On Wednesday (February 8) the coalition government’s Health and Social Care Bill reappears in the House of Lords for its report stage. The government have tabled 136 amendments described as ‘concessions’ – but calls to stop the Bill are growing.
However, stopping the Bill is problematic. Prior to parliamentary approval, the Secretary of State for Health, Andrew Lansley has driven ahead with changes which would be hard to reverse.
In our area, NHS Wiltshire (the primary care trust or PCT) is already being split into three Clinical Commissioning Groups (CCGs) which are run mainly by GPs. The North East Wiltshire CCG (or NEW) covers the area from Ramsbury to Corsham.
In other areas these CCGs are already (before they’ve been fully approved) setting budgets and commissioning health care. Doctors in Wiltshire took a little longer to decide how to divide the county up, but members of the three CCGs are now working with the PCT and executive directors of the PCT are assisting the CCGs with governance issues.
The PCT itself has made the 45 per cent savings in admin costs that Lansley demanded and from March 1 will be ‘clustered’ with the Bath and North East Somerset (BANES) PCT. The regulations have been changed so these ‘clustered’ PCTs can merge their budgets – it’s not yet clear how far the Wiltshire-BANES ‘cluster’ will be a merger.
The merged or ‘clustered’ PCTs will only last till 31 March 2013. They are not statutory bodies, but they could be taken to judicial review over decisions they take.
Further up the chain, the south west strategic health authority has already merged to become part of NHS South of England – stretching from Dover to the Isles of Scilly.
To get a new view of the coalition government’s reorganisation of the NHS, Marlborough News Online contacted Dr Huw Williams who was a partner in a Trowbridge surgery for twenty-nine years. He retired two years ago and now works two or three days a week at the surgery mainly in its specialist cardiology unit which he helped set up.
As he is not part of a CCG Dr Williams can give his views on the Bill as an experienced yet disinterested doctor.
Dr Williams’ main fear is that there is no evidence that the new system for commissioning will work: “I’m against GPs being given a lot of commissioning – I don’t think they’re any good at it. No one’s suggested getting train drivers to run a city’s transport system. Just because GPs are near to the patient it doesn’t mean they’re expert at commissioning services. It’s a delusion.”
He looks back to the experiment of practice-based fundholding, when some doctors showed responsible corporatism while others proved very poor at controlling funds and some “rogue doctors” flourished: “Commissioning groups with a hundred GPs? No way they’re all going to agree – let alone behave in a sensible way.”
Dr Williams is worried by the “inevitable conflicts of interest” as many GPs will be providers of services at the same time as they commission services – whether it’s Dr Williams’ cardiology unit or a surgery that rents space to therapists.
One of the things he fears most is political interference: “Left to the politicians you’ll get examples of people misunderstanding the difference between needs and wants. It’ll be decision-making by decibel – he who bangs the desk loudest gets results.”
However, he does think that part of the trouble the government now faces has come from the concessions Mr Lansley has made after his Bill was first paused for alterations and then savaged by the Lords. It was “tokenism”, he says, to add one hospital doctor and one nurse onto each CCG: “What on earth is she or he going to be doing? It’s a bit of a dog’s dinner.”
However, Dr Williams says that once you’ve decided on a way to operate, “The more you dilute the less chance you have of getting people involved who can make a difference.”
Government ministers have dismissed the recent high decibel opposition from GPs – from both the doctors’ union, the BMA and from the Royal College of GPs. They do not seem to realise that many of the concessions they make to the plans simply alienate GPs.
As Marlborough News Online has been reporting (see items in August 2011 and this month), GPs do not like the way the initial promise of power to commission has been eroded with more and more bodies and duties inserted into the system to look over their shoulders and monitor them.
On the other hand, as Dr Williams puts it, “patients’ expectations have been raised” by such promises as “No decision about me without me” which was at the heart of the White Paper and is being strengthened in government amendments to be debated this week in the House of Lords.
The coalition government are pushing through Parliament reforms to the Disability Living Allowance. They want to take 500,000 people off this benefit by 2015 and cut the costs of assisting the most seriously disabled by twenty per cent.
Max Preston is a freelance journalist who lives in Lockeridge. A recent graduate of Leeds University’s broadcast journalism programme, he uses a wheelchair due to cerebral palsy and currently receives Disability Living Allowance. This is his personal view.
When the Tory-Lib Dem coalition took office in 2010, I – unlike a great many of my generation – held out some degree of hope. Under Labour, dealing with the various implementing entities for disability-related policy had been an unnecessarily bureaucratic chore made all the worse by startlingly frequent passive aggression on the part of their administrators.
