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Public Accounts Committee says that the NHS must make better use of machines

Oct 25th, 2011
by John O'Connell.
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Improving technology in healthcare can save lives. The latest machines can catch illnesses earlier and can administer more effective treatments than ever. Julia Manning of 2020 Health wrote on Friday that a heart clinic in Southampton monitors pacemakers remotely so patients don’t have to travel to hospital for check-ups and diabetes patients being warned by a text to their mobile phones if they have abnormal readings of blood pressure and blood sugar levels. This improves and simplifies the lives of patients, while easing the pressure on budgets.

My paper Wasting Lives argued that technology – along with improving lifestyles – can be bigger drivers of healthcare improvement than simply spending more money on existing systems.

So it’s crucial that the procurement of capital equipment in the NHS is cost-effective and the assets are used to their fullest potential. Unfortunately, this is not the case. The Public Accounts Committee has today published a report criticising the approach to hospital equipment usage. Margaret Hodge, the PAC chair, said that the variation in the frequency machines are used across Trusts is ‘unacceptable’.

In 2009, we analysed the usage of five machines – Linacs, MRI scanners, Lithotripters, PET scanners and CT scanners – and found that it varied greatly between Trusts. For those Trusts that were below average use, bringing them up to standard would have meant more scans; over 650,000 more CT scans, for example, which is the same as having 88 additional scanners in the system.

The National Audit Office confirmed these findings in March 2011, in its report on managing capital equipment in the NHS. It found wide variations in utilisation rates of scanning machines. This means that NHS trusts are unable to compare the efficiency of machine usage with other trusts – the report says there is no repository of data to do so.

Our paper was the first to gather these numbers in a meaningful way but it’s important that this data is made available every year so that Trusts can benchmark against each other. They shouldn’t be afraid to copy the good ideas of other Trusts. Why, for example, don’t they offer scans outside of working hours, even past midnight? Perhaps they could even incentivise having scans out of hours by offering two options – a normal scan date and an earlier one for using the machine when it’s in less demand?

I spoke at the National Biomedical and Clinical Engineering Conference a couple of weeks ago and it was just these types of topics that were discussed. Can Trusts deliver quality healthcare and save money? I argued that they absolutely can – by sweating their assets to ensure they were getting maximum value from them, and looking at areas in the current budget for necessary cut backs. Our research showed that the NHS compares badly with European peers on keeping people alive with timely and effective healthcare for treatable illnesses and conditions. Technology will help but that means reforming the healthcare system so we don’t keep spending money on out-dated processes and procedures.

Fat taxes won’t solve the problem they are designed to

Oct 7th, 2011
by Tom Welsh.
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Does Britain need a fat tax? David Cameron hasn’t ruled it out. In Manchester he called for Britain to ‘wake-up’ to rising obesity levels and, with Denmark now the first country to tax foods high in saturated fat, said a fat tax ‘is something we should look at’.

But is a tax levied on fatty foods the best way to tackle obesity? Certainly, obesity costs the NHS money. In 2001, the National Audit Office conservatively estimated that the NHS would spend £3.6 billion treating obesity and related illnesses by 2010. As people get fatter, ambulance trusts are forking out £90,000 on “bariatric” ambulances with reinforced tail-lifts and inflatable lifting cushions.

Some argue that the obese should contribute towards this expenditure. Smokers pay £9.3 billion annually in cigarette taxes, drinkers pay £8.3 billion, but there is no specific levy on obesity. Sin taxes, however, are about more than raising revenue. They are a means of controlling bad behaviour. Cigarette duty raises far more than the £2.7 billion the NHS spends treating smoking-related diseases annually. Intended as polite nudges, they more often crudely shove us towards healthier lifestyles.

A fat tax along the Danish line wouldn’t just target the obese, but anyone who bought foods high in saturated fats. Butter, milk, cheese, pizza, meat and oil would be affected, and with British food prices already some of the highest in Europe, average taxpayers, struggling to buy household staples, would be penalised for eating the food they enjoy.

Sin taxes also disproportionately hit those on lower incomes – not because what they eat is more fatty, but because they spend a higher proportion of their income on food. A fat tax would be regressive, according to a 2004 report by the Institute of Fiscal Studies. It would burden the poorest households seven times more, as a proportion of income, than the richest households.

