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

NHS: a frightening statistic

According to the Kings Fund, the UK now has 2.7 hospital beds per 1000 population compared to an EU average of 5.2 and one of the lowest number of practicing doctors [in the EU] (hospital and GP) per head of population.

“Sticking plaster won’t save our services now”

“Britain’s fabric is fraying. It’s not just the occasional crisis: schools that can’t afford a five-day week, prisons getting emergency funding because officer cuts have left jails unsafe, a privatised probation service that isn’t supervising ex-criminals. The services we take for granted have been pared so deeply that many are unravelling. The danger signals are flashing everywhere.

Local authorities have lost three quarters of their central government funding since 2010. They are cutting and selling off wherever possible: parks, libraries, youth services. The mainly Tory-run councils in the County Councils Network warned last year that their members were facing a “black hole” and were heading for “truly unpalatable” cuts to key services, including children’s centres, road repairs, elderly care, and rubbish collection.

The chief executive of the Local Government Information Unit, a think tank, says councils are already on life support. Yet they face their biggest fall in funding next year. Volunteers are already running some libraries and parks. Councils will have to cut further; Theresa May’s new stronger towns fund is far too small to make a difference.

The criminal justice system has been stretched beyond reliability. The number of recorded crimes being prosecuted is falling and runs at just 8.2 per cent, as funding cuts bite, evidence isn’t scrutinised, courts close and neither defence nor prosecution teams have adequate resources or time. The chairman of the Law Society’s criminal law committee says “we are facing a crisis within our justice system, we are starting to see it crumble around us”.

In health, waiting times at A&E have hit their worst level in 15 years; in some surgeries the wait for a GP appointment can be weeks; and this week public satisfaction with the NHS fell to its lowest for more than a decade, at 53 per cent, down from 70 per cent in 2010. Britain’s spending watchdog, Sir Amyas Morse, departed from his usual role as a tenacious critic of government waste to warn us, bluntly, that May’s recent boost for the NHS is nothing like enough. An ageing population will need higher spending. The falling budgets for social care are “unsustainable”.

The news in education this week was that 15 Birmingham primary schools will close at lunchtime on Fridays because they can’t afford to stay open. It’s the most vivid recent example of the slashing of budgets per pupil by almost 10 per cent, in real terms, since 2010. Sixth forms have lost a quarter of their funding. Schools have reduced teaching hours, cut A-level courses in maths, science, languages, sacked librarians, school nurses, mental health and support staff, and cut back on music, art, drama and sport.

When this process began in 2010 I backed it. Like many people, I had come across enough unhelpful, incompetent jobsworths to know the state was wasting money. As a Labour supporter I’d written at the end of the Brown years warning that Labour was destroying its case for high public spending by squandering much of it.

Privately, many in the system agreed. One chief executive of a Labour council told me he’d been relieved to get rid of half his staff in the first couple of years; it had cleared out the pointless and lazy, and forced everyone to focus on what mattered and what worked. Other chief executives agreed cheerfully that they too had been “p***ing money up against the wall”.

But we are years past that point. We have moved beyond cutting fat, or transformation through efficiencies. Instead we are shrivelling the web of hopes, expectations and responsibilities that connect us all, making lives meaner and more limited, leaving streets dirtier, public spaces outside the prosperous southeast visibly neglected.

So many cuts are to the fabric that knitted people together or gave them purpose. The disappearance of day centres for the disabled, lunch clubs for the elderly or sport and social clubs for the young is easy to shrug off for the unaffected. But the consequences are often brutal for those who lose them, isolating people and leaving them with the cold message that unless you can pay, nobody cares. The hope that volunteers and charities could fill all the state’s gaps has evaporated. They haven’t and they don’t. Is this how we want Britain to be, and if not, where does this end?

Austerity was never meant to be lengthy, just a few tough years to drive reform. It was intended to be over by 2017, when a thriving economy would float us off the rocks, but events did not go to George Osborne’s plan. The economy is not about to rescue us now, either. All forms of Brexit are going to slow our growth.

Which leaves us with three choices. We could accept the decay of services, and decide to live in a crueller, more divided, more fearful country. If we didn’t want that, we could back a party that planned higher taxes to fund them — Britain’s tax burden is currently 34 per cent, three quarters of the French, Belgian and Danish rates.

