Select Committee on Public Accounts Minutes of Evidence

Examination of Witnesses (Questions 140 - 154)



  140. Have you sat down and developed a model that you know is the approach, that if you do not drag them in, if you do not have shared objectives from day one, it is not going to work?
  (Ms Casey) In the rough sleeping world obviously we rely very heavily on local authorities and ourselves in the unit to work with consortia of people who are brought together to agree whether they want to ensure that people do not have to sleep rough in their area or not. Those that buy into it work very effectively. Some are funded, some are not funded, but they buy into the central goal which is "we do not want Birmingham to have people sleeping on its streets, we do not want people dying out there, we want to do something about it". There are, however, people who stay outside that tent in the voluntary sector who, as Naomi said, for all reasons want the world to be different and they must carry on and do that and they raise their funds and do things in their own way. The critical thing is the Government is elected, gets a bunch of ministers, they decide they want rough sleeping sorted, they delegate that to people like us, we then work with consortiums who buy into that shared goal and on the whole most of the time there are ups and downs, as always in life, partnership is not easy, delivery is very, very hard, but we get there and hence in my little bit of the world you have seen the numbers consistently come down over two years.

  141. In my part of the world in Staffordshire we have got this association of drug and alcohol groups who have come together as a county-wide unit working very, very effectively and it looks like a model which we may be able to roll out across the country. Do you work on similar models in your own areas, models that can be rolled out from one area into the next one?
  (Ms Casey) We certainly do in rough sleeping and some of the drug action teams who are a bunch of people who are brought together to try to sort something out have based their models on the rough sleeping consortiums. There is plenty of stuff out there to learn from but it comes back again that you can sit in a room and have long consortium discussions until the cows come home, but the question is will that group actually then deliver out there on the street even in the world of drugs misuse or in the world of rough sleeping?

  142. There are key points that need to be met to make progress. If you are not meeting those key points you are not making progress.
  (Ms Casey) Exactly.

  143. You should be getting models together now to enable you to pass them out to other groups.
  (Ms Casey) We do, yes.

Mr Williams

  144. I think my colleagues have covered all of the grounds really. I think all of us as members of Parliament having to deal with our surgeries and constituency cases get frustrated at the number of organisations you have to write to try to get to the bottom of one constituent's problem. We also tend to live in a world with a democratic illusion that a minister has a magic lever he pulls and when he pulls it things actually happen inevitably as result of it. If we look at paragraph nine, which the Chairman referred to, on page three, the point made there is that not all organisations are sufficiently committed to joint working. It uses Rough Sleepers Unit as an example, but I think that would probably apply to most of them, "the Rough Sleepers Unit have found in some instances when it is not providing direct funding that it can be difficult to influence local authorities and NHS Trusts". Is this not the reality, that at end of the day it is a recognition of he who plays the fiddle calls the tune. Whoever has the money is eventually going to determine what happens, but whether that is cooperation largely depends on the income flow of the grant flow. Is that too cynical?
  (Mavis McDonald) That is rather cynical, because it assumes that sometimes spending small amounts of money to bring people together will not impact back on the wider behaviour of organisations. I think both the Rough Sleepers Organisation and Sure Start are helping, and have had some of that effect, as Louise described. I think some of the developments at local authority level round joint partnership, which might encompass a wider range of activities at the sub tier level, one expects to see influencing the behaviour of different bodies. I can quote what I think is a reasonably good example at national level, and others might want to join in. I think some of the work that was done round Neighbourhood Renewal brought in health impact issues and public health issues and brought people into an arena in which they did not normally find themselves. One of the results of that is that at local level in New Deal for Community areas and in local partnerships we have found a much greater buy-in from the public Health Service at a different kind of level. We are now going to have the public health arm and performance measurement arm of the Health Department and the National Health Service co-located alongside the Regional Offices so that they can be part of strategic discussions round the delivery programme that the regional offices are responsible for. I think you can track through changes in thinking from small programme beginnings.

  145. I was not referring to individual programmes. The implications of what you just said is in fact that you are trying to recreate the old advantages of centralisation, you were talking about the local and the central department needing to get together, and that is referred to in paragraph 10, some of the organisations involved in local partnerships told us were concerned about the behaviour of central departments. How far are you satisfied that what you are doing is going to produce long-term changes? As Mr Gibb said, it is very difficult to quantify. I think the NAO in its report does say it is too early as yet to assess. We want it to work. What conviction should we have that it is going to work in the long-term?
  (Mavis McDonald) It seems to me what we have started to get is a much clearer set of objectives in terms of what is the desired end result across a whole range of policy and there is much greater clarity about the interaction between the policies than there was. They have all been addressed in a variety of ways. If you add to that the fact that we are now very conscious of the need to be much more aware of the actual impact of what is going on on the ground; we are monitoring, we are trying to read and feedback quickly what is working and what is not working, it is running best practices, then I think one could be optimistic in saying that we will have more success. I think I would not be saying confidently to you I am sure we have everything in place to ensure that happens. There are a number of issues, from accountability to main streaming to sustaining the impetus of it over time that you get from when you first started initiatives and how you revisit it and re-energise it, which is something that the NAO pick up. Things change round all of the time. The base position is not static, other things are taking place at the same time, which you have to look at and feed in to. If you are looking at places, is the economy changing, and different places are facing different impacts, you might be able to refocus and readdress some of the issues you are handling.