Crucially, there’s little evidence a fat tax would even change behaviour. Obesity may be a growing problem, an ever heavier burden on the NHS, but indiscriminate taxation of fatty foods is not its panacea. It would not be an innovative response to an unsolved problem, but more-of-the-same intervention.

The Government must leave people to directly face the consequences of their own unhealthy actions. If someone like Paul Mason, formerly the world’s fattest man, has cost the NHS £1 million over 15 years, he should contribute towards the direct costs of his care. A fat tax would not provide this direct link between action and consequence. It would penalise the poor, increase food prices for ordinary taxpayers and stand as an unacceptable intervention into the eating habits of everyone.

NHS parking charges

Sep 30th, 2011
by Andrew Allison.
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There’s some bad news if you are sick or are visiting a sick friend or relative in Goole. Northern Lincolnshire and Goole Hospitals NHS Foundation Trust has increased parking charges at Goole Hospital. Charges have risen this month by a massive 13.33%, and then will increase again next September by the same amount. The amount of free parking time has also decreased from 40 minutes to 20 minutes.

Cllr Brent Huntingdon, the chairman of planning at Goole Town Council has said that will not be enough time to park-up, and get to the ward and back. Very true. It seems as if the Trust is determined to extract cash out of you. A spokesman for the Trust gave the usual, standard response:

“We’ve tried to make the charges as fair as possible in line with best practice national guidelines.”

Castle Hill Hospital, near Hull

Although this is a massive increase, parking charges in Goole are not as bad as they are in Hull. Hull and East Yorkshire Hospitals NHS Trust must have some of the highest parking charges in the country, charging £1.50 for the first hour; £2.50 for up to two hours, and £5 for over two hours, with a maximum stay of six hours. If you have to take your son or daughter to casualty because they have injured themselves, you have no idea how long you will be. Because it is ‘pay and display’ the hospital is almost guaranteed £5. You can’t risk putting anything less in the machine, otherwise the parking wardens will fine you.

Although I don’t object to hospitals making a charge for a well lit, secure car park, clearly most regard parking as an additional revenue stream, and because it is often difficult to park elsewhere, they have you over a barrel. Best practice national guidelines is a cop out. Massive charges, and massive increases in charges cannot be justified.

It will be interesting to see how charges differ around the country. Welsh hospitals don’t have any charges, and there are only three hospitals in Scotland that charge. Send me some examples, and I’ll prepare a list of those hospitals who are clearly taking out-patients and visitors for a ride!

What are the priorities of the NHS?

Sep 1st, 2011
by Darren Rutland.
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It has been revealed that English primary care trusts and strategic health authorities have spent more than £180 million on ‘media professionals’ over the last four years. There is non-stop debate about the future of the National Health Service and how it should be funded, yet I have heard no one back up their argument by saying that NHS bodies should spend vast sums of taxpayers’ money on spin doctors. The last financial year saw a total of £44.3 million spent on public relations officials. In 2009-10, this cost to the taxpayer was a staggering £50 million.

“The spin doctor will see you now”

The Daily Telegraph cites one example where Karl Milner, the director of communications for the Yorkshire and the Humber Strategic Health Authority, was paid more than £128,000 in 2009-10. By contrast, two senior staff actually involved in treating patients, the national cancer screening director and the director of patient care, were paid £106,000 and £127,000 respectively. While remembering this is just one authority, it is a damning insight into the thinking behind large parts of NHS spending.

And the disparities between organisations are stark. According to Richmond and Twickenham Primary Care Trust, their annual communications budget stands at £15,000. However, their counterparts in Solihull have allowed £1.2 million per year to be spent on communications. These examples give the impression that some NHS chiefs appear to be more interested in gaining good publicity than actually supporting care for their patients. Their priorities must be reassessed to ensure the best value for taxpayers, and the greatest care for patients.

‘System failure’ – £11 billion NHS IT system finally abandoned, but not before slamming a high bill on taxpayers

Aug 3rd, 2011
by Richard Poole.
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Once again central government has come under fire because of one of its costly and failing IT programmes. Unsurprisingly, a report published today by the Commons Public Accounts Committee (PAC) heavily criticised the expensive 11.4 billion ‘National Programme for IT in the NHS’ (NPfIT). They’ve said that £2.7 billion of taxpayers’ cash has been wasted by the programme, as the Department of Health has very little to show for that huge amount of cash.

