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Waterloo sunset

We submitted our reference costs for the 2017-18 financial year a few weeks ago. After weeks of number crunching and analysis it’s always a relief to wrap things up by inserting the final cost and activity figures into an all-singing macro-enabled spreadsheet and press the button that sends it winging across London to the Waterloo headquarters of NHS Improvement, the health service’s financial watchdog. Responsibility for overseeing this annual costing exercise transferred from the Department of Health to NHS Improvement in 2016 and they collect data from 234 NHS trusts across England and will publish the results later in the year.

By my reckoning it’s the fifteenth time in the last 18 years that I’ve worked on reference costs for three different NHS trusts – I’m something of an old hand at this game now. They’ve been collected annually since 1997 and are defined as “the average unit cost to the NHS of providing defined services to NHS patients in England in a given financial year” – typically an average cost per inpatient spell, or outpatient attendance or contact. The information, once published, has a multitude of uses not least as the national average costs that are derived from it form the basis of the set of prices (or national tariff) that are paid by commissioning bodies to providers of acute services in the so-called “internal market”.

But they are also used to answer questions in Parliament and to respond to queries under the Freedom of Information Act about how much NHS care costs and used by journalists to write the next big headline about how much money the NHS is “wasting” on this, that or the other. So earlier this year when the Daily Express plastered the headline “bed blocking costs the NHS £3 billion per year” on its front page the chances are that the costs bit of that headline was a hastily scribbled calculation on the back of an envelope based on figures extracted from the annual publication of reference costs – data that is available on NHS Improvement’s website for everyone to view whether you are a journalist, a politician, a patient or simply someone who is keen to learn a bit more about how much the NHS costs. So if you live in Barnsley and would like to know how much, on average, it costs your local hospital to treat someone with a urinary tract infection you can find this out (it’s £1,691 in case you’re interested). Or likewise if you reside in Barnet and are curious to know how much it costs for a child to be seen by your local child and adolescent mental health team the details are there too buried deep in the reference costs publication (I’ll let you work that one out for yourselves).

And this data, in turn, is based on figures that have been sweated over by cost accountants at more than two hundred NHS trusts, quite literally in the searing heat of this summer (air conditioning in an NHS finance department? You having a laugh?). Unlike management accountants harping on about budgets and variances or financial accountants with their fixation with debits and credits and balance sheets we cost accountants are striving to link the pounds and pence that the NHS spends on patient care to the patient “activity” (in the form of a spell in hospital as an inpatient or an outpatient attendance for instance) that we actually spend that money on. But when each NHS trust spends hundreds of millions of pounds each year treating hundreds of thousands of patients it is no easy task.

The role of the cost accountant is often portrayed as an unglamorous one – the very back of the back office populated by introspective nerds who prefer spreadsheets to social interaction. And there may be some truth in that – when was the last time, for instance, you saw Anna from finance quizzing Jac Naylor about the costs of her cardiothoracic surgery on Holby City? The reality is that Anna’s probably sent Jac an email with a bamboozling spreadsheet attached to it inviting her to comment but Jac’s likely to have ignored it as she’s a busy surgeon and, quite frankly, hasn’t got the time to engage in this financial nonsense. And as Jac, whilst recognised as a brilliant surgeon, can be a bit volatile at the best of times and Anna, who is also very good at her job but doesn’t let on about it, tends to shy away from confrontation, the email is neither replied to or followed up on. It can be tricky to get “clinical engagement” with the costing process at the best of times. As an aside, if there are any Holby scriptwriters reading this (unlikely but, hey, nothing ventured) then please message me as I have several ideas for a future costing based episode <inserts winking eye emoji>.

But, joking aside, the role of the NHS cost accountant can be an interesting and immensely rewarding one and behind the production of the annual accounts which are a legal requirement for all NHS organisations reference costs are arguably the second most important piece of work to emerge from an NHS finance department each year.

When I first joined the NHS in 1990 specialty cost statements, introduced in the late eighties, were the only attempt to assign costs to clinical activity. The costs were compiled by District Health Authorities for all the hospitals in their area but only covered a limited number of specialties and there was criticism that the costs did not account for the mix of cases treated by different hospitals. “Case mix” was far from a new concept – there had been calls for costing information to account for case mix as far back as the 1960s and ultimately this lead to the development of healthcare resource groups (HRGs).

