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Meet the man whose company runs Savernake Hospital’s financing contract

Doubts and anxieties about Savernake Hospital’s private funding initiative (PFI) have been raised by Devizes MP Claire Perry and local campaigners – both about the size of its burden on the area’s health services and its future amidst the wholesale reconfiguration of the NHS.  And some local people have expressed worries about what might become of the hospital itself.

In addition, the whole value of PFIs in building new infrastructure has been called into question at Westminster – in Parliament and within the Treasury.  And this just as the Chancellor of the Exchequer announces that he wants to get more private funding into building to help fire-up the stagnating economy.


Who better to go to for the facts (as opposed to the political rhetoric) about Savernake’s PFI and PFIs in general than Alan Birch, the group managing director of Semperian PPP Investment Partners, the largest public private partnership infrastructure fund in Europe.  Semperian owns and manages the Savernake PFI contract – and also the much bigger one for the Great Western Hospital.

Semperian’s annual bill for the Savernake Hospital PFI (known as the ‘unitary charge’) is £938,000 for the financial year 2011-2012 – paid by NHS Wiltshire, our Primary Care Trust (PCT.)  This cost is partially offset by rental payments from the other health authorities that provide services at Savernake.

And for the Great Western Hospital the unitary charge this year is £18.7 million – paid by Great Western Hospitals NHS Foundation Trust .

Alan Birch agreed to meet Marlborough News Online at the company’s regional offices in Bath. The group own and run over a hundred PFI projects. They are secondary investors in the PFI market.  They do not start projects and build hospitals, schools, army training facilities, roads and so on, they do buy up projects that have been successfully completed and then run them.

And the running of them is where things get complicated.  Aside from the capital investment and consequent interest payments, the contracts include two types of facility management: hard (which includes maintenance, replacement of equipment and of plant like boilers or switchboards) and soft (which includes facilities involving staff like catering and security.) Alan Birch says that the average proportion for Semperian PFIs that is spent on hard and soft facilities management accounts for between forty and forty-five per cent of the unitary charge.  Many of these services will be contracted out and, to maintain value for money, are put out to tender every three or five years and the unitary charge is then adjusted to ensure the taxpayer only pays the market rate for these services.


At Savernake Semperian are only responsible for ‘hard services’ – maintenance of the fabric and upkeep and replacement of hospital equipment and services like heating and lighting.

At Great Western Hospital Semperian are responsible for both hard and soft services, which includes estate management and life cycle maintenance works; catering for patients, staff, employees and visitors; portering, mail delivery, cleaning, security services, the switchboard and a 24/7 customer help desk.  It also buys the hospital’s utilities and manages the shop.

The scale of Semperian’s involvement through these soft services in the everyday life of hospitals is staggering.  At one Manchester hospital they manage ‘soft services’ valued at £17 million a year.

 








Turning to the ‘hard services’, during school holidays, Alan Birch’s project managers can be organising £70 million of maintenance work at their PFI schools – making sure they’re finished so the schools can re-open.  If they can’t re-open Semperian won’t get paid its unitary charge.  

 

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At Savernake, they’ll soon begin replacing the windows in the old, Gilbert Scott buildings with top-of-the-range double glazed windows. That’s one of the great advantages of PFIs: the companies are obliged to keep the buildings’ fabric and services up to scratch and at the end of the contract, deliver the hospital, free of charges, back to the PCT, well maintained and achieving the same output standards as on day one – but, of course, with up to date materials and technology.

Conversely, for PFI hospitals one of the disadvantages raised by critics is that over thirty years of a PFI contract patterns of health care and budgets will change and a hospital risks becoming something of a costly white elephant.  But that’s not Alan’s experience.

He explained how Semperian had developed a simple way to vary buildings so they can be continually changed and adapted to meet the changing needs of health care policy.  And it’s up to the primary care or hospital trust to ensure the buildings are configured and occupied properly.
 






Alan Birch started his career as an apprentice plumber with British Rail at Edge Hill in Liverpool.  By the time he was twenty-three he had become a manager and was given the job of preparing the Liverpool area’s maintenance organisation for privatisation.

He has been involved in PFI from the outset, negotiated the very first PFI projects for education and worked his way through every level of management until he reached his current position.  Now aged 41, whilst his family home remains in Wigan, he works from London during the week.