The report highlighted a number of failings in both the management and implementation of the system, including the inability of the Government to ensure it was getting the best contractual deals from suppliers such as BT. As the Committee notes, “BT is paid £9 million to implement systems at each NHS site, even though the same systems have been purchased for under £2 million by NHS organisations outside the Programme”, clearly underlining the Department’s poor management and inability to provide taxpayers with value for money.

Launched in 2002 by the Department of Health, the central aim of the programme was to develop an all-encompassing e-records system to make accurate patient records available to NHS staff at all times. But the project has courted controversy at every stage from its inception. Data management issues, patient confidentiality problems, numerous missed deadlines; NPfIT has it all, completely undermining its goal of increased efficiency. It has been dubbed the super-computer but there’s nothing super about it: the project takes every single failing of past IT projects – of which there have been many – and rolls them into one giant failure.

The inclination of the NHS to centralise everything has cost taxpayers dear. Richard Bacon MP, a member of the Public Accounts Committee, called it “one of the worst scandals in terms of wasting public money of my ten years on the Committee”. A scandal is right. We called for this project to be scrapped almost two years ago in our report with the Institute of Directors How to Save 50 Billion. Taxpayers’ money has already been poured down this black hole and the government have to put a stop to it, now. It seems the alternative is that local health trusts and hospitals will be allowed to develop or buy individual computer systems to suit their needs instead, but the haemorrhaging of cash must end.

And we need to remember NPfIT every single time the government – or any government in the future – comes up with a major IT project on the promise that it will magically make everything better, in exchange for a few billion from taxpayers.

Non-job of the week

Aug 3rd, 2011
by Andrew Allison.
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Everywhere you look in local government these days you seem to find change managers. This week is no exception, and once again a recruitment agency is masking the identity of an unnamed London borough council wishing to appoint a Temporary Change Manager paying between £281-£350 a day.

Another London council, meanwhile, is looking to appoint an Interim Programme Manager who will take the lead and get a grip of the Parking Commissioning project. Once again we don’t know which council it is, but we do know the successful candidate will be paid between £400-£450 a day.

Central London Community Healthcare NHS Trust (CLCH) is looking for a Head of Communications and Engagement. Here’s part of the job description:

Reporting to the Director of Strategy and Business Development the Head of Communications and Engagement will be an expert in communications and engagement. You will lead on the development and implementation of the corporate internal and external communications and involvement activities including development of long term strategy and policy, reputation management, media and community liaison.

Non-Job of the WeekI suppose it would be useful for the Head of Communications and Engagement to be an expert in communications and engagement, otherwise what would be the point of appointing them to a role paying between £60,671-£73,351 a year?

Of course I accept there has to be people employed to handle media enquiries and contact with the public, but the primary role of the NHS is to heal the sick. If this Trust has a head of communications earning over £70K a year, how large is the team beneath them? How many communications officers are there in London? How many are there in the UK? During the last general election campaign, Nick Clegg stated we now have more bureaucrats and administrators in the NHS than we have hospital beds!

It strikes me that the NHS is over-reaching itself, employing people on large salaries to put a good spin on the work of the Trust. What I want is to be able to visit my GP, and if I need to see a specialist to get an appointment in good time, and if there are any problems for my complaint to be handled promptly. This does not require the services of a Head of Communications and Engagement earning over £70K to fob me off with excuses when things go wrong.

Competition and choice benefit patients, but PCTs actively block it

Jul 28th, 2011
by John O'Connell.
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Two important stories on competition in healthcare have been reported today. The first is that research from the Centre of Economic Performance at the London School of Economics shows that competition in the NHS, introduced under the last Government, is increasing the quality of healthcare.

The authors of the report looked at data for 433,325 patients who had heart attacks between 2002 and 2008. This time period covers the time before and fixed-price competition was introduced. The scope of the study was broad too, with data from 227 English hospitals analysed. Death rates dropped by 7 per cent under fixed-price competition, and fell quicker in “more competitive markets”.  The key finding is that there were 300 less deaths from heart attacks a year after the reforms were introduced in 2006. They added the rates would be significantly higher if other ailments were taken into consideration.

Dr Cooper, one of the team that carried out the study, puts it succinctly:

Incentives cannot be a dirty word in the NHS. Creating financial incentives can save the NHS money and improve clinical quality. We find that competition between hospitals in a market with fixed prices led to very strong improvements in patient outcomes. Going forward, if the NHS is going to be successful, it can’t shy away from competition. This research isn’t about public versus private; it’s about illustrating that financial incentives can have a profound impact on hospital performance.

