Council budget cuts

The prelude to a very major cut in Council budgets is being characterised with plenty of advance warning and unsubtle Government direction as to where the cuts must fall.  Or more accurately, where expenditure is to be redirected to.

I've done some work on the Comhairle budget, and I estimate that to save the forecast 10% over three years, the Council will have to lose 300-500 jobs and the associated services.

The signs are all there.  Colleges are being forcibly merged.  Police forces are being merged.  Councils are being encouraged to share services.  That 'encouragement' will become a financial compulsion when the full impact of the cuts is known.

Due to the effect of the floor mechanism, I think the real cuts being faced by the Comhairle will be nearer 15% than 10%, and this will be the worst financial settlement in Scotland.  Again.  Again.

Then there is the instruction to increase capital expenditure, by redirecting resources.  In blunt terms that means lose admin staff and employ construction workers, so my estimate of staff losses is at best a net outcome. 

Whilst it will be good to bolster the private sector, I have serious reservations about the view that capital expenditure in some way creates more jobs than revenue expenditure.  Taking £1m from revenue will mean job losses; adding it to capital will not add the same number of jobs.  In simple terms, the lorry and the concrete has to be paid for before you can start thinking about jobs.

Whilst some may argue that it will create jobs 'overall', in the Western Isles we are likely to see local Council jobs replaced by steel rod manufacture and lorry sales on the mainland.

But it is the speed of enforced change that is going to be the problem.  You cannot sensibly rebalance a Council from one direction to another in the six months there are to set a budget.  Just think of how long the 'consultations' on redeployment will take; and how many of the 'never again' Early Retirement packages there are going to be.

The sitting Councillors are going to be on a hiding to nothing - they have to make huge cuts in February next year and seek re-election (or head for the hills) two months later. 

And who is going to get the blame - the Council, the Scottish Government or Westminster?  The answer: it's the other guys fault.  Which might be fair comment, but not a comment the public are going to appreciate when combining services means loss of jobs at the College, the Council or the Health Board when "combining services" becomes "centralising services".

As for the Scottish Government's aspiration that Councils use Prudential (sic) Borrowing to fund Capital....  That's nothing more than taking out HP, which simply means smaller cuts, but for much longer.  And wasn't the Scottish Futures Trust going to provide cheaper loans for the public sector, instead of mutating into a behemoth dishing out big contracts to big contractors?

The public sector in all it's guises is in for a very rough ride over the coming years....

A single public authority for the Western Isles?

Isn't setting up a single public authority a great idea?

It was good to see that the Council have been in discussions with the College and the Health Board to work up a combined scheme to propose to Government.

Not according to Neil Galbriath, Chair of NHS Western Isles (and former Chief Executive of the Comhairle):

“NHS Western Isles is not currently developing or participating in any work associated with the assessment of the viability/benefit of a Single Public Authority or merger with any mainland Board.

“The Comhairle is free to make its comments on its perception of change and reform of public services but its view is not one that is shared by the Health Board or other public bodies in the Western Isles. Health Board staff should feel assured that no such discussions have been entered into by the Health Board.”

So is this a kite that will never fly?  It certainly feels like a 'land grab' that has gone wrong.  Badly wrong.

Health Board funding

It was the line "NHS Western Isles got £57.7million (up 3%)" that caught my eye.

It just didn't seem right, so I looked back at the actual announcement for 2009/10, and for 2010/11 just to check the facts.

	2009/10	2010/11	2011/12
Revenue	£56.6	£58.1	£57.7
Capital	£1.9	£2.55	£0.4
Total	£58.5	£60.65	£58.1

Which by my arithmetic is a decrease of 4.1% in the current year, before inflation.

Perhaps someone could enlighten me on any mistakes I have made in reading the official figures.

Another ward to close

Nurses tell me that yet another ward in the hospital is to be closed in the coming weeks.

It is not clear which ward is to go yet, as there is a balancing act between keeping a wing open and efficiencies, but what is clear that the declining use of the hospital is turning it from"state of the art" into "white elephant" in a short period of time.

