As part of our Ask the Auditor programme, we recently spoke with Paul Callan, retired Senior Auditor for a large West Country county council about his recent efforts to save a local in-patient care hospice and how IDEA Data Analysis was vital in scrutinising the financial data published by a local NHS Clinical Commission Group.
Prior to my retirement, some eight years ago, I had been a very keen and regular user of IDEA Data Analysis (Version 7!) in my role as a Senior Auditor in a large West Country county council. Since my retirement, I have maintained an interest in a local Hospice providing specialist and community care to its patients.
Recently, as part of the local NHS Clinical Commissioning Group (CCG) “improvement & efficiency reviews,” it was decided to review the future viability of local community ‘cottage’ hospitals. The headline message seemed to be that the powers that be had determined that care could be better delivered if these cottage hospitals were shut down and the resources devoted to nurses visiting patients out in the community.
There was a lengthy consultation process during which a lot of financial figures were shared. I was aware that CCG’s was obliged to publish monthly figures for all expenditure over a prescribed figure of £50,000 (subject to certain data protection exemptions in relation to salary payment), so I looked at their website and discovered that in a typical month there were 700/800 qualifying transactions. For whatever reason, this data was merely listed as PDF output and there was no global total provided at the end of each sheet or at the end of each month.
In order to analyse these figures properly, I would now have slog through and manually copy and paste each of the 20 pages into an excel spreadsheet. Oh, how I missed my old friend IDEA software.
As a result of this analysis, we discovered that there were large sums of money being spent on a regular basis on external Management Consultants. Those of us looking to protect the cottage hospitals made representations to save it with the aid of the media – but sadly we were unsuccessful. So, life moved on. Until another bombshell was dropped just across the county border, where my aged father was dying of cancer.
Saving the Hospice
There was a proposal to close the inpatient beds at the hospice which had offered my father help in his last days. Allegedly, the hospice had advised that it could no longer afford to maintain two separate inpatient bed sites in the county. I, therefore, joined the campaign to try and save the local hospice in the town where my father lived.
Not long before, it had become a matter of record that the hospice had received funding in excess of £2m from the local NHS CCG. The figure had been quoted at a public meeting, in which the hospice aimed to justify its decisions – including that of setting up a subsidiary company acting as funeral directors. Surely some of that £2m could be used to save the hospice? I was keen to try and verify these figures.
As before, I knew that this CCG was obliged to publish monthly figures and, given that they were a multi-million-pound turnover operation, I knew that I would be looking at thousands of lines of expenditure. Excel just wouldn’t cut it this time! Enter IDEA software!
In the hopes that they might be able to help, I contacted AuditWare, the IDEA distributor for the UK & Ireland and told them my story so far, asking if I could buy a fresh copy of what was now an old version of the technology that I had used prior to retirement. It didn’t take long for AuditWare to get back in touch, and I was both surprised and delighted to see that AuditWare were happy to provide a free academic licence to enable me to analyse the data needed for my campaign (provided I wrote a few words detailing how the software helped once all was done and dusted!).
A bright IDEA
With the latest version of IDEA now at my disposal, I delved straight in. Unfortunately, I couldn’t examine in detail the expenditure of the hospice because, being a charity, they are not obliged to publish in-depth details of their expenditure. However, the IDEA software readily absorbed and analysed the CCG’s expenditure figures.
The first thing this did was to confirm the global funding to the hospice. But perhaps, more importantly, it broke down the funding according to budget headings, which was of some use. However, it has to be said that the NHS “headline” spending details are limited to Expense Type and Expense Area. Included in the details are lots of acronyms and various bits of jargon, without a decoding index. IDEA was able to quickly summarise the various items of expenditure and then to rank them in order of spend. Much of the analysis summary of these “jargon” items meant very little to me as a layperson, but the committee was fortunate in that the campaign to save the in-patient beds at the hospice had also attracted a wide cross-section of supporters including, crucially, medical professionals who were able to “decode” the jargon for me. The IDEA analysis was then used to summarise and rank the names of payees.
