› › Hc 583 Out Of Hours Gp Services In England

HC 583 - Out-of-Hours GP Services in England

Author : Great Britain. Parliament. House of Commons. Committee of Public Accounts

Publisher : The Stationery Office

Page : 24 pages

File Size : 45,14 MB

Release : 2014

Category : Political Science

ISBN : 0215078691

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Book Description

People turn to out-of-hours GP services when they are worried about their own health or that of family or friends, and want urgent advice or treatment. However, the urgent and emergency care system is complex and people struggle to know which is the right service to use. Patients' experience of and satisfaction with the out-of-hours services varies significantly and unacceptably across the country, as does the cost. NHS England has not provided effective oversight of whether the services are providing value for money. It lacks the basic information needed to understand what lies behind the variations and identify where it should intervene. It has not dealt adequately with conflicts of interest which inevitably occur when many commissioners are also providers. NHS England also needs to address the perverse financial incentives which get in the way of different urgent care services working effectively together. It needs to examine whether the out-of-hours services are working properly with other services and whether the system encourages duplication when resources are so constrained. At the most basic level, the Department of Health and NHS England must develop information to be able to know whether there will be enough GPs to cope with the growing workload.



HC 893 - Public Health England's Grant to Local Authorities

Author : Great Britain. Parliament. House of Commons. Committee of Public Accounts

Publisher : The Stationery Office

Page : 21 pages

File Size : 15,55 MB

Release : 2015

Category : Medical

ISBN : 0215083814

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Book Description

Since it was created in 2013, Public Health England (PHE) has made a good start in its efforts to protect and improve public health. Good public health is vital to tackling health inequalities and reducing burdens on the NHS. The Committee were impressed by the passion shown by PHE's Chief Executive, and his determination to challenge Government to consider public health in wider policymaking. However, we are concerned that the Department of Health is not getting local authorities to their target funding allocations for public health quickly enough, with nearly one third of 152 local authorities currently receiving funding that is more than 20% above or below what would be their fair share. The Agency decided not to change the grant distribution for 2015/16. Local authorities are also presently constrained by being tied into contracts to which the Department had previously committed, such as for sexual health interventions. It is not clear whether the public health grant to local authorities will remain ring-fenced, and they need more certainty to better plan their public health programmes. If the ring-fence is removed, there is a risk that spending on public health will decline as councils come under increasing financial pressures. There are still unacceptable health inequalities across the country, for example healthy life expectancy for men ranges from 52.5 years to 70 years depending on where they live. These inequalities make PHE's support at a local level particularly important but the Committee are concerned that PHE does not have strong enough ways of influencing local authorities to ensure progress against all of its top public health priorities. Finally, given how important it is to tackle the many wider causes of poor public health, PHE needs to influence departments more effectively and translate its own passion into action across Whitehall.



HC 973 - Care Services for People with Learning Disabilities and Challenging Behaviour

Author : Great Britain. Parliament. House of Commons. Committee of Public Accounts

Publisher : The Stationery Office

Page : 25 pages

File Size : 34,76 MB

Release : 2015

Category : Psychology

ISBN : 0215085647

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Book Description

The Winterbourne View scandal in 2011 exposed the horrific abuse of people with learning difficulties and challenging behaviour in a private mental health hospital. Concerns were also raised about a number of other institutions. As a result, the Government committed to discharging those individuals for whom it was appropriate back into their homes and communities. However, since then, too many children and adults have continued to go into mental health hospitals, and to stay there unnecessarily, because of the lack of community alternatives. The number of people with learning disabilities remaining in hospital has not fallen, and has remained broadly the same at around 3,200. It was refreshing that NHS England took responsibility for this lack of progress and has now committed to develop a closure programme for large NHS mental health hospitals, along with a transition plan for the people with learning disabilities within these hospitals, from 2016-17. Discharges from hospital are being delayed because funding does not follow the individual when they are discharged into the community. This acts as a financial disincentive for local commissioners who have to bear the costs and responsibility for planning and commissioning community services. Delaying discharge has the effect of institutionalising people, making their reintegration into the community more difficult. Some local authorities' reluctance to accept and fund individuals in the community will be exacerbated by current financial constraints. The Department should set out its proposals for 'dowry-type' payments from NHS England to meet the costs of supporting people discharged from hospital.



