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Fixing The Foundations: Rachel Reeves & the Public Sector
On 8 July, the Chancellor of the Exchequer announced that she had instructed Treasury officials to undertake a rapid audit of public spending. This document sets out the outcome of the audit, the immediate action...
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Fixing The Foundations: Rachel Reeves & the Public Sector
1. EXECUTIVE SUMMARY
On 8 July, the Chancellor of the Exchequer announced that she had instructed Treasury officials to undertake a rapid audit of public spending. This document sets out the outcome of the audit, the immediate action the government is taking in response, and the long-term measures being introduced to restore public spending control.
The audit carried out by the Treasury shows that the forecast overspend on departmental spending is expected to be £21.9 billion above the resource departmental expenditure limit (RDEL) totals set by the Treasury at Spring Budget 2024. [footnote 1], [footnote 2]
The government is taking action to address the pressure by: (i) identifying immediate savings to manage the pressure; (ii) setting out a clear process to the autumn and the Spending Review for reducing the pressure further; and (iii) making reforms to the spending and fiscal frameworks to prevent this happening again.
1.1 Immediate action on spending pressures
The government is announcing £5.5 billion worth of savings in 2024-25,
bringing the in-year pressures down to £16.4 billion.
This £21.9 billion, that the government has already reduced to £16.4 billion, is an estimate of the pressure. It is not an estimate of how much additional funding might be allocated to departments going forwards, or an estimate of how much additional government borrowing may be required this year.
Economic stability is a priority for the government. That is why it has prioritised being transparent and timely in announcing the scale of these pressures. By making £5.5 billion of immediate savings, the government is taking decisions to begin to tackle these pressures.
1.2 The path to the Budget and Spending Review
This is a significant downpayment, but these decisions alone will not be sufficient. The government is setting out further steps to tackle the spending pressures that remain and to take the difficult decisions necessary to secure the public finances.
These decisions will be set out in the Budget on 30 October. This will
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confirm the government’s fiscal policy alongside a forecast from the Office for Budget Responsibility (OBR). [footnote 3] The Chancellor will take further difficult decisions across tax and spending.
These decisions will confirm how the government’s robust fiscal rules will be met: bringing the current budget into balance so that day-to-day costs are met by revenues and getting debt falling as a share of the economy by the fifth year of the forecast.
The Budget will confirm the full details and OBR-certified costings for the government’s priority tax commitments that will close loopholes and help sustainably fund the government’s priorities. Further technical details of a number of these reforms including to the taxation of independent schools, abolition of the non-domicile regime and extension of the Energy Profits Levy have been set out by the Exchequer Secretary to the Treasury.
The Chancellor is launching a multi-year Spending Review to conclude in Spring 2025. The Chief Secretary to the Treasury will write out to departments with details of the Spending Review shortly. The government will use the Spending Review to change the way public services are delivered by embedding a mission-led approach, driving forward public service reform and making the best use of technology to better deliver services. The Spending Review will set spending plans for a minimum of three years of the five-year forecast period. Departmental expenditure limits for 2025-26 will be set alongside the Budget in October, which will also confirm control totals for 2024-25.
1.3 Strengthening the fiscal framework to ensure this never happens again
Legislation has already been introduced to guarantee that all fiscally significant announcements are subject to an independent assessment by the OBR through the Budget Responsibility Bill.
In addition, the government is announcing a series of changes that will fundamentally strengthen the spending framework and ensure that such unfunded pressures should never arise again. These will increase certainty and transparency and prevent spending decisions being repeatedly delayed. They ensure that there will always be medium-term departmental spending plans which the OBR will be able to assess aggregate pressures against.
2. PUBLIC SPENDING AUDIT
On 8 July, the Chancellor announced that HM Treasury officials had been instructed to conduct an audit of public spending for 2024-25.
This audit has been done rapidly and identified a substantial forecast overspend of £21.9 billion [footnote 4] above the resource departmental expenditure limit (RDEL) totals set by the Treasury at Spring Budget 2024.
The sources of this pressure are outlined in this chapter, which include:
• unfunded policy announcements;
• the impacts of inflation;
• recent events, such as the invasion of Ukraine; and
• public sector pay.
2.1 Timing of the Spending Review, and approach to adjusting budgets in 2022-23, 2023-24, and 2024-25
Departmental expenditure limit totals set by the Treasury at Spring Budget 2024 were insufficient to meet the spending pressures facing departments.
There has not been a spending review since 2021. As a result, departmental budgets for 2024-25 have not been systematically replanned on the basis of an up-to-date assessment of spending pressures in the last three years. Departmental budgets for the years after 2024-25 have also not yet been set.
In the absence of a spending review, some individual departmental budgets (including for the health service, defence, and education) have been increased across several fiscal events but not consistently across all years.
Since Spending Review 2021 (SR21), cash increases in forecast RDEL [footnote 5] due to policy changes by the government at fiscal events totalled £16.9 billion in 2022-23, £23.0 billion in 2023-24, and £10.8 billion in 2024-25 (see Chart 1).
Chart 1: Adjustments to RDEL for Policy Measures since Spending Review 2021
Source: OBR Policy Measures Database and HMT Calculations. “RDEL” refers to PCSE in RDEL
Most pressures on public spending funded in 2023-24 could reasonably be expected to recur in 2024-25, and many of the underlying pressures, such as those driven by public sector pay and the asylum system, have increased in size this year compared to last year. However, departmental budgets were increased by £12.2 billion less in 2024-25 than in 202324. This contributes to the significant spending pressure the government faces this year.
2.2 Unfunded policy announcements
A number of unfunded policy decisions made since SR21 have increased pressures on public spending in 2024-25 by a total of £2.6 billion. These included:
• Extending the Household Support Fund to September 2024, which was announced at Spring Budget 2024 at an estimated cost in 202425 of £500 million.
• The Advanced British Standard, which was announced in October 2023 at a cost of £260 million in 2024-25.
• Additional bus services support and the extension of the £2 bus fare cap until December 2024, which was announced as part of Network North in October 2023 at an estimated cost in 2024-25 of £250 million.
2.3 Impacts of inflation
Departmental budgets for 2024-25 were set at SR21, [footnote 6] in cash terms, but inflation has been significantly higher than forecast at the time. At SR21 the OBR forecast that the cumulative increase in prices as measured by the GDP deflator over that three-year period would be around 7%. In reality, cumulative inflation over the first two years was around 13% and is forecast to be 15% over all three years. [footnote 7] Inflation spiked to its highest level in over 30 years. [footnote 8]
This has placed considerable pressure on departmental budgets, which have not been systematically reset to account for the impact of inflation. This means 2024-25 total departmental spending (TDEL) budgets are at least £15.0 billion lower in real terms compared to SR21 plans [footnote 9]
2.4 Pressures on public spending due to recent events
In addition to pressures from inflation and pay, recent events have increased pressures significantly on public spending since SR21, including:
• Military assistance to Ukraine – The UK has committed £3 billion of military assistance to Ukraine in 2024-25 including £1.5 billion RDEL, in response to its invasion by Russia.
• Asylum – Asylum seeker arrivals, and the costs associated with supporting them in the UK, have exceeded SR21 forecasts. As a result spending on asylum support has increased seven-fold in the last three years, with asylum and immigration resulting in a pressure of £6.4 billion in 2024-25. The Rwanda migration partnership and Illegal Migration Act would have caused these spending pressures to continue rising even faster than before.
• Rail services – Pressures have emerged on rail finances, primarily due to the weaker-than-expected recovery in passenger demand following the COVID-19 pandemic, leading to a pressure of £1.6 billion in 2024-25.
These events have all taken place against a challenging fiscal backdrop, with public debt at its highest level since the early 1960s. [footnote 10]
2.5 Public sector pay
At SR21 the government set overall budgets in cash terms on an assumption that pay for public sector workforces would increase by around 3%, 2%, and 2% respectively in the three years covered.
Pay for most frontline public sector workers including NHS staff, teachers, police, armed forces and prison officers is set based on recommendations from independent Pay Review Bodies (PRBs). These recommendations have responded to higher levels of wage growth across the wider economy and so actual pay awards across PRB workforces increased by an average of 5% in 2022-23, and 6% in 2023-24. [footnote 11]
This – alongside some exceptional pay increases agreed outside the PRB process and pay awards across the Civil Service – has meant that public spending on pay is expected to be around £11-12 billion higher across central government departments in 2024-25 than it was projected to be at SR21, even before accounting for 2024-25 pay awards. [footnote 12]
The PRBs’ 2024-25 recommendations – requested in December 2023 by the previous government – then came in materially above the 2% funding departments were provided for at SR21. The previous government did not provide any indication of what was set aside in budgets for pay in its written evidence to the PRBs.
Most recommendations are in the 5-6% range and above the funding provided to departments. They are broadly in line with the average expected pay settlement in the wider economy. [footnote 13] This follows a trend of falling public sector pay relative to the private sector, with the Office for National Statistics (ONS) Annual Survey of Hours and Earnings (ASHE) showing that median annual pay in the public sector grew by 7 percentage points less than median annual pay in the private sector between 2011 and 2023 [footnote 14] and Institute for Fiscal Studies (IFS) analysis [footnote 15] from 2022 showing that the public-private sector pay differential was less favourable in 2021-22 than at any point in the 30 years preceding it.
In considering its response to these recommendations, the government carefully considered:
• The cost of the pay awards to the taxpayer; and,
• The costs of industrial action (including to public service outcomes and the wider economy) that might be expected if the recommendations were rejected; against
• The benefits from improved recruitment, retention and motivation of public sector workers, on the back of public sector pay having fallen relative to the private sector in recent years; and,
• The potential impacts of these pay awards on inflation.
In view of these factors, the government has decided to accept the headline pay recommendations in full. Further details on the implications of decisions made on public sector pay for 2024-25, and how the decision was reached are set out in the Annex.
The 2024-25 pay awards for PRB workforces, alongside a 5.0% award to the delegated Civil Service grades (whose 2024-25 pay award is also due), create an estimated further pressure of £9.4 billion in 2024-25 on top of what the last government set aside for pay. [footnote 16]
The pay year for most PRB workforces begins on 1 April. In recent years the PRB process has delivered awards around six months late, because previous governments chose to delay the process. This government intends to restore confidence in the PRB process.
As a first step the government will seek to return the process to a timeline which sees pay awards announced as close to the start of the pay year as possible and will start by remitting the PRBs for the 2025-26 pay round in September, three months earlier than for this pay round.
2.6 The results of the 2024-25 audit
As part of the audit, the Treasury has worked closely with departments to assess the scale of the 2024-25 pressure on their RDEL budgets (as published at Spring Budget 2024). The Treasury expects capital (CDEL) pressures to be managed through existing budgets this year and has therefore focused the spending audit on RDEL.
Based on this audit, the government estimates a pressure of £21.9 billion against the plans set out for departments at Spring Budget 2024. [footnote 17] Table 1 outlines the drivers of the pressure.
Table 1: 2024-25 RDEL pressures by category
1 It was agreed that some of the 2024-25 pressures would be funded by switching Capital DEL to Resource DEL. This additional Resource DEL spending is a pressure on the Resource DEL Reserve.
2 All numbers include Barnett consequentials.
3 Reserve claims that meet Consolidated Budgeting Guidance parameters as unforeseen, unavoidable and unaffordable; as well as technical adjustments (e.g. classification changes).
4 Total cost above provision in departmental plans for the 2024-25 PRB workforces, delegated civil service grades and associated workforces.
5 Resource DEL pressure above provision in departmental plans for 2024-25 resulting from 2023-24 pay awards.
6 New policy commitments announced since Spending Review 2021 assumed to be funded from the Reserve.
7 £1.6bn for rail passenger services and £1.3bn for rail maintenance.
8 Resource DEL support for Ukraine this year includes £1.5bn for military support and £0.2bn for civilian support. The total military support package this year is £3bn, including £1.5bn Capital DEL.
