Transparency or accountability ?

Politicians piously profess transparency and open government. But that is a qualitative  attitude not an act. It too often means only  access to lifeless and historical mass data. It has no primary operational point, only secondary  availability for academic research or statistical  purpose.

Accountability on the other hand, which is professed  but not practiced by government, is an act of discharge or formal process for  a purpose. It is to support with evidence and organised data the formation of policy and operational decision. That embraces the total management control system and also democratic discharge and renewal. At root is the transaction which once executed is not informative in isolation.

Often the word accountable is left meaningless and in the air as in 'making councillors accountable". But for what, to whom, and how ?

The total system concept means for a functioning enterprise the nervous system exactly as it is in the human frame: alive and dynamic with constant feedback and reaction. All organisations to a greater or lesser degree operate such a total system. The corner shop version functions considerably in the mind of the proprietor. As enterprises grow larger they must give greater attention to the design drawing and flow chart etc governing people (and machine) inter-action. The stated objective(s) of the enterprise will determine  the system  but there are timeless disciplines and techniques with many reflected in legislation.

Government(s) tend to be the only organisations that have not grown into that concept largely because of the ‘Ponzi’  or Bernie Madoff mentality in the face of supposed electoral pressures, and failure to link performance and stewardship reporting to electoral proposal. The worst recent case of government failure to do ‘proper accounts’ was that of Greece in 2009 but with UK not so far behind and the European Court of Auditors refusal to pass the accounts now for 19 years with no assurance likely in the future because of the basic defect. UK government's view of its own operations is officially said to be obscured

One must remove from one’s mind the artificial separation between numbers and words. Paradoxically in government “financial statements” are for other people. But quite simply there is the human aspiration and ‘people’ and material resource inextricably linked to the monetary resource. The recording and reporting essentials are very simple: money being a conveniently universal unit of measurement a finite amount is required to do what has to be done and stakeholders need to know the outcome; the exception is the laying out of funds (investment) and the anticipatory borrowing of money ahead of events with the score being kept for that. Contrary to what many people realise there are additional disclosure requirements such as for pay level scaling.

The Annual Report is the customary vehicle (except in government) for telling we interested parties what has been the performance, reasoning and outlook and then seeking a vote of approval plus renewed or changed authority to proceed ‘in office’. 

As regards disciplines and techniques there are a number of professional bodies. Accounting is represented principally by the ICAEW (Institute of Chartered Accountants in England and Wales; the Scottish Institute is separate !), CIMA (Chartered Institute of Management accountants) and CIPFA (Chartered Institute of public Finance and Accountancy). Some years ago there was an attempt (unsuccessful) at a merger. CIMA is least noticed in government and the Treasury ‘majority party’ are economists. The ICAEW has identified the lack of a CFO(Chief Financial Officer) at the cabinet table.

It is worth mentioning alongside the above 'philosophical' analysis that there are probably two causes of the many major project failures, Not only has there been a lack of project management skill in the manderinate but also an experience-lacking inability to think clinically and expressively about objectives and requirements sufficient for translation into IT system specifications.

Who will mend UK governance ?

DYSFUNCTIONAL UK GOVERNMENT: CONSPIRACY OR COCK-UP ? DOES IT CARE?

Chancellor George Osborne in November 2013 says in talking up the recovery prospects that “the biggest risk…….was to give into popular policies that would damage domestic businesses and the UK’s economic competitiveness”. Quite right, but not with continued  populist political short-termism trumping sound professional management for the longer term.

1 Conspiracy ?: why has government not observed the purposes, norms, concepts, principles and standards of accountability practice ? Three ‘authorities’ asked have not denied that this as a ‘secret’ Machiavellian tenet of political science ie that the masses should be kept in the dark as much as possible. Until proven otherwise professed “transparency”, being  passive,  is a lie. And, “Government’s view of its own operations remains clouded” Efficiency and Reform Board member with cost and management accounting in mind.

2 Cock-up ?: BIG-time - By 2010 the UK public sector debt had risen in two years from £580bn to £820bn (+ 40%) and is “now” (31/3/12) £1,190bn ( +another 45%) and still rising. And big-time -  repeated operational failures such as during the implementation of the universal credit welfare reform.

3 The European context first: Euro-stress ?: One only needs to read The Lost Continent by Gavin Hewitt to realise how government negligence cripples the eurozone arrangements with dire consequences for peoples. See below.

