WIREDGOV

PCS:  Are government finances based on hope rather than reality? - Responding to the 2007 pre-budget report & comprehensive spending review (CSR), the Public and Commercial Services Union (PCS) warned that more departmental budget cuts disguised as efficiency savings would further damage frontline services.

Edward Leigh MP, Chairman of the Committee of Public Accounts (CPA), said recently: “The Treasury claimed at the end of last year that, by the mid-point of its Efficiency Programme, it had already achieved an annual £13.3bn of efficiency savings.  This claim does not stand up to close scrutiny.  Our Committee found that there is a question mark over the reliability of nearly £10 billion worth (74%) of the savings claimed”.

Mr Leigh was speaking as the Committee published its Second Review of Progress of the Efficiency Programme which, on the basis of evidence from OGC and the Treasury, examined four main issues:

* the measurement of efficiency gains & headcount reductions

* the effects of efficiency projects on service quality

* the management of the Programme and

* embedding a culture of efficiency into the public sector

The Government’s Efficiency Programme is designed to achieve ongoing efficiency gains across the public sector of £21.5 billion a year by 2007-08 to improve front line services, to reduce Civil Service posts by more than 70,000 and to reallocate a further 13,500 posts to front line services.

Commenting on the CPA report, Mark Serwotka, PCS general secretary, said: "The CPA report rightly recognises what our members have been experiencing all along, that the quality of services is suffering due to the efficiency programme…………. With the government looking to save a further £30bn over the next three years through so called efficiency savings, it is difficult to see how services will not continue to suffer if they continue on the same path.  The government should pay heed to the report's recommendation to give staff more say in efficiency and properly negotiate with unions over the key issues of jobs, pay and privatisation."

PCS press release ~ CPA press release ~ Second PCS press release ~ 2007 Pre-budget spending review ~ Public and Commercial Services Union ~ Committee of Public Accounts - The Efficiency Programme: A Second Review of Progress ~ OGC - The Efficiency Team and What We Do ~ Gershon review ~ NAO - The Efficiency Programme: A Second Review of Progress ~ Previous CPA press release ~ Public Accounts Committee: Ministry of Defence Major Projects Report 2006 ~ National Audit Office: Major Projects Report 2006

HC:  How could this happen? - The Healthcare Commission has published a report detailing significant failings in infection control at Maidstone and Tunbridge Wells NHS Trust.  Between April 2004 and September 2006, more than 1,170 patients were infected across the trust’s three hospitals.  Based on a sample of patient records, the Commission estimates that about 90 of these patients definitely or probably died as a result of the infection.  

The first of the two outbreaks occurred between October and December 2005, affecting 150 patients.  Despite the fact that the monthly number of new patients with C. difficile doubled, the trust failed to identify the outbreak at the time.  A further 258 patients contracted C. difficile in a second outbreak from April to September 2006.

The Commission’s investigation found that the board was unaware of the high infection rates and did not address problems that were consistently raised by patients & staff, including shortage of nurses, poor care for patients and poor processes for managing the movement of patients from one ward to another. 

Evidence from patients, staff and the trust’s own records show that patients, including those with C. difficile, were often moved between several different wards, increasing the risk of spreading infection.  In some instances this was due to concerns about meeting the government’s target for waiting times for treatment in A&E wards.

Other factors contributing to the outbreaks included old buildings, with few single rooms or side rooms to isolate patients and a high turnover of patients which limited the time available to clean beds between patients. 

The director of infection prevention & control had insufficient understanding of the role. Many of policies adopted for preventing and managing infection were out-of-date or not easily available to staff on the wards.  Only half the clinical staff attended mandatory updates on infection control and it was often difficult for people to attend training due to shortages of staff.