It is still beyond me as to quite why I – with a diagnosis of quadriplegic cerebral palsy (CP) confining me to a wheelchair for life – needed to check in with these people on at least a semi-annual basis to reassure them that I was, indeed, still profoundly disabled and really-rather-put-out-about-it. Having said that, the Department of Work and Pensions (DWP) themselves have been – more often than not – courteous, helpful and disarmingly cognisant of how much of a pain-in-the-backside it is to have to deal with their paperwork.
After the election, I had hoped that the Lib Dems would provide a moderating influence on disability-related policy by offering a counterweight to Tory right-wingers, that efforts to cut back red tape would not be made merely for their own sake, and that David Cameron’s empathy thanks to his experiences with his own late son, Ivan (whose degree of CP was far more severe than mine), would win the day. Thus far, my optimism has not borne fruit.
Among other things, I use Disability Living Allowance (DLA) to fund a specially-adapted car which is driven for me to hospital appointments, grocery shopping excursions and – perhaps most importantly for a recent graduate – job interviews. In fact, it also pays for part of my food bills, as eating healthily (and therefore more expensively) is absolutely crucial for someone with as sedentary a lifestyle as mine.
Without DLA, I could not have gone to university and laid the foundations for what I hope will be a productive and fulfilling career in journalism.
Whilst I understand that the government wishes to substantially reduce the number of people in receipt of this type of benefit, a far more sensible course was suggested in the House of Lords by Baroness Tanni Grey-Thompson, formerly of Paralympic fame and now a steadfast crossbench advocate for the disabled.
In short, it was grossly irresponsible of peers to vote down her motion that DLA’s putative replacement – the Personal Independence Payment (or, unfortunately, PIP) – be extensively piloted before it is launched.
In its quest to make what are admittedly necessary cuts across many facets of British life, the government has lost sight of perhaps its most fundamental mandate, one to which every government is beholden: to take care of the most-vulnerable among us first. To invoke what is probably a well-worn cliché: this is not an issue of left-and-right, but of right-and-wrong.
People do abuse DLA, but this attempt to stamp out such wrongdoing appears to cut first and ask questions later, simply in order to appease the need for overall fiscal stability.
The coalition’s most fundamental mistake with regard to benefits policy precisely and dangerously mirrors that of recent Labour governments. Namely, there appears to be a presumption of guilt – that you’re trying to get one over on them – rather than innocence.
That mind-set starts from an unhelpful, even noxious place that makes staff unnecessarily hostile, gives recipients an unduly guilty conscience and renders politicians apathetic at best and cold-hearted at worst.
Admittedly, with a condition as severe as mine, one would like to believe that any reduction in my own benefits would be minimal. But having lost the support of even The Daily Mail on this issue, Messrs. Cameron and Clegg must pause to consider what they want their legacy to be.
They had an opportunity to take a commendable, non-partisan moral stand, just as they did alongside Joanna Lumley and the Ghurkhas, even as Gordon Brown refused to join them – and they have inexcusably failed to do so. Now, the DWP will have to screw up PIP before they can put it right, and hundreds of thousands of already disadvantaged people will find themselves even more marginalised and overburdened as a result.
It is worth remembering that while his premature death was undoubtedly a tragedy, Ivan Cameron was a child of privilege, and the support system that his parents rightly placed around him would have always ensured him the best-possible standard of care... because they could afford it.
The Prime Minister has, in the past, earnestly put himself forward as someone with first-hand experience of dealing with the travails of disability. As it stands, however, he has entirely abrogated the responsibility due to his own son’s memory - and he should be ashamed.
1325863256 smallMore than a million kindles may have been sold over Christmas, but Marlborough’s White Horse bookshop still beat all expectations and came up trumps with sales, especially of local books.
However, owner Michael Pooley recognises that all independent bookshops face a challenging future, revealing: “Our worry is that ebooks are eroding the business all the time.”
“It is very difficult to see how independent bookshops can get involved selling ebooks. Publishers are thinking of various ways but I fear it is not the way ahead for us.”
“I don’t know if 2012 is going to be a make or break year but it is going to be an extremely difficult one. And some independent bookshops will undoubtedly disappear.”
White Horse has had a good year in general, sales boosted in particular by the second Marlborough Literary Festival in September. “We have done much better than we expected,” Mr Pooley told Marlborough News Online.
And to an extent the bookshop, which he has owned since 1973, is protected because it owns the freehold of the premises.