He certainly knows a great deal about making economies and running a tight and efficient ship.  Along the way he has, he says quite openly, worked very hard and been rewarded very well.  He even joked he could retire and live modestly in Wigan: “But I choose to work because I like what I do.”

He likes working in the social infrastructure sector, and he likes being able to make a good return for his investors, almost all of which are public sector pension funds or UK corporates that the government has a material stake in.  That return is generally eight to nine per cent. He likes seeing the returns generated by Semperian fed back into the public sector via pension funds – forming a virtuous circle.

So he’s a little disconcerted that PFIs have suddenly become a political football.  He wonders whether if they had been named PPPs – public private partnerships – rather than PFIs, the current political squall would have arisen.  Especially as the public sector is unable to raise the money and politicians are saying how much our infrastructure needs updating.

 

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He was a little troubled when at a committee hearing, one MP failed to understand the difference between Semperian’s parent or holding company being registered in Jersey and resident in the UK.  It’s resident in the UK so it pays UK taxes like any equivalent UK company.


It is registered in Jersey so it can attract foreign investors who do not then get taxed twice on their dividends That’s in accordance with international tax treaties and is agreed by British tax authorities.
Both the Treasury and the Treasury Select Committee have been looking at ways to save money on PFIs. From a pilot scheme, the Treasury reckons it’s possible to save “around five per cent of the annual unitary charges”. 


 

The bulk of these savings will come from soft facilities management on which Alan Birch says “We don’t make a single penny and never will, all these savings are passed directly to the owners of the buildings.”  

He explains that as soft services rely on people, the savings will come from lower wages now that nationally pay increases have fallen so far behind inflation.  The November figures showed the pay of British workers up just 0.4 per cent on November 2010 while inflation is above five per cent.

There are other ways to save small parts of the unitary charges.  For example Semperian now pays Savernake’s gas and electricity bills.  This is a simple way to save money as Semperian with all its projects can bulk buy energy at far greater discounts than a small group of primary care trusts.  At Savernake this will save between £15,000 and £20,000 a year.

_________

PFIs were born in November 1992 when Norman Lamont announced “ways to increase the scope for private financing of capital projects.”   And the Conservatives’ 1997 election manifesto promised to use PFIs “to unleash a new flow of investment funds into the modernisation of the NHS.”

Labour won that election and made PFIs their own. Records show that 101 of the 135 new NHS hospitals built between 1997 and 2009 were funded using PFI. The 2010 coalition agreement confirmed its future use of PFIs.  And as at March 2011 sixty-one new PFI projects were being procured – with a total investment value of £7 billion.

Alan Birch does admit that at the beginning a few companies succeeded in making some big short term gains on projects mainly because there was a flood of money into the PFI market.  However, since the credit crisis private sector borrowing costs have tripled and sometimes public bodies can get funds more cheaply than PFI projects allow – especially now with interest rates at rock bottom levels.

An example is Semperian’s sale of two of its PFI projects to Transport for London (TfL) which is a government body with a triple-A rating and is unique in that it can raise its own external funds.  The two PFI projects are extensions to the Docklands Light Railway – the Woolwich and Arsenal links both run by Semperian companies.  

According to TfL this will save some £250 million over the length of the contract.  TfL can make this work because it does, of course, have its own maintenance teams ready to go.

Alan explained:  “On these two PFI projects Semperian could not match the cost of borrowing TfL could find, so the only pragmatic thing to do was to sell them the companies and let them realise the savings. But this is an exception. The fact is public sector funding is not normally available and so private finance is required.”

Private finance is more expensive than public finance, but if the latter is not available because a government won’t allow more borrowing, then it is not a question of comparison, more a realisation of the true costs of renewing our social infrastructure.

One of the FAQs about PFIs is why the unitary charges for NHS projects rise each year by inflation (RPI.)  This money is used to repay the capital toward the end of the contract. It means that unitary charges start lower and are paid for by matching RPI increases in funding to the PCT or hospital trust.  

However, during the current period of austerity and the reduction in NHS funding, the inflation linked unitary charge is being seen as a burden, but the inflation element is needed to repay capital raised to fund the building of the hospital.

Stirring the political storm swirling around PFIs, conservative MPs have implied that the last government simply ‘threw money’ at projects.  But a look at the Treasury’s role in the development of PFIs shows that contracts have evolved and become tighter since the days of the Major government.  The current standard contract - ‘Standardisation of PFI Contracts Version 4’ (“SoPC4” for those who need to know) – was published in March 2007 and is still in use.