4 In the UK we now have clear evidence: The Treasury has allowed governing politicians to work on the basis that future taxation is  certain and therefore to be disregarded.  See below.  The consequence – behaviour  for which Bernie Madoff is in prison -  now dangerously goes on to assume certainty of debt finance. Such negligence grows ‘character weakness’ on top of debt: in resource management, lax banking, inefficient processes, and so on. In populist terms emotive “cuts” submerge the language of governance.

5 These conclusions, which naturally follow HAS GOVERNMENT A BRAIN ? and WHO WILL MEND UK GOVERNMENT ? follow sight of the transcript of the Public Accounts Committee meeting with Treasury mandarins and others on 21^st October to receive answers to questions on the Whole of Government Accounts 2011-12 (WGAs). Some utterances by Sir Nicholas Macpherson, Permanent Secretary, are:

“For many years, members of this Committee have criticised, first the accumulation of public pension liabilities and, secondly, the accumulation of PFI debt. The benefit of WGAs is that those liabilities are squarely on our balance sheets.”  “The WGA is helping to inform the treasury’s approach (traditionally “national accounts” – basically revenue and spending - statistical) to the public finances and is a response to Parliament’s, in my view, wholly legitimate concern that a whole lot of activities were off balance sheet.”

Two sets of accounts… “The reality is that national accounts are an economist’s concept and the Whole of Government Accounts are an  accountant’s view of the world. Both are right in their own terms. Why does the Chancellor primarily focus on the national accounts when he stands up and delivers his annual Budget ? Mainly because all the big international institutions – the IMF, OECD and so on – are run by economists rather than accountants, …” WGAs ….focus on long-term liabilities…” “what accountants don’t take into account is the fact that the state has power to tax its citizens, so we don’t discount future revenue flows to set against the very big pension liabilities”.

6 There are also some 20 major topics from the WGA questioned for answer by the attending civil servants. It is striking  that without proper accounts there would be no PAC questions. Yet the newness of and approach to WGA is incredible if one realises that they are meant to be exactly the same in consolidated format and purpose as has been the norm in corporate life for generations. It is  striking too that the PAC, by default, is exercising the role and responsibility which elsewhere would be that of management in a way Parliament is not capable of. And surely the PAC is duplicating an auditor’s role ? There is also the further implication,  never mentioned, that consolidation of the whole defines the subsidiary role of all public activities – which rather spoils all the heated political ‘localism’ and ‘centralism’ arguments which are so unproductively wasteful of energy.

7 The role of debt finance is growing alongside that of taxation to fund increasingly interventionist electorate-pleasing programmes. With that comes the need to refinance old debt and service the total.  Excessive reliance on debt finance has undermined democracy, with government finance increasingly determined by repayment schedules  rather than electoral cycles. Creditors are not concerned with how money is spent, only debt security. This lies at the heart of the euro crisis of coherence and violent antipathy of Greek, and Spanish populations towards the arguably better managed Germans. It has  actually caused such depression and punishing austerity but so far without popular admission that the fault is  domestic. Treaty-based debt ceilings (expressed relative to GDP) are toothless.

8 Extracted from Gavin Hewitt’s The lost Continent pp55-68 et seq.

“During the Greek election campaign in 2009 the socialist candidate, George Papandreou tried to unearth the true state of the economy. He didn’t start to find out until later. On the day before polling the outgoing government sent an official document to the European Commission which lied about the deficit..”It was not keeping proper accounts”.

It emerged that pension funds had no money to pay the October pensions. State hospitals had not been paying their bills (e6bn). “Paying tax was almost a lifestyle choice”. “Bogus welfare claims on fake medical certificates. “millions of euros were wasted on retirement payments to long-dead pensioners”. And much more…

In 2010 Andreas Georgiou returned from the IMF to run the National Statistical Institute: “records were adjusted to suit the demands of politicians”. He found no documentation for hundreds of entities that were already classified as part of general government. “ Very importantly, a number of state-controlled bodies, like the Greek National tourism organisation and national and radio and television network were not included on the books of the government as they should have been”. A major enterprise also left out was the Hellenic Railways, which was experiencing heavy losses. NOW READ THE Comptroller & Auditor general’s qualifications of the UK Whole of Government Accounts ! And in the context of ONS statistics versus WGAs…… read  Network Rail for Hellenic Railways !

