“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

RDE struggling to cope with winter pressures

“NHS England publishes weekly reports which reveal whether hospital trusts are struggling to manage during the colder months, based on key indicators.

This is how Royal Devon and Exeter NHS Trust, which includes the Royal Devon and Exeter Hospital and 26 community hospitals across the Devon, coped from February 25 to March 3.

Bed Occupancy:

General and acute wards at the trust were 89.8 per cent full on average, above the safe limit of 85 per cent recommended by health experts. The occupancy rate has remained mostly unchanged since the previous week.

British Medical Association (BMA) guidelines state ‘to ensure safe patient care, occupancy should ideally not exceed 85 per cent’.

The BMA also raised concerns about the number of available beds needed to cope with winter demands.

On average, the trust had 670 available beds each day, of which 602 were in use.

Of those, 28 were escalation beds – temporary beds set up in periods of intense pressure.

According to NHS Improvement, a higher proportion of long-stay patients can impact the ability of hospitals to accommodate urgent admissions and manage bed capacity.

At the trust, 285 patients had been in hospital for a week or more, taking up nearly half of the occupied beds.

Of these, 96 patients had been in hospital for at least three weeks, making up 16 per cent of all occupied beds.

Ambulances:

A total of 532 patients were taken by ambulance to A&E during the week. A slight rise in emergency arrivals compared to the previous week, when 523 patients were brought by ambulance.

All of the patients arriving at a hospital by ambulance were transferred within 30 minutes.

NHS guidance states that ambulance crews should hand patients over to A&E staff within 15 minutes of arrival.

Any delay in transferring patients leaves ambulances unable to respond to other emergencies, as well as risking their patients’ safety. The previous week, three patients waited more than 30 minutes to be transferred.”

https://www.exmouthjournal.co.uk/news/rd-e-winter-pressures-1-5933264

[Ottery] “Hospital faces 18 month wait to apply for community status”

“East Devon District Council (EDDC) announced on February 27 that supporters must wait until February 2020 before re-applying for the hospital to be listed as an asset of community value (ACV). When a building is listed as an ACV, the local community has to be informed if it goes up for sale and the public can enact the ‘community right to bid’ which gives them a period of six months to determine if they can raise the finance to purchase the asset.

The initial decision not to list the building as an ACV came in December when Ottery was one of four East Devon hospitals to be nominated. EDDC stated that it did not believe the hospital furthered the social wellbeing or social interests of the local community.

At the council meeting on February 27, Cllr Roger Giles, who also sits on the Ottery Town Council, raised the matter and referenced Southwold Hospital, in Suffolk, which was successfully listed as an ACV, before becoming the first hospital in the country to be bought by the community.

As part of the decision to list it as an ACV, Cllr Giles said the strategic director of WDC stated the owner’s assertion there is no evidence of the community social wellbeing being furthered defied common sense.

Cllr Giles said this is a view shared by many local Ottery residents about their hospital and warned that Ottery and other local community hospitals are at risk because of this perverse decision. He said EDDC is suffering reputational damage as a result of this ‘very regrettable’ decision.

Cllr Ian Thomas, leader of EDDC, said each case is considered on its merits and there had been no new evidence to warrant a review for Ottery.

Last week, leading figures from the Royal Devon and Exeter Hospital and the Northern, Eastern and Western Locality Devon Clinical Commissioning Group attended a discussion to review plans for the building. A statement from the working group said: “A wide-ranging and constructive discussion took place, and a number of tasks were allocated.”

A further meeting will be held in early June.”

https://www.sidmouthherald.co.uk/news/ottery-hospital-wait-1-5930495