Category Archives: NHS

Time for the NHS to come clean on its tax avoiding bosses

Posted on by

NHS-logo

An amazing piece of evidence revealing that they were up to 2,400 off pay roll people in the NHS was slipped into an inquiry by the House of Lords by the Department of Health last week.

The findings published today in a report by Exaro News reveals that as many NHS staff as Whitehall staff were avoiding paying tax and national insurance at source – bringing the total in government to nearly 5000 in 2012.

Now no doubt some people on short-term contracts can justify this but what is becoming increasingly clear from the evidence submitted by the Department of Health ( see page 91 onwards) that many do not.

The worst offenders appear to be high earners at the top of NHS Foundation Trusts – where over a third -51 out of 147 – had someone at the top avoiding paying tax and national insurance at source. Someone was even off pay roll and claiming a full pension from the taxpayer as well!

 Monitor,the regulatory authority for NHS Foundation Trusts, is currently conducting an inquiry into exactly who is benefiting – and as a result numbers are shrinking.

 But we don’t know yet whether Monitor is going to name and shame the trusts and the people taking advantage of this tax loophole. Well if the organisation  has got any teeth it should be like the National Audit Office  and publish a full and detailed report. Avoiding tax while working for the cash strapped NHS is particularly nasty and greedy and should be stamped out. Let’s see if Monitor is going to do its job.

Is your NHS boss a tax avoider? You’ll soon find out

Posted on by
NHS bosses: subject to tax avoidance inquiry

NHS bosses: subject to tax avoidance inquiry

The tax avoidance scandal that shook up Whitehall is soon to spread to the NHS. As reported earlier following the exposure of Ed Lester, the former head of the Students Loan Company, for channelling his salary through a personal service company to avoid  paying national insurance and tax at source. The practice was still going on in Whitehall two years after the event and 125 civil servants who quit have been reported to Revenue and Customs.

 Now the NHS is to face the same scrutiny. Reports in Exaro News and Tribune last week highlighted the issue – with the findings now likely to be sooner rather than later.

An inquiry has been ordered by Jeremy Hunt, the health secretary, after Danny Alexander, Chief Secretary to the Treasury requested it.

Some two years ago a lesser inquiry – just into board members of NHS bodies – revealed some 28 out of 84 people were on this bandwagon. Earlier examples included   Robert Clarke, finance director at NHS Professionals, which supplies temporary workers to the health service, was paid at least £534,000 over three years through a personal-service company.

Another former chief executive of NHS Professionals, Neil Lloyd, was paid £631,000 off payroll over three years.

This time the Health Department sounds uncompromising. A spokesman said:

 “Tax avoidance will not be tolerated, and there is no excuse for it in the NHS, or any other part of the public sector.”

The Trust Development Authority, which provides guidance on governance to NHS trusts, is working with Monitor, which regulates the running of health bodies, to carry out the investigation to ensure that the use of off-payroll contracts is in line with guidance.

targeted is anybody earning over £58,200 a year or has been in post for more than six months and being paid through a personal service company.

In my view it cannot come soon enough. Tax avoidance deprives the Treasury of cash that could be used for better public services. Tax avoidance in the cash strapped NHS is actually depriving hospitals and communities of vital cash. All these people also earn a fair whack. They are not those forced to take a one per cent pay rise and see their living standards go down. On the contrary through tax avoidance they get richer on the backs of others.

 

Phone Hacking Trial: Clive Goodman taken ill – Martin Hickman

Posted on by

The second defendant to suffer stress in this trial.

INFORRM's avatarInforrm's Blog

Clive Goodman Day 74:  Former News of the World journalist Clive Goodman was taken to hospital today, minutes after he was due to continue giving evidence at the phone hacking trial today.

View original post 236 more words

Citizen bloggers to get new protection to investigate public scandals

Posted on by

The Information Commissioner is to put bloggers on the same footing as professional journalists allowing them to gather information on individuals and public services without fear of being challenged under the Data Protection Act.

 I am indebted to this article on the excellent Inforrm blog today which reveals that the Information Commissioner has put out new guidelines to the media for consultation.

The proposals are particularly important after a series of outrageous attempts notably by Barnet Council to force local bloggers to have to register with the Data Protection Act. The aim was to force people to register so council officials and councillors could demand to know what information was held on them. Luckily they failed. This change will make it impossible for councils like Barnet to even contemplate such action.