With the continuing population decline, budget cuts and the centralisation of services the pattern is clear.

But, just how do we reverse it?

Health Board appointments

With two local Councillors with the right political connections attending the interview panels today in Edinburgh for the position of Chair, the future direction for the Health Board should be very clear, come decision time.

Has the Board got a long-term future, and how will the capital and revenue cuts be implemented with the minimum impact on services?

Lochmaddy Hospital

Despite the well publicised 'sale' nearly 2 years ago, it still appears on the Scottish Government 'for sale' pages, and the Scottish Assessors website shows the state still liable for the rates.

Does anyone have the faintest idea what is happening with this historic building?

Euphemisms

Health Board employees will no longer be... sacked, given early retirement, not replaced, promoted to another Health Board, junked, pink slipped, made redundant, downsized, deselected, shot at dawn (largely obsolete), disemployed, given an early visit to Al Crae (slang), promoted to the Board, de-swipe-carded or unfriended by the HR section.

The new phrase is: jobs may be “discontinued.”

Beautiful isn't it.

I will return to the underlying financial issues at the Health Board in later posts, but there should be no illusion that to meet the Government's financial targets, there are going to be a lot of discontinues.

Lewis Mountain Rescue Team

Unimpeded by the shortage of mountains in the Western Isles, I understand that the proposal for a Mountain Rescue Team is being worked up by all the agencies, primarily on the grounds that if one life is saved then it is justified.

This is the public sector precautionary principle in action.

Whilst no-one in the emergency services is going to publicly criticise such a proposal, there is a certain amount of disbelief at the budget being put aside by the Health Board to pay for this.

With cuts expected across the whole of the public sector, are there better uses of a sum believed to be around to £600,000?

Health Board funding

Read the press release from the Government very, very, carefully.

The Scottish Government will continue its work to assist the Board, which is now also supported by its partner Board, NHS Highland, in areas including human resources, governance and planning.

The loss of control to NHS Highland is now structuralised, with the Western Isles a branch office, with some autonomy.

Health Secretary Nicola Sturgeon said: "Today's brokerage agreement is testimony to the Scottish Government's commitment to patients in the Western Isles."

Brokerage agreement? What the hell is that?

Although the Board will have to repay the brokerage over the six financial years beginning in 2012-13, today's agreement gives the Board a clean slate and allows it to build on its recent improved performance.

Oh! A loan of £3.1m over 6 years, which means repayments of £500,000 each and every year.

And where does that money come from if not from cuts efficiency savings.

Which makes the recent appointment of a one-time vociferous critic of cuts, all the more an obvious act of political neutering. Bloody devious, aren't they?

Health Board finances

A little light has been shone into a dark corner by the recent statement from the Health Board regarding the finances.

But to understand just what it really means, you have to cut through the jargon.

Crucial to the strategy is a promised £ 3 million loan from the Scottish Government to "clear" the accumulated deficit.

Translation: we are turning our overdraft into a loan. Doing so does not get rid of losses, it just simplifies the repayments.

But Scottish health minister Nicola Sturgeon has imposed a condition against the loan requiring satisfactory progress from the health authority board and its commitment to pay it back in the future.

The lender has told us to make cuts to be able to afford the repayments.

Though the body believes it will break-even within the last accounting period it faces more financial woes by having to make £2.9 million of savings and cutbacks in the new financial year to cover an immediate funding gap in its £68 million allocation from Government.

On top of the cuts that we are going to have to make in the current year, due to a reduction in budgets.

£100,000 savings are to come from better use of locums while freezing 27 vacancies is expected to win £610,000.

27 staff are not to be replaced. If they are not important, then why are the posts not deleted? If they are important, why are the posts remaining unfilled?

The last information I had was that at any point there were unfilled vacancies with total salaries of £1m, and that a strategy of delaying filling the posts to save a few months here and a few months there was being deliberately pursued.

