Cranbrook urgently needs temporary GP practice

Owl is amused at the idea that an extra GP practice would increase footfall in the “town”. But you just cannot call a settlement of 2,000 houses with 5 shops a town – maybe “suburb of Exeter” is now more appropriate!

“… Cranbrook temporary GP Practise
The Projects Director presented the report which sought approval for up to £150k of funding from the Enterprise Programme to enable the delivery of a temporary GP practice in Cranbrook town centre. This was an urgent requirement because of the lack of capacity at the current practice. Whilst Access Healthcare had had their contract extended there were significant concerns over the ability to deliver increasing patient numbers. Expanded facilities were therefore urgently required.
Discussions included the following:

 if not supported this would create a massive health inequality
 this was a loan therefore the borrowing would be repaid
 as well as helping the health service, this was a benefit to the residents of Cranbrook as the existing provision was under pressure. …

The current GP practice in the Younghayes Centre was at capacity. The temporary GP practice would enable the continued delivery of primary care services in Cranbrook for a period of 5 years. It would also bring increased footfall to the town centre and act as a catalyst for attracting wider investment.”

https://democracy.eastdevon.gov.uk//documents/g143/Printed%20minutes%2003rd-Apr-2019%2017.30%20Cabinet.pdf?T=1

“Revealed: Collapsed private provider to the NHS owes £11m”

“A patient transport company which collapsed after it withdrew from a key NHS contract owes more than £11m, including to the NHS, statements filed with Companies House have revealed.

Liquidators winding up Coperforma have found just a few thousand pounds in the company’s bank accounts. But the papers also showed the company owes £11.3m to unsecured creditors, including NHS organisations and suppliers of ambulances and staff.

Clinical commissioning groups in Sussex – where Coperforma won a patient transport service contract in 2016 – have claimed the company owes them £7.6m. In a statement, the county’s CCGs said: “The Sussex CCGs are actively pursuing all options to maximise recovery for the NHS of costs incurred as a result of the failure of the patient transport service contract.

“In particular, the CCGs are pursuing legal recovery against an associated party of Coperforma which provided a parent company guarantee. The CCG is currently unable to publicly give more details for legal reasons.”

Companies House lists Guernsey-based Seabourn Ltd as a “person with significant control” in Coperforma.

Coperforma claims instead that the CCGs owe it nearly £2.5m, although the documents lodged at Companies House showed the liquidators and their solicitors felt “there was not sufficient evidence to progress recovery”. The CCGs’ claim could be offset against this, it was suggested. This could still leave the CCGs owed more than £5m.

The liquidators are also investigating “potential antecedent transactions” involving the firm, although they will not say who was involved in this. These transactions normally involve the transfer of money out of a firm before it becomes insolvent.

Earlier documents, from just after the company went into administration in early 2018, suggested it had assets of around £400,000, excluding the money it said it was owed by the CCGs. It also owed £377,449 to “trade and expense creditors”.

Coperforma took over the Sussex PTS contract in April 2016, having been the only bidder for a contract which split the transport side of the service from the scheduling of ambulances. It struggled to deliver the service, with many patients arriving late for appointments or being left in hospital. Two of its subcontractors went into administration and the CCG had to pay some staff wages to make sure the service kept going.

Following growing complaints from commissioners and patients and a critical Care Quality Commission report, the company abandoned the £16m a year contract in November 2016. It was handed to South Central Ambulance Service Foundation Trust.

The Sussex CCGs involved were Eastbourne, Hailsham and Seaford; Hastings and Rother; Brighton and Hove; Coastal West Sussex; Horsham and Mid Sussex; Crawley; and High Weald Lewes Havens, which led on the PTS procurement.”

https://www.hsj.co.uk/finance-and-efficiency/revealed-collapsed-private-provider-to-the-nhs-owes-11m/7024800.article?