“The main problem is that part of the business we are in of selling books is now being done cheaper elsewhere,” he pointed out. “And it is not Amazon that is to blame. They are more interested in selling pet food and other things.”
The failure of online Amazon to ensure deliveries of book orders did, however, play a part in the White Horse bookshop’s success. So too the fact that there was a full week’s trading in the run up to Christmas Day.
The dangers ahead lie in whether major chain stores like Waterstones can survive the exploding sale of ebooks. “They are under threat,” he said.
“So it is going to be very interesting to see their results because they are very much in the same market as us.”
Local books that sold well included Roger Day’s Look, Duck & Vanish, a history of 6th Marlborough Battalion of the Wiltshire Home Guard and a history of the Free Family in Marlborough and the Upper Kennet Valley by Martin Crook with Jan Free.
PD James won the race when it came to fiction. But because there was a good spread of fiction available, no one single title sold out, which was very much the same for a wide range of cookery books, basic titles like River Cottage Veg selling well along with Heston Blumenthal.
“Customers don’t come in here and inquire about ebooks,” he added. “That is what is so strange, but it is also why I don’t really think we can get involved selling them.”
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.
|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”.
- 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.
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.”
Look, Duck and Vanish, price £12.95, is available at Marlborough’s White Horse Bookshop.
A host of good ideas for the future came from members of the public who attended last week’s open meeting of the Friends of the Railway Path held the Calley Memorial Hall, Chiseldon, reports chairman Dick Millard.
The aim of the meeting was to discuss how the path could be made better and more enjoyable for users. Some of those taking part were cyclists, some walkers and some were horse riders.
And all of them knew about and used the path.
Among the many suggestions made were calls to:
1. Provide better signing, particularly through Chiseldon, and in Marlborough.
2. Develop better access for a variety of users, especially at the Marlborough end of the path.
3. Identify parking areas for horse boxes.
4. Give better views of the surrounding countryside while preserving the habitat value of hedges and trees.
5. Make much more information available on the history of the path and the landscape which it traverses.
6. Create more things to look at and do on the way.
The committee of the Friends of the Railway Path will now start to develop a plan for what to do, and start to find suitable sources of funding.
On Wednesday morning (January 11) the Daily Telegraph’s front page, lead story was headlined: “Hospitals feed patients on 90p a meal, official figures show.” The story was also given wide publicity as one of the morning paper front pages shown on the previous night’s ITV News at Ten.
The newspaper’s report – using figures from Andrew Lansley’s Department of Health – highlighted Wiltshire NHS as spending more on food and drink per patient per day than any other primary care trust. But was the report accurate?
Picking up the headline, the Telegraph said that “the lowest spender was Western Sussex Hospital Trust which was listed as paying £2.57 a day to feed each patient” – presumably that is where their 90p came from – rounded up for headline purposes from 86p. The Telegraph then wrote that “several other trusts spent less than £1 on each meal”.
Quite how that justified using ‘hospitals’ in the plural for the headline is not clear. Nor is it clear why the headline used the present tense when the figures were for 2010-2011 – that’s up to the end of March 2011.
However, there is a major problem with the figures. They were not collected to any standard formula. This means that some of the costs quoted were for ingredients only and others included the costs of buying, storing, cooking and delivering the meals.
The Telegraph did approach Western Sussex hospitals who explained that their figure only covered ingredients. If they had included “the total cost of sourcing, preparing, cooking and serving food and drink” their figure would have been about £8 per patient per day.
That was not enough to get the Telegraph to change their misleading headline.
The Telegraph also assumed that you can simply divide the daily cost by three to get a per meal cost. But breakfasts generally cost considerably less than the main meal of the day and suppers will cost a sum in between that for breakfast and the day’s main meal.
Apart from the figure for West Sussex, another figure caught the eye: Wiltshire NHS was spending £22.31 per day per patient – the highest. This was computed including all the additional costs like cleaning the canteen and providing meals for visitors and the catering staff’s employment costs.
But even this figure has no relevance at all to the present situation. Wiltshire NHS has not provided a single hospital meal since June 2011 when – on government instructions – its community hospitals were handed over to be run by the Great Western Hospitals Foundation Trust. And GWH told Marlborough News Online that the current figure for its community hospitals – including Savernake Hospital – would be closer to £15 per patient per day for ingredients and preparation.
The £22.31 and £15 figures really only emphasise how very expensive it is to run small community hospitals spread across a huge county, when the large acute hospitals can buy ingredients and services in bulk and therefore so much more cheaply.
In the latest assessment of hospital food, GWH was rated as “excellent” and for the record the 2010-2011 figures showed GWH’s daily costs for food and drink per patient at £5.50.