9 Growing debt burdens drifted into with the associated recessions, a vicious circle,  have provided the huge jolt required.  Political leaders realise the dreadful truth when saying things about long term austerity. But where is the reform of governance ? The solutions are to hand if not definable in political language. With political short-termism having democratic benefits there can still be transformation. As an aside at PAC Q89 chair Margaret Hodge said:” “I think the Committee would always stand behind the treasury if it was tougher, as we always say, as a Finance Ministry, rather than just dishing out the money”.

10 Why must we The People be governed by people always eager to legislate, regulate and obfuscate, but not to lead by example ? Please may we now have BETTER GOVERNMENT ‘moving on’ from the military and imperial, to the professional ? Perhaps Her Majesty could ‘have a word’.

WHO WILL MEND UK GOVERNMENT ? (2)

GOVERNMENT ACCOUNTING   

Imagine: May 2013 LOCAL ELECTION RESULTS TO BE PUBLISHED ON 2^nd March 2015

That is the time it takes to produce the UK Whole of Government Accounts (WGAs) !

These, now in to their second year, are “a giant leap forward when compared with what was there before” and are “in the forefront internationally”. The Chief Executive of CIPFA commenting on the appalling PAC report (The redoubtable Margaret Hodge’s Public Accounts Committee) is being kind to the Treasury. WGA failed to get a mention in the budget 2013 documentation. Conventional consolidated accounts have been the norm in groups of companies since  time began. Yet the same Treasury defensively claims academic interest rather than operational integration, the true purpose.

The facts portrayed should be integral to the decision-action-feedback-decision loop which elsewhere is moving feedback inexorably in to real-time. As well as the discharge of accountability for performance their timeliness and quality is of the essence as data input to decisions for the future. For its forecasts and evaluations the OBR(Office of Budget Responsibility) depends on factual input for course correction. It was kept waiting 18 months for draft-only accounts. 4 months later still the Auditor General qualified his report. Normally the quality of forecasts depends on the analysis of variations between the  forecast to be updated and rolled forward, and ‘actuals’ fed back. ‘Actuals’ mean as just now, not in the dim and distant past since when much has changed.

It is not generally realised that there is a fundamental flaw at the heart of government management accounting and reporting. We have publicly protested at Brussels-led spending  whose accounts have still after 18 years not satisfied the court of Auditors. On 10^th November 2008 Matthew Elliott for the TaxPayers Alliance joined 8 of his European counterparts in signing a published letter protesting at inaccurate and audit-failed EU Accounts over 14 years (now 18). On the day following, MEP Ashley Mote’s answering letter explained that satisfactory assurance would never be attained because of “the concept of “shared management” which leaves accountability in the hands of recipients of public funds”. This immediately suggested to the undersigned that the UK hadn’t even started on its 14 year audit failure because, put another way,  ‘governments vote funds and then walk away’. Correspondence with the Comptroller and Auditor General (NAO) confirmed this and general fears about national government financial disciplines. While good intentions and improvements were stated in reply there unexpectedly came the news that it was intended for the first time to produce Whole of Government Accounts(WGAs), followed by budgets (WGBs). Called for by Parliament in 1995 the WGAs did not arrive, incredibly, until those for 2009-10 15 years later, and then only after 22 months delay in publication.   WGBs never materialised !

It has been suggested that other countries are more advanced. That seems to mean having, but not getting beyond, such as multiple area income taxes instead of simply just one. For the UK local funding theory destroys the link between local tax and local policy spending because muddled with equalisation (redistribution through grants), confiscation and precept.  

“Walking away” sets the tone for tax and spend.  Down in local government taxpayers are disregarded and disenfranchised. Nationally it is relied on that something will turn up in the form of increased economic activity. GDP at all costs is the cry notwithstanding that that includes non-productive government activity, the black economy, even crime. The cumulative circulation of money is spoken of as an unmitigated good even to the point of destruction of it’s exchange value. It all adds up to a net accumulated deficit of £1.1tn and rising currently by more than £120bn each year. Oh, look everybody. Where did that  come from ? It came from not keeping the score properly and because grandiose politics negligently trumps thrifty forward planning and sound management.

