Liverpool Care Pathway - When Division Is The Rule

When the thread is unpicked the cloth frays and are we all undone. Yet, by means of that thread may we yet find our way back through the dark wood?


Are we witnessing not merely the break up of the United Kingdom into its constituent parts but the division of England into constituent parts?

And to what end and for what purpose might that be?

The Strategic Authority: To empower the people or to diminish democracy

Divided, they rule.

Not empowerment of the people, for the people, by the people but the impoverishment of parliament.

The nuts and bolts of division: Does it all add up?

Nomenclature des Unités Territoriales Statistiques (NUTS) -

- europarl.europa

A standard for referencing the subdivisions of EU member countries developed and regulated by the European Union. The NUTS is instrumental in delivery of the EU’s Structural Fund.

In the UK, nine regional development agencies (RDAs) were established for the purpose of development, primarily economic, of England's NUT Level 1 Government Office regions.

These were non-departmental public bodies (NDPBs), otherwise known as quangos, and worked as arms length external bodies.

Apart from the London Assembly which adopted a mayoral system, these were low profile and non-elected.

RDAs or RSGs?

Local enterprise partnerships (LEPs) between local authorities and businesses set up by the Department for Business, Innovation and Skills replaced the RDAs to carry out similar functions.

- LEP Network

European funding is being directed to the LEPs. Eric Pickles (Department for Communities and Local Government) announced last year that €3.6 billion (approximately £2.9 billion) has been allocated from the European Regional Development Fund Operational Programme by the Commission. This is to fund the England European Regional Development Fund Operational Programme for 2014 to 2020.

- EU ERDF

A single European Structural and Investment Funds Growth Programme for the 2014-2020 funding period has been set up to combine three separate European Funds. These are the European Regional Development Fund (ERDF), the European Social Fund (ESF) and part of the European Agricultural Fund for Rural Development (EAFRD). The total European Regional Development Fund for the 2014-2020 funding period is €3.6bn. This sum must be supplemented by national public and private funds.

Mr. Pickles said:

We have abolished unelected regional quangos that were previously in charge of the schemes and given an important role to local enterprise partnerships and other local partners to shape and influence how the money is spent.

We also believe local partners should have a direct role in decision-making outside of a formally delegated arrangement, to further increase local engagement. The European Commission ruled this out however, as not being compliant with European Union regulations.
- Written Statement

Breaches of the rules set by the European Commission resulted in £236million of financial liabilities in penalties when the fund was overseen by the RDAs.

- European Regional Growth Fund

The Department for Communities and Local Government (DCLG) also oversees the European Territorial Cooperation (INTERREG) programmes which funded the ‘Transmanche’ and renaming the English Channel ‘Le Pond’.

Funding follows a convoluted route, as UK contributions paid to the EU budget, allocated to the European Regional Development Fund to fund the Regional Growth Fund.

For the 21^st year in a row, the EU budget was approved even though irregularities showed up, this year some 4.4 per cent of the budget amounting to £102billion.

Information on the Regional Growth Fund (RGF), updated 4 December 2015 -

The Regional Growth Fund (RGF) has supported eligible projects and programmes raising private sector investment to create economic growth and lasting employment. Since its launch in 2010 it has invested £2.7 billion to help local businesses grow and take on more staff across England.

On average for every £1 invested through the RGF, the private sector has put in £5.50 with the total investment of private sector support expected to be £16 billion. 149,000 jobs have already been created and a total of 581,000 are expected by the mid-2020s.

Businesses across all industrial sectors benefit from the funding with over £1.1 billion invested in manufacturing including:

• £364 million in the automotive industry

• £100 million in aerospace

• £104 million for low carbon enterprises

Following the 2015 Spending Review, no future rounds of the RGF are proposed.

From the LEPs have come devolution bids for the formation of combined strategic authorities.

The Greater Manchester Combined Authority ('Devo Manc') has powers over housing, skills and transport. It appears NHS England will remain responsible for many of the budgets being delegated to Greater Manchester under the devolution programme as it is employing the region’s new chief officer. That is not to say that the NHS could not be further devolved of itself.

Councils and clinical commissioning groups in Greater Manchester are being encouraged to integrate their commissioning functions, as part of the region’s devolution project and take control of the region’s £6 billion health and social care budget.

So-called 'Devo Manc' is not alone.