9 HMT’s assessment of how much Resource DEL pressures will reduce and underspends will emerge over the course of the financial year.
10 At each fiscal event, the OBR publishes an estimate of how much the government will underspend against its DEL plans, called the Allowance for Shortfall (AfS). To show total pressure against the OBR Spring Budget 2024 forecast, the Resource DEL AfS (£2.9bn) needs to be added to gross pressures.
11 Totals may not sum due to rounding.
3. IMMEDIATE ACTION ON SPENDING PRESSURES
The government is taking immediate steps to address the pressures identified in the audit by cancelling unfunded policy announcements made by the last government and taking the difficult decisions it avoided.
This document sets out the savings that have been identified. Together these will deliver £5.5 billion savings in 2024-25 rising to £8.1 billion in 2025-26. The specific savings measures are set out in Table 2:
3.1 Table 2: Immediate savings (£ millions)
1 2024-25 savings assumed to be maintained in cash terms in 202526. 2025-26 budgets will be subject to Spending Review decisions.
2 Winter Fuel Payments are classified as Annual Managed Expenditure (AME). Estimated savings sensitive to forecast take up of Pension Credit. Final savings will be certified by the OBR at the Budget taking account of any behavioural response.
3 In addition, the government is reviewing the New Hospital Programme. Savings from this programme will be subject to this review.
4 Totals may not sum due to rounding. Excludes savings from NatWest retail offer.
5 Costs associated with a NatWest retail offer are not included in current forecast. This figure reflects the avoidance of a future loss of income from share sales should a retail offer take place. It assumes a retail offer of £1bn – £3bn in size, with a package of incentives for retail investors that equates to a discount to market price of between 10-15%. It does not take account of any other potential costs involved in such an offer or any discounts associated with potential institutional sales. For these purposes the offer is assumed to take place in and costs apportioned to 2024-25.
The immediate savings identified reduce the pressure from £21.9 billion to £16.4 billion in 2024-25. This is just the first step. As is usual, the government will continue to manage down the pressure and will take further decisions across tax and spending at the Budget.
Departmental budgets for 2024-25 will be confirmed at the Budget, alongside the OBR forecast. Final departmental expenditure limits will be set out at Supplementary Estimates in the usual way.
3.2 Immediate savings
The government is taking immediate action to manage the pressures revealed in the audit. These total £5.5 billion in 2024-25 and £8.1 billion in 2025-26, and include:
• Making sure that departments absorb at least £3.2 billion of the public sector pay pressure this year. The Treasury will work closely with departments to identify savings to fund pay. To achieve this, the Treasury will help departments to bear down on waste and drive efficiency, including by:
- Taking immediate action to stop all non-essential government consultancy spend in 2024-25 and halve government spending on consultancy in future years. This will save £550 million in 2024-25 and £680 million in 2025-26. To help departments do this and make value for money decisions about how to resource work the civil service headcount cap announced by the previous administration will be lifted.
- Delivering administrative efficiencies across government –the Treasury will implement a 2% saving against government administration budgets, cutting down on waste while prioritising the frontline. This will save £225 million in 2024-25.
- Reducing communications and marketing budgets – the government will review the hundreds of millions spent each year across government on communications and marketing campaigns, with a view to making reductions.
- Continuing to dispose of surplus public sector estates, raising money for public services and enabling assets to be put to productive use where the government can increase their social value and drive greater value for money.
• Targeting Winter Fuel Payments. Winter Fuel Payments will be targeted from winter 2024-25 at households in England and Wales with someone aged over State Pension age receiving Pension Credit, Universal Credit, Income Support, income-based Jobseeker’s Allowance and income-related Employment and Support Allowance. They will continue to be worth £200 for eligible households, or £300 for eligible households with someone aged over 80. This will better target support for heating costs at those who need it, while all pensioners will benefit from the government’s commitment to maintain the triple lock for the basic and new State Pension in this Parliament. Winter Fuel Payments are devolved in Scotland and Northern Ireland.
The government wants those entitled to Pension Credit to claim it. The government will bring together the administration of Pension Credit and Housing Benefit as soon as operationally possible, so that pensioner households receiving Housing Benefit also receive any Pension Credit that they are entitled to. The Department for Work
and Pensions will continue to work with partners to encourage takeup alongside their own communication campaigns and to support people with their Pension Credit claims.
• Stopping the Rwanda migration partnership. This will create savings on flights and payments to Rwanda, and removing retrospection of the Illegal Migration Act will allow the government to process asylum seekers and reduce use of hotels.
• Cancelling the Investment Opportunity Fund. This was announced at Autumn Statement 2023 but has yet to support any projects.
• Not proceeding with adult social care charging reforms. The previous government committed to introduce these in October 2025 but did not put money aside for them. The reforms are now impossible to deliver in full to previously announced timeframes.
• Reviewing the previous government’s transport commitments. This will ensure our transport infrastructure portfolio drives economic growth and delivers value for money for taxpayers. The government is cancelling the A303 Stonehenge tunnel and the A27 schemes. These are low value, unaffordable commitments which would have cost £698 million next year. The government will also cancel the Restoring Your Railway programme, saving £85 million next year. Individual Restoring Your Railway projects will be able to be reconsidered through the Transport Secretary’s review.
• Cancelling the Advanced British Standard. The government will cancel the unfunded commitment to additional teaching hours, which would have cost almost £1 billion a year in the medium term. The government will continue to fund more and better maths teaching, additional funding to support young people resitting maths and English GCSEs, and teacher recruitment and retention incentives in 2024-25 and 2025-26.
• Reviewing the New Hospital Programme and the previous government’s ‘40 hospitals by 2030’ commitment. The government will put the programme on a more sustainable footing, following persistent delays and overruns, and recognising delivery and market constraints. The government is undertaking a full and comprehensive review of the programme while continuing to deliver the most advanced and most urgent hospitals to a realistic timeframe.
4. RESTORING PUBLIC SPENDING CONTROL
The government is committed to delivering economic stability based on sound money. The spending audit commissioned by the Chancellor has revealed the scale of the spending pressures in 2024-25. Alongside immediate savings, the Chancellor is also setting out a clear plan to restore public spending control. This plan has three steps.
First, the government is initiating a process for identifying further savings.
The government will set out its fiscal plans at a Budget on 30 October in the usual way, alongside a full economic and fiscal forecast from the OBR. This Budget will confirm departmental control totals for 2024-25.
Second, the government is launching a multi-year Spending Review which will conclude in the spring. The Spending Review will restore spending control in the medium term, setting spending policy in line with the government’s wider fiscal strategy.
Third, the government is implementing reforms to the spending framework and improving the transparency of the information Treasury shares with the OBR to ensure that this situation does not repeat itself.
The pressure revealed by the audit does not therefore represent an announcement of the government’s tax, spending or borrowing plans.
4.1 A path to the autumn
The savings set out are the first step the government is taking to manage down the 2024-25 pressure. The Chancellor has been clear that departments should, as is usual, make every effort possible to continue to manage down their pressures.
The Spending Review
The Chancellor has launched a multi-year Spending Review which will set spending plans for a minimum of three years of the five-year forecast period. The Spending Review process will bring spending back under control.
The Spending Review will conclude in spring 2025. Departmental expenditure limits for 2025-26 will be set alongside the Budget in October, to provide departments with necessary certainty.
This Spending Review will take a mission-led, reform-driven and techenabled approach to improving public services.
4.2 Strengthening the fiscal framework to ensure this never happens again
Framework reforms
The government is announcing a series of changes that will fundamentally strengthen the fiscal and spending frameworks and ensure that such unfunded pressures cannot arise again.
These will increase certainty and transparency and prevent spending decisions being repeatedly delayed. They ensure that there will always be medium-term departmental spending plans which the OBR will be able to assess aggregate pressures against. A revised Charter for Budget Responsibility which confirms the detail of these reforms will be published alongside the Budget.
The Charter will set out the government’s reforms to the framework, including committing to:
• A minimum frequency and duration of Spending Reviews;
• Improving the transparency of the information the Treasury shares with the OBR, particularly on the in-year position; and
• Formalising the OBR’s power to forecast overspend against departmental expenditure limits in aggregate.
One significant underlying cause of the spending pressures outlined in this document was the failure to hold regular spending reviews to re-plan departmental spending in the face of shocks. Instead, there has been no spending review since 2021. This means budgets are largely based on macroeconomic assumptions which are three years out of date, and departmental planning horizons have shrunk to less than one year.
To prevent this happening again, the government will update the Charter for Budget Responsibility to require spending reviews to be held every two calendar years, and with a minimum duration of three years of the five-year forecast period to ensure public services are always planned over the medium term. This will improve value for money, the planning of public expenditure and provide greater budgetary certainty.
The OBR forecast in March 2024 for 2024-25 was based on the departmental expenditure limits originally set at SR21, and the OBR was not aware of the scale of the significant spending pressures outlined in this document.
The government will ensure that this never happens again, by changing the Charter for Budget Responsibility to require the Treasury to share with the OBR its assessment of pressures against departmental expenditure limits for the current and following financial year. The OBR can interrogate this assessment and request further information required to make an assessment of whether the government is likely to underspend or overspend against those departmental limits in aggregate. Those underspends or overspends will be included in the OBR forecast.
When combined with the reforms to ensure regular spending reviews with minimum planning horizons, this will ensure future OBR forecasts are always based on detailed departmental spending plans reaching into the medium term, and that the OBR is able to make an assessment of whether potential spending pressures mean departments are likely to overspend against those plans.
The government is introducing a “fiscal lock” in legislation through the Budget Responsibility Bill. This will require that fiscally significant announcements are subject to an independent assessment by the OBR. This will ensure there is always proper scrutiny of the government’s fiscal plans.
To support economic stability, the government is committed to one major fiscal event a year, giving families and business due notice of tax and spending changes.
The government remains committed to robust fiscal rules: bringing the current budget into balance so that day-to-day costs are met by revenues and getting debt falling as a share of the economy by the fifth
year of the forecast.
4.3 Making sure government spending delivers value for money
Office for Value for Money
The government will ensure that it places value for money at the heart of its spending decisions. To do this, the government will establish a new Office for Value for Money (OVfM), led by an independent chair reporting directly to the Chancellor and Chief Secretary to the Treasury who will be appointed in due course.
The OVfM will have two primary roles. First, to provide targeted interventions, working with Treasury and departments, so that value for money governs every decision government makes. Second, to recommend system reforms to ensure any changes support the government’s missions and deliver value for money.
The OVfM will be a time-limited multidisciplinary team, based in the Treasury, and will take a task and finish approach to its activities. Following the conclusion of the Spending Review next year, the Office will evaluate the effectiveness of systems reforms, and its impact on the wider spending architecture. Its vision is to leave a legacy of concrete, embedded improvements to the value for money ecosystem to minimise the risk of poor value for money in future.
Achieving value for money in asset sales
As part of a commitment to fiscal discipline, it is important that the government seeks to ensure value for money when disposing of assets. The government intends to fully exit its shareholding in NatWest, resolving one of the last remaining legacy issues from the financial crisis. However, it will do this in a way that delivers value for money for taxpayers that funded these interventions. A retail share sale would not be value for money relative to other options for disposing of shares and so will not go ahead. The substantial size of incentives needed to attract investors in such offers can cost hundreds of millions of pounds, depending on the extent of the discount and how many shares are offered. Instead, the government will continue to use existing disposal methods to deliver value for money sales and expects a full exit to be achieved by 2025-26, subject to market conditions. This will secure the best outcome for the taxpayer and wider public services.
4.4 Reforming the public sector and welfare system
Public service performance is at a historic low. Prisons are over 99% capacity [footnote 18] and Crown Court backlogs are at a record high [footnote 19] – with victims waiting up to two years for cases to come to court. [footnote 20] In the health system, the elective care backlog is 7.6 million, with more than 300,000 people waiting more than a year for treatment. [footnote 21] A&E performance against the four hour target averages is at 75%, down from 85-90% pre-COVID-19. [footnote 22] In local government, in 2024, 19 local authorities needed Exceptional Financial Support to set a balanced budget, [footnote 23] with spending on social care increasing to 54% of councils’ general
service expenditure. [footnote 24]
Through the Spending Review process, the government will take forward work on a number of priority themes, including a greater focus on longtermism, investment in prevention, managing demand, and increasing devolution and local integration of services.