“Amount of NHS land in England earmarked for sale soars, figures show”

Ministers have been accused of “selling off the NHS family silver” after figures revealed that the amount of health service land being earmarked for sale to private developers is soaring.

The NHS is seeking buyers for 718 different plots of land or buildings it owns across England, prompting fears that underfunding has forced cash-strapped NHS trusts to dispose of vital assets.

The total of 718 sites represents a 72% rise on the 418 plots the NHS deemed as surplus to requirements two years ago.

Nurses priced out of housing developments on former NHS sites

The number of sites on the market that NHS bosses say are currently being used for clinical or medical purposes is also rising fast, from 117 last year to 140 – almost one in five of the total.

Seven of the top 10 sites with the highest value fall into that category. They include a part of Heatherwood hospital in Ascot, Berkshire – which is used by patients from Theresa May’s nearby Maidenhead constituency – valued at £35m, and part of the site of Birmingham’s City hospital (£18.8m).

Labour said the figures, contained in the NHS’s annual register of land for sale, showed that hospitals were being forced into a “firesale of assets” after years of being starved of resources while the government had restricted annual budget rises to 1% since 2010.

“Hospitals are struggling to cope with cutbacks from the Tories. The answer should be a serious long-term government-funded investment plan and not selling off the NHS’s family silver,” said Jonathan Ashworth, the shadow health secretary.

Last year a government-commissioned report by Sir Robert Naylor, a former University College London hospital chief executive, said the NHS could raise £6bn from taking a more “commercial approach” to disposing of land.

Ministers approve of the growing selloffs, which they say will help generate receipts that NHS trusts can then use to redevelop their facilities and build homes for staff.

The British Medical Association, which represents doctors, voiced unease. It said the selloffs were short-sighted and could leave hospitals with too little space to expand in future.

Dr Chaand Nagpaul, the chair of the BMA council, said: “These figure show a staggering increase in sale of NHS land in the last two years. This begs serious questions as to the reason for this surge. Was this land actually surplus or are these sales being used to plug financial deficits in hospital trusts as a result of a decade of underfunding?

“It is vital to safeguard the sale of NHS land and estate from perverse short-term financial incentives, and which may result in a reduction in estate and facilities that is insufficient to meet the future needs of patients. These figures demand scrutiny. Selling land shouldn’t be a way for the health service to make up for austerity-era cuts – especially if it could come at the expense of patient care.”

The total amount of land involved in the NHS asset sale has grown from 545.7 hectares (1,348 acres) in 2015-16 to 1,332 hectares in 2016-17 and 1,749.4 hectares last year, according to research undertaken by the House of Commons library for Ashworth.

The Department of Health and Social Care defended the rise in sales. A spokesperson said: “As part of the long-term plan for the NHS we are committed to making taxpayers’ money go further, including getting the best use out of the land and buildings the NHS owns.

“We are helping trusts dispose of surplus land or buildings so that money is saved and spent instead on improving patient care, whilst freeing up space for much needed new homes, including for NHS staff.”

https://www.theguardian.com/society/2018/sep/09/nhs-land-earmarked-for-sale-to-developers

“Theresa May’s ‘NHS Long Term Plan’ spells more cuts and privatisation”

“… In January the government unveiled its much-awaited Long Term Plan for the NHS. It caused quite a stir. In the runup to the NHS’ 70th birthday, the Prime Minister committed to a real term annual 3.4% increase in funding for frontline care between 2019/20 to 2023. The “plan” reaffirmed this commitment. However, the problem with this commitment is that it simply doesn’t meet the needs of the NHS.

For a start, all independent experts including the Institute for Fiscal Studies, Health Foundation, Kings Fund and the Nuffield Trust have stated that this amount will only allow the NHS to continue providing the same level of care it is currently providing. In short services, won’t and can’t improve with this level funding.

In fact, it is more likely that performance will deteriorate once we take into account the context of an ageing population with long-term, complex and chronic conditions. All of the aforementioned commentators agree that a 4% increase is the bare minimum required to even begin improving services.