HC 892 - The Effective Management of Tax Reliefs

Author : Great Britain. Parliament. House of Commons. Committee of Public Accounts

Publisher : The Stationery Office

Page : 21 pages

File Size : 31,77 MB

Release : 2015

Category : Business & Economics

ISBN : 0215085582

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Book Description

Tax and tax reliefs are plainly different and require different accountability arrangements. Put simply tax is where you get money in through taxation and a tax relief is where you make a conscious decision to forgo that income. Some reliefs are structural parts of the system to ensure a more progressive system or avoid double taxation. But other reliefs, costing some £100 billion a year, are designed to deliver a policy objective that could be met instead through spending programmes. HM Treasury and HM Revenue and Customs (HMRC) do not keep track of those tax reliefs intended to influence behaviour. They do not adequately report to Parliament or the public on whether reliefs are working as intended and what they cost and whether they represent good value for money. While HMRC is accountable for implementing and monitoring all tax reliefs, its statements about the extent of its responsibilities are inconsistent with its actual practices. HMRC accepts it has a role to assess, evaluate and monitor reliefs, but is unable or unwilling to define or to categorise reliefs by their purpose. While HMRC accepts the need for reporting the costs of tax reliefs, it does not see the merit in assessing the economy, efficiency and effectiveness of reliefs, or considering their cost effectiveness alongside that of alternative policy instruments such as spending programmes. HMRC does not generally assess the effectiveness of reliefs with specific objectives although in a few instances it does consider their impact on taxpayer behaviour. HMRC's failure to articulate a set of principles to guide its management and reporting of tax reliefs is a serious omission which it now needs to rectify.



HC 971 - An Update on Hinchingbrooke Health Care NHS Trust

Author : Great Britain. Parliament. House of Commons. Committee of Public Accounts

Publisher : The Stationery Office

Page : 25 pages

File Size : 14,47 MB

Release : 2015

Category : Law

ISBN : 021508425X

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Book Description

The taxpayer has been left exposed by the failure of the Hinchingbrooke franchise according to the Public Accounts Committee's report. In February 2012, Circle took operational control of Hinchingbrooke Health Care NHS Trust, becoming the first private company to run an NHS hospital. In January 2013, the Committee expressed concerns that Circle's bid to run Hinchingbrooke had not been properly risk assessed and was based on overly optimistic and unachievable savings projections. The Department of Health responded that the NHS Trust Development Authority would monitor progress and take action if the Trust was failing to deliver on its plans to make the hospital financially sustainable. In the event, Circle was not able to make the Trust sustainable and the NHS Trust Development Authority did not take effective action to protect the taxpayer. In January 2015, Circle announced that it intended to withdraw from the contract, just three years into the 10-year franchise. It was clear at the time the franchise was let that the Trust would only survive if it secured substantial savings. The Comptroller and Auditor General's 2012 report highlighted that the savings projected in Circle's bid were unprecedented as a percentage of annual turnover in the NHS.



HC 736 - Financial Sustainability Of NHS Bodies

Author : Great Britain. Parliament. House of Commons. Committee of Public Accounts

Publisher : The Stationery Office

Page : 23 pages

File Size : 14,45 MB

Release : 2015

Category : Business & Economics

ISBN : 0215081250

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Book Description

The financial health of NHS bodies has worsened in the last two financial years. The overall net surplus achieved by NHS bodies in 2012-13 of £2.1 billion fell to £722 million in 2013-14. The percentage of NHS trusts and foundation trusts in deficit increased from 10% in 2012-13 to 26% in 2013-14. Monitor found that 80% of foundation trusts that provide acute hospital services were reporting a deficit by the second quarter of 2014-15. NHS England, Monitor and the NHS Trust Development Authority recognise that radical change is needed to the way services are provided and that extra resources are required if the NHS is to become financially sustainable. The necessary changes will require further upfront investment. Present incentives to reduce A&E attendance and increase community based care services have not had the impact expected. New incentives and strong relationships are needed to promote the more effective collaboration necessary for delivering new models of care.