The crucial second step was to then examine the breakdown of payments by individual constituent parts. For example, GP surgeries receive payments composed of many strands of funding for certain works undertaken. At this point, IDEA provided a powerful tool for people with detailed medical knowledge and training to question the legitimacy of spending by amount and area.
Our analyses demonstrated that there was a potentially “unhealthy appetite” for the use of external consultants (in excess of £500K in one financial year), and IDEA revealed that this expenditure had for a couple of years all been with a single provider.
(I recall back in 2012, I was very disappointed to read that the Audit Commission had been abolished as part of the UK government’s austerity measures (BBC News). I also recall political comment at the time suggesting that this was a retrograde step. Losing this watchdog of public expenditure would place the burden for probity on the use of public funds upon “armchair auditors.”)
Despite our efforts so far, and considerable media interest in the campaign, by this time the first of the two inpatient units had closed. More motivated than ever, and using the figures produced by IDEA Data Analysis as evidence, we enlisted the enthusiastic help of the local Somerset MP in whose constituency the hospice was situated. Using the evidence provided through our use of IDEA Data Analysis, he was able to convince the Charity Commission to launch a formal investigation into the activities of the hospice, and in particular its decision to close the inpatient units. Their conclusion was that whilst the proper procedures to reach the decision had been followed, it was, crucially, not part of their remit to decide whether that decision was correct or not.
In this instance, the use of the IDEA Data Analysis has enabled us to provide the public with much more detailed information about how their money is being spent. It is now possible for laypeople to see a full listing of spending by budget heading – which may lead to some interesting questions such as “Why is Budget X twice as budget Y?” Similarly, with a full summarised and ranked listing of payees, it is now possible for patients to question why, for instance, Named Surgery A is receiving twice as much funding as Surgery B.
The Challenging Bit
It has not been the easiest of tasks in extracting clarification of the “raw information” from the local CCG. It was necessary for me to make a personal appearance at the CCG Governors meeting and seek detailed answers on why the spending on external consultants did not appear in the Procurement Register. Their answer was that this was an oversight, due to the fact that the contract was awarded by a central government procurement process and they had merely “piggybacked” on this contract, however, they did concede that in the interest of transparency that the contract should have been declared on the Procurement Register.
One learning point to share with my fellow auditors regarding NHS expenditure reporting. It appears that the amount stated as being spent on External Consultants is actually the gross figure. In this instance, the CCG had one other partner in this project and was recharging some of the costs to them. The Director of Finance stated that showing expenditure gross was the rules of NHS England. Though how Joe Public is supposed to seek clarity and the delivery of value for money in this process, which in my opinion is obfuscation at its best, remains a mystery to me.
At the time of writing the on-going Coronavirus pandemic has put all efforts on hold in relation to closely scrutinising NHS expenditure. Nevertheless, the committee, myself, and many members of the local community are very grateful to AuditWare for proving the IDEA software necessary for us to be able to ask some very challenging questions in relation to the use of scarce public expenditure. I think that it is no bad thing for public sector firms to be aware that their spending has come, and will continue to come, under close and detailed public scrutiny thanks to IDEA. The software is extensively being used by public sector firms for this purpose anyway, and on a daily basis there is plenty of revenue recovery taking place within the public sector which is helping to protect our public purse.
They say it’s better to have fought and lost than not have fought at all. A heartfelt thanks to you AuditWare!
Paul Callan was educated in London and Somerset and spent the first 20+ years of his career in domestic banking. However, by 1997 with the contraction of branch banking network well underway, he accepted voluntary redundancy.
After a period of reskilling, he became an auditor with a large West Country County Council. His specialities included financial systems audits as well as contract audits and regular audit supervision of multi-million-pound County Council contracts such as Waste Management and Highway Maintenance. He has been retired for eight years and he lives on the edge of Dartmoor with his wife.
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