Care is required on urgently necessary decentralisation which is currently only talked about ad nauseam in such as the H o C Constitution Committee  or the debt and deficit  will become even more threatening and unmanageable. In 2005 Sir Michael Lyons was given, face to face,  a scheme for local government funding which provided for both macro control and decentralisation. It was disregarded. As to “shared management”  MPs (The Business, Innovation and Skills Committee) criticise the government’s “hands-off” approach to monitoring the performance of LEPs (Lord Heseltine’s local Enterprise Partnerships) “despite the fact that they are being given taxpayers’ money and are responsible for key areas such as local infrastructure, planning and job creation”

Surely the archaically titled Treasury should BE the OBR;  its OTS (Office of Tax simplification) should BE integral and deploy rather more than the present 6 people; should SET THE STANDARD and BE THE EXAMPLE for the discharge of accountability and management reporting at all levels; should SET THE STANDARD for government managerial infrastructure and deployment: only now are senior Civil Servants receiving training in project management; it is 50 years out of date. Why are Ministers powerless in the face of the Manderinate ? Why is the Cabinet Office, with eg its component the Major Projects Authority,  uneasily trying to fill the vacuum ? Is it not understood from experience-based thought experiment what domestic government is supposed to be about ? It is not now about fighting and paying for wars, or running an empire (with a few District Commissioners), but professionally managing its own responsibilities in the domestic sphere where an increasingly interventionist stance requires modern industrial systems and attititudes to cope with the progressive sub-division of labour in modern society.

Note: reference has been made to “gobbledegook” in the WGAs. Over time the art of communication has been lost in ever-more legalistic and jargon-filled detailing of the accounting simplicities of book-balancing, assets and liabilities and factual disclosure. That this has continued is itself damning evidence of Treasury failure. And where is CIPFA and the NAO in all this ?

WHO WILL MEND UK GOVERNMENT ?

 

“For those who understand, no explanation is necessary; for those who don’t understand, no explanation is possible”

Regardless of Party or big-issue policy debate, we need better domestic government. Aside from its ordering of civil society it needs to look to the design of its own management, process and  delivery. Politicians, capable of radical thought but not radical action, are helpless in the face of a civil service that can be reluctant or inept and wrongly skilled. At least one 72 year-old body of professionalism, Operational Research, seems still beyond  their ken.

Here are just seven compelling pieces of evidence:

1. ”This is the big dirty secret that politicians scarcely talk about, an all-party fact of life. The machinery of government is breaking down. Nobody knows what to  do about it” (former government special adviser in three departments of state Katherine Raymond, Sunday Times, 28^th may 2006)

2. The extreme complexity of the over-engineered taxation system is evidenced by the unwieldy length of the annually updated official Tolley guide (the page count nearly doubled in 6 years recently to over 10,500 (larger print equivalent)). Also the individual taxpayer is denied an answer to the question “where has all the money gone ?”.

3. In 2012 HM government produced its first-ever proper and consolidated annual accounts, but with a qualified audit report. Apart from what they contained, some of which was bad enough, they took 16 years in gestation, and another 20 months to publication date after the event. The late evolution and execrable performance standard characterises a Treasury failing a nation in dire need of financial management.

4. The local government funding system does not allow real local control and accountability. Many abortive or tinkering attempts over decades to resolve its contradictions and   ‘Heath Robinson’ machinery, have been money down the drain. Similar remarks apply as in 3 to the failure cleanly to resolve the local and central divide in decision competences, and given the existence of more modern money seeking and financial management concepts. (My personal diagnosis was developed during close experience of the ‘many attempts’, coupled with relevant experience in a UK conglomerate with global reach, small HQ, sophisticated non-interfering management and key figure financial control).

5. The announcement of an academy for training senior civil servants eg in big project management is long overdue and comes only now in 2012.

6. Over-use of legislation as the instrument to solve operational problems (alluding to remarks   by recently retired Head of the Civil Service, Lord O’Donnell). Red-tape is spawned, creativity and personal responsibility inhibited yet overpaid for limited risk.

7. Evidence for proper public accountability is absent.  Government excuses itself from disciplines that it legislates for compliance by others. The once only Annual Report for 1999-2000 released on to the high street, was presumably thought too brave an idea.

That no progress has been made is amply evidenced by continuing media reports of red-tape and  lethargic bureaucracy over many years. The language is almost word for word unchanged. One exception to this thanks largely to the TaxPayers Alliance, is that money is now recognised as deriving from taxpayers  rather than being a different currency called “government money”.