Here is Gosport Borough Council on the HIOW -

Hampshire and the Isle of Wight's devolution proposals have paved the way for what Chancellor George Osborne has called "the biggest transfer of power to our local government in living memory".

Of all the devolution bids submitted to government, the ambitious region led the way in pushing for full devolution of business rates. The concept has been well received as the Chancellor announced [5 October] it will be rolled out nationally, meaning councils across the country will benefit.

While many details remain to be confirmed by the Government, the announcement comes as an early endorsement for Hampshire and the Isle of Wight's devolution bid, and further increases optimism around the plans as negotiations with central government begin in earnest.

Full devolution of business rates is central to the proposals and would see councils giving up government grants in return, making them independent of Westminster and linking the prosperity of the public sector to the success of local business.

Following last week's announcement of a devolution deal for South Yorkshire, more successful areas’ bids are expected to be named in the coming days, while it is hoped the Hampshire and the Isle of Wight deal will be announced later this year.

The area's devolution proposals are set out in a prospectus submitted to central government on behalf of 15 councils, two local enterprise partnerships and two national park authorities. The bid has also received the support of Hampshire Constabulary, Hampshire Fire & Rescue and NHS England Wessex.

Should the proposals be successful, the ambitious nature of the devolution deal and number of partners involved mean it could become a blueprint for cities and regions across the country to follow.

This is the HIOW prospectus -

Dear Ministers

The 15 local authorities, two Local Enterprise Partnerships and two National Park Authorities in the Hampshire and Isle of Wight area, together with our many partners, have worked collaboratively and successfully over a long period.

We are now taking a momentous step together in seeking devolution, to gain greater control of the decisions that affect the residents and businesses whose interests and wellbeing we put first. We are doing so in order to increase the productivity of our economy and our public services.

This requires long-term planning and investment and sustained local commitment that is not dependent on changing national priorities – which is why we are asking to be entrusted by Government with a radical degree of freedom and responsibility.

This Prospectus is our offer for a devolution deal with Government. If we can reach agreement, we will see new powers and investment transferred from Whitehall to Hampshire and the Isle of Wight, so that we can manage our area’s affairs locally and engage our communities more closely. This will simplify our accountability, and give residents and businesses more control over the issues that matter to them. There will be no expensive reorganisation. We have agreed that new powers will be exercised transparently and through existing bodies as far as possible, with area-wide arrangements only used where this will promote strategic working or reduce bureaucracy and cost.

HIOW will forego Revenue Support Grant and other grants in exchange for retention of 100% business rates generated within the area, ensuring fair distribution locally and securing the financial sustainability of the Isle of Wight.This will deliver local jobs and homes and reduce the national welfare bill.

In return for sufficient commitment from Government on infrastructure and land release, HIOW will accelerate housing delivery, completing two years early our Local Plan commitment of 76,000 homes by 2026. As part of this deal we will also go further and increase delivery by an additional 500 homes a year in priority categories: rural affordable, low-cost starter, council new-build and extra care, making use of exception sites and prioritising redundant public land.

This is how HIOW looks -

HIOW has a complex economic geography. Substantial urban settlements, primarily in the south and north, contrast with large open areas interspersed with market towns and villages. This diversity gives our area great strength, but also means that there are variations in productivity, educational attainment, employment, housing and health; for example, between north/south, urban/rural and Island/mainland. Our two LEPs (Enterprise M3 and Solent) share the same goal of fostering growth, with different emphases reflecting the diversity of the area: specialisms such as aerospace and defence are shared while others such as marine and pharmaceutical are more locally clustered.

And the LEPs -

HIOW is seeking Intermediary Body (IB) status for the EU (ERDF, ESF and EAFRD) programme for 2021-2028, giving HIOW control of the EU programme.

An Intermediate Body as defined in art. 2(6) and as referred to in art. 59(2) of the Council Regulation (EC) No 1083/2006 is eligible to submit a proposal, provided that it is an authority and is in charge of ESF evaluation. It would be advisable that the Intermediate Body inform the Managing Authority about its application,
- ec.europa.eu

HIOW has its focus set to:

Align local funding including working with Managing
Authorities on focus on EU programmes across HIOW.

Consider innovative business investment initiatives requiring critical mass across the HIOW area - e.g. a Regional Investment Bank or through an expansion and Equity Fund.

Align Local Growth Fund, European Regional Development Fund (ERDF) and European Agriculture Fund for Rural Development (EAFRD) focussed on key sectors, innovationand export support.