----

Congratulations to Angus MacCormick on his rapid rise through the ranks of the Board. Thinking about the background to his appointment, I recall the wise words of Lyndon B Johnson:

It’s probably better to have him inside the tent pissing out, than outside the tent pissing in.

Health Board funding

I'm trying to get to the bottom of the real funding awarded to the Health Board.

According to the papers today, the allocation for 2009/10 is £56.6m for Revenue and £1.9m for Capital.

I'm digging back and not finding any website that can authoritatively confirm previous allocations, but I have found that - according to a report in the Gazette -the Capital Allocation for 2007/08 was £3.85m, and according to a Parliamentary answer in March 2008 (Para S3W-10436), the provisional Revenue Allocation for 2008/09 was £55.2m.

The Revenue allocation has increased by 5.5% - which won't cover salary increases without cuts being made - and the overall allocation appears to have dropped by £0.5m, which is a bit of a kick in the teeth.

Can someone (in the Health Board?) guide us to more accurate numbers to shed some light on this, rather quiet, announcement.

Health Board - heading in the right direction

The apparent intention of Western Isles Health Board to reduce the number of patients that are to be sent to Inverness or Glasgow should be whole-heartedly and warmly welcomed.

Apart from the physical discomfort for the patients in having to travel, this also sends the signal that Ospidal nan Eilean is not a branch office of Raigmore.

With a more 'patient-centric' approach we might see the reversal of the trend towards centralisation of services in Raigmore that I warned about some time back. Although, despite accepting the report on Rural General Hospitals in full - which meant centralisation - the minister apparently said that this excluded the Western Isles. (No, I don't understand the rationale either!)

The result of this will have to be that consultants travel to their patients and operations are undertaken here, which can only improve the overall level of care available. It might mean we have to wait a bit longer to be treated, but I think that is an acceptable trade-off for being close to one's family.

As an example, a pre-school child I know requiring minor surgery will have to be in Inverness on Thursday morning for a pm check-in. They are operated on on the Friday. They are discharged on the Saturday morning - having missed the only flight at 7:30am - so they have to catch the only flight on the Sunday at 4pm or face a miserable journey by ferry. And that's two days off work for the parent and four days apart from the family.

Not good.

These plans can only improve an unsatisfactory situation.

Health Board funding

The news reaches me that the Western Isles Health Board are to receive a loan from the Government to help clear the deficit that it has incurred over a number of years.

Despite searching (and I admit I might not have had the time to look in as much depth as I would normally have), I cannot find details of the facility it replaces or the terms on which it is granted, beyond being repayable over three years.

Do the WIHB have a overdraft from the bank? Is it an unsecured loan from the bank? Or is it to replace borrowing from the Public Works Loan Board?

The answer is that it is most likely to a revolving unsecured credit facility from the bank (if Maggie Fraser from the Health Board is reading this, then I would appreciate a copy of the last set of accounts, please!) In other words, basically an agreed continuing overdraft facility, similar to those used by businesses.

Let's just imagine that the new loan saves 5% interest (and I would guess that is on the high side), then the annual saving in the first year is £150,000.

Enough to employ some additional staff. Probably in Inverness, as the Minister has awarded £250,000 extra for the additional costs of providing central support by Highland Health Board. This is described, in a wonderful piece of doublespeak as “Safeguarding the independence of WIHB” by maximising skills in admin, finance and HR. In other words, Highland will provide these skills and WIHB will pay for them.

But the real trouble arises when you remember that WIHB have to repay the £3m loan over 3 years.

Just where are they going to find £1m next year to fund this?

Why more than likely the reduction in the cost of the centralised admin services (for which read jobs) that are now being delivered by Highland.

But before you blame WIHB, remember that the negotiations over the loan will have been of the type that involves a direct instruction from the Government; which explains the fawning and financially illiterate press release from our MSP claiming that everything is wonderful.

As he had previously suggested/implied/hoped that the debt would be waived by the new Government, his sudden abandonment of his position signals that he has (again) be told what to think, and has duly fallen straight into line, and tells us all we need to know about the deal.

