Download or read book Securing the future financial sustainability of the NHS written by Great Britain: National Audit Office and published by The Stationery Office. This book was released on 2012-07-05 with total page 48 pages. Available in PDF, EPUB and Kindle. Book excerpt: 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

Download or read book Department of Health written by Great Britain: Parliament: House of Commons: Committee of Public Accounts and published by The Stationery Office. This book was released on 2012-10-30 with total page 52 pages. Available in PDF, EPUB and Kindle. Book excerpt: Ensuring a viable financial future for healthcare providers is vital if the public are to have confidence in the delivery of their local services. In 2011-12 NHS organisations in England reported a combined overall surplus of £2.1 billion. There were, however, significant variations in performance between NHS bodies. 377 NHS organisations reported a surplus in the year, but 10 NHS trusts, 21 NHS foundation trusts and three Primary Care Trusts (PCTs) reported a combined deficit of £356 million. Eleven NHS foundation trusts would not have made foundation trust status today given their financial performance, and there is a real concern that some organisations will fail. The very difficult financial situation of some NHS bodies is particularly marked in London, where two trusts reported a combined deficit of £115 million. The Department placed one of these, South London Healthcare NHS Trust, in special administration in July 2012. Also a number of trusts in financial difficulty have PFI contracts with fixed annual charges that are so high the trusts cannot break even. The Department was unable to spell out to the Committee a clear plan to achieve financial sustainability and a clear strategy for dealing with financial failure in individual trusts. The Department could not provide adequate reassurances that financial problems would not damage either the quality of care or equality of access to all citizens, wherever they live.

Download or read book Public Expenditure on Health and Care Services written by Great Britain: Parliament: House of Commons: Health Committee and published by The Stationery Office. This book was released on 2013-03-19 with total page 166 pages. Available in PDF, EPUB and Kindle. Book excerpt: This report states that the values of the NHS will only be reflected in practice if NHS and social care services are 're-imagined'. The care provided by the health and social care system will break down if quicker progress is not made to develop more integrated health and social care services which focus on meeting the needs of individual patients. It is unlikely that public expenditure on health and social care services will increase significantly in the foreseeable future. This means that the only way to sustain or improve present service levels in the NHS will be to focus on a transformation of care through genuine and sustained service integration. There must be a much more joined up approach to commissioning health and care services. On other issues the Health Committee also concludes: measures currently being used to respond to the Nicholson Challenge too often represent short-term fixes rather than the sustainable long-term service transformations; changes in tariff payments within the NHS do not constitute ’efficiency savings' - they are simply internal transfers; under-spending against budget of money allocated to the NHS has attracted adverse comment and the MPs call for a general review of the operation of Treasury rules; the NHS will not be able to rely on the present rate of paybill savings once the present restraints on public sector pay are relaxed in April 2013

Download or read book Peterborough and Stamford Hospitals NHS Foundation Trust written by Great Britain: National Audit Office and published by The Stationery Office. This book was released on 2012-11-29 with total page 48 pages. Available in PDF, EPUB and Kindle. Book excerpt: The board of Peterborough and Stamford NHS Trust failed to recognize in 2007 that a PFI scheme to build a new hospital, Peterborough City Hospital, would place considerable strain on its finances for years to come. The then board compounded the decision to proceed with the scheme, which it could not afford, with a failure to monitor other changes affecting its income and costs between 2007 and 2011. In 2011-12, the in-year deficit was £46 million and the Trust is predicting an in-year deficit of more than £50 million in 2012-13. Monitor, the regulator of foundation trusts, raised well-founded concerns about the scheme's affordability with the Trust Board and the Department, however neither addressed these concerns fully before approval of the business case. Despite its earlier views, the regulator rated the Trust as a very low financial risk, reflecting its reported financial position but this risk rating did not reflect the future impact of the PFI development. Monitor had a number of opportunities to intervene before finally placing the Trust in breach of its terms in October 2011 but concluded that an intervention would not necessarily improve or change the outcome positively. The level of healthcare undertaken by the Trust is also greater than envisaged in the PFI business case, which assumed a 14 per cent drop in outpatient activity whereas this increased by 21 per cent. In addition, NHS Peterborough, the Trust's main commissioner, which has been in financial difficulty itself, has used national and local performance indicators to withhold payments for activity undertaken by the Trust

Download or read book The Politics of Public Sector Reform written by M. Burton and published by Springer. This book was released on 2013-06-17 with total page 276 pages. Available in PDF, EPUB and Kindle. Book excerpt: The first comprehensive 'bird's eye' account of public sector reform supported by references from over 400 official sources, this book is an invaluable guide to all those in the public, private and voluntary sectors grappling with the twin challenges of managing public spending austerity and the pressure in response to transform public services.

