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The Commons Public Accounts Committee publishes it fifty third report of Session 2010-12, on the basis of evidence from the Department of Health. In the past three years, NHS trusts in England have spent around £50 million annually on buying three specific types of high value capital equipment - Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scanners, used mainly for diagnosis, and Linear Accelerator (Linac) machines for cancer treatment. The current value of these three types of machines in the NHS is around £1 billion. Patient demand for services from these machines has increased significantly in the last decade and continues to grow. Since 2007, the Department of Health has devolved responsibility for procuring and managing these machines to individual trusts but this structure is not conducive to delivering value for money. The committee is concerned that the NHS is failing to optimise its purchasing power, crucial at this time when £20 billion of savings in the NHS are required by 2015. The NHS needs to make high quality, comparable data available on machine use and cost. The procurement and management of high value equipment is fragmented and uncoordinated, leading to wasted resources and variable standards of services. Trusts have three main ways to purchase high value equipment: by dealing directly with suppliers; through framework agreements, managed by NHS Supply Chain; or by joining up with other trusts in collaborative purchasing arrangements. The Committee believes there is a lost opportunity to use collective buying power to get lower prices and the committee expects NHS Supply Chain and other collaborative procurement bodies to work with trusts to share plans on future needs and get better prices and value for money by exploiting the joint buying power.
Value for money is not being achieved across all trusts in the planning, procurement and use of 'high value equipment', such as CT, MRI scanners and Linear Accelerator Machines (linacs). Trusts are not collaborating to purchase machines and they are not getting the best prices. Around half of all CT and MRI scanners and linac machines are due for replacement within three years. Were trusts to replace existing machines, they would collectively need to find £460 million within three years. The number of diagnostic scans carried out CT and MRI machines has increased almost threefold and radiotherapy treatment sessions have increased two and a half fold over the last ten years. Many trusts face resource constraints in meeting increasing demand, with vacancy rates for consultant radiologists of around seven per cent and high rates of attrition for people training to become therapeutic radiographers delivering radiotherapy treatment. There is wide variation in utilisation rates of MRI and CT scanning machines. However, because there is no central collection of data, individual trusts cannot compare their utilisation rates and costs with other trusts in order to improve efficiency. Trusts report their average costs per scan, but they do so differently. In 2008-09, the average cost per CT scan ranged from £54 to £268; and, for MRI, it was between £84 and £472 per scan. However, for radiotherapy, the Department of Health has developed a dataset which will enable comparisons to be made about efficiency and utilisation between radiotherapy treatment centres.
The reports published as HC 1398 (ISBN 9780215561848), HC1469 (ISBN 9780215561862), HC 1468 (ISBN 9780215038548), HC 1502 ((9780215038585), HC 1530 (ISBN 9780215038913, HC 1565 (ISBN 9780215039910), HC 1444 (ISBN 9780215038968), HC 1566 (9780215039941), HC 1531 (9780215040077)
This report is a follow-up to the Committee's report on Accountability for Public Money (HC 740, session 2010-11 (ISBN 9780215559029)) an issue at the core of the relationship between Parliament and government. Accounting Officers remain accountable to Parliament for funds voted to their departments but the policy intention is that local bodies will have significant discretion over the services they deliver. In the Government's response, 'Accountability: Adapting to Decentralisation', Sir Bob Kerslake drew a distinction between those services that government delivers directly and those that it may fund but are delivered in more decentralised arrangements. He proposed that Accounting Officers set out, in Accountability System Statements, the arrangements they have in place to provide assurance about the probity and value for money of funds spent through devolved systems. All departments are expected to produce Statements by summer 2012. Departments have made a genuine effort to develop arrangements which reconcile accountability and localism but the Statements so far are unwieldy and considerably more needs to be done to improve their clarity, consistency and completeness. There is concern that accountability frameworks must drive value for money and, critically, are sufficiently robust to address the operational or financial failure of service providers. Departments are placing increasing reliance on market mechanisms such as user choice to drive up performance and value for money, but there are limits to what these mechanisms can achieve. The Treasury needs to take ownership of the system and ensure that the Comptroller and Auditor General has the necessary powers and rights of access to examine the value for money of funds spent through devolved systems
Each of the areas in the Whole-Place Community Budgets scheme has identified potential benefits from taking a more integrated approach to frontline services, focusing on outcomes like preventing avoidable hospital admissions or reducing reoffending. Greater Manchester, which covers ten local authorities, has estimated net savings of some £270 million over five years, while in West Cheshire savings of £56 million are estimated for the same period. In general, government has only limited information for identifying opportunities for integration or making an assessment of costs and benefits, which is needed to support the case for integration. In some instances where government has identified integration opportunities, benefits have not been achieved because of implementation difficulties. While the centre of government has recognized the importance of integration, it does not have clearly defined responsibilities to support or encourage frontline integration initiatives across government. It is early days for Whole-Place Community Budgets, central government and the four local areas have worked together effectively to assess the case for local service reforms. The true scale of potential benefits will become clear only if projects are implemented and evaluated robustly. Foundations have been laid but continuing collaboration - including sharing of data - between local and central government and delivery partners is essential to maximize the potential of Whole-Place Community Budgets. Accompanying this report, the NAO has released a case study looking at the four Whole-Place Community Budget areas, finding that these areas have taken a positive first step in assessing the case for integration (HC 1040, ISBN 9780102981339)
Flood protection is a national priority and features on the National Risk Register of Civil Emergencies. Recently the annual cost of flood damage has been £1.1 billion, and 5.2 million homes are at risk of flooding. In 2010-11 the Department for Environment, Food and Rural Affairs (the Department) spent £664 million on flood and coastal risk management, 95% of which went to the Environment Agency (the Agency). In 2009 the Agency projected that its flood risk management budget needed to rise by 9% during the spending review period (2011-12 to 2014-15) to sustain current levels of protection. However during the same period the Agency's flood risk management budget has been reduced by over 10%. The Department wants to increase local authority and private contributions, but expecting an increase in local authority contributions when their resources are reducing may well be over-optimistic. The Committee was very concerned that the Department did not accept ultimate responsibility for managing the risk of floods. The Department also needs more reliable information to inform its decisions on when and where to intervene if local risk management plans are inadequate. The Agency needs to improve how it involves local communities in the decision-making process. The agreement between the Department and the insurance industry that insurance cover will be provided to households at risk of flooding ends in 2013. In some areas premiums appear to have risen as a result of growing uncertainty over local levels of protection, so an early revised agreement is needed.
The Stationery Office annual catalogue 2011 provides a comprehensive source of bibliographic information on over 4900 Parliamentary, statutory and official publications - from the UK Parliament, the Northern Ireland Assembly, and many government departments and agencies - which were issued in 2011.
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.
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.