Press release ~ Investigation into outbreaks of Clostridium difficile at Maidstone and Tunbridge Wells NHS Trust ~ More information about Maidstone and Tunbridge Wells NHS Trust ~ Uniforms and Workwear: An evidence base for developing local policy ~ Isolating patients with healthcare-associated infection - A summary of best practice ~ Clean-safe-care.nhs ~ NPSA: Clean your hands campaign ~ Patient Environment Action Teams (PEATs) ~ National Patient Safety Agency ~ HPA - Healthcare-associated Infections ~ DH – Healthcare Associated Infection ~ DH – Healthcare environment ~ NHS Infection Control Training Programme ~ Microbiology and infection control ~ Healthcare associated infection: what else can the NHS do? ~ Infection control links ~ DH cleaner hospitals website ~ Clean Hospitals website ~ Hospital Infection Society ~ The Health Act (2006): Hygiene Code of Practice ~ RCN: Good practice in infection prevention and control Guidance for nursing staff ~ HC national study of healthcare associated infection ~ Changes to the mandatory healthcare associated infection surveillance system for Clostridium difficile associated diarrhoea from April 2007 ~ Investigation into outbreaks of Clostridium difficile at Stoke Mandeville Hospital, Buckinghamshire Hospitals NHS Trust ~ Simple guide to MRSA

DH:  Is this an indication of things to come for the NHS Connecting for Health programme? - There will be a return to locally led, staggered recruitment for specialty training for junior doctors in 2008, doing away with the current national IT system for applications.  Health Minister Ben Bradshaw has announced that agreement has been reached that Deaneries will organise their own recruitment process for specialty training in England in 2008 and junior doctor start dates will be staggered.

Ministers have accepted in full the proposals submitted by the Modernising Medical Careers (MMC) Programme Board for specialty training in 2008. These are interim arrangements for 2008. Formal plans for 2009 and beyond will be discussed in light of Sir John Tooke's independent review of MMC.

The Department of Health has also launched a consultation setting out proposals for managing applications for foundation and specialty training programmes from medical graduates from outside the European Economic Area (EEA). In England in 2007, there were nearly 28,000 applicants for around 15,500 training places, a ratio of roughly 2:1. There were more international graduates competing for places than UK graduates.

Press release ~ MMC inquiry - Tooke report ~ Recruiting IMGs consultation ~ Feedback form ~ Modernising Medical Careers ~ BMA ~ Academy of Medical Royal Colleges

Ofsted:  Could have done even better - A report - Reforming and developing the school workforce - by the Office for Standards in Education, Children’s Services and Skills (Ofsted) reveals that more than three quarters of teachers interviewed believed they have greater control over their work and more time to plan lessons, mark books & collaborate with colleagues thanks to a change in school working practices.

The deal Raising Standards and tackling workload: a national agreement was designed to reduce teachers’ workloads and improve standards over a period of four years using methods such as transferring administrative tasks to support staff.

Teachers felt they had greater control over their work, had time to plan collaboratively, develop resources, keep up with assessment and liaise with colleagues, improving their lessons as a result.  Most schools believed that standards were rising as a result of the reforms, however as most of the schools did not monitor & evaluate the impact on pupils’ learning, they had little firm evidence to show whether standards were rising as a result.

The report found that headteachers and senior managers continue to carry a heavy workload.  But increasingly they are supported by well qualified & experienced managers, allowing them to devote more time to strategic leadership and management.

Unfortunately, most schools interpreted the aims of reducing teachers’ workloads, improving a work/life balance and extending the roles of support staff as outcomes in themselves, rather than as the means to improve the quality of education and raise standards. Ofsted press release ~ TDA Press release ~ Reforming and developing the school workforce ~ Raising Standards and tackling workload: a national agreement ~ TDA – National Agreement ~ TDA - Support staff ~ NASUWT - National Agreement

PHSO: HMRC has a Sub-Prime moment - In her second special report on tax credits - Tax Credits: Getting it wrong? - the Parliamentary Ombudsman, Ann Abraham, says that despite the considerable improvements which HM Revenue and Customs (HMRC) has made in its administration of tax credits since her last report in 2005, it still has a very long way to go.