Increasing demand driven by demographic changes is set to further increase pressure on these services. Reform will be crucial in ensuring that the government can deliver better public service outcomes within a challenging fiscal context.
Mission-led public services
The government will change the way public services are delivered by embedding a mission-led approach. This will support preparations for the Spending Review, where the government will ensure departments are working together to deliver key priorities in a more effective and efficient way.
Missions are about much more than how public funding is allocated; they are about using all the tools at the government’s disposal to drive change and reform to improve outcomes. Mission boards will drive collaboration, delivering robust performance management practices that track progress and outcomes.
Reform-driven public services
The government will take action to improve public service outcomes. This includes developing a 10-year health plan to change and modernise the NHS, with the first step launched through an independent external assessment of the current state of the system led by Lord Darzi of Denham. Another example is the government’s commitment to transform the system for supporting children and young people with special educational needs and disabilities, in order to build an inclusive system that delivers better outcomes and is financially sustainable.
The government is committed to a more empowered, accountable and sustainable local government system, which will support strong public services. The government will use the Spending Review to improve how different tiers of government work together. This will include consolidating funding streams for local authorities into the Local Government Finance Settlement and rolling out integrated settlements for further Mayoral Combined Authorities that can show exemplary management of public money. The government will also work with councils to overhaul the local audit system as a crucial part of repairing the foundations of local government and ensuring taxpayers get better value for money.
The government is committed to tackling tax non-compliance, including from fraud and tax avoidance, to ensure everyone pays their fair share. The government will increase HMRC’s compliance staff, invest in HMRC’s resources and technology infrastructure, and make legislative changes to tackle tax non-compliance and raise revenue. The government will also carry out an urgent programme of work to ensure welfare spending is sustainable, including by supporting people into work. The Work and
Pensions Secretary will also assess levels of fraud and error in the welfare system, and consider how to bring that down ahead of the Budget.
The government is considering how to reduce the cost of politics and government over the long-term. This includes bearing down on departmental administration budgets and reviewing the size of the House of Lords, including by removing hereditary peers, to ensure that the costs associated with the Lords are proportionate.
The government will also ensure that ministers demonstrate responsibility and restraint with their pay and allowances. To support this, the government will consider tightening eligibility on severance payments to ministers leaving office to cut costs and to ensure value for money. This will include linking severance payments to time served, thereby ending the possibility of ministers receiving payments when they could have served a single day in office. The government will also explore options to withhold severance payments to ministers who have not met the standards expected of them.
Tech-enabled public services
The government will focus on improving the productivity of the public sector to deliver high quality public services and achieve value for money.
The government will create the conditions for successful digital adoption in the public sector by addressing legacy IT and utilising cloud services and data sharing. This will allow the public sector to realise the opportunities of Artificial Intelligence (AI) and improve public service outcomes.
The Artificial Intelligence Opportunities Action Plan, announced by the Department for Science, Innovation and Technology, [footnote 25] will set out a roadmap for government to capture the opportunities of AI to enhance growth and productivity and deliver better services for the public.
Better data and digital infrastructure will enable a move to more personalised public services that meet people’s needs, improving user satisfaction and efficiency. This new approach will transform public services by giving people more choice and control over the services they use.
Reforming infrastructure delivery
The government will launch the National Infrastructure and Service Transformation Authority (NISTA) which will drive more effective delivery of infrastructure across the country and support the delivery of a 10-year infrastructure strategy.
Workforce reforms
The government has accepted the recommendations of the independent Pay Review Bodies (PRBs) for 2024-25. This will ensure that UK public services can recruit, retain and motivate the people they need. It provides a basis for government and those working in the public sector to work together to reform and repair UK public services.
These pay awards provide the foundation on which workforce reform
can be delivered over the Parliament. This will be a key theme for the Spending Review, with a particular focus on:
• NHS workforce. The government is committed to training the NHS staff needed to get patients the care they need on time and will reform the way care is delivered, including a greater focus on community and preventative care. This will include enhancing medical training to create a more productive workforce by equipping doctors with both generalist and specialist skills to treat patients with increasingly complex care needs. In 2022-23, the NHS spent £9.3 billion on agency and bank staff. [footnote 26] While agency spend is now falling, the government and NHS England will review ways to go further and faster to rapidly reduce the costs of temporary staffing.
• Police. The government is committed to tackling waste through the Police Efficiency and Collaboration Programme. The programme will set nation-wide standards for procurement and establish shared services and specialist functions to drive down costs.
• Teachers. The Secretary of State for Education will work with the schools’ sector on how to make the most effective use of the workforce, particularly in the context of changes in demographics with pupil numbers decreasing in primary schools.
• Armed forces. The government will fundamentally overhaul the way the Ministry of Defence operates, through the Defence Secretary’s work on the Defence Operating Model. This will break down the barriers to productive working through a new central productivity portfolio, expose ineffective procurement practices, and reduce duplication and bureaucracy across defence – enabling the Armed Forces to be more productive.
• Civil service. The government will develop a strategic plan for a more efficient and effective civil service, including bold options to improve skills, harness digital technology and drive better outcomes for public services. The civil service will also be required to make efficiencies through reducing use of consultants and making sure back-office functions are as streamlined as possible. The government will move away from capping civil service headcount to an approach that ensures departments consider overall value for money in resourcing decisions.
5. ANNEX: RESPONDING
TO THE 2024-25 PAY REVIEW BODIES’ RECOMMENDATIONS
The government is committed to the independent Pay Review Body (PRB) process as the means for setting pay. The PRBs weigh up a number of factors when forming their recommendations, including recruitment, retention and affordability. The PRB process is independent and seeks input from both workforces and the government. The integrity of this system – including the expectation that the government will honour the recommendations – means it plays an essential role in ensuring smooth industrial relations.
In considering its response to the PRBs’ recommendations for 2024-25 pay awards, the government carefully considered:
• The cost of the pay awards to the taxpayer;
• The costs of industrial action (including to public service outcomes and the wider economy) that might be expected if the recommendations were rejected;
• The benefits from improved recruitment, retention and motivation of public sector workforces, given that public sector pay has fallen relative to the private sector in recent years; and
• The potential impacts of these pay awards on inflation.
5.1 Costs from industrial action
Industrial action in the public sector has had significant impacts on public services, with disproportionate impacts on the most vulnerable in society, the public finances and the economy. Recent industrial action across the NHS has resulted in direct costs to the Exchequer, affected patient care, and had adverse economic consequences.
• Direct fiscal cost: a total of £1.7 billion of funding was provided to NHS England to mitigate against the direct cost of industrial action in 2023-24 and ease pressures on hospitals. This was provided through a combination of reprioritised Department of Health and Social Care funding and new funding from HM Treasury. [footnote 27] This includes the cost to cover shifts and lost pay efficiencies, whilst subtracting salary savings across those staff on strike.
• Impact on patient care: industrial action has had a significant impact on elective care and placed services under increased pressure. Over 1.5 million appointments have been rescheduled to date (as of July 2024) [footnote 28] due to strike action from December 2022 to March 2024. NHS England analysis estimates that the waiting list could have fallen by an extra 430,000 since December 2022 without industrial action. [footnote 29]
• Direct economic impacts. ONS GDP data covering previous strike days highlights lost activity across the health sector. In July 2023, one of the main contributors to the fall in monthly output was the human, health and social work activities sub-sector, which fell by 1.2%. This was attributed to a 2% fall in the human health activities industry amidst strike action from healthcare workers (senior doctors, radiographers and junior doctors). [footnote 30]
• Indirect economic impacts. There are also likely to be indirect economic effects from the impact of industrial action on health outcomes. The NHS elective waiting list in England reached a record high of 7.8 million in September 2023 up from 4.6 million in December 2019, in part exacerbated by industrial action. [footnote 31] Over a similar period, ill-health related inactivity has increased sharply and has been the leading reason for rising economic inactivity, standing at a near-record 2.8 million people in the three months to May 2024. [footnote 32] Analysis by the National Institute of Economic and Social Research has highlighted that the record size of healthcare waiting lists has likely contributed to the increase in ill-health related inactivity. [footnote 33]
School teachers’ strikes have also affected students and parents, with economic impacts.
• Effects on students: The Department for Education estimates that strike action taken by school teachers across 2023 led to over 25 million school days being lost. [footnote 34] The loss of school days also has longer run impacts on children’s attainment, particularly if repeated over a sustained period.
• Direct economic effects: School closures and lost days of schooling directly translate into GDP impacts, as they reduce output for the education sector. GDP data highlights this loss of activity, for example in July 2023, amidst teacher strikes, monthly output in the education sector fell 1.7%. [footnote 35]
• Wider economic effects: There are broader and significant economic effects from parents having to take time off work to care for children who are unable to attend school during strike days, reducing output across a wide range of sectors. According to ONS survey data, 59% have to work fewer hours or are unable to work at all if schools close due to strikes. [footnote 36] If 10% of the 25 million lost school days led to a parent having to take a day off work for childcare, that would equate to 2.5 million working days lost, worth around £900 million in lost output to the economy. [footnote 37]
5.2 Benefits from improving recruitment and retention
The PRBs’ recommended awards are broadly in line with the average expected pay settlement in the wider economy. [footnote 38] Pay growth in the private sector provides an important benchmark when considering
1 RDEL represents the day-to-day (“current”) running costs of public services, grants, and administration.
2 This figure accounts for the OBR’s Allowance for Shortfall – the OBR’s forecast of underspends. See Table 1 for an explanation of how this has been calculated.
3 At the Budget, the OBR will provide an updated AME forecast, which will recognise the expected costs of Annually Managed Expenditure (AME), including the cost of compensation payments arising from the recommendations of the Infected Blood Inquiry.
4 Including the £2.9 billion Allowance for Shortfall forecast by the Office for Budget Responsibility.
5 Cash increases in forecast RDEL due to policy changes at fiscal events refer to Public Sector Current Expenditure in RDEL, which is the OBR’s measure of RDEL.
6 These budgets were set with reference to the OBR’s forecast for the GDP deflator, which measures the change in prices across the domestic economy. This measure better reflects the inflationary pressures which departments face than other measures of price inflation, such as Consumer Prices Index (CPI) inflation.
7 Outturn data from ONS. SR21 figures calculated from Economic and Fiscal Outlook - October 2021, OBR, latest forecast from Economic and Fiscal Outlook - March 2024, OBR.
8 GDP deflator, Quarterly National Accounts, ONS, June 2024.
9 In 2024-25 prices, HMT calculations based on Economic and Fiscal Outlook - October 2021, and Economic and Fiscal Outlook - March 2024, OBR.
10 Public Sector Finances June 2024, ONS, July 2024.
11 All public sector pay award decisions available on gov.uk.
12 This has largely been absorbed by departments, and therefore does not feature in Table 1.
13 The Bank of England report in their Monetary Policy Report from May 2024 that the latest Agents’ intelligence suggests that pay settlements will average 5½% across 2024 – Monetary Policy Report – May 2024 – Bank of England
14 ‘Annual Survey of Hours and Earnings (ASHE)’, ONS, March 2024. Median pay, across all employees. ASHE data is recommended by the ONS as the principal source of data for comparing public and private sector pay due to its large sample size and coverage of the entire United Kingdom
15 Public spending, pay and pensions, IFS, October 2022.
16 Total cost above provision in departmental plans for the 2024-25 PRB workforces, delegated Civil Service Grades and associated workforces.