Download or read book The New Politics of the NHS Seventh Edition written by Rudolf Klein and published by CRC Press. This book was released on 2019-05-20 with total page 473 pages. Available in PDF, EPUB and Kindle. Book excerpt: The New Politics of the NHS has become established over 30 years as the key overview of the NHS, its processes and paths of influence. The seventh edition remains a clear, easy-to-read guide to often complex debates. It encompasses both the background of the evolution of the NHS since its foundation, and a completely up-to-date picture of its prese

Download or read book Public Private Partnerships and the Law written by Yseult Marique and published by Edward Elgar Publishing. This book was released on 2014-08-30 with total page 329 pages. Available in PDF, EPUB and Kindle. Book excerpt: This timely book examines the legal regulation of Public_Private Partnerships (PPPs) and provides a systematic overview of PPPs and their functions. It covers both the contractual relationships between public and private actors and the relationships be

Download or read book Restructuring of the National Offender Management Service written by Great Britain: Parliament: House of Commons: Committee of Public Accounts and published by The Stationery Office. This book was released on 2013-03-05 with total page 40 pages. Available in PDF, EPUB and Kindle. Book excerpt: The National Offender Management Service directly manages 117 public prisons, manages the contracts of 14 private prisons, and is responsible for a prisoner population of around 86,000. It commissions and funds services from 35 probation trusts, which oversee approximately 165,000 offenders serving community sentences. For 2012-13, the Agency's budget is £3,401 million. The Agency achieved its savings targets of £230 million in 2011-12 and maintained its overall performance, despite an increase in the prison population. However, the Agency's savings targets of £246 million in 2012-13, £262 million in 2013-14 and £145 million in 2014-15 are challenging. The Agency believes it has scope to make the prison estate more efficient by closing older, more expensive prisons and investing in new ones. These plans, however, assume the prison population will stay at its current level. Furthermore, the Agency has not yet secured the up-front funding for the voluntary redundancies needed to bring down prison staffing costs. Unless overcrowding is addressed and staff continue to carry out offender management work it is increasingly likely that rehabilitation work needed to reduce the risk of prisoners reoffending will not be provided. The Agency has not done enough to address the risks to safety, decency and standards in prisons and in community services arising from staffing cuts implemented to meet financial targets. The Agency plans to increase the role of private firms and the third sector in probation but the probation trusts don't appear to have the infrastructure and skills they need to commission probation services from these providers effectively

Download or read book Funding for Local Transport written by Great Britain: Parliament: House of Commons: Committee of Public Accounts and published by The Stationery Office. This book was released on 2013-02-05 with total page 40 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Department for Transport works with local partners to deliver many of its policies. Local authorities play a key role in planning and commissioning transport services, such as bus and light rail, and providing and maintaining roads and other local infrastructure. They spent a total of £8.5 billion on transport in 2010-11. The Department provided around a quarter of this (£2.2 billion), with the rest raised locally from council tax, from the £411 million surplus raised from parking levies, or from the Department for Communities and Local Government formula grant. In 2011-12 the Department provided £1.2 billion to local authorities for highways maintenance and small transport projects in the form of two un-ringfenced formula-based grants. The Department does not monitor how un-ringfenced grants are spent and there is insufficient information to determine the impact of the Department's contribution on local authorities' spending decisions and therefore to achieving the Department's objectives. The Department plans to devolve more control over its funding to the local level (raising the proportion of resources which are not ringfenced portion from 60% to around 80%); and new local transport bodies will take on some decision-making responsibilities previously held centrally. Full details of how the new system will work are still to be determined and there is uncertainty over how the arrangements will work in practice.