Health Board Inquiry

So there is to be no public inquiry into the allegations of bullying in Western Isles NHS Board.

This was signalled a few weeks back when our MSP erroneously stated that these matters had been covered in the Parliamentary Inquiry. No doubt the NHS staff feel badly let down by both Mr Allan and his predecessor Mr Morrison over their (mis)handling of the situation, and their decisions to accept the instructions from their parties to sweep all this under the carpet.

It is not that a Public Inquiry would have done a huge amount except further embarrass the senior management who allowed the situation to develop; and possibly shed some light on the appointment process that created the situation in the first place.

But, it would have given the staff some sense of relief - and seriously boosted their morale - to have their position vindicated; those who were bullied would be relieved; and the threat of public humiliation would hang over any management who allowed such a situation to ever develop again.

Of course, it might also have caused light to be shone on the packages paid to staff who were unfairly or constructively dismissed; those who were moved elsewhere to non-jobs in the NHS; and (perhaps most importantly) over the advice given by Civil Servants to Ministers and the Board.

Cover-up anyone?

Health Board autonomy - the fall out

From: Cllr. Angus McCormack
Sent: 04 July 2008 12:29
To: Cllr. Angus Campbell; Cllr. Norman A. MacDonald
Cc: CNES - Members
Subject: WIHB

Dear Angus and Norman

I understand that you have both been on the radio this morning in regard to the story carried by The Herald yesterday. Indeed you have given it legs in today’s Herald too I believe. I regret the haste with which you issued your statement. It would have been courteous had you spoken to John Angus Mackay or myself before going in to overdrive on what is a non story. WIHB has relied heavily on other Health Boards over the past year in attempting to redress the mess left by the Currie/Manson regime. Without the help of other health boards the WIHB would not be in the much improved state that it is. This information was given to cllrs in briefings by John Turner, Acting Chief Executive and the discussions between the Convener/Chief Exec and Chair /Chief Exec have discussed these matters on an on going basis. Earlier this week Nicola Sturgeon made it clear that there was no intention to tamper with the autonomy of WIHB.

WIHB has a long way to go but the progress is positive. Why does the Comhairle have to have a go? I think an early discussion will help.

Regards

Angus

Council v Health Board v Minister

The outraged press release from the Vice-Convener about the proposed linkage between the Highland and Western Isles Health Board betrays either false anger or the fact that Angus Campbell is being kept in the dark.

I understand that this matter has been discussed by the Chair of the Health Board and the Chief Executive of the Comhairle, and that the Council's representative on the Health Board was fully aware of the discussions (did he attend the meetings?) without the knowledge of the Board or the elected Councillors.

The picture becomes less and less clear.....

But let's start with some simple questions -- How long has this been being discussed by the parties? And how long has it been on the agenda?

(Updated for more information about what has been going on)

Working together in the NHS

The news has spread far and wide and very quickly, and defensive positions have already started to be built.

Mr Coutts (Highland HB Chairman) said the move was nothing more than building a closer relationship between the two authorities and denied it would lead to a merger.

Which certainly isn't the take on it in the Western Isles.

He said: "Not even is it not on the agenda, it's specifically off the agenda. The minister has made that clear."

Which is why it is even more puzzling that the Health Minister didn't mention it in Barra - not even to very senior members of the local SNP.

NHS Highland chairman Gary Coutts said closer working with the Western Isles would allow them to share expertise in finance and human resources.

But this is the rub. At the moment the NHS is appointing "recruiting without advertising" key management staff who are flying in on Monday and back out on Friday. All of which adds to the deficit and appears to make the position much worse than it actually is.

The belief that there is no-one locally who can do the job is patronising in the extreme, and the Minister would do well to remember that the problems started when the (previous) Government starting parachuting people in.

