 2021: Johnson defends policy

Mr Johnson addressed criticism that the Government had exaggerated the number of completely new hospitals. He said at Prime Minister’s Questions: “You obviously don’t go around building on greenfield sites… you rebuild hospitals and that is what we have said for the last two-and-a-half years.”

4th July 2022: Only 5 completely new hospitals?

The BBC reported that only five of the 40 would actually be completely new hospitals. Laurie Rachet-Jacquet, an economic analyst at The Health Foundation, told the BBC: “They are not all ‘hospitals’ as most people would recognise them.”

21st December 2022: Costs mount

i reports on costs spiraling on the project, with the Government looking at cheaper ‘prefab’ construction as a method of lowering costs. Rising inflation and material shortages looked set to cause significant strain on Government budgets.

May 2023: Stephen Barclay admits some projects will be delayed

The Health Secretary said that eight of the 40 original schemes would be completed after 2030 to prioritise five other more urgent developments.

He insisted the Government would still meet its manifesto pledge by prioritising the five hospitals that are at risk of collapse and the building of three mental health hospitals by the deadline.

17th July 2023: NAO report published

The National Audit Office since raised concerns about the project, with questions over the funding of the policies and the ability for the Government to meet it’s 2030 deadline for the hospitals.

The NAO report said that at least eight “hospitals” would miss the 2030 target, and that while Mr Johnson’s government had said the plans were “fully funded”, funding for some hospitals had still not been confirmed.

The quango also said the Government’s prefab plan to save time and money was as yet “unproven”.

Using an amendment to the “Levelling Up and Regeneration” bill!

Remember, Thérèse Coffey said there are more important things than beavers, and Simon Jupp keeps telling us that “I would never vote to pollute our water”. – Owl

“Not content with the levels of pollution in our rivers already, scrapping nutrient neutrality is a disgraceful act from the government. The Conservatives seem happy for Britain’s rivers to get even worse.” – Tim Farron

Helena Horton www.theguardian.com 

Michael Gove is planning to rip up water pollution rules that builders have blamed for exacerbating England’s housing crisis but which environmental groups say are essential for protecting the country’s rivers.

The housing secretary, alongside Thérèse Coffey, the environment secretary, will announce the move on Tuesday, according to several people briefed on the plans, alongside hundreds of millions of pounds’ worth of extra funding to mitigate the potential impact on England’s waterways.

The decision will spark anger among environmentalists, who say it will further add to water pollution, as water companies are already dumping raw sewage into rivers and seas. Political advisers say water pollution has already become a major political issue in coastal areas, and has the potential to cost the Conservatives important seats at the next election.

However, it will please major developers, who say the rules are being applied so strictly that they are unable to build new homes in large parts of England. Building industry projections say housebuilding in England is forecast soon to fall below levels not seen since the second world war.

Doug Parr, policy director at Greenpeace UK, said: “Who would look at our sickly, sewage-infested rivers and conclude that what they need is weaker pollution rules? No one, and that should include our government. Scrapping or weakening limits on chemicals from sewage and farm run-offs would be a sure sign that ministers have completely given up on saving our great waterways and the precious wildlife they host.

“Instead of allowing housebuilders to cut corners, the Sunak administration should make sure we have the right infrastructure to handle our sewage so we can build new homes without sacrificing our rivers’ health. But that would require them to do what they’ve spectacularly failed to do so far – forcing water firms and housebuilders to invest their profits in upgrading treatment plants and pipes to a standard that a modern, functional country would expect.”

However, one source in the housebuilding industry said: “This is undoubtedly good news for Britain’s housing supply. The only question is why it has taken so long for the government to get round to doing something about this.”

The nutrient neutrality rules were put in place in 2017 when the UK was still a member of the EU. They say that in dozens of protected areas across England, local authorities should not give the go-ahead to any new development that is projected to add to river nutrients such as phosphates and nitrates, either through wastewater from new homes or run-off from building sites.

The regulations were first enacted by the EU in an attempt to prevent damaging buildups of algae and other plants, which can choke off aquatic life.

Developers, however, say they are being enforced by Natural England in such a strict way that they have been forced to put as many as 120,000 new homes on hold, and argue that farmland is a far bigger contributor to the pollution in question.

Under the existing rules, builders have to mitigate new nutrient loads caused by new populations in housing either onsite or elsewhere within the same catchment. They can do this by investing in new wetlands or by creating buffer zones along rivers and other watercourses. Builders have complained that doing so was costly and time-consuming.

In response to developers’ complaints, ministers launched a mitigation scheme in 2022 under which builders were allowed to buy “credits” to gain approval for their schemes. But those developers say that the process of purchasing such credits has occasionally led to unintended consequences, such as buying up farmland to take it out of use in an attempt to reduce water run-off.

Despite these changes, ministers say there is still a problem. Gove recently told the Sunday Telegraph that the rules should be changed as they get the “balance wrong”. In his announcement on Tuesday he will say the repeal of the rules is a “Brexit bonus”.

Those briefed on the plans say the government will try to change the law through an amendment to the levelling up and regeneration bill, which is currently in the House of Lords. Ministers might yet find it difficult to secure enough support for the bill, which must pass by the autumn or have to be reintroduced in a new bill in the King’s Speech in November.

The government is hoping to nullify some of the opposition with a package of hundreds of millions of pounds to reduce water pollution in other ways. They will give around £400m in grants to farmers and water companies to improve slurry infrastructure to make leaks less likely, and spend around another £300m helping builders mitigate the impact of their schemes.

Opposition parties are preparing to oppose the plans nevertheless.

Tim Farron, the Liberal Democrats’ environmental spokesperson, said: “Not content with the levels of pollution in our rivers already, scrapping nutrient neutrality is a disgraceful act from the government. The Conservatives seem happy for Britain’s rivers to get even worse.”

Shaun Spiers, head of Green Alliance, said: “It’s hard to see how the law can be enforced without nutrient neutrality. Is the government proposing more pollution or that someone else (other than the housebuilders) pays for it? The trouble is, housebuilders always oppose proper regulation if they think they can get away with it, and governments are so desperate for more housing (and so unwilling to invest in it themselves) that they always believe them.”

Katie-Jo Luxton, director of conservation at the Royal Society for the Protection of Birds, said: “If nutrient neutrality rules are scrapped, pollution will accumulate unchecked and our rivers face total ecological collapse.