The introduction of the internal market in 1990 led to something called “costing for contracting” – the production of cost-based prices to be charged by provider trusts to purchasers of healthcare such as District Health Authorities and GP fundholders. Most of this was done on spreadsheets and, unlike the national tariff introduced later, different prices could be charged to different purchasers for the same activity. Oh what fun we had during the contract negotiation season, munching on our late night pizzas, crumbs going everywhere, shifting costs from one purchaser to another in order to be competitive on price like less good looking versions of Bud Fox in a low budget production of Wall Street.

Reference costs represented an attempt to introduce a more standardised approach to costing and to provide a measure of the relative efficiency of different providers through the collection of cost information from all hospitals for benchmarking purposes. The first reference costs collection was for the 1997-98 financial year and marked, at the time, a significant step up in hospital costing to identifying a cost for a group of clinical procedures or treatments that were clinically similar and consumed similar levels of resources – the aforementioned healthcare resource group or HRG.

Previously a view prevailed that it was not possible to attach an accurate cost to a procedure or treatment as no two patients were the same – the variability of patients, doctors and diseases makes it difficult to assign costs with any degree of accuracy but the introduction of HRGs represented an attempt to get round that problem. However even when two patients have the same condition and are treated by the same doctor on the same day who is to say that their costs will be similar?

As a management accountant at a small northern mental health and community trust in the late nineties I remember a booklet introducing reference costs being plopped down on my desk and taking it home to learn more. We purchased a new piece of software shortly afterwards that would assist us in calculating unit costs for each of our services but it was not until 2001 when I took up my first costing role at an acute hospital that I got properly involved in actually calculating reference costs. Since then the annual reference costs exercise has tended to dominate my summer months. Holidays put on hold. Gorgeous summer evenings spent in the office. Bus journeys home spent scrutinising the 200 page tea-stained document known as the annual reference costs guidance. And worldwide and personal events framed by how reference costs is going.

While Brazil were beating Germany in the final of the 2002 World Cup in Japan I was sat in a portacabin in Mansfield frantically trying to complete our reference costs on time whilst listening to the match on the radio. In an Edinburgh strip club on my brother’s stag do in the summer of 2005 I found myself repeatedly tuning out of the flashing lights and scantily clad dance routines to ponder how I was going to clear all the validation errors in our reference costs return when I got back into the office the following Monday. What a saddo. A year later and I was trying to convince a maxillofacial surgeon, who was one of the finance department’s most outspoken critics, of the merits of reference costs. After weeks of meetings and emails and scrubbing up in theatre to watch an operation being performed we had managed to produce a set of average costs per procedure that we both felt were robust and clinically meaningful. And in 2008 when I moved down to London I got to experience patient level costing for the first time and witness at close quarters what a mini-industry it had already become.

As with most occupations we like to think that we’re continually improving things but in reality hospital costing information was being produced more than a hundred years ago – largely as a means of measuring the relative efficiency of different hospitals but also, interestingly, during the second world war this costing information was used as the basis of funding different hospitals for treating additional patients as part of the war effort. But reference costs as we know them are set to disappear soon as our Waterloo-based watchdog seeks to replace them with an annual collection of patient level costs from all provider trusts.

Many trusts have been costing at patient level since the mid-noughties but soon it will become compulsory for all 234 provider trusts – each one required to either upgrade their existing system or purchase new costing software (a new costing system typically requiring an initial outlay of between £30k and £100k) that meets the requirements of NHS Improvement’s Costing Transformation Programme. Half a dozen suppliers offer systems that claim to be CTP compliant but, and here’s the catch, there are significant doubts about the compliance of at least one of those systems and NHS Improvement, when pressed on this, are unable to clarify whether a system definitely meets the criteria set out in the CTP or not. Seemingly the risk of being sued for loss of business by one of these suppliers overrides NHS Improvement’s primary objective of offering support to NHS organisations to deliver high quality patient care.