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Savernake being extended and refurbished under PFI in 2004
Two things are certain: without the PFI Savernake would never have been extended and renovated.  It was re-built within budget and on time.  Its PFI contract means that far from saddling our grandchildren with a debt, they will, in 2035, inherit a hospital even more modern and as well-maintained as it was on day one of its new existence, and with renewed services and equipment.

Alan Birch says that discussions with the government about PFIs in the reorganised NHS have been going on for several months.  He thinks that Great Western Hospital will be the best people to hold the Savernake Hospital PFI contract after the PCT is abolished in 2013.

GWH now manage most parts of Savernake Hospital and its fabric. And Semperian’s full-time GWH manager also looks after Savernake.
 











This would seem to be a perfect fit as Great Western Hospitals NHS Foundation Trust took over Wiltshire’s community health staff – and community hospitals – from the PCT in June this year.

Alan Birch has comfort for those who fear Savernake Hospital might simply disappear when Wiltshire’s primary care trust disappears.  The contract has a clause which means that “upon the Trust ceasing to exist”, the contract is passed automatically to its “successor” organisation which may include “any person to whom the Secretary of State [for Health] in exercising his statutory powers…transfers the property, rights and obligations of the Trust under this Agreement”.


FACTS CHECK:

  • Semperian PPP Investment Partners is a £1.3 billion company.  It is one quarter owned by the Transport for London pension fund.  Its other shareholders are similar institutions.
  • The money to rebuild and extend Savernake was lent at 6.98 per cent a year.
  • PFI keeps debt off the government’s books. The national debt would increase by at least £35 billion if all PFI liabilities were included.
  • By May 1997, seventy PFI schemes were in the NHS pipeline.
  • In the NHS at present there are £2.9 billion of PFI projects under construction and another £1.4 billion worth in the preparation or procurement stage.
  • The Treasury estimates that when all Department of Health PFI projects are taken into account the annual unitary charges will add up to over £1.5 billion for 2011-2012.

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Pigs take centre stage at carol service

Shepherds watched their flocks by night, a little donkey carried Mary to Bethlehem, and wise men followed yonder star on camels.

But piglets took centre stage at a Marlborough carol service on Friday, when children from St Mary's Primary School were each given a hand-carved wooden pig by wood turner Richard Miles.

Mr Miles carved 200 of the little animals, which were presented to children at the end of a carol service at St Mary's Church, during which the children sang 13 carols and songs and told the story of the nativity.

Mr Miles has a long association with the school, and built the school's nativity scene – which includes hand-carved candles – which has delighted children and adults alike for three years.

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Whatever the costume, they're all Nativity angels

They might be dressed as shepherds, wise men or even animals, but to their proud parents and grandparents they're all little angels.

Nativity plays kicked off in earnest at schools around the Marlborough area this week, and Marlborough News Online was given access to the dress rehearsal for the performance by St Katharine's School, Savernake.

 

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Ding, dong the Marlborough community choir makes another surprise hit

choirchoirThey did it last year, providing a festive song to surprise Christmas shoppers in Waitrose.  And they were then again today (Saturday) in the Marlborough store.

Fifteen members of Marlborough Community Choir, shopping baskets in hand, suddenly gathered between the fruit, cheese and cooked meat stalls and burst into a Ding, Dong song, something they call a flashmob demonstration.

It was partly to entertain the shoppers and partly to hand out leaflets to promote their Christmas, Etc evening at St Peter’s, Marlborough, on December 10 (£7.50 tickets from marlboroughcommunitychoir.org for the 7.30pm performance).


Vanessa LaFaye of the Marlborough Community Choir in singing in Waitrose Vanessa LaFaye of the Marlborough Community Choir in singing in Waitrose That’s when the choir, launched 18 months ago by American writer and photographer Vanessa LaFaye, will have the Pewsey Vale songstresses Mother’s Jam as special guest stars, raising funds for Home Start Kennet.

And the choir will be back at Waitrose for an hour-long concert of carols and festive songs at midday on December 17.

“The flashmob today was great fun, thanks to Richard Clare at Waitrose for helping to spring it on the staff as well as the customers,” Vanessa (pictured) told Marlborough News Online.

 

“The choir has been going for just over a year and the membership has grown to about 40 regulars.  We're now gearing up for our fundraising concert on December 10 at St Peter’s.”
“Then on 1December 12 we're singing for the residents at Merlin Court and Marlborough Lodge, before ending our Christmas season back at Waitrose on the 17th.”