17 The government laid Main Estimates for 2024-25 before Parliament on 17 July, the earliest available opportunity after the General Election and considerably later than the usual timetable. These Estimates were prepared before the General Election, and the government was forced to lay them unchanged in order to allow them to be voted on before the summer recess. This was necessary to avoid departments experiencing cash shortages over the summer. The pressures
the recruitment and retention impacts from pay awards. [footnote 39]
Recruitment and retention has deteriorated across many public sector workforces since 2011, with previous governments having capped or frozen pay on multiple occasions. ONS’ Annual Survey of Hours and Earnings (ASHE) shows that median annual pay in the public sector grew by 7 percentage points less than median annual pay in the private sector between 2011 and 2023. [footnote 40]. The PRBs’ recommendations are calibrated to support recruitment and retention of their workforces. This has benefits for the taxpayer and the users of these services.
• Improved public services outcomes: retaining experienced teachers is key to boosting teaching quality, [footnote 41] which evidence suggests is the single most important in-school factor affecting pupil outcomes.
• Reduced reliance on expensive temporary staffing, particularly in the NHS: In 2022-23, the NHS spent £9.3 billion on temporary staffing due to workforce shortfalls. [footnote 42]
• Reduced turnover and so recruitment costs: Over the mediumterm, improved retention will result in savings associated with recruiting and training new personnel. For example, it costs an estimated £92,000 to recruit and train an infantry soldier and between £500,000 and £600,000 to train and pay for a Service person to become a Corporal air engineer. [footnote 43]
set out in this document represent a more realistic assessment of DEL spending. As usual, departmental spending limits will be finalised at Supplementary Estimates.
18 ‘Adult Male Prison Population and Capacity Release’, Ministry of Justice, July 2024.
19 ‘Criminal court statistics quarterly’, Ministry of Justice, March 2024
20 ‘Criminal court statistics quarterly’, Ministry of Justice, March 2024
21 ‘Referral to treatment waiting times’, NHS England, May 2024
22 ‘A&E Attendances and Emergency Admissions’, NHS England
23 Exceptional financial support for local authorities for 2024-25, MHCLG, February 2024.
24 Local authority revenue expenditure and financing England: 2022 to 2023, MHCLG. Excludes policing, schools and the Better Care Fund, June 2024.
25 AI expert to lead Action Plan to ensure UK reaps the benefits of Artificial Intelligence, DSIT, July 2024.
26 NHS England Financial Performance Report, NHS England, Q4 2022-23.
27 ‘2023 To 2024 revised financial directions to NHS England’, DHSC, March 2024.
28 ‘NHS faces fresh strike disruption amid heat health warnings’, NHS England, June 2024.
29 Based on NHS supplementary statistics and published IA analysis.
30 ‘Monthly GDP low level industry dataset’, ONS, May 2024.
31 ‘Referral to treatment waiting times’, NHS England, May 2024.
32 INAC01 SA: Economic inactivity by reason (seasonally adjusted) - Office for National Statistics (ons.gov.uk)
33 NIESR Spring 2024 UK Economic Outlook, Box B, May 2024
34 School closures during the 2023 teacher strikes – GOV.UK (www.gov.uk)
35 Monthly GDP low level industry dataset, ONS, July 2024.
36 ‘The Impact of strikes in the UK: June 2022 to February 2023’, ONS, March 2023 June 2022 to February 2023.
37 Based on 2.5 million parent working days lost at 8 hours per day, using the ONS average hourly productivity figure for 2023 of £44.64, Output per hour worked, ONS, May 2024.
38 Monetary Policy Report, Bank of England, May 2024.
39 Assessing the impact of pay and financial incentives in improving shortage subject teacher supply, National Foundation for Education Researchers (NFER), 2022.
40 Median pay, across all employees. ASHE data, March 2024.
41 ‘Does Teaching Experience Increase Teacher Effectiveness?’, Learning Policy Institute, June 2016.
42 NHS England Financial Performance Report, NHS England, Q4 2022-23.
43 Internal Ministry of Defence (MoD) analysis.
New public procurement rules to drive growth, opportunities for small businesses and exclude suppliers that fail to deliver
New laws putting growth, small businesses and transparency at the heart of public contract awards are now in force, as part of a transformation of the government’s commercial landscape that delivers on the Plan for Change.
A more open public procurement regime driving value for money is now in place through the Procurement Act 2023, which sets rules that all public bodies must follow when they buy goods and services.
The Act will boost growth by slashing red tape for small and medium sized businesses applying for government contractscombining multiple regulations into one simple set, and publishing procurement data in a standard, open format on a Central
Digital Platform.
It is bolstered by a new National Procurement Policy Statement (NPPS) that sets out this government’s Mission-led priorities which the public sector must have regard to in its procurement activity.
The changes open up opportunities for small businesses to bid for public sector contracts, helping deliver growth and opportunity across the UK. It ends late payments that put small businesses at risk, introducing a mandate of 30-day payment terms for all public sector contracts.
Costs for both business and the public sector will be reduced through simple new processes that drive innovation, offering greater
flexibility for buyers to tailor procurement to their exact needs. For example, providing public bodies more opportunities to negotiate with suppliers, and using built-in stages to procurement cycles such as demonstrations and testing prototypes.
Cabinet Office Minister Georgia Gould said: “Public sector procurement can now fully deliver on the Plan for Change - unleashing local growth, opening up opportunities and embedding transparency and accountability.
The Procurement Act, supported by our new National Procurement Policy Statement, will tear down barriers that stop small businesses from winning government work, giving them greater opportunity to access the £400 billion spent on public procurement every year, investing in home-grown talent and driving innovation and growth.”
Shirley Cooper, Crown Representative for Small Businesses, said: “This once–in-ageneration change to public procurement laws will provide enormous opportunities for small businesses to take a greater share of contracts.
The Act, which goes live alongside our bold new National Procurement Policy Statement, will drive economic growth and deliver on the Government’s Missions and the Plan for Change.
I thank the public sector for the considerable amount of work done to prepare for and understand these new rules, and how they can fully benefit both businesses and the
taxpayer.”
To deliver on this, a Central Digital Platform is now in operation which will streamline processes and cut red tape, allowing suppliers to register their details and see all bidding opportunities in one place. This will encourage more suppliers to bid for government work, increasing competition and in turn supporting economic growth.
Citizens can also scrutinise public procurement data published on this platform, as part of the Act’s rules for greater transparency.
The Government will also use tough new powers to investigate supplier misconduct, including underperforming suppliers and those that pose security risks to supply chains, with the ability to debar or exclude them from contracts.
to the Dementia Friends initiative, with a view to all FRAs joining the scheme over the coming years.
The Procurement Review Unit (PRU) and National Security Unit for Procurement (NSUP), now operational as dedicated resources in the Cabinet Office, will carry out this work. The NSUP will take robust action against any organisation, actor or entity which presents a national security threat.
Cllr Jeremy Hilton, Chair of the LGA’s Fire Services Management Committee, said:
“Fire and rescue services have proven just how effective they can be by halving the instances of fire over the last decade through both their responses to emergencies and their extensive programme of prevention work,” said Cllr Jeremy Hilton, Chair of the LGA’s Fire Services Management Committee.
Emma Jones CBE, founder of Enterprise Nation, said: “Accessing public sector work can act like a growth accelerator for SMEs. Government contracts are solid and reliable and pay within 30 days. They help SMEs develop and invest in new processes, products and efficiencies, as well as take on more staff in their local community.
By seeing Government procurement through this lens, opening up contracts to more diverse and community-based businesses will be a powerful way to deliver economic growth.
“They are now exploring how they can use their expertise in further prevention work to improve the public’s health by providing critical interventions, promoting health messages and referring to appropriate services.
My organisation has already been busy readying SMEs for this moment. This legislation is the beginning of the next step in the journey to increasing government spend with SMEs and boosting the economy.”
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Terry Corby, founder and CEO of Good Business Pays, said: “The public sector spends around £300 billion every year and represents a huge opportunity to drive growth in the UK. Buying more from SMEs, making it easier for them to tender for work and get paid faster will help drive growth in our communities across the UK.
“Over half of all fire related deaths and injuries in the home happen to people over 60 and we know that impairment and disability increase the risk of harm from fires and other hazards too. This work means that not only can we prevent fires and other emergencies, but action can be taken to help people who may not even realise that they need extra help.”
The commitment to pay all suppliers through the supply chain in under 30 days is important. If implemented well, the new Procurement Act will represent the biggest step-change towards best practice payment culture. I founded Good Business Pays five years ago, and provide a great example for all commercial organisations to follow.”
The Local Government Association represents all 49 fire and rescue authorities (FRAs) in England and Wales and more than 370 local councils.
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Only eight per cent of public sector frontline workers equipped with 5G
Only eight per cent of public sector frontline workers equipped with 4G
The UK public sector could be missing out on the opportunity to provide faster and more cost-effective communitybased services to citizens due to slow 4G adoption amongst Britain’s vital frontline.
The UK public sector could be missing out on the opportunity to provide faster and more cost-effective community based services to citizens due to slow 5G adoption amongst Britain’s vital frontline.
Fewer than one in 10 public sector frontline workers are currently using 5G technology, research amongst public sector decision makers by YouGov for Vodafone UK has revealed. The slow uptake of 5G technology in the public sector appears to be attributable to a lack of knowledge of the benefits it can provide and perception of overall costs involved, which was cited as one of the key obstacles to adoption by those that don’t already have 5G.
Fewer than one in 10 public sector frontline workers are currently using 4G technology, research amongst public sector decision makers by YouGov for Vodafone UK has revealed. The slow uptake of 4G technology in the public sector appears to be attributable to a lack of knowledge of the benefits it can provide and perception of overall costs involved, which was cited as one of the key obstacles to adoption by those that don’t already have 4G.
Frontline workers, such as police officers, nurses and social workers, could all benefit from 4G’s greater speed and capacity to
Frontline workers, such as police officers, nurses and social workers, could all benefit from 5G’s greater speed and capacity to
access critical information and update records electronically while out in the community. Fast mobile connectivity would improve critical decision making in the field, reduce time spent on administration and ultimately help to improve the service provided to citizens.
access critical information and update records electronically while out in the community. Fast mobile connectivity would improve critical decision making in the field, reduce time spent on administration and ultimately help to improve the service provided to citizens.
“As public sector organisations face continued budget cuts, delivering quality services to citizens is an increasing challenge,” said Mick Wayman, Head of Public Sector at Vodafone UK. “Armed with cost-effective mobile devices and 4G connectivity, frontline workers can access and update centralised records such as medical and criminal history while they are out in the field. This helps them to make better decisions in the moment, eliminates the need to go ‘back to base’ to complete paperwork and reduces time spent on
“As public sector organisations face continued budget cuts, delivering quality services to citizens is an increasing challenge,” said Mick Wayman, Head of Public Sector at Vodafone UK. “Armed with cost-effective mobile devices and 5G connectivity, frontline workers can access and update centralised records such as medical and criminal history while they are out in the field. This helps them to make better decisions in the moment, eliminates the need to go ‘back to base’ to complete paperwork and reduces time spent on administration. They can reinvest
time and resource where they’re needed most, whether that’s visiting a patient in their own home, on the beat, or elsewhere in the community. In frontline services such as the police where every second counts, 5G really can make a big difference.”
administration. They can reinvest time and resource where they’re needed most, whether that’s visiting a patient in their own home, on the beat, or elsewhere in the community. In frontline services such as the police where every second counts, 4G really can make a big difference.”
Fast, reliable access to information on the frontline is vital. With 5G, large files, applications and critical information can be uploaded and downloaded in an instant: a feature that over half (54 per cent) of public sector respondents said is very or fairly important to their organisation.
Fast, reliable access to information on the frontline is vital. With 4G, large files, applications and critical information can be uploaded and downloaded in an instant: a feature that over half (54 per cent) of public sector respondents said is very or fairly important to their organisation.
Crucially, giving those on the frontline fast, high capacity connectivity and access to information would also support public sector decision makers’ top three priorities which were cited as improving operational efficiency, improving customer experience and reducing overall business costs. However, the research found there is still some way to go for the public sector to realise 5G’s potential to help meet their top priorities, as the benefits are not widely understood and cost is still seen as barrier to adoption.