According to the latest census by the Healthcare Financial Management Association (HFMA), published earlier this year, there are 16,443 finance staff working in the NHS in England, accounting for less than 1.4% of the 1.2 million staff that work in the English health service. And of those finance staff, 352 were employed in costing roles across 234 NHS trusts in England (little more than 2% of the finance staff that are employed by the NHS) – equating to an average of around 1.5 costing accountants per trust. It’s apparent therefore that this is a specialised role that often requires you to look beyond your own organisation for advice. A costing lead often reports to a deputy director of finance who may have scant knowledge of the intricacies of costing so the opportunity to ask your manager or a colleague for advice is much reduced.

As a result it’s perhaps no surprise that something akin to a goalkeepers’ union formed in the early years of reference costs and it, somewhat bizarrely, provided my first experience of using an internet discussion forum as the Department of Health established a forum for those involved in costing to ask questions and exchange views. Although Department of Health staff offered some advice on the forum it quickly became a means for cost accountants all over the country to help each other out and became an invaluable source of information, and something of a comfort blanket, at the time for relative newbies like me. As was our local costing group that met regularly and brought together costing leads from across South Yorkshire and the East Midlands – we discussed problems, often had a good moan, but came up with solutions too. The likes of Sue from Derby, David and Trevor from Sheffield and Julia from Rotherham were experienced cost accountants and I learnt loads from them in those early years.

There were some who questioned the accuracy and usefulness of reference costs with its emphasis on averages and there were always rumours that some trusts paid little attention to the annual costing exercise, doing the bare minimum necessary to get through, but it was clear that many trusts with experienced costing staff spent many months on the exercise during which their costing teams built up a wealth of knowledge about the services that their organisations provided. In all my years working in NHS finance departments I’ve met very few finance professionals who are as knowledgeable about their organisation’s “business” as this group of cost accountants.

In the dash for the nirvana of patient level costing it feels like we’ve lost a little of that curiosity, empathy and genuine interest in what we are doing in favour of an almost robotic churning out of huge volumes of numbers that can be fiendishly difficult to interpret. All the while having to acknowledge that what we’re trying to do – accurately cost every single patient that our organisations see or treat or operate on (including every single dressing or drug or stitch or cup of tea they drank or minute they spent with a nurse, doctor or therapist) – is ultimately impossible and what we end up with is merely an approximation of the true cost just as reference costs are. The jury is out on whether the CTP will be successful and whether investment in yet more new systems (not an area where the NHS has a great track record) will be worth it all in the end. They’ve had their faults but I, for one, will be sad to see the sun set on reference costs.

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From remembering Denis to table tennis

A piece I wrote for a recent edition of FC United of Manchester’s matchday programme on the club’s work in developing participation in sporting and other activities in the local community during 2017-18

Some supporters may be unaware that FC United of Manchester’s first team coach Tom Conroy is also the club’s sport development manager, a role that seeks to encourage participation in football and other sports in Moston and north Manchester for people of all ages and backgrounds. The work undertaken by the club in the local community over the last year was set out in a sixteen page report prepared by Tom for July’s board meeting and makes for fascinating reading. It’s available to read online, as are all the monthly reports shared by the board following its monthly meetings, simply by logging onto the members’ forum.

Whilst, on the football front, the men’s first team inevitably attracts the lion’s share of our attention the report highlights that a staggering 84 football teams currently use the facilities at Broadhurst Park on a weekly basis either for training or matches or both. This includes a number of Moston Juniors teams as the relationship with our partner football club has strengthened over the last twelve months and we have begun to work together more closely and develop a joint action plan. For instance, it is hoped that the development of the Wildcats girls’ football team, which sees us running weekly football sessions for girls aged 5 to 15 years, will lead to the formation of a Moston Juniors girls’ team that may ultimately provide a pathway to the FC United women’s team.