And she added: “We were thrilled to be invited by Waitrose manager, Andy Davies, who is making a really generous donation of £100 to the choir.  We'll be singing for an hour, and hope that it puts the shoppers in a festive mood!”

“Next year, we're very pleased that Hamptons in Marlborough is going to help promote our big concert in aid of Comic Relief on February 25, Singing for Laughs.”

“We really appreciate all the support from the local businesses, especially during such difficult trading conditions.”

 

 

 

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Your phone service is ready for you.

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Hundreds flock to see Santa in the Town Hall Grotto

Hundreds of people flocked to We Love Marlborough's Christmas Art Market and Santa's Grotto on Thursday to shop, meet Father Christmas and have arty fun.

The not-for-profit arts organisation hosted a day and evening of events on two floors of the Town Hall, to coincide with the switching on of the Christmas Lights.

Louisa Davison, from We Love Marlborough, said: “We are throughly exhausted but really pleased with how many people came to see Santa, see the stalls and take part in the art activities.”

Upstairs, Santa – accompanied by the Sleigh Belles – met over 100 children, some of whom brought him small gifts, pictures and hand-written letters.

On We Love Marlborough's Facebook page mum Lucy Brenk said: “Santa was worth the wait when we finally met him. Very good with the children,” while Jim Nicolson praised the “great atmosphere.”

And while parents faced long queues at times, children were entertained by a host of activities including face painting, Christmas crafts and the production of a huge Christmas mural, featuring Santa on his sleigh and measuring over four metres by three metres.

Meanwhile downstairs, 13 craftsmen and artists from across Wiltshire – including woodturners, jewellery makers, fine artists and potters – offered visitors the opportunity to buy beautiful handcrafted gifts.

Stall holders enjoyed themselves as much as the shoppers. Victoria Mellor, from Usborne Books, said: “Many thanks to We Love Marlborough team! It was a good event with lots of people bustling around. Look forward to next year.”

And Amanda Horner from Ramsbury Tea Co said: “Thanks for a great market last night; we met some wonderful people and talked a lot of tea!” 


Children decorating the giant Christmas muralChildren decorating the giant Christmas muralEager children queue to see SantaEager children queue to see SantaEager children queue to see SantaEager children queue to see Santa

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Busy fete boosts school funds

More than £600 was raised by parents, children and supporters at Saturday's St Katharine's School Christmas Fair, which was held at Marlborough Town Hall.

Stick the nose on Rudolph, lucky dip, face painting and a competition to find hidden Christmas objects in a container of fake snow - courtesy of toy shop Ducklings - were among the attractions.

There were also plenty of activities: children were invited to decorate biscuits, paint ceramics and make holly decorations, while some stalls sold Christmas gifts made by the children in their classes.

The children themselves serenaded shoppers with Christmas songs and even Father Christmas took time out of his busy schedule to visit the event.

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Marlborough’s own Dad’s Army is brought back to memorable life

They called them the Local Defence Volunteers at the start, the brave band of men who took up arms after the flight from Dunkirk to protect our shores – and sky – from the expected hordes of Hitler’s troops.

Tommy Trinder, the cheeky stand-up comedian of radio fame labelled them Look, Duck and Vanish.  And so it was later left to Winston Churchill to rename the biggest unpaid army ever raised in Britain the Home Guard.

And, of course, it has stuck to this day and embellished by the comic antics of the BBC’s long-running and loved TV show Dad’s Army.

“If it hadn’t been for Dad’s Army, the Home guard would have been largely forgotten,” admits local historian Roger Day (pictured). “But the record needs to be put straight by emphasising how close this nation came to a Nazi invasion in 1940.”

And so he sincerely hopes his new book, Look, Duck and Vanish, a fascinating and highly readable  history of the 6th (Marlborough) Battalion of the Wiltshire Home Guard from 1940 to 1944 will go a considerable way to addressing the issue.

Indeed, it is a valuable exercise in social history, packed with pictures and illustrations, the more so since he thought he had left it too late to research such a history when he was contacted by Sir Sydney Giffard in 2008.  He asked if Roger was interested in the Marlborough Home Guard and piles of documents relating to World War II that he held.

They had belonged to his father, Walter Giffard, the battalion’s commander, and Marlborough-born Roger discovered that the range of information was “beyond my wildest dreams.”