The relevant parts -outlined in the proposed guidelines- are to exempt journalists and bloggers from the requirement to provide such information if  they are pursuing a story in the public interest.This exemption allows journalists to mount a public interest defence to most apparent breaches of the Data Protection Act but it will be easier to rely on the exemption.  This states:

  • As long as the aim is to publish a story (or for someone else to publish it), all the background information collected, used or created as part of investigation can also be exempt,
  • The  proposed rules also allow bloggers as well as journalists – if they were forced to hand over information- to redact any information which could lead to the source being identified..
  • Information about someone’s health, sex life or criminal behaviour should only be collected if the journalist is very confident the public interest overrides their right to privacy.

These changes along with the new Defamation Act should be welcomed by everyone. It amounts to official recognition that the world is changing and that public bodies, whether it be your local council, hospital, or, as is increasingly the case, private companies running public services that they should expect to be heavily scrutinised. It also serves as a warning to directors of private companies, arrogant councillors, and insensitive public providers, that they will not be able to bully active citizens who want to probe their activities and they will not be able to force the disclosure of sources or information that led to their exposure. consultation on the new guidelines from the ICO ends on April 22nd.

Result: NHS acts on a serious medical misdiagnosis on the Isles of Scilly

Posted on by
Isles of Scilly; beautiful and tranquil but medically problematic

Isles of Scilly; beautiful and tranquil but medically problematic

Readers of this blog may just remember that over three years ago I suffered a serious injury – a triple shoulder fracture – when I tripped and fell awkwardly on a rocky path on Tresco on the Isles of Scilly.

An accident 28 miles off mainland Britain is always a tricky problem – but mine was compounded by the failure of both a duty doctor and nurse at St Mary’s Hospital – the GP led hospital on the islands – to realise this had happened. It was never X rayed and both staff thought I had bruised and sprained my shoulder.

 It was only when my wife made consult my own GP in Berkhamsted – a week after the  accident- that I was sent off to Watford General Hospital who discovered I had been walking around with three broken bones – and  the main bone between my shoulder and elbow had almost come out of its socket. Due to heroic efforts by one administrator at Watford they managed to find me a bed and I had a  five-hour operation to put me back together. This I might say after physiotherapy is  now 95 per cent back to normal. I have also been full of praise about the surgeon who did it,Andrew Irwin.
I put in two complaints to the NHS authorities in Isle of Scilly – one about the service – when I discovered the hospital had an X-ray machine but only a radiographer available for two hours a week. So bad luck if you had an accident outside Tuesday afternoon.

 I also complained about the doctor’s failure to diagnose the problem – and got an apology and found the doctor had been sent for retraining to deal with accidents on the mainland.

 Until today I had not heard anything positive about the paucity of X-ray services, only a rather defensive reaction saying that it was difficult to do anything. It certainly made me worried given the Isles of Scilly is a mecca for all sorts of sports from sailing, windsurfing,diving,rock climbing as well as great walking country.

Imagine my surprise to receive a communication through NHS Choices today to say the hospital has now replaced its ageing X-ray equipment with a new digital X ray – presumably allowing computer images to be sent to other major hospitals. It added: “Extending access to a radiographer is work in progress and is being looked into by the Kernow Clinical Commissioning Group and the Islands Health and Well Being Board. With regards to staff training, MIU training up-dates are provided twice a year by the MIU Lead. She will revisit limb examinations on her next visit. “

 Well it may have taken over three years but I am glad that some action is being taken. To my mind it shows that it is worth complaining if the NHS fails to deliver – authorities do appear to take note, even if it takes time.

Half Revealed: The NHS fat cat executives and their pay offs

Posted on by

ImageThe  Department of Health is refusing to disclose  the names half the  very senior people who have received big pay-offs as part of this year’s re-organisation of the National Health Service..

Nine months after the last Primary Care Trust and Strategic Health Authority closed down in England the ministry is stalling on releasing the names of people who have walked off with payments of anything between £100,000 and £600,000 plus.

A report by me and Frederica Whitehead in Exaro News  shows that 44 very senior people – chief executives or directors – have received £12.2m in redundancy payments- an average of £277,000 each.

The National Audit Office said in a report in July on NHS reforms that the payments went to board-level managers in strategic health authorities (SHAs) and chief executives of primary care trusts (PCTs).

According to the NAO, 10 SHAs and 151 PCTs were scrapped in March under Hunt’s reforms to the National Health Service, and new commissioning bodies created.

Exaro today publishes details of the 23 top officials named by the Department of Health, along with the NHS bodies that employed them and their redundancy payments.

They are released as a result of the assiduous work of Conservative MP, Stephen Barclay, a member of the Commons Public Accounts Committee, who quite rightly pursues whether taxpayers money is being spent properly.

But the ministry is refusing the publish details of the remaining 21 – saying it is up to those who received the largesse to decide whether they should be named and the payments revealed.

