Achievement Of Foundation Trust Status By Nhs Hospital Trusts
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| Author | : Great Britain: National Audit Office |
| Publisher | : The Stationery Office |
| Total Pages | : 40 |
| Release | : 2011-10-13 |
| Genre | : Medical |
| ISBN | : 9780102976724 |
Many NHS trusts need to tackle a range of financial, quality and governance issues if they are to meet the standards required of them to become self-governing foundation trusts by 2014. The Department of Health and the NHS will now have to decide how they will deal with those facing the most severe problems. The processes the Department has put in place to help NHS trusts achieve foundation status have brought matters to a head, by highlighting the challenges many trusts face in proving their long term viability. At least 20 trusts face such substantial problems that they are not financially or clinically viable in their current form. These problems are often deep-seated and long-standing. Size and location can cause problems, including a mismatch between hospital capacity and local demand for services from commissioners. In some cases the Department will need to be involved in decisions about and support for reconfigurations of local hospital services. Other trusts may have less severe problems, but will still have to improve their financial and, in some cases, clinical performance if they are to be sustainable in the long term and become foundation trusts. The most common challenges are financial. An initial review of 22 trusts with major PFI schemes has identified up to six trusts for which the scale of debt repayments, together with other financial problems, means that they are not currently viable. Trusts also face a great challenge in making year-on-year cost savings of at least four per cent.
| Author | : Great Britain: National Audit Office |
| Publisher | : The Stationery Office |
| Total Pages | : 48 |
| Release | : 2012-07-05 |
| Genre | : Medical |
| ISBN | : 9780102977202 |
Although in 2011-12 there was a surplus of £2.1 billion across the NHS as a whole, there is also some financial distress, particularly in some hospital trusts. In the long term, achieving financially sustainable healthcare is likely to mean changes to how and where people access services, and some local commissioners are already consulting on and developing plans to do this. Currently, some organisations have relied on additional financial support from within the NHS. 10 NHS trusts, 21 NHS foundation trusts, and three Primary Care Trusts (PCTs) have reported a combined deficit of £356 million. There are four foundation trusts and 17 NHS trusts which between 2006-07 and 2011-12 needed injections of working capital from the Department of Health totalling £1 billion. The Department anticipates that NHS trusts and NHS foundation trusts are likely to need around £300 million more public dividend capital in 2012-13. 51 per cent of PCTs reported concern about the financial sustainability of their healthcare providers. Previously, PCTs and Strategic Health Authorities (SHAs) have been able to support otherwise weak providers. It is not yet clear whether clinical commissioning groups and the NHS Commissioning Board will agree to provide financial support to providers in this way. The NAO concludes that it is hard to see how continuing to give financial support to organisations in difficulty will be a sustainable way of reconciling growing demand for healthcare with the size of efficiency gains required within the NHS
| Author | : Great Britain: National Audit Office |
| Publisher | : Stationery Office |
| Total Pages | : 64 |
| Release | : 2013-07-18 |
| Genre | : Medical |
| ISBN | : 9780102986112 |
This update finds that there was a surplus of £2.1 billion across the NHS as a whole in 2012-13, matching that in 2011-12. The financial performance of NHS trusts and foundation trusts should be considered in the context of a period of little to zero growth in funding for NHS services over the last two years and during a period of significant structural change across the NHS. Measured by the total surplus or deficit of hospital trusts, financial performance for the NHS appears stronger in 2012-13 than it did in 2011-12. However, there are signs of increasing pressure. As last year, there was a substantial gap between the trusts with the largest surpluses and those with the largest deficits. When primary care trusts (PCTs) and strategic health authorities are also included, there is a similar variation between local health economies. NHS trusts in difficulty rely on cash support from the Department of Health or non-recurrent local revenue support from strategic health authorities and primary care trusts but this is not a sustainable way of reconciling growing demand with the scale of efficiency gains required within the NHS. At the end of 2012-13, there were still 100 NHS trusts that had not achieved foundation trust status. The risk that NHS trusts will not maintain their planned trajectory to foundation trust status increased substantially in 2012-13. This is a period of major transition for the NHS, as clinical commissioning groups take over from strategic health authorities and PCTs the responsibility for commissioning health services.
