Exclusive: Are whistleblowers now too frit to reveal when NHS patients and care home residents are in danger?

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Dr Henrietta Hughes, 4 day a week National Guardian Pic Credit: CQC

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Tucked away in a recent National Audit Office report on the NHS and social care regulator, the Care Quality Commission, is the extraordinary statistic that the number of whistleblowers who tipped off the regulator fell by a staggering 16 per cent to 7452 in 2016-17. That is one in six fewer whistleblowers than the previous year. See paragraph 2.19 of the report.

The figure compares with 153,000 members of the public – an increase of one per cent – expressing concerns about services during the same period.

I have written about this in Tribune this week.

And the latest figures come after  a report by Robert Francis QC to Jeremy Hunt, the health secretary,which was highly critical of the way some had been treated after they made a complaint.

In 2015, Francis reported widespread severe victimisation of staff by senior management when they spoke up for patients. Francis recognised that sacked whistleblowers are blacklisted and recommended a re-employment scheme but nothing seems to have come of it.

His most substantial recommendation was for a National Guardian to protect staff. This led the CQC to create a part time post with no powers. The first appointee, Dame Eileen Sills, quit before starting.

Since then Dr Henrietta Hughes . a GP has been appointed  as National Guardian, on a four day week. And according  to the CQC  yesterday marked her first year as the National Guardian for the NHS with the publication of her first case review report and her annual report highlighting the work of Freedom to Speak Up Guardians.

The one case review she published covered Southport and Ormskirk Health Trust which  has the unenviable reputation for bullying and discriminating against black and ethnic minority staff , a dodgy appointments system favouring some people against others and an attitude of not bothering when staff raise concerns about patients. This might sound familiar incidently for those who have followed my articles on staff practices at the Equality and Human Rights Commission but we should wait for the employment tribunals to see what happened there.

Dr Hughes has recommended a series of recommendations to put matters right – 22 in all – and there is promise from the interim chief executive of the trust, Karen Jackson, to act  with a new senior management team. We shall see. Also this was a trial – how many reports are we going to get from her in future?

The National Guardian has also produced a series of high flown documents which sound terribly good in theory – but again I think we should wait to see what happens.

What has happened so far is that the appointment of a national guardian has coincided with a drop in whistleblowers telling the CQC when things are going wrong.

What we do know is that staff do lose jobs are blacklisted and get the reputation of being troublemakers. There is a  website which covers 11 such cases here. All designed I suspect to cover up an NHS and care system creaking at the seams and not being adequately financed. I hope Dr Hughes does not turn out to be a convenient fig leaf for a service in trouble.

 

Nuclear decommissioning: How Whitehall turned toxic waste into a dirty mess

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Decommissioned power station at Wylfa in Anglesey

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It is possibly Whitehall’s biggest blunder. it certainly involves one of the biggest contracts ever let by government. And you will have shelled out hundreds of millions of pounds for very little in return.

The subject is the decommissioning of 10 nuclear power stations and two research centres – now all past their sell by date – and all leaving the taxpayer with an almighty bill to detoxify them and make them safe.

The total bill to do this was meant to be £3.8 billion but it turned out to do it properly would cost £6.2 billion- making it possibly one of the biggest contracts ever let by Whitehall.

And what a mess Whitehall civil servants and their ministers made of it. The whole sorry story was revealed in a report by Parliament’s financial watchdog, the National Audit Office, this month.

. The  £6.2 billion contract was approved by the Treasury because it promised to save taxpayers £904m by loading risks on the contractors. Instead it has only saved £255m and this has been partly wiped out by a botched tendering procurement which ended up with a rival consortia being able to sue the government for damages.

The company that won – an American led consortium Cavendish Fluor Partnership (CFP) based in Texas- was awarded the contract illegally.

We know this because its rivals Energy Solutions which includes Bechtel successfully sued  the government in the High Court last year and the High Court ruled that Fluor should have been disqualified because the final contract was nothing like the one put out to tender.The Business, Energy and Industrial Strategy ministry has just settled the bill with Energy Solutions by agreeing to pay then £97.3m in compensation.