The facts and figures on our football development work come thick and fast in Tom’s report. A weekly pan-disability football session takes place at Broadhurst Park and we now have two disability football teams that play in the Greater Manchester Ability Counts League. The East Manchester Junior League continues to use Broadhurst Park for matches as thirty six teams and around 350 children play on the 3G pitch on Saturday mornings. A group from Freedom From Torture, a charity that provides support for victims of torture who arrive in the UK as asylum seekers, hold weekly football sessions on the 3G pitch and also took part in the Refugee World Cup in Manchester in June – FC United was the only football club involved in this tournament. Walking football sessions have proved popular with two weekly sessions at Broadhurst Park and a number of friendly matches with walking football teams from away teams took place on the 3G pitch prior to the first team’s match on the main pitch last season. And 2017-18 saw us begin to provide weekly football sessions for adults with mental health issues and may see us create a mental health team in future.

The development of other sports is not only one of the club’s strategic objectives but also one of our commitments for securing funding from Sport England and Manchester City Council for the building of our Broadhurst Park home. Few supporters may be aware for instance that, in partnership with Table Tennis England, we have purchased two table tennis tables for use in the community cabin and there are plans to establish a table tennis club in future. Similarly our school summer holiday multi-sports camps which see us working with the North Manchester Sports and Activity Forum to provide opportunities for kids to take part in a whole range of sports in the school summer holidays may also fly under the radar. Over eighty kids took part in sports such as cricket, athletics, tag rugby, football, dodgeball and baseball during the summer holidays in 2017 and this summer more than 150 were registered to take part.

But the club’s commitment to its local community stretches beyond participation in sport to encompass a whole range of non-sporting activities as we aim to offer a site that is of genuine value to the local community and is open and accessible to people of all backgrounds. For the second year running the club opened on Christmas Day to offer some festive comfort to local homeless people and this year that commitment expanded beyond the festive period to working with other organisations to help homeless people across the city including providing support (in the form of warm clothing, food and blankets) for a local mosque which had opened its doors to provide warmth and shelter for rough sleepers during bitterly cold weather earlier this year.

Meanwhile the Sporting Memories group continued to tackle the problem of social isolation with its regular Friday afternoon get together of around a dozen older football supporters, swapping sporting tales over a brew, even featuring in a piece in the Daily Telegraph last December as they reminisced about Manchester derbies in years gone by (including Denis Law’s infamous backheel). The group has been such a success that there are plans to take this on the road to care homes and sheltered housing and work with those that can’t necessarily make it to Broadhurst Park every week.

As Tom’s report explains there are plans to expand our community work as we use the soon to be opened redeveloped space under the St Mary’s Road End terrace to reach out to more community organisations and offer space for meetings, events and a range of activities including fitness classes, yoga, tea parties and weight training. And, as NHS budgets are increasingly stretched, we will also utilise this space to promote healthier lifestyles that will include us hosting a range of health clinics and drop-in sessions for local residents in partnership with local NHS organisations.

What happens on the pitch will always be our bread and butter but off it as we wrestle with the challenges of operating a sustainable, successful, fan-owned, democratically run football club Tom’s report offers a reminder that we can make a major contribution to creating a happier, healthier and more resilient community in Moston and across north Manchester. There’s much to be proud for all of us that own and support this football club.

Here to stay

 

A follow-up to a piece I wrote back in the summer of 2016 (Hey, we beat you guys) about a good friend of mine, and former work colleague, who had migrated, on her own, to the UK from Bangladesh in 2008.

A few weeks ago on one of those beautiful warm, cloudless summer mornings when anything feels possible we met at a South London tube station and wheeled Chisty’s large wheelie suitcase down the road. She could have been dashing off to the airport on her summer holidays but was instead heading for an appointment at an organisation that offers advice on immigration issues about applying for indefinite leave to remain in the UK. Chisty was by now approaching her tenth anniversary of arriving in England so was eligible to apply for ILR on the grounds of “long residence” and thus attain the right to stay in the country indefinitely, something not afforded by the time constrained student and tier 2 visas that she had held to date. It’s a potentially huge step that would allow much greater freedom to work and travel, access to public funds and provide an opportunity after a further twelve months of settled residency to apply for British citizenship, something that Chisty is very keen to do. Things that we take for granted such as the ability to move jobs (the tier 2 visa which Chisty held required an employer to sponsor her and any move to a different employer meant that a new visa had to be acquired) and the right to free hospital treatment without having to pay an annual charge for using the NHS would now be accessible to Chisty too.