But were there still members of Marlborough’s Dad’s Army around to interview – was he too late?

The surprise there was that he discovered more than 20 who could recognise themselves among the photographs now in his possession and had a mindful of memories before some, alas, have now passed on.

Their mission at first was to watch the skies for it was believed the Germans would infiltrate by launching an airborne invasion of spies and fifth columnists, so the volunteers were nicknamed parashooters.

Life on night patrol could be full of scares and possibly trigger happy volunteers, some of whom were equipped with American gangster-style Thompson sub-machine guns.

And there were plenty of them. Within five days of an appeal by Sir Anthony Eden more than 250,000 men had volunteered and in Marlborough’s seven sections there were no fewer than 520 in the volunteer ranks.

Not that anything stupendous happened. “Fortunately, the war by-passed Marlborough to a large extent, so it’s difficult to say exactly what the Marlborough Battalion’s most significant event was,” admits Roger, who now lives in Hungerford.

“However, the day a German aircraft dropped its bombs while the battalion was watching a demonstration on Manton Down must be near the top of the list.  If the aim had been better the consequences could have been disastrous.”

Roger’s own passion for history started as a child when his parents and grandparents recounted their stories of life on the Home Front.  And it is after a career as an engineer, insurance agent and postman that, now retired, he has appropriately brought it back to life in book form.

I loved the story of the night-time challenge issued when a wayward sound was heard, only for the perpetrator to turn out to be a “barking” hedgehog.

Roger recalls: “I thought Dickie Brown’s account of being on guard at the Durley roadblock when a young soldier refused to hand his paybook to toy soldiers is one of the best stories.  I still wonder if Lionel Wootton would really have shot him.”

Luckily he didn’t.

As Tommy Trinder used to cry “You lucky people!” when he performed, so we are fortunate too that Roger Day has worked so hard and researched so diligently to bring back to beautiful life the 6th Battalion of the Marlborough Home Guard.

There may yet be more to follow.

“My interest in the 6th Marlborough Battalion does not end with the publication of this book, as I am fairly certain there’s a lot of material still waiting to be rediscovered,” Roger points out.

“I therefore invite ay reader with further information to please make contact, so that it might be included in future editions.”

Roger email contact address is: This email address is being protected from spambots. You need JavaScript enabled to view it.

Look, Duck and Vanish, price £12.95, is available at Marlborough’s White Horse Bookshop.

 

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Police launch Christmas Safety campaign

Wiltshire Police today launched their 2011 Christmas Safety Campaign, with the focus on the prevention of crime and advice on how to keep valuables, homes and vehicles safe.

The festive season is particularly tempting for criminals as they expect to find gifts and high value goods in people’s homes and cars, say the police.

It is important that homeowners keep their house secure and that they take precautions in order to stop opportunistic criminals.

Towns will be very busy and with the increased number of people, police say it will be easier for purse thieves to strike unnoticed.

“So, when out shopping, keep your purse and handbag near you and don’t carry large amounts of cash,” reads the advice.

“Mobile phones and wallets in back pockets are also a target so keep them secure.  Be careful at cash machines and when paying with your card, shield your PIN and remember never to give the number to anyone, even bank staff.”

More shoppers mean more cars in car parks, full of goodies for opportunistic thieves.  The police advise:

  • Remove Satellite Navigation systems and clean away suction marks on the window.
  • Make sure car doors, windows and sun roofs are all properly closed and locked.
  • Remove your stereo if you can, mark it with the vehicle registration number if you can’t.
  • Do not leave Christmas presents or other valuables like laptops, mobile phones, handbags, credit cards, cheque books or vehicle documents in your car.  If it is unavoidable - place them in the boot and ensure equipment is completely switched off.
  • Leave your glove box open to show there is nothing in it.
  • Leave nothing on show - you may know that there is no wallet in your jacket, but a thief will break a window just to check.
  • If you own a van, make sure you remove tools overnight and display an appropriate sign in the rear window making this clear.