What’s more, none of this funding will be going towards public health initiatives. Historically, local authorities have funded services providing sexual health services, alcohol services, drug services and other public health services through the Public Health Grant.

A grant from central government to local government. But this grant has been butchered by the Conservatives. Between 2014/15 and 2019/20 it has suffered a real term cut of £700m. That amounts to nearly a fall of 25% per person across the entire country. As a result, improvements in life expectancy are now stalling – according to the Health Foundation think tank – for the first time in 100 years.

Similarly, the funding won’t be going towards capital expenditure. This is what allows NHS Trusts to spend on core infrastructure, both physical and digital. As well as medical equipment and medical devices such as scanners for cancer and ambulances. Between 2010/11 and 2014/15 capital spending was subjected to a 17% cut. In more recent years, its budget has been consistently raided in order to prop up social care and the day-to-day running of front-line NHS services. In 2018 Jeremy Hunt raided £1bn from the budget to go towards funding social care.

Not only is such an action perverse in light of the fact that the Conservatives have subjected social care to an overall cut of £7bn since 2010, it was also a brazen example of the short term thinking which has led to the breaking down of ambulances during last years “winter crisis”, the breaking down of CT scanners, blocked drains and sewage leaking into clinical facilities, leaks from ceilings going onto active operating tables and even the collapse of an entire floor of an NHS hospital. …”

https://www.redpepper.org.uk/theresa-mays-nhs-long-term-plan-spells-more-cuts-and-privatisation/

Outgoing audit chief tells government some home truths

“I still get angry – and that is the word for it, angry – 10 years into the role, when I see badly-thought-through programmes and wasted public money,” says outgoing watchdog chief Sir Amyas Morse. “And the reason I’m angry is because the citizen ends up picking up the tab. They are the ones who end up suffering.”

For almost a decade, as comptroller and auditor general – the head of the National Audit Office – it’s been Morse’s statutory duty to keep an eagle eye on the spending of central government departments, holding ministers and civil servants to account for cost overruns, project mismanagement and profligacy with taxpayers’ money.

He doesn’t have far to look. As he prepares to leave his post in May, Morse’s final public speech at the Institute for Government last week included a damning list of failures: Crossrail costing £2.8bn more than forecast; changes to probation costing £467m to put right; the smart meters fiasco that will cost at least £500m more than originally estimated; and the Ministry of Defence’s latest unaffordable and unsustainable 10-year equipment plan going over budget by at least £7bn. And that’s just a selection from the past few months.

Morse looks back in anger at the billions that could have been spent on vital services, wasted instead through what he calls “inappropriate bravado” on the part of government ministers, lording it over cowed civil servants, behind an increasing amount of secrecy and spin. “We don’t need people jumping out of an aeroplane in the dark with a parachute of taxpayers’ money,” he says.

A proud Scot – his only meeting with Theresa May was a “brief conversation” at a No 10 Burns Night last year – Morse cares passionately about public services. While his upbringing has contributed to his concern for fairness, it’s his decade at the watchdog, to which he came from a senior position in consultancy PricewaterhouseCoopers via the MoD, that has fuelled his rage over the wasteful ways of too many government ministers. “I really realised that society belongs to us. We’re all paying for it.”

Public money is finite, he points out. There is no magic money tree. When money is lost in one place, it’s taken away from another programme, usually one that’s easier to cut. Every wasted £1bn, he says, is enough to run NHS England for three days, fund 625m A&E attendances, 135m day cases in hospital, or 4m ambulance attendances.

Morse has warned the government that it needs to invest more in the NHS and social care, to meet the needs of an ageing population. In 2016-17, the UK spent just over £170bn on health and social care – more than 10% of GDP, but less than the 11.2% of GDP Germany spent in 2015 on health alone. …”

https://www.theguardian.com/society/2019/mar/20/amyas-morse-head-national-audit-office-ministers-waste-taxpayers-billions

Shadow state – part 3

And now the Chartered Institute of Public Finance and Accounting agrees privatisation isn’t working. The National Audit Office and the Government’s own Public Accounts Committee have said the same.