I’d come along to provide some support (two pairs of eyes and ears are usually better than one in situations like this) but it was already apparent that Chisty’s preparation had been meticulous. Instead of holiday clothes, hair products and make-up her suitcase was full of papers from her ten years in the UK – it weighed a ton. She’d collected every scrap of paper that related to previous visa applications or interactions with the Home Office, pay slips, tax records, bank statements, any correspondence relating to the numerous rented properties that she’d lived in, college and university certificates and letters relating to her years of studying – all filed neatly in plastic wallets. Even details of every trip abroad during the last ten years (there are limits to the amount of time that someone applying for ILR is allowed to have been out of the UK during the qualifying period) – literally anything that would support what she had been doing and where she had been doing it for what amounts to almost her entire adult life. She explained that she’d assembled this paper mountain in the knowledge that, at some point, it would be needed and that day was nearly here.

We were greeted by an elderly gentleman who smiled warmly and explained that he’d been helping people with visa applications for more than forty years but added, apologetically, that the organisation used to offer advice for free but the creation of a “hostile environment” for immigrants over the last decade had meant that funding streams had dried up thus forcing them to charge for providing advice. Legal and other assistance available to migrants tends to be slashed when politicians want to be seen to be tough on immigration.

Chisty had downloaded a copy of the form for applying for indefinite leave to remain in the UK from the Home Office website and begun to fill it out and we spent an hour and a half going through it page by page discussing the best way to answer each question and provide the necessary supporting documentation – Chisty regularly rooting through the contents of her suitcase for the latter. The form, all thirty two pages of it, demands careful attention – a missing detail or something entered incorrectly or in the wrong box could render the whole application invalid thus sending you back to square one like a game of bureaucratic snakes and ladders. Worse still it could lead to an application being refused and possible deportation. Two years ago when she successfully applied for a job with another NHS organisation Chisty’s application for a new tier 2 visa was refused, through no fault of her own, as her potential new employer took too long to issue a certificate of sponsorship (they were not a registered tier 2 sponsor at that point) and quoted incorrect salary details. Although this did not affect her existing visa she was still sent a letter by the Home Office informing her that she “may have to leave the country” if she did not have any other legal basis to remain here. Simple administrative errors like this can change peoples’ lives and cause untold worry; the sleepless nights and the fear that migrants live with that, at any time, the rules could change and they could be sent home are rarely factored into the immigration debate.

So it pays to get some advice on how best to fill out an ILR application especially when you’re going to be forking out more than two thousand pounds simply to apply for the right to stay in the country. Chisty intended to use the premium same day service which costs a whopping £2,999 but even the basic service, which takes a few months before you find out if your application has been successful, costs £2,389. As recently as 2003 applying for ILR was free and the first charge introduced in April of that year was a mere £155. The fees have trebled since 2010 resulting in charges that are now ridiculously disproportionate to the administrative cost incurred in processing an ILR application (a typical premium service appointment takes no more than three hours) and simply add to the worry of an already stressful situation; another hefty obstacle thrown in the way of would-be residents.

A few weeks later in July and Chisty was leaping another immigration hurdle as she sat her Life in the UK Test at an exam centre in west London. The computerised test consists of 24 multiple choice questions about life in the UK (anything from medieval monarchs and tea drinking etiquette to Olympic gold medal winners) with a score of at least 18 being required to pass. Various websites offer trial runs of the test (there are hundreds of possible questions with 24 selected at random) and curious to have a go I scored 21 on my first attempt. Chisty, whose knowledge of the British royal family and popular culture definitely surpasses mine, passed first time taking only ten minutes to rattle through the two dozen questions. ILR applicants must also have sufficient knowledge of the English language but as Chisty had already gained a degree taught entirely in her second language there was no need for her to attend an English for Speakers of Other Languages course.