| Author | : Great Britain: Parliament: House of Commons: Committee of Public Accounts |
| Publisher | : The Stationery Office |
| Total Pages | : 52 |
| Release | : 2012-05-02 |
| Genre | : Business & Economics |
| ISBN | : 9780215044129 |
This report examines the risks and rewards for private equity investors in government private finance projects. The Private Finance Initiative (PFI) model has been used by governments in some 700 projects over the last 20 years but defects, including failures to demonstrate the value for money case satisfactorily, the use of long inflexible contracts and the costly contracting process, and inefficient pricing of equity have made continuing with the current model unsustainable. The Treasury is currently reviewing the PFI model. It needs to improve flexibility in the way that private finance is used, establishing quicker and more efficient procurement procedures and achieving a better balance between investors' risks and their rewards. Private finance should only be used where it secures real value for money for the taxpayer, not because of definitional statistical incentives to get projects off the balance sheet (only some 20% of long term PFI liabilities are recorded as debt in the national accounts). Business cases must be an unbiased and transparent assessment of the best form of procurement for the particular project being undertaken, taking account of expected tax receipts from alternative options and not adjusting assumptions to bias the outcome of the assessment. The Treasury needs to collect data on investors' experiences and use this information to assess and challenge investors' returns. There needs to be greater transparency over the pricing of contracts, and inefficiencies which add to the cost of private deals, such as long procurement times, need to be addressed.
| Author | : Great Britain: Parliament: House of Commons: Committee of Public Accounts |
| Publisher | : The Stationery Office |
| Total Pages | : 48 |
| Release | : 2012-05-22 |
| Genre | : Education |
| ISBN | : 9780215045102 |
The Department for Education provides funding for local authorities to pay for three and four year olds to receive their entitlement to 15 hours of free education each week. The Department devolves delivery to local authorities and providers but it is responsible for the overall value for money from the system. In 2011-12 the Department's estimated funding for the entitlement of £1.9 billion provided over 800,000 three and four year olds with access to free education; an estimated annual allocation of approximately £2,300 per child. While the Department and local authorities have focused on ensuring places for children are available, there has been less attention on how value for money can be secured and improved. While there is evidence of educational improvement at age five, the evidence that this is sustained is questionable. The Department needs to do more to understand how educational benefits can be lasting. There is not enough good information for parents to make informed choices and there is concern at reports that some families are still not receiving the entitlement free of charge. It is important that all parents know what the entitlement is and that it should be provided completely free. Early years education has the greatest benefit for children from disadvantaged backgrounds however these children have the lowest levels of take-up and deprived areas have the lowest levels of high quality services. The Department needs to identify and share good practice from those local authorities which are having the most success.
| Author | : Great Britain: Parliament: House of Commons: Committee of Public Accounts |
| Publisher | : The Stationery Office |
| Total Pages | : 44 |
| Release | : 2012-05-24 |
| Genre | : Business & Economics |
| ISBN | : 9780215045195 |
HMRC estimates that the tax gap - the difference between taxes due and the amount actually collected - stood at £35 billion (7.9% of tax due) in 2009-10, although other estimates suggest the figure is much greater. The Compliance and Enforcement Programme brought in £4.32 billion of tax revenue over the five years to 2010-11and is expected to generate a further £8.87 billion by 2014-15. However, in shedding more than 3,300 staff, the Department lost £1.1 billion in potential tax revenue: about £10 in tax lost for every £1 in running costs saved. The Committee is also not confident that the Department is sufficiently clear about the marginal rate of return it could achieve from different levels of spending. In order to live within funding limits, the Department had to defer the introduction of new systems or reduce their scope. In particular, by delaying implementation of its new Caseflow and Spectrum systems, the Department reduced the expected additional tax revenue of £743 million by 2010-11 to £547 million by 2014-15. In this Spending Review period £917 million has been allocated to further activities to tackle tax evasion and avoidance, and to collect more debt. This investment is more than double the money spent on the Programme over the last five years, and is expected to generate an additional £7 billion a year by 2014-15. It is therefore essential that the Department learns and applies lessons learnt. There was also alarm at reports that the Department had advised that the use of managed service companies to avoid tax could ever be appropriate for full-time employees of public bodies
| Author | : Great Britain: Parliament: House of Commons: Committee of Public Accounts |
| Publisher | : The Stationery Office |
| Total Pages | : 44 |
| Release | : 2012-03-13 |
| Genre | : Business & Economics |
| ISBN | : 9780215042927 |