Will this cause a change of policy – particularly in the NHS? Not a chance!

“The collapse of outsourcing giant Interserve will be “costly and disruptive” for the public sector, a public services commentator has told PF.

Interserve, one of Britain’s biggest government contractors, was due to file for administration this evening. This was after just under 60% of the company’s shareholders voted against a rescue plan earlier today.

The business holds thousands of public sector contracts, including for local government, cleaning schools and hospitals. It also runs catering and probation services as well as managing construction projects.

John Tizard told PF that public sector clients will need to “spring into action either to bring the services back into public management or to broker the contracts to other contractors”.

The firm’s collapse will likely be “costly and disruptive” for public services, he added. The ‘deleveraging plan’, proposed on Friday, would have seen creditors take control in a ‘debt-for-equity’ swap. It was rejected 59% to 41% by shareholders.

The rescue plan would have meant lenders being given the greater number of shares in the business with the shareholders’ stake being reduced to 5%, the BBC has reported. A US hedge fund Coltrane, which owns 27% of the company, voted to reject the proposals.

Tizard told PF: “It’s another question mark over the appropriateness of outsourcing particularly on this scale – to companies that have business models which are risky and fragile and where ownership changes.

“They are likely to go into administration because Coltrane has said they won’t vote for the deal, but can we really afford to have key public services decided by US hedge funds?” he queried.

Tizard said he had no doubt that contingency plans will have been drawn and added that it was now necessary for public sector clients to implement these.

Interserve employs 45,000 people in the UK. Its website also states that it provides probation services for 40,000 people on behalf of the Ministry of Justice.

A damning report from the National Audit Office recently highlighted the failings of prison reforms, which saw probation services transferred to the private sector.”

https://www.publicfinance.co.uk/news/2019/03/public-sector-likely-suffer-collapse-interserve

“Public Accounts Committee calls for ‘step change’ in transparency in local public bodies”

“There is a need for a step change in transparency by local public bodies and particularly those in the NHS, MPs have said.

In a report, Auditing local government, the Public Accounts Committee noted that in 2017-18, auditors found that more than 1 in 5 local public bodies did not have proper arrangements in place to secure value for money for taxpayers.

“The numbers are worst for local NHS bodies such as clinical commissioning groups and hospital trusts, where 38% did not have proper arrangements,” it said.

The MPs added that some local bodies were not putting enough information in the public domain about their performance, including reports from their external auditors.

The report called on central government departments to make clear their expectations, “not only for what is made publicly available, but also for making the information accessible to users and so helping citizens to hold local bodies to account”.

The PAC said there appeared to be few consequences for those local bodies who did not take auditors’ concerns seriously and address them promptly. “Even where local auditors use their additional reporting powers to highlight failings, this does not always lead to the bodies taking immediate action.”

The report also recorded the MPs’ concern that, as partnership working becomes more complex, accountability arrangements will be weakened, and the performance of individual local bodies will become less transparent.

Meg Hillier MP, chair of the committee, said: “Taxpayers must be assured that their money is well-spent but in too many cases local bodies cannot properly safeguard value. Particularly concerning are NHS bodies such as Clinical Commissioning Groups and hospital trusts: last year almost two in five did not have adequate arrangements.

“As we reported last week, many CCGs are underperforming and this must improve as they take on responsibility for commissioning services across larger populations.”

Hillier added: “It is vital that local bodies take auditors’ concerns seriously, address them swiftly and ensure meaningful information on performance is made accessible to the public.

“Our report sets out ways central government can help to drive improvements at local level and we urge it to respond positively to our recommendations.” …”

https://www.localgovernmentlawyer.co.uk/governance/396-governance-news/40088-public-accounts-committee-calls-for-step-change-in-transparency-in-local-public-bodies