But the real bill was even more. The NAO found that the full cost amounted to £122m.  It spent £13.8 million on legal and external advisers. Of this, £3.2 million was spent on the competition and £8.6 million was spent on legal fees in the ensuing litigation. The NDA estimates that in-house staff time has cost £10.8 million. This excludes the cost of staff time of senior central government officials who were heavily involved in decisions, particularly about the National Decommissioning  Authority’s settlement and its decision to terminate the contract.

One reason for this debacle is believe or not is that officials  did  not know the state of some of the decommissioned  power stations so had to revise its estimates as more problems came to light- changing the terms of the winning bidder’s contract.

Amyas Morse, head of the National Audit Office: “The NDA’s fundamental failures in the Magnox contract procurement raise serious questions about its understanding of procurement regulations; its ability to manage large, complex procurements; and why the errors detected by the High Court judgement were not identified earlier.

In light of these issues, the Department must consider whether its governance and oversight arrangements surrounding the NDA are sufficiently clear and effective in providing the scrutiny and assurance it requires to meet the standards expected in managing public money.”

There is now an inquiry going on under Steve Holliday, former chief executive of the National Grid. Its terms of reference include whether disciplinary action should be taken against the civil servants who made such a botched job and cost us even more money. It could mean heads should roll.

And it leaves the government another big problem because the contract with the present consortium has had to be terminated in 2019 – nine years before it is due to end.

And the axe is due to fall just as Brexit comes in – leaving more unfinished business just when Britain may well leave Euratom. What a mess.

I have written about this in Tribune. The full NAO report is here.

 

 

 

Why Francis Maude and Amyas Morse are right to ginger up complacent Whitehall

2015 General Election - Cabinet

Lord Maude Pic creditL gov.uk

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Last week I attended  what turned out to be a highly controversial debate on the future of the civil service – one of a series on various issues chaired by John Bercow,  at Speakers House in the House of Commons.

I found myself  surprisingly agreeing with Lord Maude, the former  Tory Cabinet Office minister, and with his opponent, Bronwen Maddox, director  of the Institute of Government, ( who rightly highlighted the mistake to privatise the probation service) over why the top echelons of Whitehall need radical reform.

Don’t get me wrong I am not about to become a card carrying member of the Tory Party ( even if their average age at 72 is nearer mine) and I would  disagree with Maude profoundly over his savage cuts agenda, but on the management of Whitehall he is talking sense. He is also a Whitehall insider and his full speech is here.

I have often wondered why time and time again Whitehall is  dragged before the Commons Public Accounts Committee to explain fiasco after fiasco on how millions if not billions of pounds are wasted on defence contracts, computer projects, collecting tax, benefit errors and big transport  and energy infrastructure projects.

Francis Maude provided part of the answer – our top civil servants are not up to the job. because they are not trained properly  to do it. And they rely, I am afraid, still on too much secrecy, to cover this up.

They are not trained for the complexities of modern Britain and complacently still believe we have the best civil service in the world while the rest of the world is changing fast.

What was more shocking is that he proposed some  modest remedies to change this – and brought down a howl of protest from  stuck in the mud mandarins. He thought it might be a good idea if fast stream graduates got wide ranging training in different government departments over a  two year period rather than being stuck in one ministry.

As he said : ” Bright graduates thought they were joining the Civil Service; and were then surprised to find that they joined a specific ministry where training took a definite second-place to the job to which they were assigned.

My modest reform to make the Fast Stream programme look and feel more like a typical two year graduate training programme met with surprising resistance, with four permanent secretaries, including at the Treasury, showing up to tell me that it was completely impossible.

Apparently, if the Civil Service trained its graduate entry the way high-performing private sector entities do, the government would fall apart. If I insisted, as I did, that Fast Stream trainees did four six months postings in different parts of government, then they would be unable to do any useful work.”

He also suggested a much broader programme for the top senior mandarins – giving them international business school experience – and , believe or not, got threatened with exposure in the Daily Mail for wasting taxpayers money!

As he said: “The second eye-opener was when I proposed that senior civil servants headed for very big responsibilities should be put through top management courses, typically three months, at top business schools. High performing organisations routinely do this; and I have seen people come out transformed into a bigger, more confident and capable leaders. So I proposed first that the ten permanent secretaries should go through these courses before the 2015 election.

“The first objection was that this would be very expensive and that the Daily Mail would make a fuss. My response was to say: Bring it on. If the Mail really want to object to us spending £60,000 on someone managing a budget of tens of billions, I’d love to have the argument.”