However, the report also shows the distress which can be caused to some of the most vulnerable families (those on the lowest incomes) when they find themselves with such a debt to repay - often unexpectedly, and sometimes a very long time after the money has been received & spent.  Ms Abraham said that this again raised the question of whether the current tax credit system could truly meet the needs of this particular group.

 

However, Ms Abraham's main criticisms in the report are of the application of the guidance, Code of Practice 26 (COP 26), which HMRC uses when deciding whether to waive overpayments.  Some 91% of the tax credits complaints referred to the Ombudsman relate to this issue and the outcomes of some of the decisions seemed to fly in the face of the aims of the tax credit policy.

Press release ~ Tax Credits: Getting it wrong? ~ Code of Practice 26 (COP 26) ~ Tax Credits: Putting Things Right ~ HM Revenue & Customs: Tax Credits ~ CAB – Overpayment of Tax credits ~ Working Families Tax Credit Estimator

DH: Given the numbers, is it enough? – The government has announced a £170m expansion of psychological therapies to provide better support for people with mental health problems such as anxiety and depression.

Millions of people suffer from depression & anxiety and mental health problems are the largest single cause of disability and illness in England - accounting for 40% of all disability (physical and mental), nearly 40% of people on Incapacity Benefit (and a secondary factor for 10% more of them) and a third of all GPs' time.

About 1 in 6 UK adults has a common mental health condition (i.e. depression or anxiety disorders) and an estimated 91m working days a year are lost to mental illness. Huge numbers of people suffering from these conditions are not getting the treatment they need to bring them out of the misery these conditions involve. 

Professor Lord Layard of the LSE puts the total economic loss, in sick leave, lost jobs and reduced output, due to depression & chronic anxiety at £12bn a year (1% of our national income) of which £7bn hits the taxpayer in incapacity benefits paid out and income tax not received.

Psychological therapies have proved to be as effective as drugs in tackling these common mental health problems and are often more effective in the longer term. NICE guidelines on treatment for depression and anxiety recommend therapies, such as cognitive behavioural therapy (CBT).

Press release ~ Cognitive behavioural therapy (CBT) ~ British Psychological Society ~ DH - Improving Access to Psychological Therapies (IAPT) ~ Choices in Mental Health: Psychological therapies ~ London School of Economics Depression Report ~ Unite/Mental Health Nurses Association ~ World Federation for Mental Health ~ UK Inquiry into Mental Health and Well-being ~ Mind ~ National review of adult specialist community mental health services in England ~ National Service Framework for mental health ~ DH – Mental Health ~ Care Programme Approach (CPA) ~ Care programme Approach Association ~ Revie wing the Care Programme Approach 2006 – Closed Consultation ~ Mental Health Care - Care programme approach

MoD:  "When you go home tell them of us and say for your tomorrow we gave our today” - HM The Queen has dedicated the Armed Forces Memorial (AFM) in Staffordshire. The memorial contains the names of almost 16,000 service men & women, regular and reserve, killed on duty since the end of WWII. The AFM will open to the public at 0900 on 29 October 2007.

The AFM remembers all those killed on duty and includes members of the Royal Fleet Auxiliary (RFA) and the Merchant Navy (MN) killed while serving in direct support of HM Forces. It includes those killed in conflicts or on training exercises, by terrorist action or on peacekeeping missions.

The Memorial is independent. It is not Government funded, nor is it controlled or managed by a veterans' or other organisation. Non-denominational & inclusive, access and use of the Memorial will be administered by the AFM Board of Trustees, who will safeguard equal access to all.

 

The location, chosen to allow easy access from all corners of the UK, is within the National Memorial Arboretum (NMA) in Staffordshire which is managed by the Royal British Legion. The NMA covers 60 hectares of woodland and it hosts memorials from a range of organisations both military & civilian, charities, local and overseas groups.

Press release ~ Armed Forces Memorial Appeal ~ Commonwealth War Graves Commission ~ Royal British Legion ~ The National Memorial Arboretum ~ Friends of the National Memorial Arboretum