The solution lies in:

1. The establishment of a small System Architect’s Department of State headed by a ‘Chief Engineer’ for the ‘Ship of State’, to give intelligent design impetus to all machinery and processes. 

2. The Crown appointment of a person of Beeching-like strength to head a ‘polaris’ project for the simplification of tax and reduction in number of the different levies. Re-stated  primary objectives for taxation as a whole, and  implementation-ready end-date would be established before commencement of project planning.

3. Attention to  financial discipline as called for by the National Audit Office

4. Implementation of a new local funding system as offered personally to  Sir Michael Lyons in 2005, and others, which would resolve the anomalies described in 4 above, This would be simple to implement without conflicting with 2 above.(The Local Government Select Committee’s consideration in 2006-07 included evidence submitted by me (ev111) which was clearly reflected in the conclusion drawn that a return to the drawing board was necessary.  This was ignored by government.)

5. Delivery of timely narrative audited annual reports to discharge accountability (for public money). This with 6 below will be transformational.

6. Provision to individual citizens of a tax share statement or calculator, linked to the national accounts, and printed on the back of existing documentation such as coding notices and council tax invoices.

Peter Webb                                                                                                            17^th February 2012

HAS GOVERNMENT A BRAIN ? And what of Surrey CC ?

Elected government is ultimately responsible to the people for getting it right executively and operationally, yet politicians stand apart  from the Civil Service. The retiring  Head Sir Gus O’Donnell has just said that there is too much problem solving by legislation, and not enough risk-taking.

The Rt Hons Eric Pickles, for local government, and David Cameron, for Departments of State, knowing that government costs an awful lot of money but trying to leave it to us to do their job for them, love the new idea of the “armchair audit”. They fondly imagine you and I excitedly poring over masses of  unformed data about things beyond our ken and “holding to account”.  But this only means that we are left to wonder what it all adds up to, and who in the shapeless body of government can be held to account, how and for what exactly.

Consider a terrifying thought in the light of the deficit-laden  public finances.  The Chancellor, for his Autumn Statement, relied on input from the Office of Budget Responsibility. This included provisional data in the first ever Whole of Government (consolidated) Accounts, for 2009-10. These are only now (today) due to be placed before the House of Commons by the Treasury with a report by the Comptroller and Auditor General ( will he not sign them as has happened in Europe now for 17 years ?). That data is 21 months out of date.

So called management-speak, particularly of the financial kind, is anathema to politicians. The front line is good and the back office bad. They have a poor sense of the dynamics of delivery up to the point where the word sounds good in political-speak. Government is 50 years behind the times in the evolution stakes. The ship of state is not designed to cleave the waters and is without a chief engineer (a new Department of State perhaps ?). They seem unable to grasp the concept of the Total System, and System Architecture now transformed by communication technology advance. This failing is crystal clear to one who has been fortunate in his industrial post-graduate on-the-job training and career-long senior experience.

There is a crying need for simplification with a big S in thought and practise. And this is aside from the desperate need for radical simplification of the tax system beyond just the usual tinkering which seems only to increase the length of the official guide.

Big problems have spawned a body of analysis tools and techniques based on common sense and some mathematics, and the ordered and disciplined use of symbolic and diagrammatic portrayal for communication and resolution.  Operational Research has like other professional disciplines been prone to jargon. However it has given sight to blind people. One can quote Organisation and Methods, Work Study, Critical Path Planning (CPP), and now Lean Technology.

The important thing is the mind-bending leading to decisions for action and its direction, completion and feed-back. What is the economic case for a fire extinguisher ? What is the optimum pump layout and spacing on a forecourt ? What the best alternative cash flow projection.

Here is some history which may be news to some.  In the US in the cold war there was an urgent need for a new weapon. Its creation had to be from then unknown science to  meet a definable objective delivered in the shortest possible time. It was a vast project. The Polaris submarine was born of CPP which in turn was based on Network Analysis. That in turn took a simple line (activity) and joined it to a circle (event) from which the inter-connections spread out working back from the wished-for deadline. This is still at the heart of project planning and  management with additions for optimum resource allocation – not a restraint financially with Polaris.