As a senior individual in the Council succinctly put it, "These people have no interest in how the local NHS operates, as long as they do their job and get paid." There is no buy-in to the community that they are supposedly working for, and a series of temps produces a hugely unsatisfactory set-up on which to build for success.

And whilst the Minister may have taken merger of the agenda, I suspect the hands of civil servants guiding the strategy towards a major cost-saving exercise, as we share expertise in finance and HR by moving the jobs to Inverness.

It is nothing short of an attempt to remove the Board by stealth, over time, and is a slap in the face to those who worked long and hard to get independent control over health, all those years ago.

------

Press Release from WINHS (to give the other 'official') view

A preliminary discussion took place at a recent meeting with the Chairs involved regarding the concept of strengthening partnership working between island and mainland Boards.

The Board Chairman responded on the basis that NHS Western Isles already has formal and informal partnership arrangements with a number of Boards. NHS Western Isles is currently also drawing on the support of a number of mainland Boards to bolster our capacity.

A commitment was made at Chair level to explore further how best these partnerships might be established and developed in practical ways in order to ensure that Western Isles Health Board remains an independent and sustainable entity, working in partnership with others.

The Cabinet Secretary reaffirmed on Tuesday (1st July), on her visit to Benbecula, that the Board would continue to exist in the Western Isles, and also acknowledged that the smaller island Boards needed to work in partnership with other Boards in order to develop and deliver safe and sustainable services to the populations they serve.

Contrary to the impression given by a so-called ‘health service insider’ in The Herald report today, the purpose of establishing stronger formal partnerships would be to strengthen the capacity in the Western Isles – not to dilute it.

As soon as any further details are available, these will be communicated widely.

Threat to Health Board

Not that long ago I was saying that I thought that the future of the Western Isles Health Board as an independent entity was looking much more secure, following the strong performance of the new management team.

During the fiasco that was the Manson regime I repeatedly warned that the political undermining of the standing of the Health Board would only result in the control being transferred to Highland Health Board. And the repeated failure of our then MSP, Alasdair Morrison, to acknowledge that there was a problem would have been funny were it not that serious. (I think it also cost him the election).

Now we have a new plan whereby the WIHB is to be 'twinned' with Highland Health Board (and Orkney and Shetland with Grampian) to provide 'support' and senior managment level.

A Western Isles health service insider said: "This twinning is the thin edge of the wedge which will ultimately see the migration of good-quality jobs from the islands to Inverness.

"It will commence with partnering and then move to efficiency arrangements which will lead to the senior partner directing where posts will be located and it is inevitable that these senior posts will remain in Inverness.

Or according to the Government:

"The proposed partnership arrangements have been warmly welcomed by all those involved. They will help strengthen the island boards' management and governance regimes and will enhance their independent status."

I know which view I subscribe to, and I fully support the WIHB in their view that this must be opposed if the future independence of the Board is to be guaranteed.

Or as the Health Board source says,

"It is now more incumbent upon local MSP Alasdair Allan to ensure that his party colleague Nicola Sturgeon delivers on his pre-election promise to his constituents and the NHS unions and staff that there would be an inquiry under an SNP administration."

We're waiting......

The simple test of intent is - if it is THAT good, then why didn't Health Secretary, Nicola Sturgeon, announce this during her visit to the hospital in Barra this week?

Chief Executives...

The first little piggy (who was actually a big, bad wolf) went to an non-existent superannuated job invented by his mate who appointed him to get him away from the mess he created.

The second little piggy (who was actually a bigger, badder wolf) was sacked for building a fabricated house.

The third little piggy was the most intelligent and most effective, and moved on to bigger and better things.

The piggies' employer smiled and prepared and advert, hoping that no more wolves would apply.

Decisive action

It is good to see the Health Board taking decisive action and reducing the complement of Chief Executives from three to two.

The shame is that it has taken so long for the disciplinary process to be concluded over what is understood to be a simple matter.

Now, the disciplinary process must turn it's attention to the other Chief Executive, Dick Manson, and take early and clear decisions before he retires from his non-job with a nice fat state pension.