On the same day, I read in the Financial Times (£) that PCTs have been deliberately limiting patients’ choice of where they receive their healthcare. Around 40 per cent of patients now choose not to go their local NHS hospital so this is affects a significant number of people. Tactics include setting minimum waiting times before patients are treated; telling GPs where to send patients; and using referral management centres – providing a second opinion on a GP’s diagnosis and directing patients elsewhere.

This is indicative of the attitudes prevalent in the NHS. Despite evidence showing that competition and patient choice work, existing institutions and comfortable incumbent bureaucrats are working hard to ensure that patients do exactly what they tell them to.

Scare-mongering about privatisation is stifling a very urgent debate about the benefits of competition in healthcare provision. It’s time to put patients first.

Needless bureaucracy and how FOI compliance should be much cheaper

Jul 26th, 2011
by Rory Meakin.
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Anna Bailey recently chronicled the difficulties faced by people trying to exercise their legal right to get information from Nottingham City Council. The point of the Freedom of Information Act was to open up public information to greater scrutiny and make government more transparent. It was intended that public bodies would begin to routinely publish most information and that requests would only need to be made for the most obscure items that no one would be likely to request anyway. Sadly, many organisations have treated the Act as simply another layer of bureaucracy requiring more staff and, naturally, more funding.

No shortage of bureaucracy in the NHS

Despite recent advances in opening up official information to public scrutiny, those of us who wish to get hold of information often have to rely on the Freedom of Information Act in order to do our bit in holding those who spend taxpayers’ money to account. Sadly, instead of embracing the transparency agenda, many authorities choose instead to waste staff time and taxpayers’ money in attempts to hide what they are doing in our names and with our money.

I’ve copied below the transcript of an email exchange I recently enjoyed with an official in the NHS and someone with a fancier job title who I presume was her manager.

——————————————————————————————-
Hi Rory

Please find attached the information as per your FOI request as discussed.
Assistant Bureaucrat
——————————————————————————————-
Hello Assistant Bureaucrat,

Thank you for your email. The attachment you sent appears to be a scanned in PDF of a printed out spreadsheet. Would it be possible to kindly send the spreadsheet itself?

Kind regards,
Rory Meakin
——————————————————————————————-
Hi Rory

Just to confirm that we do not normally send out editable documents when replying to FOI requests.

Many thanks
Senior Bureaucrat
——————————————————————————————-
Hello Senior Bureaucrat,

I’d like to confirm that I wanted to know if you would provide the document I requested rather than what you normally do.

As you have taken the time to convert the information from a versatile, easy-to-use document into a unflexible, difficult-to-use alternative, you will appreciate this hampers our ability to scrutinise the information and therefore acts as a barrier to accountability, transparency and openness, for what seems to be no better reason than it is existing practice to do so.

Could you kindly reconsider my request?

Many thanks,
Rory
——————————————————————————————-
Hi Rory

Spreadsheet attached as requested.

Regards,
Assistant Bureaucrat

Transparency would help solve the £500m a year wasted on inefficient NHS consumables purchasing

May 20th, 2011
by Rory Meakin.
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The Public Accounts Committee has published a damning report today into NHS procurement. Among other things, the report cites the National Audit Office which says the NHS is wasting £500 million a year simply by ordering supplies in small, frequent batches rather than less frequently but in larger quantities.

“The NAO has estimated that trusts could save around £500 million annually, 10% of their consumables expenditure, by amalgamating small orders into larger, less frequent ones, rationalising and standardising product choices and striking committed volume deals across multiple trusts.”

Too often we hear about the supposed cuts being ‘savage’, but this is exactly the sort of cut that any government ought to make. The money could be used to pay for services that people actually value, to fund a tax cut or to help reduce the Government’s huge deficit. Almost any use of the money would be preferable to wasting it on buying consumables at inflated prices. But how can such waste be cut? After all, hospital procurement staff and structures will be more or less the same in the near future as they would have been when the data was collected. The committee’s report was, in its understated way, critical of the culture in the NHS towards value for money:

“There has not been a culture of efficient procurement in the NHS. The lack of data makes it difficult for trust boards to challenge managers on the efficiency of procurement and there has not been sufficient control over procurement practices. At a time when all trusts are required to make efficiency savings – 4% in 2011-12 alone – they should seek to achieve as much of these as possible from improvements in procurement.”