My pet example: Local government let alone national government doesn’t even yet discharge and sign off accountability by delivered narrative Annual Report by the leader or chairman. To do this it requires the financial aspect, ie audited annual accounts, to be available quickly to complete the  picture. Our resident taxpayers’ rights are dismissed with bland talk of (passive) transparency. It has often been said that to speed up from the present six months or so would cost more in council tax when in practice the reverse is probably true. Certainly each day of delay wastefully diminishes value. I first met the problem early in my career 50 years ago when a new Chief Accountant.  I had been on a one-day Operational Research course  and discovered the remarkably simple network analysis idea –simple is revolutionary as was the invention in 1492 of double entry book-keeping. I was able to apply this to the production of a bar-chart company-wide  inter-facing timetable for completion of the Accounts. It was  a crash course in my employer’s  manufacturing company activities outside the financial. But only now in 2011 has SCC, according to an official Minute (of a committee), come to understand this interdependence within itself to contrast with the traditional departmentalised silo mentality, a political rather than reality tuned mind-set.

As a local tax campaigner I recently spotted a recruitment advertisement for a Lean technologist for the Royal Surrey County Hospital. Expecting to be able to go yah boo non-job ! I contacted the recruiting agency who, however,  gave me full explanation and reference to the professional body. Once again I experienced the thrill of discovery. This technique started life in the Toyota Company seeking to ‘car-centre’ its production and assembly process to optimise the movement of people and parts etc. focussing on the car  rather than the separate and remote or awkwardly placed departments. It is increasingly used in hospitals to patient-centre the medical process. The working analysis will discover and portray for resolution the high proportion of ‘idle’ time and ‘in-between’ activity. It is noteworthy that these disciplines are not employed primarily to save money but anyone with imagination will see that this must be one result.

It is good to be able to report that at our recent meeting with  Leader David Hodge and Acting Assistant Head of Finance of Surrey County Council Sheila Little, we learnt that work and results now ensue from Change and Efficiency Directorate employment of this thinking in its Public Value Reviews. Please may it extend to a revolution in the ‘mainline’ ways things are done by, for example, simplification  of its constitution and innovative streamlining of due process. The last World War took less time to fight and finish than it took SCC to initiate and “sign off” the new street lighting.

Please let’s transform the ways and attitudes of government by letting in and encouraging higher quality brainpower and management clout.  Politicians need to regain our trust in their competence.

Watch out ! There are (local) Party politicians about !

It has only recently struck me how much legislation is designed in  a vain attempt to control or counteract the inadequacy of Party politicians where they have responsibility for actual decision-making.

Currently the department of Communities & Local Government has consulted before legislating to privatise and modernise Local Public Audit. There is debate about how to secure audit independence, and auditor selection and appointment when in fact there are established  or frequently updated safeguards in custom and practise. But it seems that this is not safe with local councils who must have an Audit Committee with balanced party representation. As if we wouldn’t notice if Surrey CC appointed Messrs Hide, Fix and Fiddle, Accountants, of Back Street Woking. In other words they are not regarded as competent to decide on their own and cannot be trusted.

Because the local politicians elected to run their councils are not expected to be experienced or of sound judgement, and might bully their professional staff  there must be a statutory officer (sec 151 Officer) to be responsible for vetting financial forecasts and adequacy of reserves. In other words they are not competent to decide and cannot be trusted.

Select Committees have been the thing for years now at Westminster because of the shortcomings of the House of Commons chamber for governance. Now it is required of local councils to have them too. This in spite of their membership of committees having to be politically  ‘balanced’. In fact they may well not have relevant knowledge or judgement for their subject. And their talking shops conflict with the purposes and objectives of line management at the top of which sits “political management”.  In other words they are collectively not competent to decide and cannot be trusted.

Councils have large staffs to answer their members’ questions. But at taxpayers’ expense they are  also allowed to employ political assistants.  In other words they get away with murder even if they are not competent to decide and cannot be trusted.

And taxpayers have to pay for all the extra rituals, regulations and restrictions necessary to keep politicians from doing too much damage.

Innovation in Surrey CC ?

The STAG is grateful to a supporter for this article which helpfully summarises where we are with the growing policy and  local public service issue of health and social care. Taxpayers are not only concerned about their own ‘joined up’ care outlook but also the demands on our pockets as determined by the quality of its management. In particular the management of Inter-agency collaboration can make or break outcomes.

We are forever concerned about how we have to keep paying more and more rates and taxes for what seems to be just bureaucracy. So I was delighted to meet a team at one of Surrey’s Borough Councils recently that are dedicated to saving us money and being passionate about improving their services. They are the Borough Community Support Services team. We talked about looking after older people. Why would a STAG member want to talk about older people, you might well ask? It is not just because several of us are those older people with time to worry about these things!