 Mr Barclay rightly thinks this is unacceptable – in any big company or in Whitehall – these figures  for senior people would be published as part of an annual report.

 I agree. At a time of big pay restraint, shortage of money for services in the NHS, is it right that say in the North of England some £3m should be set aside for redundancy and early retirement of just 12 individuals?

Again a two tier system is in operation and the ministry is aiding and abetting it by allowing those in receipts of large sums of taxpayers money to escape being held to account.

 

 

The next NHS scandal: Taking cash from the deprived and handing it to the affluent

Posted on by

Sunderland Clinical Commissioning Group- the biggest loser of NHS funds in England

Sunderland Clinical Commissioning Group- the biggest loser of NHS funds in England

Next April NHS England plans to take away money from some of the most deprived parts of the country and give it to areas that are the most affluent.
An arcane formula that decides how much your local NHS clinical commissioning body has to spend on you is expected to be changed by removing a weighting that automatically gives a bit of extra cash to areas of social deprivation. It will also mean that less money will go to areas where people die younger and more to areas where people live longer.
I am indebted to research by the Royal College of Nursing who have recalculated the effect of the change and I have already written about it for Tribune Magazine.
The political implications of this change- just over a year before the next general election are enormous. While NHS England is obviously not a branch of Conservative Central Office, its decisions will be remarkably helpful to the coalition government.
Without spending an extra penny it will appear that there is more spending on the NHS in many Conservative and Liberal Democrat marginals by election day and far less spending in many Labour strongholds where there is more social deprivation.
As the table illustrates the changes at the top and bottom are going to be dramatic.
Losers and Gainers; Health spending per head

Losers and Gainers; Health spending per head


Translate this into Westminster politics this means extra help for Tory and Liberal Democrat seats in the south. Gainers include Tory strongholds in Royal Windsor, Ascot and Maidenhead – the latter the seat held by Theresa May, the home secretary; South East Hampshire, Eastbourne, Hailsham and Seaford ( Liberal Democrat seats); the West Sussex coast, Gosport and Fareham and Newbury.
Most useful is Reading North and West, which includes a Tory marginal, and has an extra £98 per person to spend; Dorset (£89) which is both a Liberal Democrat and Tory area, and South Gloucestershire, part of the Cotswolds, which gains £86.
While the losers with the exception of Carlisle ( a Labour Tory marginal with a 853 Tory majority) are all Labour.Worst affected will be Sunderland which will lose health care spending worth £146 per person. Nearly equally badly affected will be South Tyneside, Newcastle West and Gateshead.
Also if you take the latest Office of National Statistics life expectancy figures you will live much longer in Dorset than in Blackpool.
In 2009–11, male life expectancy at birth was highest in East Dorset (83.0 years); 9.2 years
higher than in Blackpool, which had the lowest figure (73.8 years).
• For females, life expectancy at birth was also highest in East Dorset at 86.4 years and lowest in
Manchester where females could expect to live for 79.3 years.
• According to 2009–11 mortality rates, approximately 91% of baby boys and 94% of girls in East
Dorset at birth will reach their 65th birthday. The comparable figures were 77% and 86% in
Blackpool and Manchester respectively.
No wonder the RCN is furious. As Glenn Turp, regional director for the RCN Northern region says: “The North East and Cumbria suffers from some of the worst health inequalities in the country. NHS England should be aiming to reduce inequalities in health outcomes, not make them worse.
“Given the size of health inequalities in this region, I believe that NHS England should actually be increasing funds to the areas with the worst outcomes. However, NHS England’s own data shows these proposals will do the opposite.”
Of course this figures are not yet in stone. But taken together with welfare cuts, big drops in the standard of living for the majority,and slashing support for the disabled – NHS England is merely helping the wealthy and rich in Windsor, Maidenhead and Hampshire villages get better NHS services all paid by the taxpayer at the expense of a Sunderland council tenant. All helping the coalition win the next general election.

Result! West Herts Hospitals Trust changes patient ambulance services after scandal of a 5 hour wait