Syringes etc could be £500m cheaper

Fortunately, there does appear to be a disinfecting light at the end of the tunnel. Just as non-jobs could be rooted out of local authorities by way of HR Transparency, so too could existing structures of NHS control be better placed to scrutinise wasteful, inefficient procurement with a bit more transparency there. As the committee reports,

“A lack of data has limited progress towards more efficient procurement, and the Department must now address this. The Department plans to require all products sold to the NHS to have standard bar-coding. Bar-coding of products would help trusts to rationalise the range of products they buy and compare prices, providing the data they need to benchmark their performance.”

This would make it far easier for NHS trust boards to scrutinise management and has to be a step in the right direction. But it shouldn’t be left just to boards of directors. The money being spent is taxpayers’ and the trusts spending it are public bodies. Details should be published routinely so taxpayers can see for themselves how their money is being spent and provide the pressure of additional scrutiny that would help cut down on waste.

Non-job of the week

May 4th, 2011
by Andrew Allison.
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We have long said Political Advisers are non-jobs. Now it seems one of them agrees with us. This is from someone’s Twitter profile, giving details of their job description:

Labour Political Adviser. It is an unnecessary role, proven by the fact that many councils operate perfectly well without them.

To save their blushes, I am not going to name this person, but I assume they are trying to be sarcastic – perhaps even witty – as they quote from our report last year. Of course, the truth is many councils do operate perfectly well without political advisers. It’s a warning to those who tweet. You never know who’s watching, and they may not always be as kind as us and protect your anonymity!

Every person I speak to who works on the frontline in the NHS repeat the same phrases. “If you want to find waste, look no further than here.” “There would be more money for patient care if it wasn’t for the excessive number of managers.”

During last year’s general election campaign, Nick Clegg commented that there were the same number of managers in the NHS as there were beds. I have long thought the NHS is in danger of collapsing under the weight of its own bureaucracy.

Here is an example. This job is advertised on the website www.jobs.nhs.uk. Brent Teaching Primary Care Trust (PCT) is looking for an Improvement Manager.

People from different cultures and backgrounds make Brent’s community thriving and exciting, and our staff reflect and enjoy this diversity. Here at NHS Brent / Brent Community Services it is our job to meet the healthcare needs of this vibrant area of NW London. If you want to join our team in delivering a more responsive and effective health service in Brent, we want to hear from you.

This role is part of Delivering Management costs across North West London for the Brent and Harrow sub-cluster. The role is in a new team working with GPs in Brent.

Please note that the job description for this role is a generic to all band 8a roles in the North West London Cluster, in addition to the job description candidates should make reference to the additional role specification. Applications should indicate candidates’ skills, knowledge and qualifications required on both of these documents.

So at a time when the government is reining in spending, Brent PCT creates a new team. I am not an expert on what all these managers do, but those who work in the NHS tell me many of them either don’t understand the jobs of those they are managing, or are simply not needed. I think the job of  Performance Manager falls into the latter category. Surely there are enough managers already and the staff understand their jobs?

Staying in Brent, the council is looking for a Chief Information Officer, paying a very handsome £91,869 – £108,084 a year. Here is an extract from the job advert:

In the spring of 2013 our new community focused Civic Centre will open in Wembley. Colleagues working for the council, local residents, businesses and voluntary groups will be dependent on you to deliver a state-of-the-art IT environment.

The efficient use of information and technology is critical to the council working more efficiently and you must be someone who can develop and sell their ideas and who can deliver major projects on time and to budget. The clock is already counting down. Are you the person we are seeking?

Reporting to the Director of Finance and Corporate Services, this is an exciting opportunity to lead what is acknowledged to be one of the most innovative IT teams in local government.We’ve already implemented a modern low cost IT platform but there is still much to do.

So there we have it.  A new community focused Civic Centre; an information team delivering low cost solutions. All must be well in Brent. When you look at the budget the council passed two months ago, it appears not. Cuts to early year’s education and libraries, to name but two, yet the council can still afford swanky new buildings, and pay a six-figure salary for a Chief Communications Officer. Once again we have a council not focusing on delivering core services. Instead, it would rather deal in grandiose schemes and jobs.

Non-job of the week

Apr 6th, 2011
by Andrew Allison.
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Those who have seen the film ‘Groundhog Day’ will have an insight into what it’s like writing this weekly feature. Another week passes by, yet the same councils and the same recruitment agency keep popping up.