Download or read book HM Treasury written by Great Britain: Parliament: House of Commons: Committee of Public Accounts and published by The Stationery Office. This book was released on 2013-04-29 with total page 44 pages. Available in PDF, EPUB and Kindle. Book excerpt: Infrastructure UK, an advisory unit within the Treasury, was established in 2010 with a remit to specify what economic infrastructure is needed in the UK, to identify the key barriers to achieving that investment and to mobilise systems and resources, both public and private to make it happen. The first National Infrastructure Plan was published in 2010. The latest update of the plan, published in December 2012, comprised over 500 prospective programmes and projects for new economic infrastructure expected to cost £310 billion. Some 64% of this amount is expected to be spent on infrastructure that will be wholly owned and financed by the private sector with households bearing the costs through higher bills or fares. Many of the investment proposals impact on energy supply and are therefore particularly time critical. The Committee believes that this will lead to higher costs which will be borne by consumers and are particularly concerned at the impact of higher energy bills on those with low incomes. Many of the programmes are broad categories and in total they include more than 200 individual projects. This does not suggest a properly targeted and prioritised infrastructure plan. Furthermore, the statutory framework provided by the Energy Bill is coming rather late in the day when the energy crunch is fast approaching. It is likely that the UK will buy ever more energy from overseas and at a higher price due to the failure to secure investment. In these circumstances greater transparency is needed over investors' costs, risks and rewards

Download or read book HC 1141 The Work of the Committee of Public Accounts 2010 15 written by Great Britain. Parliament. House of Commons. Committee of Public Accounts and published by The Stationery Office. This book was released on 2015 with total page 41 pages. Available in PDF, EPUB and Kindle. Book excerpt: This report summarises the key areas of the Committee's work over the past five years. It draws out the areas where progress has been made and where their successors might wish to press in future. The Committee has assiduously followed the taxpayer's pound wherever it was spent. Since 2010 they held 276 evidence sessions and published 244 unanimous reports to hold government to account for its performance. 88% of their recommendations were accepted by departments. In many cases they successfully secured substantial changes, for example with the once secret tax avoidance industry. They secured consensus from government and from industry that private providers of public services do have a duty of care to the taxpayer, and in pushing the protection of whistleblowers further up the agenda of all government departments. By drawing attention to mistakes in the Department for Transport's procurement of the West Coast Mainline, more recent procurements for Crossrail, Thameslink and Intercity Express have all benefited from more expert advice and a more appropriate level of challenge from senior staff. After discovery in 2012-13 that 63% of calls to government call centres were to higher rate telephone numbers, the Government accepted our recommendation that telephone lines serving vulnerable and low income groups never be charged above the geographic rate and that 03 numbers should be available for all government telephone lines. They also secured a commitment to close large mental health hospitals.

Download or read book HM Revenue and Customs written by Great Britain. Parliament. House of Commons. Committee of Public Accounts and published by The Stationery Office. This book was released on 2012-12-03 with total page 84 pages. Available in PDF, EPUB and Kindle. Book excerpt: This report looks at a range of issues among HM Revenue & Customs' activities, but principally into the corporation tax paid by multinational companies. International companies are able to exploit national and international tax structures to minimise corporation tax on the economic activity they conduct in the UK. It is believed that this practice is widespread and that HMRC is not taking sufficiently aggressive action to assess and collect the appropriate amount of corporation tax. Both HMRC and corporate taxpayers are failing to meet the legitimate public expectations from the tax system. Evidence received was unconvincing, in some cases evasive, and there is concern that multinationals have an unfair competitive advantage. A change of mindset needs also to apply to HMRC's approach to the Tax Gap - the difference between tax collected and that which, in the Department's view, should be collected. While total tax revenues have increased by £4 billion since 2010-11, the Department's own assessment of the gap stands at £32 billion and has only reduced by £1 billion since 2004-05. HMRC deserves praise for clearing the backlog of un-reconciled legacy PAYE cases, before its target of December 2012, but is too complacent about the service it provides to customers. The next challenges HMRC faces are the roll-out of the Real Time Information system and the changes to child benefit. The system is vital for the Department for Work and Pensions' introduction of Universal Credit, but HMRC has no contingency planning to cope with any delays in implementation. The Department's performance in reducing the level of error and fraud on the tax credits it pays has got worse rather than better, and it has failed to meet its target