Crucially, giving those on the frontline fast, high capacity connectivity and access to information would also support public sector decision makers’ top three priorities which were cited as improving operational efficiency, improving customer experience and reducing overall business costs. However, the research found there is still some way to go for the public sector to realise 4G’s potential to help meet their top priorities, as the benefits are not widely understood and cost is still seen as barrier to adoption.
“We are working with public sector organisations to tear down the barriers standing in the way of putting 5G connectivity in the hands of more of Britain’s frontline,” said Mr Wayman. “We are helping organisations to understand how the technology can assist in driving efficiency, delivering better services to citizens and meeting their key priorities.
We want to ensure that those on the frontline are able to take advantage of the right technologies, such as 5G, that will help them to do their jobs in the most effective way possible.”
“We are working with public sector organisations to tear down the barriers standing in the way of putting 4G connectivity in the hands of more of Britain’s frontline,” said Mr Wayman. “We are helping organisations to understand how the technology can assist in driving efficiency, delivering better services to citizens and meeting their key priorities. We want to ensure that those on the frontline are able to take advantage of the right technologies, such as 4G, that will help them to do their jobs in the most effective way possible.”
How high is Kilimanjaro and other call centre queries
Council call centres handle more than 50 million calls each year, usually about council tax and parking, but they also receive some more bizarre queries which can leave staff baffled.
The Local Government Association, which represents more than 370 councils in England and Wales, has revealed some of the quirkier examples from the past 12 months. Asking the regulations for hosting a mouse race, getting help with a tricky crossword answer and finding out how to cook instant noodles are just a few examples of unusual enquiries received by council customer call centres in the last year.
These include Somerset County Council being asked about the rules and regulations for mouse racing and what to do in the event of eating an out-of-date pork pie. While Nottinghamshire County Council was offered a cat by a resident who claimed it was a nuisance and asked by one individual if they knew their lost holiday romance, who lived in the area.
One elderly resident contacted Stevenage Borough Council to ask where she could buy a shopping trolley and was directed to her nearest store by staff after a quick internet search.
Cllr Peter Fleming, Deputy Chairman of the LGA, said: “These light-hearted examples of calls highlight the variety of issues that councils deal with every day –from the slightly amusing to the outright bizarre.
“Even if they do feel as though they are outside their remit, council call centre staff will always try their hardest to assist where they can. But whilst councils offer more
than 800 services, some requests are simply beyond them.
“The fact that councils are so often the first port of call for residents who are seeking a solution to their problems shows just how central a role councils play in the lives of their communities.”
Top 10 bizarre calls received
Do you know how much water I need to cook super noodles? (Stevenage Borough Council)
What are the rules and regulations for hosting a mouse race? (Somerset County Council)
Can I exercise my kestrel on your tip? (Nottinghamshire County Council)
A call from an elderly lady asking for help on her crossword. Seven letters, James Bond’s cat loving nemesis, begins with B? (Staffordshire County Council)
What is the daily room rate at the Holiday Inn express? (Stevenage Borough Council)
What size tin is required for the Mary Berry strawberry tart featured on the BBC’s Great British Bake Off? (Somerset County Council)
I met a boy whilst on holiday in Ibiza, but I’ve lost his number, he said he lived in Nottingham and his dad is a bin man, do you know him? (Nottinghamshire County Council)
How many geese are on the boating lake in Cleethorpes this year – caller wanted to visit but had an allergy to feathers (North East Lincolnshire Council)
What time does your website close? (Poole Borough Council)
How high is Mt Kilimanjaro? (Somerset County Council)
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The problem with health and social care crises is that they require a rapid response. In many areas, the only really rapid response available is hospital.
Not in Nottingham, though, where commissioners at Nottingham North and East Nottingham West CCGs have worked with the British Red Cross to develop the Crisis Intervention Community Support Service to prevent admission to hospital or respite care by providing short, targeted interventions.
This is a service that other CCGs could do well to look at
The service is known locally by its acronym, CICSS, pronounced “kicks,” and has been running since 2010. Last year, just over three quarters of the people referred to the service did not need an admission. This adds up to 748 admissions avoided, saving the two CCGs a combined total of nearly £1.5m.
“Our main theme at British Red Cross is refusing to ignore people in crisis,” says service manager Ruth Beedel. “It doesn’t matter what size that crisis is, it is what matters to the person.”
“So the idea of CICSS is to put in some support very quickly for a short period of time to help people over a difficult period and either help them return to independence or give their GP time to set up a package of ongoing support.”
The service is available to anyone over the age of 18, though in reality the client group is overwhelmingly 65-plus.
“We had one lady of 102,” says Ruth.
When any of the GPs in the two CCG areas identifies someone who is struggling and for whom a short package might prevent an admission, they call a central hub run by community provider Nottinghamshire Healthcare County Health Partnerships.
“Most of our referrals come from GPs but we do also get them from pharmacists, who are worried about medication, and from physios and OTs,” says Ruth.
The service does not take referrals for people who have been in hospital more than 24 hours, with one exception – the Ling’s Bar rehabilitation hospital – as there is a Home from Hospital service to support them.
The hub collects some basic information and refers on to CICSS where co-ordinators take the case before making contact with the potential service user.
“We call to say that the GP thinks you might want some help and ask if we can come to make an assessment. If they say yes, we go and see them in their home.” More than 90 per cent accept the offer.
The response is rapid rather than emergency, says Ruth. GPs can ask for patients to be seen within the hour and very often that is possible. Usually, though, first contact is within 12 hours.
“We find it really helps if a relative or friend can be there for the assessment visit,” says Ruth. “The service users do not know us and it is important they feel safe.”
The team doing these visits consists of 12 healthcare assistants. The minimum requirement is NVQ level 2 although in practice they are all either at, or working towards, level 3. They cover two shifts –7am to 3pm and 3pm to 10pm – 365 days a year.
“At the initial assessment we look at the whole picture to try to understand what the service user wants, what they understand about our service and what we can offer,” says Ruth.
“We ask what they want to achieve and usually that is something like they want to be independent again or to do their shopping on their own or to be how they were before they got ill. Then we have to unpack that a bit and work out how to achieve it.”
Sometimes it is daily activities, helping the service user to prepare meals or prompting them to take medication.
“I could be helping them to mobilise more effectively,” says Ruth. “It’s not rocket science but it needs very special people to do it effectively and we have some wonderful HCAs.”
These are Level 1 service users whom CICSS can support for 14 days. More and
HEALTH & SOCIAL CARE
Mr W was 84 and at home, receiving palliative care for terminal cancer. When his health deteriorated rapidly, the district nursing team called in CICSS to provide 48 hours of care while they set up a care package.
CICSS visited him three times a day, helping with personal care safely and comfortably and with dignity. The HCAs were able to alert the district nursing team to an area of soreness and prevent it getting worse. When the care package was delayed because paperwork did not arrive in time, CICSS extended its support. A week later, CICSS handed over care. Mr W stayed at home comfortably and surrounded by his family throughout.
8 HEALTH SOCIAL CARE
HEALTH & SOCIAL CARE
more frequently, though, service users require help with personal care – toileting and washing. These are Level 2 service users who can receive seven days more intensive help.
The HCAs report back to the coordinators after this initial assessment and put together a schedule of visits. The service keeps GPs informed along the way.
“That means the GPs are aware and they can mobilise other services. We are a bit like the eyes and ears of the GP. We see their patients regularly.”
They also signpost service users to other organisations that might help and liaise with GPs and community and social services about ongoing support.
Like the NHS, CICSS is seeing rising levels of dependency and complexity, including early signs of dementia, people needing end of life care and those with high body mass index. Recently, commissioners have asked CICSS to accept referrals of patients assessed by GPs as high risk of admission – adding again to the complexity of work.
The CCGs have provided additional funds and CICSS is responding with training to support the HCAs. “We are trying to build some resilience into the team as well as enhanced skills,” says Ruth.
Dr Guy Mansford, who is clinical lead for Nottingham West CCG and a partner at the Oak Medical Centre in Beeston, says quite simply that CICSS is “brilliant”.
“It’s really raised our expectations of what can happen. In the past we would see someone not coping at home and we might make a referral to Social Services who might say they could see them in two weeks if we were lucky. There was no assurance and often we would end up admitting them to hospital.
“Now I can call CICSS and know that someone will be there within the hour. I
can tell the patient and be sure that it will happen. They are as responsive as we are.”
His only worry is that CICSS may end up filling rather more of the gap left by social services than it should. “We have to hold social services to account,” he says.
Candice Lau, senior service improvement manager at Nottingham North and East CCG, says the feedback from providers and service users is excellent and that CICSS fills a real gap. The fact that CICSS is CQC regulated provides an added layer of assurance about quality, she adds.
It costs the combined CCGs just under £250,000 a year to run and with just under £1.5m saved through avoided admissions on paper this is value for money. However, she would like to evaluate this more closely. “It’s always very difficult to allocate savings exactly,” she says.
Certainly CICSS is adding value not just for service users but also the NHS locally and it is, says Ms Lau, a transferable model. “The Red Cross is very experienced at running these sorts of crisis services,” she says. “This is a service that other CCGs could do well to look at.”
Mrs P was 82, in poor health and living alone with some support from her son. She was referred to CICSS by her GP after a visit to A&E for help with personal care needs.
The team visited every morning to help her wash and dress and have some breakfast. They also helped make her environment safe, for example by having a key safe fitted so she did not need to go to the door when her son was not present. They referred her to the Department for Work and Pensions for financial advice. Meanwhile, social services informed CICSS that they were not able to provide support for Mrs P. The GP and CICSS pressed the case and eventually a care package of morning and evening visits was commissioned – but not until 30 days after the initial referral. CICSS continued to support Mrs P throughout.
HELPING THE SANDWICH GENERATION REMAIN IN POST
Of all public sector workers, NHS staff are most likely to work through their breaks and lunchtime, according to a report published last month by the Guardian newspaper. The newspaper’s Clockoff survey, which analysed the well-being of more than 3,700 public sector staff across the board, found that 85 per cent of those who took part in the online survey insisted stress was a fact of life for them.
Dr Jill Miller, Research Adviser at the CIPD and an expert on staff wellbeing, isn’t particularly surprised at the findings. She authored the 15th CIPD Absence Management Survey which provided benchmarking data for both public and private sector organisations throughout the UK.
Her figures showed that although absence as a whole had fallen by one day per employee (6.6 days) compared to the previous year (7.6), the figure was still far higher for public sector staff than in the private sector (7.0 days per employee compared to 5.5 days respectively).
With lots of public sector restructuring and job losses as a result, it’s thought one reason for higher absences in government – and voluntary sector - jobs could be presenteeism- staff turning up at work when genuinely ill.
“Our survey found that one third of organisations had seen an increase in presenteeism,” said Dr Miller. “And it was higher in the public sector where there were also higher levels of workload and stress.
“If people come to work when they are genuinely ill then it takes them far longer to recover from an illness. Instead of taking one or two days off to get over it they eventually end up having to take much more time off as their illness worsens.”
The reasons those interviewed gave for presenteeism included:
•Worries over job security and because of this not wanting to take time off
•Not wanting to shoulder colleagues with an even higher burden than they already had
•Concerned about letting their clients down if they were absent (this particularly applied to those working in the care field such as social workers and health visitors)
Despite the increase in absence rates Dr Miller is optimistic that organisations are starting to recognise the need to focus on staff well-being, with the public sector in particular faring far better in this respect than private organisations. She has been particularly impressed by housing associations she’s studied, and notes the NHS is also gearing up activity.
“There is a lot of more proactive activity going on now than, say, five years ago. Many more organisations are putting good initiatives in place such as Work Life Balance programmes, Healthy Eating initiatives and offering employees access to counselling, or at least signposting them to areas where they can find people to help them.