Alternatively, Philip Hammond could seize the chance to start reversing this policy in his spring statement next week. In America many Republicans and Democrats, for different reasons, have begun to treat deficits with insouciance, after years of obsessing over them. What matters is whether governments can afford the interest on the debt. Rates are low. Britain desperately needs investment in its people and their futures. The cautious Hammond should open the financial taps.”

Source: The Times (pay wall)

Ambulances not reaching rural areas quickly enough

The article includes a postcode checker to show the situation where you live.

“Critically injured patients in rural areas are at risk due to the time it takes the ambulance service to reach them, a BBC investigation has found.
Some rural communities wait more than 20 minutes on average for 999 crews or trained members of the community to reach life-threatening cases such as cardiac arrests and stab victims.

A response should come in six to eight minutes, depending on where you live.
Experts said delays could make the difference between life and death.
This was particularly the case for cardiac arrests where “every second counts”, the British Heart Foundation (BHF) said. …”

https://www.bbc.co.uk/news/health-47362797

“At last we are turning away from our mania for hiving off public services”

Owl says: Do not be mislead into thinking, when reading this article, that the NHS has stopped privatisation. In fact, it simply makes it cheaper and easier for private companies to compete with the NHS.

“… In the wave after wave of attacks on the NHS launched by the right, the issue of values is brushed aside. The monopoly of the NHS must be broken. Forget the principles of the co-operative: in practice, runs the argument, it becomes an inefficient monopoly of production and delivery that must be challenged by private sector competition. The NHS can still be free at the point of use, but the structures that provide health must be the closest simulacrum to a market as possible. The NHS can be reduced to a brand that houses a hyperefficient network of private sector deliverers competing for contracts.

Hence the Andrew Lansley health “reforms” in 2012 that compelled the NHS to outsource delivery. But the same thinking informed the Tories’ engagement across the public sector. Thus justice secretary Chris Grayling’s probation service “reforms” in 2013 and the normally sane Philip Hammond, as defence secretary, agreeing that army recruitment could be contracted out to Capita in 2012. Tory antipathy to the public sector was given free rein, the lush public outsourcing industry was turbo-boosted – and the public sector fragmented.

Last week saw the death knell of all three “reforms” and with it a pillar of thinking that sustains the current Tory party. Thursday’s call by NHS England to repeal section 75 of Lansley’s Health and Social Care Act, which requires every significant contract worth cumulatively more than £600K to be outsourced in any circumstance, replacing them with a best value test, is a watershed. It will empower commissioners to weigh up whether the loss of an integrated, co-operative service by outsourcing offsets any short-term financial gain. A health system is a structure of interconnected moving parts that requires co-ordination, backed by the overriding principle that the alpha and omega of decision making is care, not maximum profit. …”

https://www.theguardian.com/commentisfree/2019/mar/03/at-last-we-are-turning-away-from-our-mania-for-hiving-off-public-services

NHS Patient Survey on “Improved Access to GP services” in Devon

If you want to have your say on “improved access” to GP services in Devon there is a survey you can fill in here:

https://www.surveymonkey.co.uk/r/66MFMTV

What they really want to know is whether patients would be prepared to see another GP from another practice in another area out of normal office hours, how far they would be prepared to travel and by what means.

“Sidmouth doctor speaks out over struggling GPs and lack of extra funding”

“A struggling Sid Valley GP surgery missed out on extra funding after it all went into secondary care, prompting a Sidmouth doctor to speak out.

Doctor Joe Stych, a practice partners at Sid Valley Practice, has voiced his frustration after a funding bid was denied to redevelop Blackmore Health Centre which was rated as ‘unfit-for-purpose’, by regulators the Care Quality Commission (CQC).

Dr Stych said Sidmouth GPs had been working hard on a plan to future proof GP services in Sidmouth for the last two years.

The latest setback follows the disappointment in 2016-17 when a plan to buy and redevelop the centre was turned down.

Dr Stych said a plan to extend the Beacon Medical Centre and move GP services from Blackmore Health Centre to Sidmouth Victoria Hospital was proposed, helping support the hospital’s medical Ward.

He added: “It was ranked by Devon CCG as the third highest priority project for funding needed locally, but it was overlooked.

“Funding went to the first, second, fifth and eighth ranked projects.

“All funding in Devon has gone to secondary care.

“No funding has been assigned to struggling GPs.

“It is ludicrous that this scheme has been unsuccessful. It makes no sense to me.

“It would increase capacity and improve patient care at the same time as saving the NHS money.