  146. This Committee is essentially about accountability and if you look at page 21 it says there, "If Parliament is not able to identify total expenditure and outcomes achieved by the joint initiatives then Parliament cannot take assurance that taxpayers' money has been well spent". If you then leave that and jump to page 40 where they deal with two initiatives, the one relating to rough sleeping and the action one relating to childcare, again I am not interested in the question about the individual case, I am more interested in the footnote, if you look at footnote 1 it says, referring to the figures in Table 15, "Cost is central government expenditure only in real terms at 2001 prices. Data on other spending directed towards reducing rough sleeping or creating childcare places by local authorities, voluntary agencies and businesses is not available". Coming back to Mr Gibb's point about the nebulous of the study, how can we know if we do not know the full cost, whether the government is bearing a fair load, whether it is just taking on other peoples' load or whether others are made to carry more because government sums are going down in one programme while going up in other? It is very difficult for an accounting Committee to judge with that sort of information, is it not, or lack of information?
  (Mavis McDonald) As Louise has already said you need a much wider range of data before you can make a proper cost benefit analysis and evaluation of the cost effectiveness of these kinds of programmes. That is where I think you do need to do a full evaluation. If you look at the report that started off rough sleeping, you have a clear guide as to where you might be looking to find where the potential savings are, because if you are preventing people coming on to the streets then you are changing the position in terms of the numbers of people who are very expensive to deal with as individual cases. Hopefully the better your prevention programme is the more you address the number of the kinds of problems that led to the congruence of the growth of figures of rough sleeping in the early 1990s.

  147. Do you not perhaps feel that structural change might make it easier rather than trying to get changes in long-term attitudes of people who administer these programmes?
  (Mavis McDonald) I think structural change might well work in certain cases. I quoted the DWP and Job Centre Plus Agency as one example.

  148. Are you going to make any recommendations to that effect to ministers? If you feel structural changes are desirable do you see it as part of your job to tell ministers that an easier way to deal with this is to alter the structure rather than to try to alter attitudes?
  (Mavis McDonald) Yes. In any studies that the SEU do or the PIU do or we do ourselves in the Cabinet Office, if that looked like the right answer then we would say so. I think other departments too would make the same recommendations.

  149. Who decides? We can see that most of these are ministerial initiatives but do you have an initiating power yourself or do you make recommendations to ministers on areas where you think the exercise you are involved in could be of advantage?
  (Mavis McDonald) Just to quote two examples that I am most familiar with, both the Performance and Innovation Unit and the Social Exclusion Unit work with ministers but they work with departments in terms of analysing where they think the most immediate requirements and needs are. Both of them work to various oversight committees which are also capable of bringing their own views to bear on what should be done. The strategy, as it were, for what is looked at can be managed in the same way as any other kind of strategic approach.

  150. Oversight committees and so on, it is all rather labyrinthine.
  (Mavis McDonald) Some of them at ministerial level I mentioned before. There is the Ministerial Committee on Social Exclusion, for example, which sees part of its task as looking at what the current agenda is, who is handling it—not all work on social exclusion clearly is done within the Social Exclusion Unit—and deciding as part of that whether there are any particular issues that are being missed. Similarly, the Chancellor in setting up the spending review takes an overview of where in terms of money being spent and issues being addressed he thinks it is appropriate to recommend to his colleagues that there ought to be a cross-cutting review and ministers also engage in steering committees across relevant departments.

  151. One area that keeps recurring with us, whether we are dealing with the problems of the elderly or waiting lists, for example, is the bed blocking issue. Who is responsible? Is the NHS responsible? Is the Social Security Department responsible? Who should move first when they are separate decision making bodies with separate funds to break through this blocking system? Is that something that you feel could usefully be addressed or is it in the process of being addressed to your knowledge?
  (Mr Mitchell) It is to a certain extent in the process of being addressed. The kinds of problems that produce bed blocking are a variety of things like the lack of availability of sufficient professional therapists in hospitals to give older people with broken legs the therapy they need to get out, it can be the lack of availability of people to assess them for what is required, it can be the lack of availability of flexible domiciliary services for people at home or it can be the lack of residential or nursing home places for them to go to.

  152. May I say I appreciate that and I promise you from our own analysis we are aware of that. Since there has been an awareness of that mix of practice and mix of responsibilities for a long time, all I want to know is is it now going to be addressed? Is there something similar to what we have been talking about either devised or already operating in that area?
  (Mr Mitchell) It is certainly being actively addressed because the Secretary of State for Health was recently allocated additional funding to tackle bed blocking both in this year and next. The Department of Health has been charged by the Chancellor of the Exchequer in making that allocation to work out what really are the problems to be tackled here and how can this additional money be used to best effect to get at this problem. It has to be said that this links to the reorganisation of the National Health Service going on at the moment and the creation of care trusts which are now possible where it will be possible for the responsibilities for older people in any particular locality, the commissioning of services for those people, to be vested in a single organisation. That is permissive, it is not compulsory.

  153. Finally, in the Cabinet Office would you be involved in helping to develop a more integrated system in relation to this particular problem or is this something that would be dealt with completely by the NHS as the paymaster?
  (Mavis McDonald) We could be. It is the kind of thing where the secretariats, the people who service the Cabinet Committees and the sub-committees, could be asked to take this issue and go away and do an analysis of the problems of who needs to do what to try and resolve it. It could be the sort of thing that the PIU would be asked to do a study of if there was not work already in hand, which as Stephen says there is, we are not sure either of us who is leading it. It could be the kind of issue where the Prime Minister could ask for a separate committee to be set up to look at what was required at ministerial level.


  154. Thank you very much, Ms McDonald, for coming to answer our questions this afternoon. This is, of course, a nebulous subject but for all that a very important one. We hope that you will keep Government joined up and held to account once the political pressure has died away and you are working against the grain of Whitehall. Thank you very much. Certainly speaking for myself may I say that we particularly thank Louise Casey who obviously feels passionately for her cause. It is good to have a passionate civil servant occasionally. Thank you very much.
  (Mavis McDonald) I hope you do not think that the others of us are without passion.

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