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Early action in public policy delivery involves the use of resources to tackle causes rather than symptoms. The Government spends nearly £400 billion each year on, for example, health, education, employment, justice and welfare, but huge numbers of people still suffer preventable health problems that are expensive to treat, too many young people leave school with too few qualifications and unable to get a job, too many young offenders commit further crimes when they leave prison, often because of drugs or alcohol addiction, and too many families get locked into benefit dependency. A concerted increase in effective early action could help to deal with the root causes of such problems, benefiting individuals and society and saving the taxpayer billions of pounds each year, but governments have consistently failed to deliver. Early action accounts for only a fraction of annual spending and this spending is not properly co-ordinated. There is no common definition of early action, no central ownership, and little capacity at the centre to drive effective delivery and share good practice. The Treasury is far too focussed on the short term. Robust evidence on the cost-effectiveness of early action and strong incentives for departments to implement early action projects are both vital. Good evidence, however, is thin on the ground and existing incentives do not seem to be working. Addressing social problems effectively also requires that departments work together but, despite some encouraging evidence of joint working amongst departments and at the local level, silo behaviour still predominates.
Universal Credit is the DWP's single biggest programme and enjoys cross-party support, yet its implementation has been extraordinarily poor. The failure to develop a comprehensive plan has led to extensive delay and the waste of a yet to be determined amount of public money. £425 million has been spent so far on the programme. It is likely that much of this, including at least £140 million worth of IT assets, will now have to be written off. Lack of day-to-day control meant early warning signs were missed, with senior managers becoming aware of problems only through ad hoc reviews. Pressure to deliver a programme of this magnitude within such an ambitious timescale created a fortress culture where only good news was reported and problems were denied. There has been a shocking absence of control over suppliers, with the Department failing to implement the most basic procedures for monitoring and authorising expenditure. The pilot programme is not a proper pilot. Its scope is limited and does not deal with the key issues that Universal Credit must address: the volume of claims; their complexity; change in claimants' circumstances; and the need for claimants to meet conditions for continuing entitlement to benefit. The programme will not hit its current target of enrolling 184,000 claimants by April 2014. The Department will have to speed up the later stages of the programme if it is to meet the 2017 completion date but that will pose new risks. Meeting any specific timetable from now on is less important than delivering the programme successfully
The New Homes Bonus was introduced as a financial incentive for local authorities to encourage the building of new homes. The scheme is funded from existing local authority grants. £7.5 billion will have been redistributed between councils by 2018-19, so there is a lot of money at stake. It is clearly vital that the incentives work and the Government achieves its aim. It is therefore disappointing that after more than two years of the scheme being up and running, no evaluation is in place and no credible data is available to show whether the scheme is working or not. So far the areas which have gained most money tend to be the areas where housing need is lowest. The areas that have lost most tend to be those where needs are greatest. The Department has yet to demonstrate whether the New Homes Bonus works. Is it helping to create more new homes than would have been built anyway? Is it the best way for Government to use its limited resources to create more homes where they are needed most? Its planned evaluation of the Bonus scheme is now urgent
Nearly one fifth of consultant posts in emergency departments were either vacant or filled by locums in 2012. Neither the Department nor NHS England have a clear strategy to tackle the shortage of A&E consultants and there is too much reliance on temporary staff to fill gaps. The Committee raised the possibility of paying consultants more to work at struggling hospitals. Greater use in A&E of consultants from other departments could also be made, or mandate that all trainee consultants spend time in A&E, or make A&E positions more attractive through improved terms and conditions. The slow introduction of round-the-clock consultant cover in hospitals - which will not be in place before the end of 2016-17 - is also having a negative impact. More people die as a result of being admitted at the weekend when fewer consultants are in A&E. Changing this relies on the British Medical Association and NHS Employers negotiating a more flexible consultants' contract, and neither the Department nor NHS England has direct control over the timescale or details of these negotiations. Hospitals, GPs and community health services all have a role to play in reducing emergency admissions - but financial incentives to make this happen are not in place. While hospitals get no money if patients are readmitted within 30 days, there are no financial incentives for community and social care services to reduce emergency admissions. Both the Department of Health and NHS England struggled to explain to us who is ultimately accountable for the efficient delivery of local A&E services
Although officially 'dismantled', the National Programme for IT in the NHS continues in the form of separate component programmes which are still racking up big costs. The original contracts with CSC totalled £3.1 billion for the setting up of the Lorenzo care records system in trusts in the North, Midlands and East. Despite the contractor's weak performance, the Department of Health is itself in a weak position in its attempts to renegotiate the contracts. It couldn't meet the contractual obligation to make enough trusts available to take the system. We still don't know what the full cost of the National Programme will be. The Department's latest estimate of £9.8 billion leaves out the future costs of Lorenzo or the potential large future costs arising from the Department's termination of Fujitsu's contract for care records systems in the South of England. Parliament needs to be kept informed not only of what additional costs are being incurred, but also of exactly what has been delivered so far. The Department estimates £3.7 billion of benefits to March 2012, just half of the costs incurred. There is still a long way to go before government departments can honestly say that they have learned and properly applied the lessons from previous contracting. Given the Department's track record with the National Programme, it is very hard to believe that the paperless NHS towards which the Department is working has much chance of being achieved by the target date of 2018