“However, we still have a while to go until it becomes business as usual. In an ideal world it would be great to see staff wellbeing become a key business operation. Realistically, though, it’ll be some time before we can celebrate that particular day.”
Communicating honestly and openly with staff – particularly around restructuring exercises - would be another way of reducing stress and absenteeism, insists Dr Miller. That includes allowing staff to ask questions rather than simply dictating what’s about to happen.
“Employees often get anxious about the reasons for changing the structure of an organisation and what’s going to
happen to their role within it. Management ignore these feelings to their detriment,” she said. “Where there is a vacuum of information and no communication, staff, understandably, start to hypothesise.”
Introducing flexible working is another method of which she is in favour. This is particularly relevant today with the ‘sandwich generation,’ she says, where many workers find themselves with children and caring for elderly parents while at the same time trying to hold down a full-time job.
“Asking employees to work core hours allows people time to build their working day around their other responsibilities and helps the burden of juggling of all these roles on a continual basis. People don’t just automatically switch off their caring role when they come to work.”
Home working, which happens less in the public sector than the private, is another initiative which can help with juggling responsibilities. However, this involves a different mindset for managers – who often need guidance and how to manage such a scenario.
Getting staff to work flexibly and from home doesn’t cost an organisation much more money – and in fact could lead to savings with rent and utility bills. Health and wellbeing initiatives, on the other hand, can cost money. However, as far as Dr Miller is concerned it’s definitely money well spent.
Dr Jill Miller
W HAT IS THE REAL IMPACT OF A CAP ON P u BLIC SECTOR
E x
IT
PAYMENTS ?
£557 MILLION FOR PUBLIC BUILDINGS TO SWITCH TO CLEANER HEATING AND SAVE ON ENERGY BILLS
Schools, pools, and hospitals will be supported to make energy efficient upgrades, and businesses with high energy use will receive funding to help cut bills and emissions
More public buildings and businesses will benefit from over half a billion pounds in funding to help reduce their energy bills and carbon emissions.
Schools, pools, and hospitals will be supported to make energy efficient upgrades, with over £557 million government investment. The new projects will help reduce emissions and cut bills, as part of the government’s plan to reach its world-leading net zero targets in a sustainable, pragmatic way.
Heat pumps, solar panels, insulation and low-energy lighting will be rolled out to reduce the use of fossil fuels across the public sector and strengthen the UK’s energy independence, helping save taxpayers hundreds of millions of pounds.
This follows significant progress already made towards reaching net zero – with the UK becoming the first major economy to halve emissions. Decarbonising the public sector is expected to save an estimated £650 million per year on average to 2037.
Minister for Energy Efficiency and Green Finance Lord Callanan said: “From school
corridors to the businesses that power up our economy, we want to make sure buildings of all shapes and sizes are supported to deliver net zero.
By allocating over £557 million today, we are standing steadfast behind our public sector and local businesses, providing the help they need to make the switch to cleaner, homegrown energy.
This will not only help cut bills in the long term, but ensure we keep reducing our emissions – having already led the world by halving them since 1990.”
Over 1,000 projects have now received funding since 2020 to upgrade thousands of buildings through the Public Sector Decarbonisation Scheme. New projects receiving funding in this phase include:
• Royal United Hospitals Bath NHS Foundation Trust has been awarded over £21 million to decarbonise 3 buildings by installing new heat pumps alongside other measures including wall, loft and roof insulation, double glazing and LED lighting
• Loughborough University has been awarded over £2 million to decarbonise their Olympic size swimming pool by replacing old gas-fired boilers with more efficient, cleaner heat pumps
• Surrey County Council has been awarded over £5 million to cut emissions across 19 sites including 6 libraries, 4 nursing homes, 2 community centres, Guildford Fire Station, 5 schools and the council’s own headquarters in Reigate
The government has also announced the award of £27.5 million from the Industrial Energy Transformation Fund to support businesses with high energy use to reduce their bills and carbon emissions, with new projects including:
• Pilkington UK will relocate its glass manufacturing line to a single facility in St Helens, helping to reduce their carbon emissions by producing glass from one, upgraded furnace, rather than running two
• Sofidel plans to replace their current natural gas steam boiler with one that can run on green hydrogen at their
Leicester paper mill, helping to transform their energy intensive manufacturing process
• Plastipak UK will upgrade 13 drying systems at their Wrexham plant to help save energy during the production of preforms and containers for food, drink and dairy products
Today’s announcements demonstrate further progress towards the government’s commitment to spend more than £12 billion on energy efficiency by 2028, helping even more organisations and businesses to benefit from cleaner, more secure energy.
Salix Chief Executive Emma Clancy said: “The climate crisis is one of the greatest challenges of our time. It requires all of us, including governments and businesses, to make change and reduce our carbon footprint.
The Public Sector Decarbonisation Scheme enables the public sector to tap into a fund which can transform our public buildings. These are the sites we use every day; our schools, universities, leisure centres and others will become
more energy efficient as well as being comfortable places to use thanks to this funding.
Every day our teams at Salix work with the public sector to achieve ambitious net zero goals and we’re looking forward to working with the latest successful Public Sector Decarbonisation Scheme grant recipients.
Together we will continue to take positive action to address our impact on the climate.”
Royal United Hospitals Bath NHS
Foundation Trust Chief Executive Cara Charles-Barks said: “We are beginning to make great strides to reduce our emissions, through initiatives such as decommissioning our entire nitrous oxide manifold and a sustainable travel plan.
This grant is therefore invaluable. It will enable us to make these essential changes in the coming years and will have a positive impact on the environment and the experience of being in hospital. We know that getting this right will be better for the health and wellbeing of the people we care for, the people we work with and the
people in our community.”
Managing Director of Pilkington UK Neil Syder said: “This project represents one of the single biggest investments we’ve made in our UK manufacturing facilities in decades, and will ultimately secure the future of rolled glass manufacturing in the UK.
Working out of one furnace will enable us to make a permanent and significant saving in CO2 emissions. It’s a radical shift in the way we operate, but we know that if we are to achieve our net zero ambitions, we need to make change across all areas of our business.
The Watson Street site has been operating since the 1800s and forms a key piece of our history. Throughout the years, the site has been instrumental in the development of different products, paving the way for a rich history of innovation in glass solutions.
Yet this move marks a new chapter in our story that allows us to embrace more sustainable ways of making glass and continue to drive forward our vision for change in partnership with the industry.”
NHS DELIVERY AND CONTINUOUS IMPROVEMENT REVIEW
Recommendations: How can improvement-led delivery enhance the quality of outcomes for our patients, communities and our health and care workforce?
The delivery and continuous improvement (DCI) review considered how the NHS, working in partnership through integrated care systems (ICSs), delivers on its current priorities while continuously improving for the longer term. We know that focusing on improvement, as an essential component of quality, enables
us to achieve more consistent, highquality care. The review team explored how we ‘improve with purpose’, using all the assets at our disposal: data and evidence, digital transformation and the skills and experience of our health and care workforce. Having assessed the current approach to delivery-led
improvement both within NHS England and more widely, the review team made 10 recommendations which were endorsed by NHS England’s Executive Group (outlined in this report). NHS England’s Board has now consolidated these recommendations into three actions:
1. Describe a single, shared NHS improvement approach. NHS England will set an expectation that all NHS providers, working in partnership with their integrated care boards, will embed a quality improvement method aligned with the improvement approach to support increased productivity and enable improved health outcomes. This will require a commitment from NHS England itself to work differently, in line with the improvement approach and the new Operating Framework.
2. Co-design with our health and care partners a leadership for improvement programme, commissioned and supported by NHS England, enrolling all providers and systems (including primary care) in it to support a whole-system focus on improving healthcare outcomes with our workforce, patients and communities.
3. Establish a national improvement board, to agree the small number of shared national priorities on which NHS England, with providers and systems, will focus our improvement-led delivery work, with national co-ordination and regional leadership. The new board will support more consistent, high-quality delivery of services to improve performance and reduce unwarranted variation.
BACKGROUND TO THE DCI REVIEW
THE THREE NHS ENGLAND ACTIONS
THE NHS IMPROVEMENT
APPROACH
NHS England will set an expectation that all NHS providers, working in partnership through integrated care systems, will embed aquality improvement method aligned with the NHS improvement approach. This will inform our ways of working across services atevery level of place: primary care networks, local care networks, provider collaboratives and integrated care systems. It will require a commitment from NHS England itself to work differently, in line with the new NHS operating framework.
Context: the evidence for improvement-led delivery
WHAT IS IMPROVEMENT-LED DELIVERY?
Improvement-led delivery involves a whole-system (or whole-organisation) focus on quality, using evidence-based quality improvement methods to increase productivity and deliver better health outcomes for patients and communities. It is underpinned by the use of data and measurement to achieve these outcomes.
WHAT IS THE EVIDENCE?
Improvement-led delivery is a long term approach to delivery that facilitates stronger organisational governance, productivity and positive cultural change over time. Many parts of the NHS have a long tradition of embedding approaches focused on quality improvement:
Appendices: These DCI review’s 10 recommendations were presented to NHS England’s Executive Group in October 2022
PROPOSED TIMELINE FOR IMPLEMENTING THE THREE ACTIONS
*19 April 2023: Publication of this Delivery and Continuous Improvement Review at NHS England’s NHS leadership event with ICB and trust CEOs
DCI REVIEW METHOD AND ENGAGEMENT PROCESS
The review team gathered evidence and insights directly from more than 1,000 people across the health and care system. Participants who have provided their insights and feedback include:
• Lived experience partners through NHS England’s experience of care team
• ICB chief executives and non-executive directors (NEDs)
• Provider chief executives and NEDs
• Clinical leaders and people working at the point of care, such as nurses, GPs, consultants, and pharmacists
• Strategic roles including operational, improvement and transformation specialists
• ALB partners and collaborators, such as AQUA, CSUs and Health Data Research UK
• Networks, think tanks and academics, such as Q community, The King’s Fund, and The Health Foundation.
• National bodies, such as CQC, local government representatives, and NHS Confederation
• Regional groups, such as local health and social care partnerships, and Academic Health Science Networks
• NHS England national and regional teams
Emerging insights were reported to the review’s fortnightly steering group chaired by Sir David Sloman and Anne Eden.
During the course of the review, we provided inputs into several concurrent work programmes, seeking to align our emergent findings where appropriate. These included:
• The operating framework programme
• The Creating the new NHS England change programme
• Finance and productivity board
• NHS England business planning and guidance
The review team did not undertake original quantitative research or analysis. It focused on collating and considering existing research and evidence to inform our recommendations.
While we have set out implementation plans to sit alongside these recommendations, we recognise that:
• our recommendations are closely interdependent with the ongoing NHS England change programme, which will shape how NHS England’soperating framework is realised.
• full implementation of our recommendations across the NHS (and, in time, health and care systems) will require ongoing co-designbetween national and regional teams with leaders in systems and providers as well as wider partners, using a collaborative approach centred on learning.
LOCAL GOvERNMENT
T HE C OMMERCIALISATION CHALLENGE
The one thing we can guarantee from the forthcoming spending review is that things will get tougher for local government. We will simply have less money, but still have lots to do. Resolving that dilemma is the challenge for the rest of this decade, says Joe Simpson.
We have five possible strategies to address the problem. One is to raise more taxes. What we know is that there is no public appetite for this. The most recent illustration of this was the referendum in Bedfordshire seeking public support for a higher police precept. Police are one of the more popular (and visible) public services but the vote against was clear.
A second option would be to reduce service provision, but as we see more economic recovery that strategy too will find little public support. Our third option is greater efficiency. We should always be vigilant and seek further efficiencies, but the low hanging fruit has already been collected. There may still be some big opportunities (could digital rework our basic services?) but it is unlikely that the scale of efficiency changes saving can be sustained to match the saving targets we need.