So, you’ve kept your Christmas gifts safe when out shopping; now keep them safe at home:

  • NEVER open your door to anyone that hasn’t made an appointment, even if you are expecting them always check their identification and if you are at all suspicious contact Wiltshire Police.
  • All doors should be fitted with a minimum of 5 lever mortice locks
  • All windows should be fitted with locks except any designated as fire escape
  • Close and lock all windows and doors when leaving the house, even if you are just going into the garden.
  • Keep front and back doors locked while you are in your home to prevent persons walking in without your knowledge
  • Close all windows when leaving a room, especially those at the front of the house.
  • Double check that all doors and windows are locked at night.
  • Keep valuable items out of view and reach of windows and doors.
  • Never leave a spare key in a hiding place like a plant pot or letterbox – a thief knows all the hiding places.
  • Keep car keys out of sight, never leave them on view in a hallway
  • Hide financial documents – if someone does break in you don’t want them to also steal from your bank account
  • Lock tools and ladders away so that a thief cannot use them to break in.
  • Never leave a shed or garage unlocked, even when you are gardening and especially if it has a connecting door to your property.
  • Make sure you have good lighting around your property and consider investing in a burglar alarm.
  • Secure the rear access to your home. A thief is less likely to be seen at the rear of your property.
  • Make sure any hedging at the front of your property is no higher than one meter.  This will allow passersby to see anyone acting suspiciously.
  • Mark all valuable items with a property marking system identifiable to you.
  • Take photographs of all jewellery including hallmarks and keep them safe. Do not leave valuable jewellery in a box on your dressing table; it’s the first place a thief will look.
  • Make a list of the serial number of your electronic items and keep it safe.
  • Make sure you have up-to-date contents insurance.
  • Register all electronic items and any others with serial numbers at sites such as www.immobilise.co.uk
  • Join your local Neighbourhood Watch. If there isn't one, consider setting one up yourself.
  • And after all the fun of Christmas make sure you don’t put your rubbish out too early, putting your packing and boxes on display will advertise all the new items you have in your home, giving thieves a shopping list to choose from.


Throughout December there will be increased patrols in key areas of Wiltshire towns, particularly during the evenings and weekends when alcohol is a major factor.

Police say they will be working closely with partners to crack down on anti social behaviour.  Neighbourhood Policing Teams will also be out and about giving out crime prevention advice and discussing any concerns in the community.

Over the next few weeks, advice will be issued from the Wiltshire Fire Service, NHS and the SARC (Sexual Assault Referral Centre) with essential information on how to keep safe over the festive season.

Chief Superintendant Steve Hedley said: “Christmas should be a time to enjoy and not one to spend detailing the items you have had stolen to a police officer.”

“We encourage everyone to take action as most of the measures we have suggested cost nothing and are very easy to implement.”

“By making sure that you don’t leave gifts and valuables in cars, keeping doors and windows secured, marking property and most importantly reporting any suspicious activity you can help prevent yourself and members of your community from becoming a victim and having Christmas celebrations ruined.”

“Throughout the year, we ask that people keep an eye out for those more vulnerable neighbours and it is important to reiterate this message.  Distraction burglars and bogus callers continue to target the elderly and vulnerable and we need your help to stop them.  If you see anyone acting suspiciously, take their description and details of any vehicle including direction of travel and call us.”

Further information about crime prevention can be obtained from your local Neighbourhood Policing Team who can be contacted on 101 or visit the website www.wiltshire.police.uk

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Jazz fans have a chance to double their donations

Marlborough Jazz Festival supporters can make their donations go a little further in December.

For five days only, starting at 10am on Monday, 5 December 2011, donations will be doubled through the Big Give scheme's Christmas Challenge.

From December 5 to 9, online donations to all 8,000 charities supported by the organisation will be matched by the Big Give’s partners and the charities’ major donors and supporters.

In a letter to supporters, chairman Susie Fisher writes: “Simply make your online donation to the Marlborough Arts Association, the charity which operates the Marlborough Jazz Festival, via the Big Give and your generous gift could doubly benefit the 2012 Marlborough Jazz Festival.”

Marlborough Arts Association has set itself a campaign target of £20,000.

For further details, log on to http://new.thebiggive.org.uk/project/marlboroughjazz

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Jeff James talks about his resignation, Savernake Hospital, the NHS’s future and his own future

Jeff James’ resignation last month as Chief Executive of two primary care trusts (PCTs) – Wiltshire and Bath & North East Somerset (BANES) – came as a great shock to his colleagues and friends.  He had been with Wiltshire NHS since it was formed in 2006 and was appointed to BANES this year.

As part of the government’s major reorganisation of the NHS, Wiltshire and BANES were ‘clustered’ together to save money and make way for the abolition of PCTs in 2013 when the GP-led Clinical Commissioning Groups (CCGs) and Wiltshire Council take over.  During the ‘clustering’ process, the team he had built at NHS Wiltshire saw many redundancies as costs were saved.