“The overall scheme cost was small at £1.3million but would have made a huge difference.”

Dr Stych said the Government had since revealed its ‘10 year plan’ for the NHS with focus on moving more work out of hospitals into GPs and the community.

He added: “Without the infrastructure to support existing health services, let alone an expansion into the community, even more challenging times lay ahead.

“The reality is that we are already working at capacity and have no room to expand.

“We are already limited in what we can achieve by space constraints.”

He said the practice has an enthusiastic team with GPs in extended roles, operating on skin cancer and performing carpal tunnel operations so patients do not have to travel to Exeter.

They are involved in research to offer new and developing treatments to patients and train medical students and junior doctor.

A Department of Health and Social Care spokesman said: “The latest round of funding applications were highly competitive and the funding was prioritised on the strength of bids received from local NHS teams.

“The Devon STP (Sustainability and Transformation Partnership) will benefit from more than £50million to transform services for patients.”

The spokesman added that the funding was not allocated proportionally but on the strength of bids received.

Each was evaluated against six criteria – deliverability, service and demand management, transformation and patient benefit, financial sustainability, value for money and estates.

The Devon funding will go towards University Hospitals Plymouth NHS Trust – with £29.7million going to transforming urgent and emergency care, £9.3million to Devon imaging facilities and £3.5million to digital histopathology.

A further £8million was given to Devon Partnership NHS Trust for adult acute mental health service across Devon.

The spokesman said: “GPs are the bedrock of the NHS, and the ‘long term plan’ makes clear our commitment to the future of GPs, with primary and community care set to receive £4.5billion more in real terms a year by 2023/24.

“Last year a record 3,473 doctors were recruited into GP training and the new five year contract for GPs will see 20,000 more staff working in GP practices – helping free up doctors to spend more time with the patients who need them.”

A spokesman for the NHS in Devon said: “The Sidmouth scheme was a high priority for the Devon Sustainability and Transformation Partnership and we are still working with the practice and our partners to explore other options.”

https://www.sidmouthherald.co.uk/news/sidmouth-doctor-speaks-out-1-5911840

Brexit: education and health spending rerouted to fishing and farming

“Cabinet ministers are being told that some of their most prized projects cannot be developed because so many officials have been diverted to delivering Brexit, it has emerged.

Ministers’ priority programmes have fallen victim to “re-prioritisation”, according to internal government warnings seen by the Observer.

Government insiders said they knew of examples of officials usually dealing with schools and hospitals who were now redeployed to work on farming and fishing as a result of the scramble to prepare for all Brexit outcomes, including no deal. “It’s a real worry now that things are being held up and not happening,” said one senior Whitehall source. “We are really starting to see it as the Brexit process drags on and on.”

A memo to a senior minister, said: “In the context of ongoing cross-government re-prioritisation exercises, departments have not yet been able to resource the necessary cross-government team to deliver the work.”

The government’s plans for resolving the crisis in social care and a review of university finance are among the major policy proposals that are said to have been held up by Brexit, while many other areas have suffered due to the lack of parliamentary time and political instability. …”

https://www.theguardian.com/politics/2019/feb/17/health-and-rail-plans-sidelined-ahead-of-brexit-deadline

Newton Poppleford GP surgery: lost, never to be regained

This means that, should the NHS ever regain the funding and doctors it needs, and should the local surgery then be in a position to open a secondary surgery in Newton Poppleford, it can never happen.

Anyone buying a new Clinton Devon Estates house at Newton Poppleford (particularly if they have children, or a chronic health condition or are elderly) might want to think twice if this is a suitable location for them.

And EVERYONE should beware “promises” from developers.

A Devon development site once earmarked for a “much needed” GP surgery is being turned into housing instead – much to the disappointment of residents.

People living in Newton Poppleford have to travel miles for medical care.

It comes as a report from the government watchdog, the National Audit Office, has criticised how community infrastructure projects for healthcare, education, and transport are often abandoned once planning permission’s been granted.