So if the first three options cannot deliver the solution we need to focus on the remaining two. First is behaviour changeso that the call on our services is reduced. To give an example, if weight levels returned to their 1992 average there would be one million fewer people with type 2 diabetes. Achieving that change would save money and make people healthier. Indeed there are five million people at risk of getting type 2 diabetes, so addressing this is critical. So a real focus on behaviour change/early intervention makes sense. The problem is, however, that the savings achieved are in the future. Indeed, we may even have higher short term costs as we twin track sustaining existing provision whilst also funding the strategies to deliver the behaviour change.
My fifth strategy is, therefore, to deliver services which people or organisations are prepared to pay for. Some might say this would go against the very ethos of local government. Whenever people hark back to a golden age of local government, they always reference Joe Chamberlain. But the gas and water he provided for Birmingham were not free goods.
In his book Joseph Chamberlain: Entrepreneur in Politics, Peter T Marsh writes “his main object was not municipal takeover of the local gas supply so much as a large increase in the town’s financial base for further civic undertakings...he assured (the council) ...that municipal consolidation of the gas companies would yield the town an annual profit of at least £15,000 rising to £50,000 within fourteen years- a provision which proved to be a great underestimate”.
Such enterprise was not restricted to Birmingham. As Barry Quirk, chief executive of Lewisham likes to remind us, in the 19th century the public baths of inner London all ran at a profit, (something city treasurers of today can only dream of when they consider the running costs of swimming pools). Into the 20th century we have the example of Hull and its phone company. Today consider the success of Manchester Airport, owned by its local authorities. The company now also runs Stansted Airport.
Commercialisation therefore is not a “new” idea but part of local government’s DNA. But this is not about replacing the private sector. It is about looking at opportunities where either the private sector finds
it difficult to operate, or where public investment delivers benefits both to the public and private sectors. Chamberlain’s investments in utilities delivered benefits not just to Birmingham’s citizens, but also to Birmingham’s businesses. The “city of a thousand trades” needed effective utilities.
The question we need to ask is, what sort of commercial challenges should 21st century local government consider? The whole devolution debate has been framed around questions of economic growth, schemes involving “earn back” and the like.
Commercialisation is more than effective procurement, or tough negotiation, but it does require commercial rigour. Not every place can become a world leader, so we must recognise what commercial strengths we might have. Secondly, like every old skill we have sort of forgotten, or which have become rusty, on day one we do not attempt the most difficult manoeuvre. So let’s start by being more commercial amongst ourselves, building on the practice of different authorities which already have developed expertise in certain areas and have traded that expertise. Finally, let’s share the learning and let’s do it quickly. Seize the opportunity to embrace commercialisation and then we have a chance to shape our own destiny.
Joe Simpson is Director of The Leadership Centre
Joe Simpson
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Life Safety f ire r i S k aSS e SS ment
(SP205)-BAFE Scheme for
Everyone responsible for a building, whether in the public or private sector, must be aware of the importance of adequate fire protection for their customers, staff and property.
The legislation (Regulatory Reform (Fire Safety) Order and Fire (Scotland) Act 2005) requires that the ‘responsible person’ or ‘duty holder’ for a building carries out an adequate fire risk assessment and follows the requirements in providing fire protection. There is a wide range of standards and guidance documents available, which can be complicated and therefore there is often a need in all but the smallest buildings to gain expert help.
Whilst for some premises it is perfectly possible for the responsible person (duty holder in Scottish legislation) to carry out the fire risk assessment, for larger or more complicated premises, it may be necessary to call in an expert.
In the public sector this is even more important to ensure that safety is seen as a professional priority and that every aspect of their duty of care has been considered.
There are a number of professional accreditation bodies which offer lists of assessors, but nowhere to find independently certificated companies that meet nationally accepted standards. A number of major facilities management companies who offer services to public bodies, now recognise that they need to have independent certification of the quality of their work.
BAFE, the independent quality approvals body for the fire protection industry, has a scheme for companies who provide Life Safety Fire Risk Assessment (SP205),
Fire Protection
which has been accredited by UKAS and is delivered by a number of licensed certification bodies. This scheme was launched in May 2012 and organisations are now being certificated across the UK.
BAFE (based at the Fire Service College at Moreton in Marsh, Gloucestershire) is the independent registration body for companies that have achieved third party quality certification of their fire protection services. Users and specifiers currently gain the reassurance that over 1250 BAFE registered providers of fire alarms, portable extinguishers, and emergency lighting meet UK standards and are regularly audited.
The Government publishes guidelines for fire protection in a range of premises which state:
‘Third party certification schemes for fire protection products and related services are an effective means of providing the fullest possible assurances, offering a level of quality, reliability and safety that noncertificated products may lack. This does not mean goods and services that are not third-party approved are less reliable, but there is no obvious way in which this can be demonstrated.’
Many public bodies and commercial organisations now specify the requirement for their fire protection service providers to be third party certificated. There are a growing number of tenders now stating this as part of the pre qualification criteria. This is not a question of recommending one company over another, as there is now such a wide range of companies available who are certificated, but a matter of refining choices for end users.
What does BAFE scheme SP205 offer to specifiers and building owners/managers?
Under the legal provisions that apply in the UK, the duty holder or responsible person for a building is required to make a fire risk assessment to clarify the fire precautions necessary to ensure the safety of staff, service users and property. BAFE scheme SP205 will identify organisations that have been independently certificated to deliver this service.
For more information go to the BAFE website www.bafe.org.uk
Key points of BAFE scheme SP205
• This scheme has been developed by a group of industry experts to help the building ‘responsible person’ meet the requirements for Fire Risk assessments under the Regulatory Reform(Fire Safety) Order 2005 and Fire (Scotland) Act 2005
• SP205 specifies that companies must have the required technical and quality management capabilities.
• Risk assessment staff need to meet appropriate standards.
• The scheme has been designed to meet the requirements of companies large and small, recognising that there are many individuals working as assessors.
• BAFE has been working closely with the Competency Council which was independently set up to monitor and develop Risk Assessor competence criteria.
• SP205 is delivered by UKAS accredited certification bodies.
DON’T GAMBLE WITH YOUR FIRE RISK ASSESSMENT!
If you are responsible for a business premises, the law requires that you have a fire risk assessment.
To find competent providers, you need BAFE.
Under the provisions of the Regulatory Reform (Fire Safety) Order 2005, the Duty Holder or Responsible Person for a building is required to make a Fire Risk Assessment to clarify the fire precautions necessary to ensure the safety of staff, customers and property.
At present there are no adequate means to ensure the competence and reliability of a company commissioned to carry this out.
BAFE scheme ‘Life Safety Fire Risk Assessment SP205’ has been developed specifically to address this situation, and will provide reassurance to the Responsible Person that they are doing everything possible to meet their obligations.
Don’t leave everything to chance. Make sure that your suppliers are registered with BAFE.
EFFICIENCIES 20 EFFICIENCIES
HOW TO MEET SAvINGS TARGETS WITHOuT SCRAPPING FRONTLINE SERvICES
spending cuts across the public sector
needn’t be at the cost of quality or service
Public sector workers have been under immense financial pressure to find savings for a number of years now and still the challenge increases with the current government now looking for further 40% cutbacks, whilst the demand for goods and services continues to grow , says Nigel Scorey.
Traditionally, the top-down approach would have been to make the necessary budget cuts, then apply pressure on managers to find further slashing of the quality or quantity of services to meet targets. The prevalent attitude amongst beleaguered managers has therefore not surprisingly been to try and protect services and quality and defend requirements in their area, hoping other services will take the hit, rather than embracing change and working collaboratively to find solutions that reduce cost whilst maintaining service standards.
The public sector’s receptiveness to the value and advantages of professional procurement has been mixed as the process is understandably seen as cumbersome and often the buyers are seen as at odds with the needs of frontline staff. However with the pressure increasing, more and more public sector professionals are embracing more forward thinking procurement solutions, transferring lessons and tactics gleaned from the corporate world into the public sector. This is by no means a revolutionary idea, but with a change in attitude from
both the user and the buyer communities, the benefits associated with this approach are being firmly recognised.
Long before government accepted the need to look at cost cutting measures, big business had been ravaged by recession. The private sector learned early on not to cut back on the customer experience- at the risk of losing custom and the business itself. Instead it forced managers to work across functions and with procurement to find solutions that were fit for purpose, whilst enhancing the consumer experience of the brand. Local government needs to take heed from grassroots level up. Spending cuts across the public sector needn’t be at the cost of quality or service. Quality frontline services can be delivered within available resources through a simple review of a spend area’s direct impact on the consumer versus the savings achievable through an aligned procurement strategy. The programme then starts with low impact / high savings areas, quickly proving the model. Savings are delivered through a fit for purpose collaborative approach, consolidating the huge range of suppliers and specification in use, without comprising the public services that affect millions of local people.
Now is the time for widespread change to embrace a new way of resolving cuts. It has to start with changes in attitude from a defensive and protective approach to one that embraces the need for collaboration and new ways of working. Then changes
Nigel Scorey
in the approach to procurement from a process and criteria-led doctrine to one that is consumer needs-led. Finally, managers have to embrace changes to supplier and specification that sees one fit for purpose solution utilised across functions and user communities from the multitude in use within one organisation today. In short, embracing change to develop strategic improvements that will help reduce costs and improve social value.
Embracing change on this scale is tough for any organisation. Public sector managers can benefit greatly from combining their insight into their areas with hands-on procurement professionals operationally experienced in delivering such programmes on both sides of the public and private fence. Providing a 360 overview to help overcome the inevitable challenges of defensiveness and protecting services, whilst ensuring that procurement teams are seen as understanding the needs of the consumer and what genuinely constitutes fit for
purpose. Ultimately developing and delivering a truly collaborative approach to ‘change management’.
Procure4 is one of a number of small businesses that provides such professionals in both local government and the NHS. It was engaged by Solihull Metropolitan Borough Council a number of years ago to achieve cashable savings which would help with investment in a new shared services infrastructure. The Council knew it had to gain control of spending and reduce the high number of low value transactions. Procure4 analysed the spend data and current processes across a number of categories, prioritising temporary labour, telecoms, strategic highways, print, office supplies, property services, adaptation works, books and ICT as the place to start a major programme of change. Approach strategies were established for each category, including use of eProcurement tools and traditional tender. A fully auditable savings process was implemented and enabled clear
benefits tracking within the Council.
In year one, more than £1m collectable savings with significant other cashable and non-cashable efficiency gains were delivered. In the second year, a further £1m was delivered. The tangible savings enabled budgets to be re-assessed and freed up resources for use on back office systems which then supported frontline services. More importantly, through broader training and skills transfer, a refreshed attitude to change management was established which ensured that the Council could move forward independently to tackle larger and more challenging areas of budget cuts with confidence and a truly collaborative, cross functional approach.
The public sector is dealing with huge spending cuts and unwavering demand for services. Swift change is hard to come by, but change is taking place in some areas of local government where forward thinking CEOs embrace learning from other sectors and new models of service delivery are developed to address financial pressures. As the Solihull Metropolitan Borough Council contact demonstrates, through embracing change on a number of levels, local government can adopt a truly collaborative and proactive approach to reducing budgets, utilising simple procurement techniques to ensure the quality of frontline services and the consumer experience remain the priority of public service provision.
In recent years, Procure4 has taken learning from blue chip business to public sector organisations as diverse as Suffolk Council and South Staffordshire NHS, helping under pressure managers to comfortably meet budget constraints across multiple categories.
Nigel Scorey is CEO of Procure4 www.procure4.com
HOW TO CuT YOuR POSTAGE COSTS
Communication is vital to government organisations but the estimated cost to the public
sector is around £1.10 to send
a letter, printed and delivered. One smart and efficient solution is helping to bridge the gap
With public sector spending now firmly in the spotlight, the pressure for public services and healthcare providers to deliver more for less is greater than ever. Public sector managers must try to balance budgets and increase efficiency without affecting services or patient care.