Jeff James, who is 58, has worked in the NHS for thirty-one years – sixteen of them as a chief executive.  He was ordained priest in the Church of England in 2002.

Why did he resign?  Jeff James told Marlborough News Online that he had looked at the balance in his life between work, home and the church, and found it was not the balance he wanted. 

Why did he resign now?  “Now is as good a time as any.  If I didn’t change now, I’d have to wait till 2013.  Going now gives someone the chance to see through next year’s business plan and conclude the handover to the CCGs and the local authority.”

Did he resign because of the government’s reorganisation? No, but… “In 2013 the kind of job I’ve really enjoyed doing won’t exist.”  The fragmentation of the NHS means that no one will again have the whole canvas of health services to work with.  James now has national, regional and local responsibilities and is involved in almost every part of Wiltshire’s health service.

The Wiltshire PCT’s portfolio of responsibilities is being divided between the CCGs (in charge of some local commissioning), the yet-to-be-formed NHS Commissioning Board (in charge of specialist services), Wiltshire Council (public health and, through the new Health and Wellbeing Boards, strategy), Great Western Hospital (community health) and support services (Commissioning Support Services – CSUs, the latest out of the Department of Health’s copious store of acronyms, whose agenda is still be settled and which will ultimately be privatised.)

Jeff James would miss, for example, overseeing NHS Wiltshire’s work running the screening calls for Wiltshire, Swindon and Devon – work in which his team have become expert.

Savernake Hospital

In the Marlborough area, Jeff James is best known as the man who closed Savernake Hospital Minor Injuries Unit (MIU) and Day Hospital very soon after the community hospital had, at great cost, been expanded and renovated.  Why were they closed?

James says the decision was not specific to Marlborough and was brought about partly by costs and partly by a change in the model of service – creating a new balance between care at home and care in hospital. During his time at NHS Wiltshire he has pioneered the much admired Neighbourhood Teams bringing care and daily treatment to people in their homes.

James makes the point that consultation on the future of health care across Wiltshire had begun in 2005 - before he and NHS Wiltshire came on the scene. And that was also driven in part by costs. The Kennet and West Wiltshire PCT (K&WW) had run up an over-spend of £44 million by the end of 2005 and were on track to add another £24 million during 2006-2007.

The future of Savernake had been considered by the (then) Wiltshire Health Authority in 2002.  Then the issue was handed over to K&WW: “They were very optimistic about the money available, very optimistic about the clinical role of Savernake and not as aware as they might have been about the trends in hospital usage.”

Beds in community hospitals were becoming less busy.  More people were going home sooner after surgery. And community nursing and minor treatment in GPs surgeries was becoming the norm: “Gosh! How did anyone reach the conclusion that [upgrading Savernake] was the right thing to do.”

James and NHS Wiltshire’s Chairman, Tony Barron, have been criticised for the way they conducted the judicial review led by Val Compton which alleged the consultation on closing the MIU and Day Hospital was unfair and the decision unreasonable. Why, for instance, did they contest the cap on costs?  Each side had to pursue their ‘best interest’ and “The wider consequences in the NHS if we had lost would have set a pattern with serious financial consequences. We had a responsibility to conduct our case pretty vigorously.”

Both James and Barron have been the subject of some pretty fierce personal attacks.  During the 2010 general election campaign, the Devizes constituency’s independent conservative candidate pictured them as arrested criminals in American-type police mug-shots. And one campaigner greeted James’ resignation with a tweet: “The end of the road for Jeff James”.

“It’s part of the rough and tumble. When I first started in the NHS there was a committee, in the late 1980s chief execs and chairmen came along and we started to have a much more personal debate. Tony and I decided to make a lot of the running in the public debate – it was a style choice. If you are the person who is the accountable officer you can’t but be held responsible.”

“We don’t live in respectful or deferential times – that’s a good thing. But we can all wish there was a different tenor to the debate. The alternative is that you withdraw from the public.  Out of the public exchange you don’t get agreement, but by not doing it anonymously people may come to understand the reasoning.”

The NHS’ future

Jeff James sees some risks in the government’s new design for the NHS. He has made sure that as an organisation NHS Wiltshire has low costs – “mean management to fit austere economic times” – and the costs for the CCG’s will be higher.  (Wiltshire NHS costs £21 per head of its population, against an average of £35 for other PCTs in the region and a probable £25 for the CCGs.)