He also, in answer to a question from me, about the secrecy surrounding who decided the bonuses paid to top Department of Works and Pensions who are responsible for Universal Credit, called for more transparency. He also suggested that civil servants should be much less timid in challenging ministers over public spending projects – ending the idea that when a top civil servant demands an ” ministerial directive” to do the job it shouldn’t be seen as a nuclear option but commonplace.

Since going to the debate I have discovered he has a strong ally over this – Amyas Morse, head of the National Audit Office -wrote a year ago about the failure of Whitehall to do the job in this area.

“The threat of this can prevent poor decisions about use of taxpayers’ money, and discussions about possible directions can have ‘invisible’ positive influence on decision-making.

” However, the evidence suggests the mechanism is not being used effectively. Major projects where there were clear value for money concerns, such as the FiReControl Project (2004-2011 which had cost £635 million when it was cancelled) or the National Programme for IT in the NHS (costing £11.4 billion between 2002 and 2011), were not the subject of directions.”

Instead the timid mandarins query  tiny projects by comparison – such as the use of money for a consultancy on the future of Manton Airfield in Kent- and are too frightened to challenge really big decisions.

The time has come for a radical change in direction in Whitehall to get better and more broadly trained civil servants at the top who would take better decisions on how they spend our money.

 

The £20,000 benefit bonus rewards for the metropolitan elite at the Department of Work and Pensions

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Neil Couling – £145,000 a year

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Last week I had a story in the Sunday Mirror about top bonuses and pay rises for five of the most senior  and well paid civil servants at the Department of Work and Pensions over the last two years.

The information was published in the annual report and accounts  of the DWP released last month. These same accounts were qualified for the 29th year  running according to the the National Audit Office – because of fraud and error in payouts to claimants rendered them inaccurate and wrong.

 

 

Sir Robert Devereux pic credit Twitter

Sir Robert Devereux – £190,000 a year Pic credit : Twitter

The bonuses announcement came at the same time as 31 Labour MPs had called for a pause in the roll out of the ministry’s new Universal Credit  programme – which replaces five benefits – because of reported chaos in its administration leaving some claimants without money for up to six weeks. One of those 31 MPs, Kevan Jones, who represents Durham North said the bonuses were a ” reward for failure”.

He described them as “an insult to many of my constituents who are already living on the breadline. In my constituency they plan to introduce this in November which could leave thousands of people without money in the run up to Christmas.”

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Mayank Prakash £220,000 a year including £20,00 bonus Pic credit: DWP Digital

Within days of the publication of the story the FDA ( the First Division Association) which represents the top civil servants attacked the article in a report in Civil Service World.

Jawad Raza, FDA national officer for DWP, said officials should not be used as targets by political opponents of the system simply for doing their jobs.

“The suggestion that these civil servants have been ‘rewarded for failure’ shows a blatant disregard for the facts regarding their pay and

Jeremy Moore pic credit

jeremy moore – £135,000 plus £20,000 bonus

wilfully misrepresents the true complexity of their roles,” he said.

“Senior civil servants have delivered billions of pounds worth of savings since 2010 with an ever reducing workforce. These are highly skilled professionals working in challenging circumstances and they deserve to be adequately remunerated without having their names and faces spread across news pages.”

Sorry Jawad I think there is more to this.

The five civil servants are Sir Robert Devereux, permanent secretary at the Department of Work and Pensions; Neil

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Andrew Rhodes – £140,000 a year plus £15,000 bonus

Couling, director general of universal credit; Jeremy Moore, director of strategy; Mayank Prakash, director general of digital technology and Andrew Rhodes, director of operations have received between £10,000 and £20,000 each .They are nearly all paid more than Theresa May, the PM.

The bonuses were awarded for “ top performance “ and “ leadership “when the rest of Whitehall is limited to one per cent pay rises and many benefits have been frozen.

Sir Robert last year received up to £20,000 extra on a salary of up to £185,000 a year. This year he hasn’t received any bonus but his basic salary has moved to £190,000 a year.

Neil Couling, who is directly responsible for universal credit, got a bonus of up to £20,000 last year on a salary of £125,000 a year. This year instead of a bonus his salary has jumped by £20,000 to £145,000 a year.