Posted on by

West Herts acted on complaint

West Herts acted on complaint

My complaint about the appalling situation that left my wife, recovering from a stroke, waiting five hours for a privatised patient ambulance at Hemel Hempstead Urgent Care Centre to take her back to Gossoms End rehab centre in Berkhamsted has yielded results.
The West Herts Hospitals Trust, which manages the contract for Medical Services Ltd, the private company providing the ambulances, ordered an investigation into the incident and a review of the service.
The inquiry confirmed that my wife, Margaret, had in fact, waited 5 hours 15 minutes for the ambulance.
It then found the following damning facts:
The excessive delay was caused, as I expected, by the company supplying insufficient numbers of ambulances to do the job. They had only two vehicles – an ambulance and a seven seater minibus – on that Saturday afternoon and evening – to supply the entire needs of West Hertfordshire.
The company did not manage the call -indeed it appears it disappeared off their radar because they didn’t have proper management controls to check why nobody had turned up.
Neither the company nor Hemel Hemsptead Urgent Care Centre even reported the delay – which amounted to a big breach of Medical Services Ltd contract – until days after the event. Indeed there is a hint in the report they may not have bothered – if I had not publicly raised it in this blog and with the Berkhamsted and Tring Gazette.
The report is honest enough to admit that both Medical Services and the West Herts Health Trust have let my wife down. West Herts admit ” it could have been avoided with closer controls and proactive management of the activity levels.” The investigators also found “no examples of good practice ” in managing this contract.
The good news is that West Herts and Medical Services Ltd have pinpointed deficiencies in the service and are taking action to put things right.
The main changes are:
Medical Services will contract some patient ambulance services to a taxi firm where people are mobile enough to get in a taxi.This will mean that people like my wife who couldn’t get out of her wheelchair to get in a taxi will get priority ambulance treatment.
Medical services Ltd will review ambulance rosters to put more on at the weekend and employ an additional member of staff at Watford.
The senior management at Medical Services Ltd will take direct charge for a trial period of their control room and take action if anybody is waiting for more than an hour.
West Herts are also strengthening their management procedures and using the information to change the procurement of new contracts. This includes financial penalties for breach of contract – all patients not to wait for more than two hours is written into current contract.
There are two lessons to be learned from this. Far too many people are happy just to grumble rather than complain if the NHS service is not up to scratch. this shows if you do complain you can get something done.
Second, West Herts Hospitals Trust are to be congratulated for taking the complaint on the chin and doing something about it. They have also been honest and open in releasing the report to me without having to go to the trouble of putting in a Freedom of Information request.
The proof of the pudding will now be whether the services does improve – but I see Medical Services Ltd contract is up for renewal next May. They had better step up to the plate.

Revealed: The damning reports on privatised patients ambulance services ( and some public ones as well)

Posted on by

Medical Services Ltd on" NHS " ambulance.They passed the Care Quality Care Commission inspection for Hertfordshire,but many others didn't Pic taken by myself

Medical Services Ltd on” NHS ” ambulance. They passed Care Quality Care Commission inspection, but many others didn’t Pic taken by myself

Following my appalling experience of a five hour wait for a privatised ambulance from Medical Services Ltd to pick my stroke victim wife in Hemel Hempstead, Hertfordshire I decided to look at the national picture for England. The company has passed an inspection by the Care Quality Commission- which regulates and inspects all NHS services-though the inspectors report admitted it never talked to patients.
People had already contacted me from Manchester and Devon to highlight private bidders for services which included bin collectors, bus companies, car parking and foreign firms queuing up across England to take over NHS patient ambulance services.
For example Arriva, the bus company, has landed a lucrative contract in Greater Manchester to take over ferrying disabled people, cancer and renal patients, despite a petition signed by 14,000 people opposing the move and opposition from Unison and two Labour MPs.

This is also following the company’s new subsidiary Ambuline being criticised by the Care Quality Commissionfor poor staff training, staff shortages and failing to keep records of whether vehicles were properly cleaned to avoid infection risks in a contract they run in Leicestershire. The CGC made a second inspection and now says the service is satisfactory.

In Manchester there are already complaints about Arriva not having enough ambulances and using taxis to transport disabled patients.

In South Devon and parts of Cornwall and Somerset ambulance services are to be taken over by the successor company to National Car Parks – NSL – who beat a refuse collection company and the NHS provided services.