As part of the 2010 Spending Review the government announced a significant reduction in the budget of the Department for Transport, with spending due to be 15% lower by 2014-15, in real terms, than the Department's £12.8 billion budget in 2010-11. The Department prepared early, identifying areas for budget reductions based on good analysis. But for road users, railway passengers and taxpayers, there are many questions which remain unanswered. The Department doesn't fully understand the impact of its cuts to road maintenance. There is concern that short-term budget cutting could prove counter-productive, costing more in the long-term as a result of increased vehicle damage and the higher cost of repairing the more severe road damage. Another area of concern is rail spending. The Department spends two-thirds of its budget through third party organisations such as Network Rail and Transport for London. While information and assurance have improved over some third party spending, there is still a lack of proper accountability and transparency for Network Rail. Rail budgets aren't being reduced as much as other areas, yet passengers still face high fares. The Department hands Network Rail over £3 billion each year, underwrites debt of over £25 billion and continues to treat it as a private sector company. The National Audit Office must be allowed full audit access as quickly as possible.. Better contingency plans for dealing with threats to its planned budget reductions also need to be developed - for example if some of its planned efficiency savings do not deliver or if inflation is higher than forecast
| Author | : Great Britain: Parliament: House of Commons: Committee of Public Accounts |
| Publisher | : The Stationery Office |
| Total Pages | : 44 |
| Release | : 2012-03-23 |
| Genre | : Education |
| ISBN | : 9780215043382 |
The Department for Business, Innovation and Skills and the Skills Funding Agency provide funding for further education students aged 19-plus. The Department for Education and the Young People's Learning Agency fund further education for 16-to-18-year-olds. These two departments provided £7.7 billion in funding to the sector during the 2010/11 academic year. The various government bodies that interact with the sector have different funding, qualification and assurance systems. Differences in the information required and collected create an unnecessary burden for training providers and divert money away from learners. To provide value for money, the systems need to be appropriate, efficient, avoid unnecessary duplication, and balance the protections they provide for public money with the costs of the bureaucracy they impose. No one body is currently accountable for reducing bureaucracy in the further education sector. Instead, the two Departments and the two funding agencies maintain separate responsibilities based on their funding streams. BIS has a stated policy objective of reducing bureaucracy imposed on further education providers but would not accept overall responsibility for bringing together efforts to reduce bureaucracy in the sector. Both BIS and DfE, and their funding agencies, have launched separate initiatives designed to simplify the requirements they place on providers. However BIS does not manage the simplification as a programme with a clear and consistent goal. While BIS has required the Agency to reduce its own administrative costs by 33%, there is no rational view on the amount by which they would like to reduce bureaucracy in providers nor do they accept that measurement of progress is necessary.
| Author | : Great Britain: Parliament: House of Commons: Committee of Public Accounts |
| Publisher | : The Stationery Office |
| Total Pages | : 48 |
| Release | : 2012-02-24 |
| Genre | : Education |
| ISBN | : 9780215041906 |
Almost a third of young people with a Statement of special educational needs at the age of 16 are not in any form of education, employment or training two years later. The Government spent £640 million on special education for 16- to 25-year-olds in 2009-10, yet too many of these young people are falling through the gaps after they leave compulsory education, damaging their life chances and leaving a legacy of costs to the taxpayer. The system is extremely complex and difficult to navigate, with an array of different providers. Too many parents and young people are not given the information they need to make decisions about what is right for them. But three quarters of local authorities do not give parents any information at all about the respective performance of schools, FE colleges and specialist providers. The Department doesn't know how much money is actually spent on support. The huge variation between local authorities in funding per student suggests that a postcode lottery is at work. Students with higher-level needs are placed on the basis of statutory assessments of need; however, witnesses emphasised just how patchy the quality of these assessments can be. The opportunity for reform presented by the Department's recent Special Educational Needs Green Paper should be used to address our concerns It is right for local authorities to decide how to meet the needs of young people in their area - but local people must have access to clear information so that they can hold local authorities to account for how well they deliver
| Author | : Great Britain: Parliament: House of Commons: Committee of Public Accounts |
| Publisher | : The Stationery Office |
| Total Pages | : 68 |
| Release | : 2012-01-17 |
| Genre | : Business & Economics |
| ISBN | : 9780215040480 |
Under European Directives, all member states are required to install 'intelligent metering systems' - smart meters - to at least 80% of domestic electricity consumers by 2020. The UK Government has opted for a more challenging programme, with plans for energy suppliers to install smart electricity and gas meters in all homes and smaller non-domestic premises in Great Britain by 2019. The Department estimates that the smart meters programme will cost some £11.7 billion. This large complex programme requires replacing around 53 million gas and electricity meters, with significant uncertainties over the estimated costs and benefits involved. Installation costs will be borne by consumers through their energy bills, but many of the benefits accrue in the first instance to energy suppliers. No transparent mechanism presently exists for ensuring savings to the supplier are passed on to consumers, and the track record of energy companies to date does not inspire confidence that this will happen. There remain significant uncertainties in a number of key areas in the programme and the Department needs to address these by conducting proper trials to identify and manage the risks associated with an IT project involving such a substantial amount of money which is financed by individuals as consumers. The Department needs to ensure that the vulnerable, those on low incomes and those who use prepayment meters also benefit from smart meters. It would be unacceptable if these consumers bore the costs of smart meters through higher charges without getting a share of the potential benefits.