Docmail is used by over 20,000 organisations across the UK as a vital communication tool and has printed and delivered over 68 million letters since its launch in 2008. Of these, a third have been sent by healthcare, local government and education institutions, including GP surgeries, schools and local councils, representing a collective saving of around £8 million on the cost of traditional print and mailing.
Docmail’s hybrid mail solution allows users to benefit from savings in administrative time and postage costs. Faster, more costeffective and secure, Docmail relieves the labour intensive task of a manual postal mailing, especially at peak times - all for just 39p per letter.
Through the secure online portal, Docmail users create personalised letters, print and deliver a high quality communication piece securely to all, or a selection of their database.
Martin’s Oak Surgery, a small practice in East Sussex, has been using Docmail for four years. Practice Manager Carey Sinclair says the difference it’s made to their practice is significant:
“We have saved weeks in staff time and hundreds of pounds using Docmail for large runs – it’s more efficient than the more traditional method. Our flu campaign alone saves us over £800. By using EMIS Web searches, we save even more. We believe that other medical practices should benefit from it, too.”
From appointment letters and clinic campaigns to result reminders, invitations for QOF indicators and invoicing, the capabilities of the innovative Docmail system offer limitless options for healthcare and medical organisations. In recognition of its benefits, CFH Docmail recently secured a new agreement with GP Systems of Choice as part of its Lot 2 Additional GP IT Services Framework, which include the Docmail hybrid mail solution.
As part of its ongoing strategy to develop innovative mail delivery mechanics which save their customers time and money as well as well as reducing the impact on the environment, CFH Docmail has recently launched Dotpost, an innovative online document delivery solution.
Dotpost is a secure online platform that allows users to store documents easily – and free of charge. Recipients simply register using a unique invitation code and they can view, save and print the documents they need on any device (PC, smartphone or tablet).
Dotpost reduces the amount of paper used
and slashes postage costs. Free Dotpost accounts can be offered to all citizens so they can benefit from free storage and delivery of documents from all public sector departments.
Dotpost was used recently by Ian Brown, Head of Revenue and Benefits at Wiltshire Council.
“The Dotpost system is slick and easy to use, and we are hopeful that this will lead to a reduction in our usual postage and stationery bill. The Dotpost system helps us to access customers in a more personal way and to take a step towards our ambition of a much more efficient communications system. It has also allowed us to manage our database more effectively, and meet customer’s expectations, in terms of electronic delivery.”
CFH Docmail Managing Director Dave Broadway believes the Dotpost solution is an ideal way to deliver documents securely in the digital age.
“Mass mailing is an expensive task and email is wholly unreliable. We believe that this way of sending letters and reports – is a great alternative to print and post, and of course much easier for citizens if they can store and view all paperwork in one secure portal.”
www.docmail.co.uk
t he Demoni S ation of the Private Provi D er
David Pearce looks at the commissioning of musculoskeletal physiotherapy and its outstanding improvement on patient care
After 18 months and thousands of amendments, the Health and Social Care Bill was passed in Parliament in March 2012. The writing was on the wall for NHS Providers and staff to either embrace the changes or disappear. In East Kent, GPs, Commissioners and Independent Providers embraced the changes and became the pathfinders for the development of GP-Commission-led services, delivered to Key Performance Indicators which would provide value for money, and safe and efficient, high-quality physical therapy services.
Working as the superintendent physiotherapist for the Canterbury and Coastal area gave insight into a failing NHS physiotherapy service. New to Follow Up ratios were climbing, Did Not Attend rates were as high as 20% and waiting times even reached a maximum of 53 weeks for routine, chronic conditions.
In partnership with local GPs and Practice Based Commissioners, EKTRA was established in 2007 with the prime objective of tackling the deplorable problems in East Kent NHS Physiotherapy services. An independent, contracted service was commissioned by the NHS and produced a truly efficient and seamless service for its patients. The independent management of patient referrals allowed for patient choice and expansion of service availability, delivered by a plurality of providers.
Where patients were previously being funnelled into secondary and primary care physio centres and hitting bottle necks of high waiting times, they are now allowed to choose to have their physio in their GP surgery near home or their workplace or
even in one of EKTRA’s six private clinics. NHS patients can now experience the quality, integrity and care of real private healthcare, without the worry of having to find the funds to pay. This is what is commonly referred to in the media as privatisation of the NHS.
With this phrase, media outlets and politicians have incited a belief and scared off the public, reminding them of past problems experienced from privatisation of the public sector and grossly expensive Private Finance Initiatives. Ultimately, they have demonised the private companies as fat cats creaming off the profits.
Sadly, we’re not shown the full picture. Providing a contract for companies like EKTRA is similar to finding a decorator to rejuvenate your house. You tell them what you want, they do what you want. You don’t worry about when you’re going to decorate, the materials you will need, the planning and execution of the process. This method is tried and tested in all walks of life, yet we seem more reluctant implementing this in our health service.
This aspect of NHS service is not being privatised. There is no selling off or ownership of the NHS. EKTRA and other providers must provide the service to agreed NHS standards or will fail and disappear quickly. The contracts are zerobased in value. They cost nothing to the NHS when not providing treatments or for failed appointments, down time or peaks and troughs in demand. This ultimately results in highly efficient, cost effective and VFM patient care. The private sector is only providing what the NHS failed to do and has not been able to provide within its
capacity. Therefore, demand has grossly exceeded supply!
Over 8 years of experience, EKTRA has seen its physical therapy services bring DNA rates down to 4.98% and the NFU ratio to 1 : 3.35. Waiting times are massively reduced with appointments booked within one week and urgent cases within 48 hours. This is a startling improvement on the historical average NHS wait of 12+ weeks. Numbers and statistics have become a very important element of controlling overstretched and under resourced services. However, patient care is paramount as each single patient referral is the most important asset to EKTRA, a growing healthcare company.
The local CCGs benefit from our services as it reduces their financial burden by decreasing secondary care referrals and prescribing and administrative costs. The service provides real-time records with flawless communication between GP/ physiotherapist and the patient. Both GPs and physiotherapists have a sense of ownership and control over the service. Equally, physiotherapists are empowered and supported to work autonomously with flexible working patterns, according to demand.
If you want to provide a first class community-based service that could be recommended to your friends and family then this is the business model to follow. It works.
David Pearce is Principal Physiotherapist and Company Director, EKTRA Ltd.
www.ektralimited.com
COMMENT
WHY ARE SI x TH FORM COLLEGES BEING C u T?
WHY ARE SIXTH FORM COLLEGES BEING CUT?
Sixth form colleges are almost universally acclaimed as a success story in British education. They have outperformed other schools and have a proud record in giving adults a second chance to improve their skills and qualifications. Yet a recent report from the Sixth Form College Association (SFCA) shows that six years of cuts in 16-19 education funding is having a devastating impact on the sector and the choices available to students, says Ben Thomas.
Sixth form colleges are almost universally acclaimed as a success story in British education. They have outperformed other schools and have a proud record in giving adults a second chance to improve their skills and qualifications.
Ben
Thomas
Yet a recent report from the Sixth Form College Association (SFCA) shows that six years of cuts in 16-19 education funding is having a devastating impact on the sector and the choices available to students.
Most colleges were established in the 1960s when a group of progressive Local Education Authorities established a more rational and efficient approach to delivering post-16 education. By size efficiencies they were able to increase the number of courses available, provide specialist teaching at both A level and in vocational training, offer better extra-curricular activities and provide a vital bridge between school and university education.
efficient and effective education, why are they being starved of funding?
Most colleges were established in the 1960s when a group of progressive Local Education Authorities established a more rational and efficient approach to delivering post-16 education. By size efficiencies they were able to increase the number of courses available, provide specialist teaching at both A level and in vocational training, offer better extra-curricular activities and provide a vital bridge between school and university education.
The sector has seen funding cuts across England of 33% since 2011, and the SFCA report found that:
The sector has seen funding cuts across England of 33% since 2011, and the SFCA report found that:
•70% of college leaders do not believe that the amount of funding they are likely to receive in 2016 will be enough provide a high-quality education
•70% of college leaders do not believe that the amount of funding they are likely to receive in 2016 will be enough provide a high-quality education
•72% of colleges have dropped courses as a result of cuts since 2011
•72% of colleges have dropped courses as a result of cuts since 2011
colleges provide such an efficient and effective education, why are they being starved of funding?
Most believe it is simply a question of fashion. Because sixth form colleges are not new and the government is so intent on demonstrating the success of the academy and free school programme, they are blind to their success and unwilling to divert any resources away from their pet projects.
Most believe it is simply a question of fashion. Because sixth form colleges are not new and the government is so intent on demonstrating the success of the academy and free school programme, they are blind to their success and unwilling to divert any resources away from their pet projects.
It has also been suggested that the experience of sixth form and further education colleges in general is so divorced from the typical ministerial background of private school and university that they simply do not understand the value and benefit that they provide for those from more disadvantaged backgrounds.
It has also been suggested that the experience of sixth form and further education colleges in general is so divorced from the typical ministerial background of private school and university that they simply do not understand the value and benefit that they provide for those from more disadvantaged backgrounds.
As sixth form colleges are being squeezed, the choices available to students in many areas are being restricted and inefficiency is increased.
As sixth form colleges are being squeezed, the choices available to students in many areas are being restricted and inefficiency is increased.
Further cuts will make it unsustainable. Colleges are already reducing vocational courses and the extra-curricular and enrichment activities that have made them special. The number of colleges in England has already reduced from over 110 to 93. Many are considering converting to academy status to benefit from more favourable VAT treatment, but this will reduce their academic freedom and ability to innovate.
Further cuts will make it unsustainable. Colleges are already reducing vocational courses and the extra-curricular and enrichment activities that have made them special. The number of colleges in England has already reduced from over 110 to 93. Many are considering converting to academy status to benefit from more favourable VAT treatment, but this will reduce their academic freedom and ability to innovate.
•76% of colleges have reduced or removed extracurricular activities for students
•76% of colleges have reduced or removed extracurricular activities for students
•81% of colleges are now teaching students in larger class sizes because of funding cuts
•81% of colleges are now teaching students in larger class sizes because of funding cuts
These cuts, along with a discriminatory funding system are placing the very future of the sector at risk. Many of the cuts have been in modern languages, science and maths - subjects ministers are purporting to encourage.
These cuts, along with a discriminatory funding system are placing the very future of the sector at risk. Many of the cuts have been in modern languages, science and maths - subjects ministers are purporting to encourage.
The unanswered question remains, if the government is committed to a compulsory education till eighteen and sixth form
The unanswered question remains, if the government is committed to a compulsory education till eighteen and sixth form colleges provide such an
Or is it simply that sixth form colleges hark back to the days of planned provision by the hated Local Education Authority and progressive educational ideas of the 1960s?
Or is it simply that sixth form colleges hark back to the days of planned provision by the hated Local Education Authority and progressive educational ideas of the 1960s?
Whatever the answer, the dogmatic insistence that academisation is the only solution for improving educational outcomes,increasing student choice and eliminating the skills and productivity gap is actually making these problems worse in the post 16 sector.
Whatever the answer, the dogmatic insistence that academisation is the only solution for improving educational outcomes,increasing student choice and eliminating the skills and productivity gap is actually making these problems worse in the post 16 sector.
The unplanned growth in academy sixth forms is having a perverse outcome in that it is actually reducing subject choice and learning opportunities.
The unplanned growth in academy sixth forms is having a perverse outcome in that it is actually reducing subject choice and learning opportunities.
The government needs to re-think its approach to post 16 education if it wants to avoid a crisis in provision. It is no longer sustainable to protect schools budgets at all costs and at the expense of the post 16 sector. Sixth form colleges are an education success story that we cannot afford to lose.
The government needs to re-think its approach to post 16 education if it wants to avoid a crisis in provision. It is no longer sustainable to protect schools budgets at all costs and at the expense of the post 16 sector. Sixth form colleges are an education success story that we cannot afford to lose.
The government needs to rethink its approach to post 16 education if it wants to avoid a crisis in provision