Mayank Prakash, director of digital strategy has received a bonus of up to £20,000  this yearon top of salary of £200,000 taking his annual salary to £220,000 .

Jeremy Moore, director of strategy, has received bonuses two years running –  totalling up to £40,000 over the two years – taking his total salary to £155,000 a year.

Andrew Rhodes, director of operations has received a £10-15,000 bonus this year, taking his salary to £155,000 a year. He also claimed £37,600 in travel expenses.

The ministry insist that all these pay rises were decided objectively by line managers.

In a statement it said:

Line managers are required to make an evidence-based and objective assessment over whether objectives have been met, not met or exceeded. 

 Individual performance is assessed by the individual’s line manager through an appraisal discussion, with supporting evidence from a range of stakeholders.

But apart from Sir Robert – whose bonus was decided by Sir Jeremy Heywood, the Cabinet Secretary – the Department declined to say who these line managers are and which outside organisations and people recommended they should get bonuses. The bad news for the DWP is that Kevan Jones plans to table a Parliamentary Question next month to find out who.

Now the FDA has a point that compared to the top of the  private sector they are badly paid. A report put out by the House of Commons library revealed that the top 3000 bankers are ALL earning over £884,000 a year – which makes £20,000 sound small beer. But if anything that reflects that huge growth of inequality in Britain.

At other end of society how effective are these five top men ( note they are all men) in delivering what they are supposed to do. All are responsible in one way or another for the delivery of Universal Credit.

At present they are using Newcastle-upon-Tyne – to roll out the full effect of Universial Credit.

Catherine McKinnell , Labour MP for Newcastle North, said:“ My office has been deluged with complaints from constituents about a Universal Credit system that is clearly struggling to cope and failing to deliver the support that claimants need in anything like an orderly or timely fashion.”

Her debate can be read here.  Suffice to say it reveals a very sorry picture. The  new IT system means people can’t talk to a human. It has  a verification process that requires claimants to produce photographic identification such as a passport or driving licence, “which many simply do not possess and certainly cannot afford, even though some have been in receipt of benefits for several years.”

“I also have numerous examples of Universal Credit claims being shut down before they should be; of documentation being provided to the DWP, at the constituent’s cost, and repeatedly being lost or even destroyed; and of totally conflicting, often incorrect, information being provided to constituents about their claims.”

For a time the ministry effectively banned MPs from taking up cases by making impossible verification demands before they would talk about it.

What this shows to me is a growing disconnect between the people at the top – who are computer savvy, have nice centrally heated homes, no problems with bills, can afford expensive holidays, and can’t conceive of anyone not having a passport – designing a system for poor, dispossessed, desperate people without any understanding of how the world works for them.

It was this disconnect between the elite and the poor  in the USA that led to the rise of Donald Trump and I suspect this huge gulf between the Metropolitan elite – whom top Whitehall civil servants are part – and the provincial poor is in the end going to propel Jeremy Corbyn into Downing Street.

 

You are paying £2.5m to keep this tram train in a depot

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The Rotherham train tram – staying in the depot until next year

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This is the new Sheffield to Rotherham tram train. It should have been in service over a year ago. Instead it is going nowhere. It is one of seven train trams  confined to a depot and won’t go into service until next May at the earliest.

As a taxpayer you are paying the private rail and bus company  Stagecoach £2.5m compensation for a service it can’t run because Network Rail haven’t completed the job on time.

But the £2.5m is small beer to another much bigger bill you are paying Network Rail to adapt a route both extending tram tracks and using a disused railway track to create the new service from Sheffield to Rotherham.

That bill is now nearly five times what was originally estimated -it has gone from £18.7 m to £75.1m – a staggering increase on the original projected cost.

Details of this scandal are published in a report by Parliament’s financial watchdog, the National Audit Office and will no doubt be examined by MPs on the Commons public accounts committee later this year. I have written about it in Tribune magazine today.

The project is important because it is a pilot scheme and if it is successful lead to other tram train projects in Glasgow to the airport and in the South Wales valleys outside Cardiff.

The bungling of the project – originally approved by two Liberal Democrat ministers, Norman Baker and Danny Alexander – as  a worthy new public transport scheme has infuriated Sheffield Labour MP Clive Betts who has put the whole blame on bad management by Network Rail.