HC 708 - Managing and Removing Foreign National Offenders

Author : Great Britain. Parliament. House of Commons. Committee of Public Accounts

Publisher : The Stationery Office

Page : 24 pages

File Size : 18,7 MB

Release : 2015

Category : Computers

ISBN : 021508103X

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Book Description

It is eight years since the Committee last looked at this issue and they are dismayed to find so little progress has been made in removing foreign national offenders from the UK. This is despite firm commitments to improve and a ten-fold increase in resources devoted to this work. The public bodies involved are missing too many opportunities to remove foreign national offenders early and are wasting resources, through a combination of a lack of focus on early action at the border and police stations, poor joint working in prisons, and inefficient caseworking in the Home Office. This, combined with very poor management information and non-existent cost data, results in a system that appears to be dysfunctional. Our concerns about the system were not allayed by the evidence we received. The Home Office will need to act with urgency on the recommendations we make in this report if it is to secure public confidence in its ability to tackle effectively these and the wider immigration system issues on which the Committee has previously reported.



HC 809 - Children in Care

Author : Great Britain. Parliament. House of Commons. Committee of Public Accounts

Publisher : The Stationery Office

Page : 25 pages

File Size : 13,54 MB

Release : 2015

Category : Political Science

ISBN : 0215083997

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Book Description

The Department for Education should set out how it will lead and work with others to improve the outcomes for children by improving the quality of care according to the Committee's report. The Department for Education holds policy responsibility for children in care, and has national oversight of the local authorities who provide the services for these children. Although the Department is clearly best placed to provide the leadership required in many cases, it shows an alarming reluctance to play an active role in securing better services and outcomes for children in care. It chooses to limit its role to passing legislation, publishing guidance and intervening after Ofsted has failed a local authority service. It does far too little to disseminate actively what works and to support authorities to improve before they are failed by Ofsted. It sits on a wealth of information and knowledge which it fails to use in an active way to support better outcomes for this most vulnerable group of children. While 62% of children in care have suffered abuse and neglect, too many still do not get the right placement first time, too many are moved too often, and too few are placed close to their homes.



HC 811 - Financial Support for Students at Alternative Higher Education Providers

Author : Great Britain. Parliament. House of Commons. Committee of Public Accounts

Publisher : The Stationery Office

Page : 24 pages

File Size : 12,77 MB

Release : 2015

Category : Education, Higher

ISBN : 0215081625

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Book Description

Approximately 140 institutions offering higher education are termed 'alternative providers'. These alternative providers comprise a diverse range of organisations ranging from private companies to charitable institutions. They do not receive government grants directly but do access public funding through student loans which are used to pay their fees. Following the announcement of higher education reforms in 2011, and the associated increase in tuition fee loans, there has been substantial and rapid growth in the sector. Between 2010/11 and 2013/14, the number of students claiming support for courses at alternative providers rose from 7,000 to 53,000. Over the same period, the total amount of public money paid to students at alternative providers, through tuition fee loans and maintenance loans and grants, has risen from around £50 million to around £675 million. The Department has overall responsibility for oversight of publicly-funded higher education, including alternative providers with publicly-funded students. The Department did not learn from previous Government experience, furthermore, it has been slow to react to warning signs. The rapid expansion in numbers was concentrated in five colleges that accounted for 50% of the expansion. 20% of students receiving funding were not registered for a qualification and drop-out rates were very high in some institutions. There was also evidence from whistleblowers that proficiency in English language was not tested, that some institutions were recruiting students on the streets, and that students claiming funding were not attending colleges.



HC 709 - Lessons from Major Rail Infrastructure Programmes

Author : Great Britain. Parliament. House of Commons. Committee of Public Accounts

Publisher : The Stationery Office

Page : 20 pages

File Size : 22,32 MB

Release : 2015

Category : Business & Economics

ISBN : 0215081013

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Book Description

The Department for Transport is responsible for a number of ambitious, expensive transport infrastructure programmes including the planned High Speed 2 programme. The Committee though is not convinced that these programmes are part of a clear strategic approach to investment in the rail network. In particular, recent proposals for a railway connecting cities in the north of England - a possible High Speed 3 - suggest that the Department takes a piecemeal approach to its rail investment, rather than considering what would benefit the system as a whole and prioritising its investment accordingly. The Department told us it will deliver the full High Speed 2 programme within its overall funding envelope of £50 billion. However, this funding includes a generous contingency and the Committee is concerned that, without appropriate controls, it could be used to mask cost increases. When it comes to the wider regeneration benefits, insufficient planning meant that regeneration benefits in Ebbsfleet did not flow from High Speed 1 as expected. Although the Department told the Committee that it has learned and is applying these lessons on High Speed 2, it needs to set out clearly who is responsible for ensuring that benefits are realised, and how that work will be coordinated.