…seriously if ever you’ve thought that this country is a soft touch when it comes to immigration, that we basically let anyone in, that we’re being “swamped” by immigrants believe me you haven’t got a clue…

And so to D-day. It’s not often that good news emerges from the drab tower block in Croydon that is home to the UK’s immigration service but after years of grafting to build a new life in a foreign country; years of studying and working to be able to afford to study; years of not going out because she’s too knackered and couldn’t afford to anyway; years of gruelling bus and tube journeys from the arse end of town to work spirit crushing shifts in city centre fast food takeaways; years of sacrifice to try to ensure a better future for herself and her family; years of not being able to move jobs due to the restrictions of her visa; years of snotty letters from faceless Home Office bureaucrats; years of filling in forms and forking out thousands of pounds on visa applications, health surcharges and legal advice; years of uncertainty of not quite knowing whether she would be allowed to build her future in the UK or not Chisty emerged from Lunar House on a Friday afternoon earlier this month having been granted indefinite leave to remain in the UK – almost exactly ten years to the day since arriving in England from Bangladesh as a nineteen year old accompanied only by a wheelie suitcase, a scholarship to study business and finance at a London college and hopes of building a better life.

A Whatsapp message stating simply “#HereToStay” brought a smile to my face as I ate lunch. At times, over the last few years, it has felt like Chisty’s been trying to climb a mountain in a pair of high heeled shoes but, at last, the summit has been reached and a new horizon has opened up. She’s finally free to stay in the country and live her life as a Londoner, as an NHS worker, as a graduate, as a finance professional, as a friend, as a daughter, as a sister and as a young Muslim woman unencumbered by visa requirements and arbitrary lines drawn on maps.

“It feels like I’ve just come out of prison” she said when I asked Chisty how she felt now that she was free to stay in the country indefinitely. She said that it was a relief to know that she would no longer have to answer the question “do you have the right to work in the UK?” on job application forms by ticking the box marked “no” and that this would all being well, finally, enable her to make progress in her chosen career in finance. “A great weight has been lifted off my shoulders mentally and financially” she added and said that she particularly looked forward to not having to worry about having to pay two or three thousand pounds on visa applications every few years – perhaps she could “start saving money to buy a home of her own”. And, erm, maybe some clothes and make-up too!

Next week a small group of us will meet to celebrate this momentous occasion at a Bengali restaurant in Whitechapel in east London which is home to Britain’s largest Bangladeshi population and close to Altab Ali Park, the only park in London named after a Bengali – Ali was a young Bangladeshi textile worker who was murdered by racists in a nearby street in 1978. Along a path at the centre of the small park is a beautiful line from a poem by the Bengali poet Rabindranath Tagore – “the shade of my tree is offered to those who come and go fleetingly”. Several decades after those words were written, a young Bengali woman will now have the opportunity to set down some roots in the UK and come and go as she pleases.

Eine kleine shitmusik

A piece I wrote for the latest edition of the FC United of Manchester fanzine Top of the World

At the end of our latest Euro away match in Salzburg as the players came over to applaud the travelling fans and congregated on the touchline in front of us they were asked to “give us a song”. There was a momentary pause as they glanced at each other, the new players looking for guidance, and we waited for a tune. Which one would they choose from FC United’s extensive songbook? Well the answer turned out to be none as they instead launched into a rendition of “football’s coming home” with most of FC’s support joining in. The faces of a few of our older fans were a picture. But the choice of song shouldn’t have been a surprise as most of our support had been giddily belting it out at regular intervals following England’s World Cup quarter final win earlier in the afternoon, and it got played over the tannoy pre-match and again afterwards along with second album Oasis. At least the latter got a bit of stick from some supporters though.

There was even a suggestion pre-match that should England require extra time to see off the flat pack furniture specialists that the kick-off of our friendly match should be delayed. I guess it’s a sign of how much our support has changed over the years. Had this happened at the 2006 World Cup, say, I can’t imagine Baddiel and Skinner’s slice of Britpop would have been sung with anything like the same gusto. If at all, to be honest. And as for moving kick-off times, yer wot?

My own relationship with the national team can be split into two distinct phases pre- and post-1998 such that I was able to enjoy a pre-match beer in the centre of Salzburg with barely two hoots given for what was going on in Russia. As a youngster things were very different although my first memory of England in the World Cup is missing Robbo’s early goal against France in 1982 as we were still finishing our tea – the slightly avant garde notion of simultaneously eating and watching telly (or of rearranging our usual 5pm teatime) hadn’t quite caught on in our house back then. Eventually we settled down to watch England go on to beat a very good French side 3-1 and I was buzzing. Eight years later I was blasting out World in Motion several times a day through the month of June and six years on was gutted when “we” lost on penalties (again) in the Euro ’96 semi.