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A Karlsruhe tram train : In operation since the 1980s on streets and mainline railways. Pic credit : random streets blogspot

The scheme which was nearly cancelled twice however should not have been rocket science. Tram trains have existed in Germany – Karlsruhe was the first city to have one – since 1980 yet according to the MP Network Rail couldn’t be bothered to consult them to get advice  before they started.

Another big failing was not to appreciate that the tram trains might require two different electrification systems and a failure to appreciate how much work was needed on the railway lines to bring them back into public service – including the need to alter a junction.

Rob McIntosh, Network Rail’s London North Eastern and East Midlands Route Managing Director, said: “Sheffield to Rotherham tram-train is an ambitious pilot, a UK first, that will bring new travel choices to people of South Yorkshire when services begin in 2018. The project continues to be complex and challenging but will deliver real benefits for thousands of daily commuters.

…”the project has been extended to include additional work to future-proof the tram-train electrification system for later conversion to the national rail standard system that was  not part of the original scope. Such factors have added time and cost to the pilot which is under significant pressure  to deliver.”

However this is still another sorry saga and could impact on future projects. Plans are now going ahead for a £144m tram train link from Glasgow’s Queen Street station to Glasgow Airport using the same technology. Whether this will also overrun remains to be seen.

Gag, cover up and secret privatisation: What is the real story behind the NHS clinical correspondence scandal

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NHS archives. Pic credit: Health IT Central

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A week ago the media was full of the huge scandal of over 700,000 clinical correspondence documents – including details of sensitive patient conditions – going missing and  instead of being delivered to GPs being dumped in rooms.

The story was originally broken by the  Guardian in February this year which revealed that NHS England was secretly working on how to sort out it  without disclosing the scandal to the public. Jeremy Hunt had made a perfunctory statement to Parliament in 2016 not disclosing the full state of affairs in July 2016.

Last week the National Audit Office published a very thorough investigation into the scandal – including discovering that somehow the NHS also lost  highly confidential reports dating back to 2005 which identified children subject to child protection orders which must never be disclosed to the public without the individual’s consent. And in 1788 cases it look possible that patient treatment could have been harmed as a  result.

The mislaid and unprocessed correspondence covers GPs and now abolished Primary Care Trusts in the East Midlands, North East London and South West England .

The NHS has paid GPs £2.6m up front  to examine the mislaid documents but they have yet to complete the work so a proper picture can still not be obtained.

In one bizarre incident some 205,000 documents were kept in a room marked “ clinical notes”. The report says: “A subsequent review found that the label had been removed by an SBS general manager because “you don’t want to advertise what’s in that room”.

“ NHS SBS told us that it was important that documents were held securely and therefore not having a label on the door was appropriate as part of this.”

Now this scandal is bad enough but in the small print of the National Audit Office report there lurked another extraordinary scandal – SBS  and its auditors, BDO, decided to frustrate the National Audit Office finding out what had gone wrong.

Both the company and the auditor refused to hand over the files unless the National Audit Office signed an indemnity letter – which  could get them off the hook should enraged patients decide to sue them for their negligence.

The NAO to its credit refused to do so and in its own report says, if it had, Parliament would not have been told the full story. As the report says:

“NHS SBS and BDO felt unable to share with us their reports into the incident unless we also signed a letter (which would indemnify them). This is common practice among audit organisations.

“We declined to sign any letter that would limit our ability to report on the incident.”

Instead the NAO used its statutory powers to force NHS England, which had copies of the documents after signing the indemnity letters, to hand them over.

Now NHS Shared Business Services was set up as a joint venture with the private sector  under the Blair administration in 2004 when John ( now Lord ) Reid was health secretary. It was an equal partnership between the  Department of Health and Xansa Ltd,a British outsourcing technology company 50 per cent owned by the staff. In 2007 it was taken over by Steria, a French  rival, with British staff pocketing millions of pounds as the French paid a 70 per cent premium on the share price.

In 2014 Steria merged with another French rival Sopra creating a French owned global conglomerate. They are now planning to take over a Swedish firm

But two years before Andrew Lansley, then secretary of state for health, quietly and without any public announcement, transfered a single share to the French company, so it became the majority owner and could dictate policy. Just to make sure the Department of Health, which had civil servants on the board, declined to take up the directorships on the grounds of ” conflict of interest”.