Police forces pay widely varying prices for very similar items, which means money is being wasted. The price paid for such basic items as standard-issue boots can vary from £25 to £114, or £14 to £43 for handcuffs. This is even the case where items are identical. It cannot be right that prices paid for the same type of high-visibility jacket varied by as much as 33%. With central funding being cut, police forces must ensure they get best value for money from procurement so that they can focus resources on fighting crime. Forces can make big savings through bulk-buying of items, but have been unable to agree on the most simple things, like how many pockets they should have on their uniforms. The Department cannot persuade enough individual forces to cooperate with its attempts to introduce more centralised procurement, in part because forces are sceptical about the commercial competence of procurement officers working at the centre. National contracts with suppliers are not used by enough forces and do not cover many basic goods and services. Forces' use of the new, online police procurement 'hub' is also woefully below the Home Office's expectations. By 2013, a miniscule 2% of items were being bought through this central hub, against a target of 80% by the end of this Parliament. Police and Crime Commissioners have authority over local spending but, as the Department remains accountable for public money voted by Parliament, it cannot step back from value for money issues
The Department for Transport has yet to present a convincing strategic case for High Speed 2. It has not yet demonstrated that this is the best way to spend £50 billion on rail investment in these constrained times, and that the improved connectivity will promote growth in the regions rather than sucking even more activity into London. The pattern so far has been for costs to spiral - from more than £16 billion to £21 billion plus for phase one - and the estimated benefits to dwindle. The Department has been making huge spending decisions on the basis of fragile numbers, out-of-date data and assumptions which do not reflect real life, such as assuming business travellers do not work on trains using modern technology. The Department has ambitious and unrealistic, plans for passing the Bill for High Speed 2. The timetable is much tighter than for either High Speed 1 or Crossrail, despite the fact High Speed 2 is a much larger programme. Not allowing enough time for preparation undermines projects from the start. A rushed approach contributed to the failure of the InterCity West Coast franchise award. The Department has increased its High Speed rail team, but getting the right mix of skills is challenging and the Department lacks the commercial skills necessary to protect taxpayers' interest on a programme of this size
In the three years to December 2012, the BBC gave 150 senior managers severance payments totalling £25 million. The BBC paid more salary in lieu of notice than it was obliged to in 22 of the 150 severance payments for senior managers in the three years to December 2012, at a cost of £1.4 million. It is unacceptable for the BBC, or any other public body, to give departing senior managers huge severance payments that far exceed their contractual entitlements. Some of the justifications put forward by the BBC were extraordinary. The Committee welcomes the changes that the BBC's Director General, Lord Hall, has made to cap severance pay. Recommendations include: the BBC should remind its staff that they are all individually responsible for protecting public money and challenging wasteful practices; to protect licence fee payers' interests and its own reputation, the BBC should establish internal procedures that provide clear central oversight and effective scrutiny of severance payments; the BBC Executive and the BBC Trust need to overhaul the way they conduct their business, and record and communicate decisions properly; the BBC Trust should be more willing to challenge practices and decisions where there is a risk that the interests of licence fee payers could be compromised; the BBC Trust and the BBC Executive need to ensure that decision-making is transparent and accountability taken seriously, based on a shared understanding of value for money, with tangible evidence of individuals taking public responsibility for their decisions.
The Department for International Development is committed to tackling malaria, which affected 219 million people in 2010 and led to 660,000 deaths. However, there is concern that spending by DFID on measures to combat the disease, rising each year to £500 million a year by 2015, may not provide good value as the Department does not have good enough infrastructure everywhere to manage the expenditure effectively. About half of the total number of malaria cases worldwide occur in just two countries - Nigeria and the Democratic Republic of Congo - but the Department has been spreading its resources across 17 countries. It now agrees it should do more work in these two countries but has yet to complete an analysis which would ensure well-informed decisions on where to focus resources. Cuts in funding carry their own risks. On the other hand, long-term commitments can create an equally long-term dependence on UK funding. DfID need to plan and support long term sustainable programmes to combat malaria for which developing countries can take responsibility themselves. DfID must ensure their actions do not have unintended consequences. The Department, for example, the mass distribution of free or subsidised bed nets can damage local businesses selling locally produced nets. It is also essential that the Department make the most of quick, cheap and easy diagnostic tests to increase the number of people who can be quickly diagnosed and effectively treated. This could lead to a halving of the current expenditure on drugs.
The Whole of Government Accounts for 2011-12 presents the combined financial activities of some 3,000 organisations. It provides vital data on which Government needs to act. Key issues have been identified, such as the £19.4 billion liability for clinical negligence claims. But it is frustrating to see other issues seemingly ignored in long-term policy making and spending decisions. In one year, the public sector was defrauded of over £20 billion and the tax gap rose to £35 billion. The financial liabilities for dealing with nuclear waste also keep growing. There is room for improvement in the document itself and how it is used. Users find it hard to understand, for example, why the Government debt and deficit highlighted in the WGA differ from those reported in the ONS's National Accounts. Also, by changing definitions in its commentary published alongside the WGA, the Treasury makes it difficult to track changes over time. The Treasury's introduction in the commentary of a new concept of so-called 'direct' expenditure leaves out key costs such as the interest paid on the National Debt. The publicly owned and controlled bodies - such as Network Rail and the taxpayer owned banks - are still being excluded, in defiance of normal accounting rules. The usefulness of the WGA is also being limited by the length of time it takes to produce the document and by poor quality data from some of the bodies. The accounts have again been qualified over the completeness, timeliness and accuracy of the information supplied for schools and academies