In a statement, the developers Clinton Devon Estates said the withdrawal of the surgery plans was understandably very disappointing, but the decision was made by a local medical practice due to circumstances beyond their control with unexpected changes to NHS policy.

https://www.bbc.co.uk/news/live/uk-england-devon-47170553

Ottery Town Council (particularly Councillor Carter) makes itself a laughing stock (again)

Owl says: It is well-known that Councillor Carter (one of the Greendale Carters) has no love for independent councillors!

https://eastdevonwatch.org/2018/11/07/majority-of-ottery-town-council-remarkably-unconcerned-about-the-future-of-their-hospital/

https://eastdevonwatch.org/2019/02/08/decision-overturned-to-set-up-ottery-hospital-working-group/

From the blog of Independent Councillor Claire Wright:

“Ottery St Mary Town Council revisited the contentious issue of whether it should support setting up a group to ensure the future of Ottery Hospital at yet another fraught meeting on Monday 4 February.

A bit of background information – at the town council meeting on 6 November a similar proposal was agreed by three votes to nil. Subsequently the town council abstainers (who thought that they had won) called for an extraordinary town council meeting to overturn the decision, which took place on 29 November.

Subsequently it became known that two members of the Health and Care Forum had established a limited company whose purpose is unclear.

I still find it hard to believe that a proposal to set up a working group to help retain the hospital, by a councillor – Geoff Pratt, who was asked as to help by the Health and Care Team Chair, has resulted in a bitter row lasting four months.

Our offer of help has been sullied, dragged through the dirt and subject to chicanery by political opponents who appear to be engaging in some kind of strange game of cat and mouse. I have been insulted on social media and mine and the town’s residents continued efforts over the years to retain the hospital and its beds have been rudely ridiculed and dismissed.

Myself and Dr Margaret Hall, who was also subject to unpleasantness, have both pulled out of any potential group as a result. It was difficult to believe the level of vitriol from a minority of people.

On Monday evening the town council finally agreed to meet with the hospital League of Friends Chair, Adrian Rutter, who came across as the voice of reason on Monday evening. However, as soon as the row seemed to abate, Cllr Paul Carter bizarrely decided to reignite it by insinuating that our offer of help was a bid to cause trouble.

One councillor announced that she didn’t think Mr Rutter should be allowed to speak as he hadn’t asked to do so at the beginning of the meeting!

Cllr Carter then accused me of smirking (I was doing anything but smirking!) and the mayor refused to let me respond. I did, however, manage to ask Cllr Carter why he was trying to reignite the row again.

Once again there were raised tempers, including from members of the public. One of whom told me afterwards it was one of the worst town council meetings he had ever attended.

It was not very clear what was agreed, but I believe the town council deferred a decision to establish the working group.”

http://www.claire-wright.org/index.php/post/ottery_town_council_to_meet_with_league_of_friends_chairman

“Decision overturned to set up Ottery Hospital working group”

What IS going on at Ottery town council? Sounds like a nest of vipers! AND a nest of political chicanery … Who IS it (or who are they) fomenting this silly behaviour – and why? If you can’t work together for the good of the community – should you even be a councillor at all?

“A proposal to create a working group to safeguard Ottery Hospital has been overturned following more heated debate over how to save it.

A motion was submitted on January 24, signed by councillors Glyn Dobson, Ian Holmes, Anne Edwards and Lynn Harding, to re-examine the decision to support or rescind a motion to set up the group.

The proposal was passed in November, with many councillors abstaining due to a lack of information or because they felt it would duplicate the work of the town’s health and care forum.

Residents had their say at an extraordinary meeting on November 29, when a motion was first made to re-examine the motion.

The decision was deferred until February to allow organisations involved in saving the hospital to meet and gather information.

Speaking at Monday’s town council meeting, Councillor Roger Giles, who supported the group, said: “The purpose of the working group was to bring all sorts of organisations and good people together to embrace the skill and expertise and energy of the LOF (League of Friends).

“I really can’t see why we are not doing something – we need to campaign, we need to get as many services as we can in Ottery Hospital.

“Fill it up, get it used to capacity, and ensure its future. That’s the essence of what I am trying to achieve.”

Adrian Rutter, chairman of the hospital League of Friends, said everyone had the same aim but did not share a way of working together.

Mayor Paul Bartlett offered to meet representatives from the health and care forum and League of Friends to discuss any problems between the two groups.

Members voted to rescind the group by five votes to three.

Following the vote, Deputy Mayor Paul Carter said he was ‘disappointed’ members were failing to pull together.

He said: “If you have expertise that can help what’s already happening, why not help and join in?

“I cannot believe we’re all grown-ups down this table and we keep going down different avenues.

“I would very much like, going forward, to try and pull together and look down the same road.”

He added: “We do not need to be going on independent routes to be a collective and a team.