Danish company,Falke which runs private ambulances and fire services, has bought a 45 per cent stake in Medical Services, with the obvious intention of buying up more services. It had already talked and entertained Brian Coleman, the former Tory chairman of the London fire Brigade, to discuss buying up London’s entire fire service.See my earlier blog.
The most damning stuff has come from the Care Quality Commission’s website which reveals a worrying picture. It shows that small private ambulance services in Dagenham, Wigan, Dorset, Wiltshire, Buckinghamshire, Bicester and Peterborough have been required to make improvements after their first inspections to bring them up to scratch, particularly over management and record keeping and staff standards.
You can find the inspections on the care quality commission website. Type in ambulances under services on home page.The roll call of companies found wanting by CQC inspections is too large for this blog but here are some of the firms.
International Medical Assistance, Tamworth; Patients at risk of harm from poor service which may now be under new management..
Medical Services Ltd Warrington : Failed to have proper records such as references on staff recruitment
APMS services, Peterborough. Staff inadequately trained to care for patients
Henry Ward, Buckingham. Had no checks on staff including whether they had a criminal record.
AFG Birmingham Recruitment staff bad, some had no interviews.Ambulance breakdown not reported.
BN Gibson, Newark. Staff not trained properly to manage medicines.
AST, Surbiton Staff references not obtained.
Remote Medical Service, Manchester poor recruitment policy and no training to deal with abuse of patients.
Caring for You PTS -Benfleet,Essex Staff started work without waiting for criminal record clearance.
Collingwood Medical Services, Salisbury, Staff not trained to safeguard patients from abuse.
Paramedico Correspondence Event Cover, West Wickham, Kent. Staff not fully trained, recruitment procedures not followed including independent criminal record check,
Medical Response Services, Wigan. Newly recruited staff not properly checked.
Medicar Ltd,Clacton, Essex. Staff references not obtained, no management supervision recorded, no complaints procedure.
First Aid Medical Services Ltd. Sheffield Owner only just aware that staff had to have criminal record checks, no knowledge of rules protecting patients from abuse.
Ambu Kare, Peterborough. No guidance on how to transport people with intravenous drips,patients belongings and medical needs not signed for, inaccurate info given to patients about complaints.
Plymouth Central Ambulance Service Ltd. Never applied for criminal records or medical checks on staff, one person didn’t have a satisfactory report from Criminal record Bureau.
NHS
East of England Ambulance Service. Failed to respond in time in Norfolk and Suffolk, particularly bad in responding to stroke patients in that area.
NHS Ambulance Trust London :Hit by equipment and staff shortages posing moderate risk to patients.

More worryingly it shows that the CQC has a backlog of inspections and has not looked at some of the big new privatised services, including Medical Services Ltd operation in Birmingham and Arriva’s new operation in Nottingham.
The overall picture is completely unsatisfactory given the big expansion in privatisation. What we could see is a dumbing down of standards, companies relying on out of date training provided earlier by the NHS, and no proper checks on who is being employed to look after vulnerable patients. The latter is regarded as a ” minor” by the CQC but I wonder whether patients would like to be looked after by people with criminal records.
The CQC – which has an appalling record of missing abuse in care homes- does not seem to have a real handle on this. They also don’t seem to want to seek patients views on privatised services – but do check up on those run by the NHS. Some double standards here and I wonder if they have the resources to do a proper job of inspecting the 856 services provided by companies and the NHS.

Coming your way: £3.8 billion to spend on public health

Posted on by

Norman Lamb: off the cuff and off piste at Localis Pic courtesy of The Guardian

Norman Lamb: off the cuff and off piste at Localis
Pic courtesy of The Guardian

In the middle of the biggest wave of austerity to hit England since the 1930s a cool £3.8 billion will be handed over to your local town hall and local NHS from 2015. The aim will be to switch money from your big hospital to your local community to spend on public health and social care.
Do you trust your local council to spend it wisely? Who will know what it has been spent on? and it will it unleash clever new ideas as promised to help local people?
This was a point of a press conference yesterday by the rather arcane titled think tank,Localis,to publish a report asking precisely that. Read it here.
It was launched by a Liberal Democrat health minister Norman Lamb, who began well by throwing his boring Whitehall brief on the floor and launching a passionate off the cuff speech calling for new ideas to stimulate local public health services.
As he was off piste, he refreshingly condemned those private companies exploiting lowly paid care workers, some even on below minimum wage rates,or zero hour contracts, and not being paid for travel between seeing different customers. He might have added that they should join a good union like Unite or GMB to take up their plight, but then he is a Liberal Democrat.
What is interesting about this initiative is that it might do some good. It means more freedom and money for local people to find ways to help the elderly, disabled, the local alcoholics and drug takers and if combined with better housing, transport, planning, job creation and children’s services it might make a difference.
But it is a big IF and it is clear from the Localis report that people have to be made accountable for how this money is spent and that has not been properly worked out. As the brilliant local government expert Tony Travers put it, that you know better who to complain about the dustbins than you do over public health. And he did not get a satisfactory answer from the minister.
In Berkhamsted as a previous blog pointed out we already have the makings of this at Gossoms End, a NHS community hospital with a GP surgery, a nursery, physio and local sheltered housing attached to get good local care. The minister said that the people of Great Yarmouth and Yeovil are also soon to benefit from new community schemes.
In the meantime an invitation to see Gossoms End is still there, Norman. That is if you can get your bossy civil servants to give you any space in your diary. And they may lynch you for throwing away their boring prepared speech.