In the government’s Health and Social Care Bill, local authorities get more say in health services, running the new Health and Wellbeing Boards.  Might some of them flex their muscles and try to dominate the commissioning process? James admits there may be ‘tensions’. They may know the pain in closing a school: “Imagine how much more exquisite that pain would be if they were allocating health service resources” – closing a ward or a hospital.  And at least one person on the Boards will have to face re-election.

In Andrew Lansley’s new order “We’ll have three agendas: the local ‘popular’ agenda, the clinical agenda and the national political agenda – with the local agenda bumping into the national one.”

Jeff James’ future

Once it’s decided when he will leave his posts (he can be held to six months’ notice), Jeff James wants to take some time off. “It’s a bit like deep-sea diving – after the pressure of the last few years, I need to decompress for a time – or I’ll get the bends.” 
Then he wants to divide his non-family time about 50-50 between work and the church, and would very much like to do more parish work.  Where will that be? “My wife comes from Cornwall and I’m from Wales – so we’ll see!”
Having watched Jeff James in action over the past six months for Marlborough News Online, I’ll bet he very soon gets a call from a university – his experience and analysis will be a great draw for them.  The university might be in Wales or it might be nearer to Cornwall.

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11.11.2011 brings back to life the Armistice tragedy of a family’s missing grandfather

Three red poppy wreaths were left at the foot of Marlborough’s war memorial to the town’s “own” 7th Battalion of the Wiltshire Regiment in yesterday’s traditional Armistice Day ceremony.

One was laid by the Mayor, Councillor Alexander Kirk Wilson, on behalf of himself and the town council, the second by Lt. Col Austin Pearce of 4 Military Intelligence Battalion, who were honoured with the freedom to march in Marlborough last June.

But it was the third wreath, laid by 73-year-old retired schoolteacher David Chandler, that evoked the poignancy of the moment on what was the remarkable date of 11.11.2011 watched by dozens of students from St John’s School.

It was Mr Chandler’s tribute to his grandfather, Private Andrew Ferguson, the gamekeeper who went to war and never returned, his body never found in the fighting fields of far-off Salonika, in northern Greece.

He laid his wreath on the stone World War 1 memorial on his behalf and that of two other grand children, Carolyn and Christopher, who last month, together with their spouses, went to see the battlefield for themselves.

As the memorial inscription recounts, the 7th Battalion, formed in September, 1914, was sent to billets in Marlborough in April, 1915, and trained on the Common, hence its local link.

After going initially to France, it was then sent to Salonika, to protect the Serbs from the Ottoman Turks who together with the Bulgarians had joined the German cause.

But Private Ferguson, gamekeeper to the Marquis of Aylesbury who volunteered for the army, aged 39, was killed at the front a year later, on April 24, 1917, his body one of many never recovered.

“He was my mother’s father, my grandfather,” Mr Chandler told me at his home in Alma Place, Marlborough. “He left a widow and seven children. We have no information as to where and how he died.”

Last month Mr Chandler led the family party of six to Salonika, visiting the town of Doiran, on the border of Macedonia, where there is the main Commonwealth war grave but no memorial to Private Ferguson.

“He was one of 2,000 soldiers who just disappeared without trace, lost forever,” said Mr Chandler. “But we were delighted to make the journey and to be there.  It was a moving experience we shall always remember.”

He was equally pleased yesterday to see so many students from St John’s School, Marlborough, and a few from St Peter’s School, taking part in the ceremony of two minutes silence outside Marlborough town hall, then walking down to hill to the London Road memorial to see the wreath laying ceremony take place.

It was a reminder for him of a similar Armistice event that used to be staged at a school where he taught.

“It is important for them to know what happened is all part of life,” explained Mr Chandler. “It was very moving to see them all there.  I never ever thought it was something that would take off in its own momentum and still be appreciated today.”  

That is thanks to Dr Patrick Hazlewood, St John’s headteacher, who was there supervising the event along with colleagues.

“We had two representatives from every tutor group in the school,” he told me.  “We talked a little bit about the event before we went down, about the importance of remembrance and what the two minutes silence actually means.”

“They found it to be a very moving experience.  On the way back to school, we talked about how they felt. It was a tingle down the spine for them. One or two said they were close to tears.”

And he added: “It was part of their education.  It is really important that every generation remembers.”

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