It’s simple, really. The average age of the population is getting older by 2 months every year, consequently suffering poorer health for longer. NHS Surrey spends £1.6 Bn on our health, and the Council spends about 40% of its overall budget (less Education) on Adult Social Care (£374 M). A staggering 75% of this total is spent on looking after the 3% of the most critically ill people, who are commonly older people with long term conditions, such as heart or lung problems, diabetes and dementia. If there are ways of looking after these people more efficiently and effectively, then they surely must be taken.

It is a ‘must’ rather than an option. We will have 15 million senior citizens in England by 2020, with less working age people to look after us! If we don’t change anything, care will cost over 20% of GDP by 2050 (OECD report), so we have to change the way we provide care, or it will collapse. You can already see the strain it is under now, with press stories about health or care problems almost daily. It needs a new way of managing care that costs less, while also giving people a better service.

This can now be done by using modern computers and telecommunications to enable people to be cared for in the comfort of their own homes for much longer, instead of in expensive hospitals or care homes. And who would not prefer to stay at home? The facility is called telecare. This used to be simply about falls monitors, which raised alarms when you fell over, to call for someone to help you get up again. But now there are sophisticated home based monitors for all sorts of things like blood pressure, breathing capability, heart rate, and so on, so that an alert can be raised when conditions start to go in the wrong direction. Early corrective interventions will avoid serious episodes that mean emergency hospitalisation.

New telecare can save big money, because every A&E visit costs about £2,000 to process, followed often by a 7 day stay at another £4,000, then frequent outpatient and GP visits which keep adding to the cost paid for by the NHS. Moving to a care home will cost at least £35,000 per year, the average life there is 3 years, mostly paid for by the Council. But for people who own their own homes it can mean selling up and losing much of their children’s legacy. Keeping people in their own homes makes economic sense, as well as improving patients’ safety and wellbeing.

However, caring for patients in their own homes for much longer than presently possible, requires much more than just monitoring of their condition. The new telecare technology makes it possible to enable:

• Video consultations between carers and patients that gives carers a much better understanding of conditions than just looking at monitoring charts, or asking questions over the telephone
• Much more opportunity for the many care service organisations to collaborate on behalf of the patient. The commonest complaint about the NHS is that it is ‘not joined up’. But it is not just the NHS: Councils, Pharmacists, Opticians, Housing Trusts, Meals-on-wheels, and many others, all have duties of care, and need to be part of the ‘joined up care’ service
• On call contacts for the patient, with a variety of trusted specialists for advice, and video training and guidance reminders for self care, to enable them to understand and live better with their conditions, rather than suffering them. This alleviates the demands on (and costs of) professional staff.
• Provision of respite for personal carers (friends and family), whose dedication to caring for their loved ones makes a huge contribution that the authorities would otherwise have to take on, but creates great demands and stresses on individuals

Clearly, to make big savings in care costs, this technology needs to be deployed on a large scale. Then the question becomes ‘how can this be managed?’ The aim is to provide highly personalised care by a wide variety of care organisations to individuals living in a wide variety of circumstances with a wide variety of health conditions, and yet keep personal information very secure. This is both a technology challenge and a management challenge for the 21^st century that most developed countries around the world are facing.

One challenge is that there are many suppliers of telecare equipment that are proprietary, which means that care providers have restricted choices for patients with complex needs, and may have to operate several systems to serve all their clients. This is not manageable on a large scale, and has been a severe limitation on the growth of telecare use.

Another major challenge to the authorities is the need for early identification of people who need help, because so much more can be done to prevent them going in to hospital and care homes. Both the NHS and Councils claim they only identify about 30% of people who could be helped, but they are different 30%’s, because there is very little collaboration between them! A typical problem is that an NHS hospital discharges a patient after a serious episode, who then goes home with no support, because the hospital does not refer the patient to Social Services.

What is interesting and very encouraging is that the Community Support Services team at the Council have recognised these challenges. They are working hard on collaborating closely with the local NHS, and are insisting that all telecare and telehealth is to be managed with a single platform, challenging suppliers to cooperate. What is more, they have impressed SCC with their efforts and plans so much, that they have been asked to take their programme across the whole of Surrey CC.

STAG members can look forward to joined up care in their final years!