“I always say we’re stronger together.”

https://www.sidmouthherald.co.uk/news/decision-overturned-to-set-up-ottery-hospital-working-group-1-5883068

Chilling report on NHS sustainability – it isn’t sustainable

Owl says: anyone who cares about the NHS should read EVERY PAGE of this 58-page report, which is written in clear and accessible language.

Every page signals a death-knell for the NHS sooner rather than later.

It is hard to pick out anything – every page tells a story of (deliberate?) mismanagement, underfunding and chaotic accounting.

For example:

“Key findings

The funding settlement for the NHS long-term plan

8 The long-term funding settlement does not cover key areas of health spending. The 3.4% average uplift in funding applies to the budget for NHS England and not to the Department’s entire budget. The Department’s budget covers other important areas of health spending such as most capital investment for buildings and equipment, prevention initiatives run by Public Health England and local authorities, and funding for doctors’ and nurses’ training. Spending in these areas could affect the NHS’s ability to deliver the priorities of the long-term plan, especially if funding for these areas reduces. The government will consider proposals in these areas as part of its 2019 Spending Review. In addition, without a long-term funding settlement for social care, local NHS bodies are concerned that it will be very difficult to make the NHS sustainable (paragraphs 2.27 and 2.28).

9 There is a risk that the NHS will be unable to use the extra funding optimally because of staff shortages. Difficulties in recruiting NHS staff presents a real risk that some of the extra £20.5 billion funding will either not be used optimally (more expensive agency staff will need to be used to deliver additional services) or will go unspent as even if commissioners have the resources to commission additional activity, health care providers may not have the staff to deliver it (paragraphs 1.19 and 2.29).

10 From what we have seen so far, the NHS long-term plan sets out a prudent approach to achieving the priorities and tests set by the government, but a number of risks remain. The long-term plan describes how the NHS aims to achieve the range of priorities and five financial tests, set by the government in return for the long-term funding settlement, which NHS England believes are stretching but feasible. As with all long-term plans, it provides a helpful indicator of the direction of travel, but significant internal and external risks remain to making the plan happen. These risks include: growing pressures on services; staffing shortages; funding for social care and public health; and the strength of the economy. Our reports have highlighted how previous funding boosts appear to have mostly been spent on dealing with current pressures rather than making the changes that are needed to put the NHS on a sustainable footing (paragraphs 2.24 to 2.26).

Financial and operational performance of NHS bodies

11 In 2017-18, NHS commissioners and trusts reported a combined deficit of £21 million. This was made up of:

The combined deficit of £21 million does not include adjustments needed to report against the Department’s budget for day-to-day resources and administration costs.

12 It is not clear that funding is reaching the right parts of the system.
The overspends by trusts and CCGs were broadly offset by the underspend by NHS England. In 2017-18, NHS England’s underspend included: £962 million from non-recurrent central programme costs, including efficiencies from vacancies;

a £280 million contribution to the risk reserve and £223 million from centrally commissioned services, mostly specialised services (paragraphs 1.4 and 1.8).

13 Most of the combined trust deficit is accounted for by a small number of trusts, while the number of CCGs in deficit increased in 2017-18. The net trust deficit hides wide variation in performance between trusts, with 100 out of 232 trusts in deficit. In 2017-18, 69% of the total trust deficit was accounted for by 10 trusts. NHS Improvement has committed to returning the trust sector to balance in 2020-21, but it is difficult to see how this will be achieved for the worst-performing trusts under current arrangements. Although support provided to trusts in NHS Improvement’s financial special measures programme has been successful in improving the position of some trusts (by £49 million in 2017-18), the financial performance of the 10 worst-performing trusts deteriorated significantly in 2017-18. Between 2016-17 and 2017-18, the number of CCGs reporting overspends against their planned position increased from 57 to 75. The NHS long-term plan sets out the national bodies’ aim that no NHS organisation is reporting a deficit by 2023-24 (paragraphs 1.6 and 1.11).