Once again Morgan Hunt is advertising for a £200-£300 a day interim job, and once again we haven’t a clue who the employer is, and after you’ve read the job description, you won’t even know exactly what the job is!

Morgan Hunt’s client, a Healthcare Provider based in the South West, is currently looking to recruit a Programme Manager to develop and implement a robust project management framework for all the strategic redesign projects being undertaken in the Trust, ensuring that the patient is central to any redesign.

As Programme Manager, you will have the opportunity to be responsible for the development of clear project management policies, procedures, plans, tools and documentation to support the implementation of the Strategic Redesign Programme.

Key responsibilities include:

- Providing advice and support to the Project Managers to ensure that they have appropriate plans in place to successfully deliver their milestone outcome
- Ensuring there is effective supervision, performance monitoring and management of the Programme, to ensure successful delivery of the projects within the agreed timescales and that the Programme and Projects are regularly evaluated to measure for impact
- Working with the Communications Department to ensure effective communication channels so that all key stakeholders are fully aware of the progress of the Strategic Redesign Programme

The successful candidate for the role of Programme Manager should have the following:

- Demonstrable working experience of project management/co-ordination
- Experience of successfully leading and managing a (team of project managers) project responsible for projects from £100k to £10m in value
- Excellent analytical skills to develop, read and interpret complex information
- Strong leadership and project management skills

So there we have it. This job may well be paying an appropriate going rate. If we knew which trust it was, and quite what the projects were, we would be in a better position to find out. Unfortunately, we don’t, and it is very likely we never will.

The old faithful, Surrey County Council, is continuing to expand its change programme. It is now looking for a Senior Performance and Research Manager (Intelligence) on £54,085. This is to add to the Performance Manager, Performance Officer, Intelligence Officer, Change Officer, and Senior Change Manager; and they are the ones we know about. At this rate there are going to me more people employed in change and performance than there are delivering front line services!

The winner this week is another old chestnut too. We highlighted how many political analysts councils employ in a report last year. Now – thanks to a supporter – we have found out the West Midlands Fire Service employs a Political Analyst and Researcher. I issued a Freedom of Information Request to the fire service asking what the salary is, including any bonuses, how long as he been employed by the authority and how long this post has been in existence. Unsurprisingly, his salary was not revealed as it is below £58,200 – the senior civil service minimum pay band. He has been in post since September 2009.

Why does the fire service need a Political Analyst? Surely it is not beyond the wit of the Chief Fire Officer to keep himself up-to-date of any political changes? According to its website, the Fire Authority is made-up of 27 elected councillors, so they are paid to keep abreast of political changes. The public want the fire service to do what it says on the tin. That’s what we pay our taxes for.

Cornish health waste

Mar 21st, 2011
by Tim Newark.
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The Chief Executive of the Royal Cornwall Hospitals Trust (RCHT) has warned its 5,000 staff that they need to make savings this year of £26 million. That means losing 200 jobs and cutting the budget by 15% in back-room departments and a further 10% in front-line services. Unions are up in arms because they fear that many of their members are being downgraded as they are told to reapply for less senior jobs. Said one radiographer: “We suspect people will be downgraded to Band 6 but still doing the Band 7 role, on less money.”

But not everyone seems to be onside with the savings message. A Cornish TPA supporter passes on the discontent of a Truro nurse. Despite the impending cuts, the RCHT hospital at Truro is investing in a computer programme designed to allow nurses and other front line staff to upload their thoughts and written reports on a screen above their desk ‘to flash the news for all to see’.

“Another unnecessary job to add to the workers’ day. What fun the desk-bound management section have,” noted our informant. “I am not sure how this new project works, but to cut staff and install expensive equipment that create work seems to be unproductive, unnecessary, or silly.”

If it is anything like Truro’s 49-page ‘Policy and Procedure for Being Open’, highlighting the need for interpersonal skills in a hospital, or the 10-day management jolly disguised as ‘New Horizon Thinking’ to promote leadership skills among middle and senior hospital managers, it really should be the first in line for the chop.

It is certainly fascinating to note the cost of computer equipment and services last month at the RCHT—a total of £201,867.41 in just one month. Just when the Chief Executive is asking for cuts in staff and wages.

Tim Newark, Bath & South-West TaxPayers’ Alliance

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