Responding to the report, the director of the GWH department that provides food and drink, Mark Bagnall, said: “We put a lot of effort into providing patients with a choice of high quality, nutritious food and prepare almost 580,000 meals a year at the Great Western Hospital. No one wants to be in hospital in the first place so it is important that patients receive the food they need to recover.”
And he emphasised the differences size made to the cost of meals: “With such a large number of meals being produced we can achieve large economies of scale which means we can produce good food at a lower cost than some smaller organisations and our current average spend per patient per day is around £6.00 - which is broadly in line with many other Trusts of this size.”
The figures, issued through the NHS Information Centre, appeared in an agency story (Press Association or PA) timed at 02.49 am on Wednesday morning (January 11). But the Telegraph headline was shown on television at about 10.25 pm the previous evening. And the Telegraph’s journalist had had time to include extra research and comment.
So it seems likely the figures were leaked to the Telegraph well ahead of the PA story. Both the Telegraph and PA stories included long quotes from the health minister, Simon Burns.
What’s the game?
A clue comes in the Telegraph’s own story: “Government sources said last night that concern about the poor state of nutrition in some hospitals had prompted David Cameron’s warning last week about declining basic standards of care in the NHS.” So this, it appears, was designed to support the prime minister’s campaign.
Or perhaps this was an attempt to deflect attention away from health secretary Andrew Lansley’s problems over the faulty breast implants crisis. This issue has forced him to criticise the private health sector – to which he is about to hand over large parts of the NHS. And also means he has to extend regulation and its attendant bureaucracy.
Alternatively, this could simply be part of the coalition government’s longer term plan to destabilise the NHS and so make it easier to justify its costly reorganisation and the surreptitious moves toward privatisation.
The Department of Health has pointed out that the money hospitals are spending on food has gone up over the past five years. The average per patient per day in 2005-2006 was £6.53 and in 2010-2011 it was £8.58 - which somewhat undermines the Telegraph's headline.
Marlborough News Online is making enquiries to find out why this information was published at this time and in such misleading form.
Marlborough’s newest charity shop has had a splendid Christmas with generous donations and sales enabling it to break its £1,000 minimum target for the week.
“We’ve exceeded all our expectations,” revealed Fred Chard, manager of the RSPCA shop, based in the former High Street Sony Centre. “We’ve been surprised by the generosity of the people of Marlborough.”
“Our target was to achieve at least £1,000 in the full trading week – Monday to Saturday – before Christmas, and we’ve gone beyond that. For our first Christmas here it’s gone extremely well.”
Evening and ball gowns specially bought for the opening of the charity shop have been one major attraction, customers galore pouring in either to buy or donate to the RSPCA’s North Wiltshire branch.
And now the remaining sparkling and colourful garments on a special clothes rail of their own are selling for “sale” prices ranging from £15 to £30.
“Ninety per cent of them are new and are really excellent value,” said Kathy Hole, from Avebury (pictured), who has been in charge of them. “Some of evening gowns still have their original labels on them and have never been worn.”
In fact they didn’t have far to travel to the RSPCA site, having been bought from Marlborough’s Ballgown Shop as “an investment” for its launch in October.
Sixty-year-old Mr Chard, from Swindon, who has been given the task of establishing the Marlborough store, the third after Chippenham and Swindon to be opened by North Wiltshire RSPCA, and with three more planned for the future.
They form part of a 170 charity chain throughout the country, each store separately registered to the RSPCA branch that launched it, to ensure that the funds raised are used locally for animal welfare.
“That can be anything from boarding unwanted cats to helping people who can’t pay particular vets’ bills,” he explained. “We also run a lost and found register and find homes for unwanted rabbits and smaller animals.”
His business background in food retail with the Co-op has helped to set up the store – the plan is to hand over to someone local soon – and in the New Year he will continue his current search for a permanent job.
“Unfortunately, like a lot of people, I got made redundant last year after spending over 40 years with the Co-op group,” he revealed. “Getting back into that is proving very, very difficult, especially at the level I worked at as a regional manager.”
Meanwhile, he is seeking to increase the donations of good quality clothing to the Marlborough shop, especially for children and for men, as well as bric a brac and discarded Christmas presents.
“Our customers are predominately women since they are the shoppers,” he explained. “Our problem is that we haven’t got a large amount of men’s clothing because, as you are aware, men tend to hang on to clothes a lot longer than ladies.”
“Women buy clothes and quickly move them on – and that’s a bonus for us.”
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.
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.