Intermediary Body (IB) status for the EU (ERDF, European Social Fund (ESF) and European Agricultural Fund for Rural Development (EAFRD) programme for 2021-2028,giving HIOW control of the EU programme.

This will allow us to align local resources and partner organisations, EU Structural and Investment Funds (ESIF) available for R&D,sector development and export support.

Access EU and other energy efficiency funding

Mr. Osborne has his focus also set.

In Europe, the transition of power has always been to the centre.

Any apparent support for autonomy of the regions/nationalities is subordinate to this project.

HIOW will complete the health and social care project.

HIOW will share core capacity to reduce the cost of service outcomes; develop transformative digital platforms; reimagine public services; deliver a single adoption service; and pursue innovative approaches to health and social care integration and ‘blue light’ collaboration.

Our strong tradition of collaboration brings together many high-performing bodies as well as our extended public sector family, including Health bodies, Hampshire Constabulary and Hampshire and Isle of Wight Fire and Rescue Services.This broad and capable partnership provides a platform for the successful delivery of our devolution proposals.

The HIOW partners will undertake a full governance review, exploring all options including a Combined Authority with a directly elected mayor as well as other forms of democratic governance, such as committee governance and executive arrangements, to determine the most appropriate, robust and cost-effective governance solution for the HIOW area.

This will be developed on the basis of partners’ agreement to support proposals for a HIOW Combined Authority, building on partners’ existing powers, responsibilities and boundaries, and the outcome of our negotiations with Government.

The role of the LEPs in the governance arrangements will be considered as part of the governance review on the basis of the LEPs’ agreement to support proposals for a HIOW Combined Authority, building on the LEPs’ existing powers, responsibilities and boundaries. The LEPs will rightly play a key role in influencing proposals and funding related to theeconomic prosperity of HIOW.

We are committed to engaging the public and all relevant local partners in our governance review, including our eight Clinical Commissioning Groups and wider health partners, Hampshire Constabulary and the Police and Crime Commissioner, Fire and Rescue services, parish and town councils and the voluntary and community sector. Should our proposals be agreed as part of Spending Review 2015 we would expect to conduct a full public consultation in the spring of 2016.

We will maximise our productivity potential and make a direct contribution to the £22 billion NHS gap by accelerating innovative approaches to health and social care integration. Our devolution proposals build on our existing Vanguard pilots and relate to expenditure of £2.7 billion per annum.

The Vanguard pilots:

Isle of Wight’s ‘My Life a Full Life’ vanguard, Hampshire County Council’s Integrated Personal Commissioning vanguard, Southern Health NHS Foundation Trust’s Better Local Care Multi-speciality Community Provider vanguard and North East Hampshire and Farnham CCG’s vanguard.

This is My life a full life –

The HIOW focus on the increasing pressure of a ‘large and growing elderly and ageing population’ on health care resources:

HIOW is home to large and growing elderly and ageing populations and this cohort is increasing pressure on health, care and other services. The demographics for the area will present further challenges in the years ahead, particularly to meet an increasing population with multiple morbidities and the demand for locally-based community health and social care services.

As part of a devolved approach the local authorities and other agencies and Trusts will work with NHS England and the relevant Clinical Commissioning Groups will work together to address these problems.

Our proposal, while recognising the need to reduce pressure on A&E admissions, and the speed of and requirement for improved hospital discharge arrangements, will be the mechanism and plan around which NHS England, our Clinical Commissioning Groups (CCGs) and local authorities would pool resources across the area. It will provide the basis for the development of a shift of health and social care resources towards locally-based community services and early intervention and prevention strategies.

Ultimately we believe that our plan will require greater local control of existing social care and health budgets in return for improved health and wellbeing outcomes across the area.

My life, a complete life...?

HIOW, like Devo Manc and others, is pinning its future on EU funding provision and assuming control of the EU budget.

Have they nailed their colours to the mast...?

There is ample provision for the Smart Alec and an economy of favours not at all favourable to transparency.

Additional reading -

Liverpool Care Pathway - When Justice Must Be Bought And Those Who Seek It Punished

Liverpool Care Pathway - When Creep Comes To Slide

Liverpool Care Pathway - A Renegade State

Liverpool Care Pathway - Litigating The Litigants

And, yes, this is a ‘grey old island’... of mist and mellow fruitfulness and close bosom-friend of the maturing sun!