Download or read book Tax Avoidance written by Great Britain: Parliament: House of Commons: Committee of Public Accounts and published by The Stationery Office. This book was released on 2013-02-19 with total page 66 pages. Available in PDF, EPUB and Kindle. Book excerpt: HMRC estimates that in 2010-11 the tax gap due to avoidance was £5 billion and that the present total tax at risk from avoidance over time is £10.2 billion. There is a proliferation of contrived schemes which exploit loopholes in legislation and abuse available tax relief schemes. Promoters are deliberately taking advantage of the time lag between the launch of a scheme and the closure of the scheme by HMRC. Promoters and providers sign up as many clients as possible before HMRC changes the law and shuts the scheme. They then move on to a new scheme and repeat the process. The complexity of tax law creates opportunities for avoidance, there is no effective deterrent, and HMRC is ineffective in challenging promoters. All too often Government introduces tax incentives to stimulate economic activity that become an opportunity for tax avoidance. Promoters collect their fees even when the schemes are found not to deliver a tax advantage and few schemes are covered by mis-selling regulations. Those who promote a tax avoidance scheme are required to notify HMRC of the scheme however, HMRC does not know how much avoidance is not disclosed but should. It is alarming that some QCs' opinions are being used by promoters as a "reasonable excuse" for non-disclosure which prevents HMRC from applying a penalty. HMRC could learn from how other countries deter and tackle tax avoidance. HMRC should also name and shame those who promote tax avoidance schemes, to harness public opinion and reduce the appetite of companies to promote or use avoidance schemes.

Download or read book Excess Votes in 2011 12 written by Great Britain: Parliament: House of Commons: Committee of Public Accounts and published by The Stationery Office. This book was released on 2013-02-07 with total page 22 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Ministry of Defence written by Great Britain: Parliament: House of Commons: Committee of Public Accounts and published by The Stationery Office. This book was released on 2013-02-28 with total page 42 pages. Available in PDF, EPUB and Kindle. Book excerpt: The National Audit Office report on this topic published as HC 190, session 2012-13 (ISBN 9780102975529)

Download or read book Department for Transport written by Great Britain: Parliament: House of Commons: Committee of Public Accounts and published by The Stationery Office. This book was released on 2013-02-26 with total page 48 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Department for Transport's complete lack of common sense in the way it ran the West Coast franchise competition has landed the taxpayer with a bill of £50 million at the very least. If you factor in the cost of delays to investment on the line, and the potential knock-on effect on other franchise competitions, then the final cost to the taxpayer will be very much larger. The Department made fundamental errors in calculating the level of risk capital it would require bidders to put on the table and it did not demand appropriate levels of capital from both bidders. Faced with the possibility of legal challenge, it cancelled the competition. The Department failed to learn from mistakes made in previous projects. Recommendations made in the Committee's report 'The failure of Metronet' (HC 390, session 2009-10, ISBN 9780215544216) to prevent a lack of oversight and information were clearly not applied in this competition. Cuts in staffing and in consultancy budgets contributed to a lack of key skills. There was no single person responsible from beginning to end and, therefore, no one who had to live with the consequences of bad policy decisions. For three months, there was no single person in charge at all. Not only that, there was no senior civil servant in the team responsible for the work, despite the critical importance of this multi-billion pound franchise. Given that the Department got it so wrong over this competition, there is concern over how properly it will handle future projects, including HS2 and Thameslink

Download or read book The Ministry of Justice s Language Service Contract written by Great Britain: Parliament: House of Commons: Committee of Public Accounts and published by The Stationery Office. This book was released on 2012-12-14 with total page 78 pages. Available in PDF, EPUB and Kindle. Book excerpt: Before January 2012, the Ministry generally booked interpretation services directly with individual interpreters, many of whom were listed on the National Register of Public Service Interpreters (NRPSI). This approach was administratively inefficient and the Ministry decided to set up a new centralised procurement system. The Ministry awarded the contract to a company, ALS, that was clearly incapable of delivering. Despite having been warned that ALS was too small to shoulder a contract worth more than £1 million, it went ahead and handed them an annual £42 million national contract. The Ministry did not understand its own basic requirements and ignored the views of interpreters, who had serious concerns about the contract. Capita took over ALS in late 2011. The Ministry needed access to 1,200 interpreters when the contract went live but the company had only 280 properly assessed interpreters willing to work for it. The Ministry, though, still decided to go live nationally in one go. Many of the 'interpreters' it thought were available had simply registered an interest on the company's website and had been subject to no official checks. As a result, the company was able to meet only 58% of bookings causing a sharp rise in delayed, postponed and abandoned trials; individuals being kept on remand solely because no interpreter was available; and the quality of interpreters has at times been appalling. However Capita has only been fined £2,200 to date for failing to meet the terms of the contract. Capita-ALS is now fulfilling more bookings, but it is still struggling