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The report Access To Clinical Trial Information And The Stockpiling Of Tamiflu (HC 295) examines two separate but connected issues; the routine withholding of clinical trial information from doctors and researchers, and the effectiveness of stockpiling of Tamiflu during an influenza pandemic. The full results of clinical trials are being routinely and legally withheld from doctors and researchers by the manufacturers of medicines. The ability of doctors, researchers and patients to make informed decisions about treatments is being undermined. Regulators and the industry have recently made proposals to open up access, but these do not cover the issue of access to the results of trials in the past which bear on the efficacy and safety of medicines in use today. Research suggests that the probability of completed trials being published is roughly 50%. Trials which give a favorable verdict are about twice as likely to be published as trials giving unfavorable
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
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
Telephone services are a vital part of government support, accounting for 43% of all customer contacts. But departments are continuing to make extensive use of higher rate phone numbers for customer telephone lines despite the fact that many people are put off calling as a result. The most vulnerable callers, on the lowest incomes, face some of the highest charges. Costs to callers are even higher because the caller has to endure long waiting times and poor customer service. In the face of this evidence we welcome the Cabinet Office's acknowledgement that it was "inappropriate" for vulnerable citizens to pay a substantial charge to access public services and its commitment to establish best practice in this field and ensure it is followed across government
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
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
For many years Governments have sought to breakdown silo working in departments and ensure better integration across departments to ensure more effective services and better value for money. The Cabinet Office and the Treasury are best placed to support and promote integration across the Government, as they are responsible for coordinating policy and allocating monies. However, they are failing to provide the necessary strategic leadership and are not doing enough to tackle the barriers to integration. These include the lack of good information to identify where the Government could do better by joining services, funding arrangements which make it difficult for bodies to invest in joint working, and the risk that Accounting Officers are reluctant to pool budgets in case they lose control and authority. In contrast, the Whole-Place Community Budgets programme has involved local public bodies and central government working together to develop evidence-based plans for new integrated services. Four local areas have analysed in detail the expected costs and benefits of integration and their findings show clear potential for improving outcomes and reducing costs. The Department for Communities and Local Government, which manages the Whole-Place Community Budgets programme, has provided effective support to date. However, if other central government departments are not committed to Whole-Place Community Budgets it may, like similar initiatives in the past, fail to deliver any significant and lasting change. The programme must be evaluated properly to see whether the early promise translates to real change on the ground and improves value for money.
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
Tobacco smuggling represents a significant risk to revenues. It undermines initiatives to reduce smoking and it is linked to the activities of organised criminal gangs. HMRC estimates that duty not paid on tobacco smoked in the UK in 2010-11 resulted in revenue losses of around £1.9 billion. Some 9% of cigarettes and 38% of hand-rolling tobacco sold in the UK are estimated to be illicit, yet there were only 265 prosecutions for tobacco smuggling in 2012-13. HMRC's 2010 Spending Review settlement included £25 million over four years to invest in new initiatives to tackle tobacco smuggling. However HMRC was also required to find efficiency savings so total spending on HMRC's tobacco strategy in 2011-12 rose by only £3 million to £68.9 million and fell to £67.4 million in 2012-13. By the end of 2012-13, three of the five Spending Review-funded projects had yielded nothing and the Committee is not convinced that the Spending Review projects will deliver the £900 million benefit, in terms of revenue loss prevented, that HMRC now predicts they will achieve by March 2015. The Department has also failed to challenge UK tobacco manufacturers who turn a blind eye to the avoidance of UK tax by supplying more of their products to European countries than the legitimate market in those countries could possibly require. The tobacco then finds its way back into the UK market without tax being paid. The supply of some brands of hand-rolling tobacco to some countries in 2011 exceeded legitimate demand by 240%.
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.