I asked BDO and NHS Shared Business Services why they had sought to frustrate the NAO.

BDO replied putting the onus on the privatised company  saying :

“BDO was in no way obstructive or concerned about making its reports accessible to the relevant third parties.” BDO has a contractual duty of confidentiality to clients as well as an ethical duty of confidentiality under the Code of Ethics of the Institute of Chartered Accountants in England & Wales (ICAEW). Therefore, unless required by law or regulation, we cannot disclose information to third parties (such as the NAO) without the express permission of our client. 

The letters dealing with obtaining the necessary consents and agreeing the basis for access are drafted in accordance with professional guidance issued by the ICAEW. As the NAO report acknowledges in its report (paragraph 3.19), this is “common practice among audit organisations”.

 Patients of the NHS are not a party to such letters and therefore their legal rights are completely unaffected.”

NHS Business Shared Services said :

“The recent NAO report highlights a number of failings in the mail redirection service provided to NHS England. We regret this situation and have co-operated fully with the National Audit Office in its investigation. All of the correspondence backlog has now been delivered to GP surgeries for filing and NHS England has so far found no evidence of patient harm. NHS SBS no longer provides this mail redirection service.”

There appear to be contradictions in both statements.  I gather the safe delivery of clinical correspondence  is now in the hands of Capita.

 

How the Tories have fixed the road programme to maximise the motorist vote

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M62 motorway £161m of improvements planned before voters next go to the polls. pic credit: BBC

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The government is fiddling its £11.4 billion road  building and improvement programme  so that  new road schemes will be timed to have their maximum impact to gain votes from motorists when they go the polls.

The Department of Transport already fiddled its present plans  by fixing the time for new road schemes to coincide with voters going to the polls in 2015.

Now they are planning to have the largest number of schemes  going ahead in 2019 to 2020  just when people go to the polls for the next general election.

This disclosure does not come from the Labour Party or the Liberal Democrats – who were party to the first part of the plan – but from an impeccably detailed analysis by Whitehall’s spending watchdog, the National Audit Office – with a reputation for independence and political neutrality.

Their investigation into the highways agency programme  for motorways and A roads reveals that ministers cut short the planning period for new road schemes to just 17 months- instead of a normal 30 month period – so it could be timed to come out for the 2015 general election.

And their analysis  of present plans show the busiest period for new schemes to start will be in 2019-20 just as people are preparing to cast their votes. I have written about this in Tribune magazine.

The manipulation of the road scheme plans has however meant the ministry has  had one embarrassing drawback. Ministers over committed the number of schemes that can be built within its present budget and at least 16 may have to be scrapped because they are not value for money.  But this embarrassing decision will be taken soon – mid term – so it should not affect campaigning in the run up to the election. So in fact the promises made by the Tories in 2015 will in part be fake news.

The  NAO report says the rush to produce a plan before the 2015 election “meant that the Department and the Highways Agency could not carry out sufficient analysis and planning to ensure that the Road Investment Strategy was affordable and deliverable, and that the projects would produce high benefits relative to costs.

“In particular, the need to develop so many new projects more or less from scratch meant that the portfolio of enhancement projects contained a high level of uncertainty from the outset.”

The report says: “The Department chose to set a capital programme which was forecast to exceed funding by £652 million. 

This ‘over-programming’ had been standard practice in the Highways Agency, as it was expected that some schemes would be delayed or drop out of the portfolio as it was refined. By August 2016, the amount by which forecast capital costs exceeded available funding had increased to £841 million.”

Among the projects that have generated extra money include £234m for Project Stack – to allow lorries to be parked on the M20 while waiting to go abroad – which will be essential if border controls are introduced as a result of Brexit. Another £161m is needed to bring forward two projects on the M62 which the government wants to turn into a smart motorway  for 60 miles between Manchester and Leeds.

Amyas Morse, head of the National Audit Office, said: “The Department and Highways England need to agree a more realistic and affordable plan if they are to provide optimal value from the Road Investment Strategy”.

…Decisive action needs to be taken before the updated delivery plan is published in the summer if shortcomings in the current strategy are not to be carried over into future road investment periods.”

But the truth is the government know motorists’ votes play a part in any election. and they will do their damnest to fix schemes – from a local by pass to improved motorways – to make sure they can be used to maximum electoral advantage.