14 There are indications that the underlying financial health in some trusts
is getting worse. In 2017-18, trusts reported that their combined underlying deficit was £4.3 billion, or £1.85 billion if the Provider Sustainability Fund (which replaced the Sustainability and Transformation Fund in 2018-19) is allocated to trusts in future years. There is no historical data on the underlying deficit that takes account of one-off savings, emergency extra cash and other short-term fixes that boost the financial position of the NHS, so it is not clear whether this position is getting better or worse. However, indicators such as cash support and one-off efficiency savings suggest the position has not improved. For example, in 2017-18, the Department gave £3.2 billion in loans to support trusts in difficulty, up from £2.8 billion in 2016-17. In 2017-18, 26% of trusts’ savings were one-off. Trusts will need to make additional savings in 2018-19 to replace these one-off savings (paragraphs 1.13, 1.14, 2.13, 2.17 and 2.18).”

Click to access NHS-financial-sustainability_.pdf

“NHS and councils full of financial problems, says watchdog”

“National Audit Office shocked by state of bodies including police and fire authorities.

The number of NHS and local government bodies with significant financial weaknesses in their ability to give value for money is unacceptably high and increasing, according to Whitehall’s spending watchdog.

The National Audit Office has examined the financial statements from nearly 937 local health authorities, councils, police and local fire bodies which are responsible for about £154bn of net revenue spending every year.

Auditors conclude in a report published on Wednesday that the number of local bodies with significant weaknesses increased from 170 (18%) in 2015-16 to 208 (22%) in 2017-18.

It follows the publication of an International Monetary Fund report in October which found that the UK’s public finances were among the weakest in the world after the 2008 financial crash.

Sir Amyas Morse, the head of the NAO, said he was shocked by the persistent high level of qualified audit reports at local public bodies.

“A qualification is a judgment that something is seriously wrong, but despite these continued warnings, the number of bodies receiving qualifications is trending upwards,” he said.

“Let us hear no cries of: ‘Where were the auditors?’ when things go wrong. The answer will be: ‘They did the job, but you weren’t listening.’

“This is not good enough. Local bodies need to address their weaknesses, and departments across government should ensure they are challenging local bodies to demonstrate how they are responding.”

Each year, local auditors give an opinion on whether local public bodies have produced financial statements which comply with reporting requirements and are error-free, and conclude whether local public bodies have arrangements to manage their business and finances.

Wednesday’s report examined accounts from 495 local authorities, local police and local fire bodies in England; and 442 local local NHS bodies in England, which include clinical commissioning groups, NHS trusts and NHS foundation trusts.

In the NHS, the number receiving qualified accounts rose from 130 (29%) to 168 (38%) across the same period. The number of local government bodies receiving qualified conclusions was 40 (8%) in 2015-16, but 18% of single-tier local authorities and county councils received a qualification in 2017-18.

Meg Hillier, the chair of parliament’s public accounts committee, said: “It is deeply concerning that local auditors are raising increasing numbers of concerns about local bodies’ arrangements to secure value for money, but these are often not being listened to and there is no consequence for the local bodies themselves.

“With ever-stretched public services, citizens deserve to know that there are effective arrangements in place to make sure they are getting value for money.

“Local auditors should be using the full range of their powers and local bodies should be acting on their findings transparently, with departments holding them to account.”

https://www.theguardian.com/society/2019/jan/10/nhs-and-councils-full-of-financial-problems-says-watchdog

NHS: the REAL cost of privatisation

“The biggest emergencies-only hospital in Europe will take three years longer than expected to build and cost nearly twice its original budget.

The Midland Metropolitan Hospital was intended to treat 170,000 A&E patients a year from this summer but will not open until 2022. It will also cost at least £605 million, despite originally being priced at £350 million.

The problems were highlighted after Theresa May unveiled a ten-year strategy for the health service that included a £20 billion spending boost by 2023. The delay and increased costs were caused by the collapse a year ago of the construction company Carillion, halting building under the private finance initiative. The failure forced the NHS to implement contingency plans in 14 hospitals to maintain essential services delivered by Carillion.

The new 670-bed hospital in Smethwick, West Midlands, is meant to replace large parts of Sandwell Hospital and City Hospital, Birmingham. Carillion was paid £205 million towards the project before the firm’s collapse.

Toby Lewis, chief executive of the Sandwell and West Birmingham Hospitals NHS Trust, told its board last month that more than £400 million would be spent completing the hospital and keeping emergency services running at the Birmingham hospital.

The trust is paying Balfour Beatty, the construction company, £10 million to “winter-proof” the new hospital, which was left open to the elements. It is poised to seek bids from companies to complete the building, although some have already made clear that they are not interested.

John Spellar, Labour MP for Warley, said that outlay on maintaining existing hospital facilities had been cut in anticipation of the new building and that the delay was affecting recruitment and training. He said that civil servants were to blame for transferring too much risk to the private sector when they had “no concept what it actually means”.

A parliamentary inquiry into the failure of the multinational contractor with liabilities of almost £7 billion found that its “business model was an unsustainable dash for cash. The mystery is not that it collapsed but how it kept going for so long”.

Carillion was also building the Royal Liverpool Hospital, which features in a BBC Two documentary to be broadcast tomorrow. Aidan Kehoe, chief executive of the Royal Liverpool, tells the Hospitalprogramme: “I am very angry at the way Carillion have behaved. To leave us in this position is, I think, just unacceptable. These people are taking huge bonuses that they are not paying back and they are leaving the people waiting years more for a hospital. Serious questions have to be asked about the way Carillion have behaved.”

The £500 million Liverpool hospital building was due to be finished two years ago but is not expected to be completed until next year.

Jayne Halloran, an associate director at the Royal Liverpool and Broadgreen University Hospital Trust, said that it was expensive to maintain the partially built hospital, where 14 staff work full time turning taps on and off to stop legionella bacteria from growing. “It takes six days to complete that for the whole building,” Ms Halloran said.”

Source: Times, pay wall

“Andrew Lansley law that forced hospitals to compete could be axed”

Note: this 10-year plan does not tackle the crisis in social care nor the bigger crises of not having enough staff for either service.

[Andrew Lansley’s 2012 act made local GP groups “customers” to buy services from competing hospitals]

“Implementing the new ten-year plan could involve the reversal of market-based reforms introduced in 2012 by the former health secretary Andrew Lansley.

More than 100 local bodies would be merged under proposals to move away from internal health service competition and make parts of the NHS work more closely together.

The request for new laws by Simon Stevens, head of NHS England, sets the government up for a battle in the Commons. The reversal of the reforms is also likely to prove embarrassing for the Conservatives. Labour has already demanded an apology for a “bureaucratic disaster” that it says wasted billions.

The Health and Social Care Act 2012 made local GP groups “customers” to buy services from competing hospitals and other providers. It provoked opposition from health unions who said that it would fragment care. Senior Tories came to regard it as the coalition government’s biggest mistake.

Ministers will seek to present the changes as commonsense tidying up measures requested by the NHS. They hope that this will avoid a divisive political battle, but while opposition to privatisation was a key Labour objection to the act the party is unlikely to back a Conservative NHS reform.

In the ten-year plan Mr Stevens argues that there are too many NHS institutions working autonomously when they need to work together to join up care for patients. While arguing that his plan could be achieved in current structures, he said that changes to the law “would support more rapid progress”.

Matt Hancock, the health secretary, said: “We want to foster a culture of ambition and innovation in the way our health sector organises the services it delivers. I am prepared to make the changes necessary for this to become a reality, including changing the law.”

Jonathan Ashworth, the shadow health secretary, said: “The fact NHS bosses are now proposing significant changes to the Health and Social Care Act confirms what a wasteful, bureaucratic disaster it was in the first place.”

Source: The Times (paywall)

EDDC says community hospitals do not contribute to social well-being

“Here is my letter, about Ottery Hospital, which was published in the Sidmouth Herald about ten days ago [from Ottery Hospital campaigner Philip Algar]:

Last August, I asked the Ottery Town Council to request the East Devon District Council to declare the Ottery Hospital to be an asset of community value. Such a designation would have delayed any decision by NHS Properties to sell the hospital.

The request was rejected by EDDC because the hospital was not a community asset.

Unlike swimming pools and pubs, it did not contribute to “social wellbeing”! This is manifest nonsense but there is a more disturbing aspect to this EDDC decision which challenges common sense and justice.

Apparently, there is no precise definition of social wellbeing so any determination must be subjective. This is demonstrated by the fact that three district councils in Devon have granted the status to hospitals in their areas.

This raises some serious questions.

What was different about the request to give the Ottery hospital this designation? EDDC admit that they gave more weight to an NHS objection than they did to the wishes of the people of Ottery and district whom they are supposed to represent.

Why did NHS Properties oppose this proposal whilst other councils granted the desired status to hospitals serving their electors? Who should we blame for having our hospital treated in this way? Is it EDDC for cravenly giving in to the NHS or should it be the NHS itself which may plan to close the hospital entirely and sell the site and so opposes any action that could delay implementing such a decision?”