But the ’98 World Cup and its aftermath changed all that as David Beckham got sent off against Argentina and became public enemy number one as a well fancied England side were knocked out in the second round – the “silly little boy” had apparently let the entire country down with his petulance. Back then I still supported England. Well, if going to a pub and gawping at a TV screen for a couple of hours counts as “support”, which I guess by then it did. Leaving the pub afterwards I was gutted that England had been knocked out. But weeks later as abuse continued to be hurled at Beckham and United by the Anyone But United brigade and the tabloid press I decided that I’d had enough of the national side and its supporters. Fuck it.

That season after the World Cup in France following United home and away it felt like it was us against the world and it was magnificent. Arguably the treble might not have happened but for Beckham’s sending off in St Etienne as we circled the wagons, the siege mentality was cranked up to ten and we serenaded away grounds everywhere with chants of AR-GEN-TI-NA. We took on all comers including Murdoch and beat the lot.

By the summer of 2000 I’d gone backpacking and as I emerged blinking into the sunshine from a Los Angeles youth hostel late one June morning groups of crimson faced ex-pats were exiting nearby bars cursing Phil Neville as England had been knocked out of the Euros (to be honest I’d forgotten they were even playing). And two years later my masculinity was being called into question at work as I was the only bloke in the office on the day that England played Argentina in a lunchtime kick-off in the 2002 World Cup. I was pleased for Beckham that he scored that penalty (and for Nicky Butt who bossed the midfield that day) but that was as far as my level of arsedness with the fortunes of the three lions went. And by the time of the 2006 World Cup I genuinely found it amusing when they lost on penalties to Portugal – Gerrard and Carragher missed their spot kicks and our boy Ronaldo applied the coup de grace. Hahaha.

Of course we’ve got a lot of younger supporters for whom all this ABU tit for tat will probably mean little. So who can blame them for getting carried away, like most of the nation, about England doing alright in the World Cup. But some of FC’s older support really should know better. And what’s all this nonsense with inflatables? At times during the match in Salzburg I felt like I’d turned up at a Headingley test match mid-afternoon when everyone is six pints down and pissing around with a beach ball or summat oblivious to the action on the pitch. All that was missing was the fucking Mexican wave. And what’s with that inflatable crocodile? Granted the first time I saw it at York last season it raised a half smile but now that the scouser to whom it referred has disappeared why bother? Or is this the sort of wacky inflatable banana level of support we’ve sunk to now?

On the pitch from the brief moments I actually observed when I wasn’t muttering into my beer about the state of our support it looks like we’ve got the making of a half decent side – Tommy and his management team appear to be sorting things and it bodes well for the season ahead. It might be time for us to sort ourselves out on the terraces as well.

For starters we could do worse than take a look at SV Austria Salzburg’s support that, as with the match at Broadhurst Park a year and a half ago, was noisy, vibrant, colourful and never stopped singing and bobbing up and down all match. Frankly they were miles better than us. We may have won 3-1 on the pitch but we were soundly thumped off it perhaps for the first time in a Euro away where we have usually done ourselves proud and shown solidarity with the home support in the process; St Pauli and Babelsberg perhaps the best examples of that.

Should we be concerned or should we just live and let live? After all, there’d been a drop of golden sun, the beer had been flowing and it’s not every day that England get the better of Sweden. If some of our supporters want to belt out “football’s coming home” like they’re in a lagered-up Superdried Milton Keynes sports bar shouldn’t we just let them get on with it? To a degree, yes, I suppose but I’m genuinely puzzled as to why someone would bring a St George’s flag that simply said England on it (just in case you weren’t sure which nation it represented) to an FC United match – no mention of Manchester, United or FC United or any nods whatsoever to our red history. It’s not exactly bouncing up and down on an ambulance or trashing some Ikea furniture but I thought we had more class.

There are some amongst our support who have followed England for years including one of our board members who was out in Russia for the entire tournament. Fair play to them. But for many of us United post-1998 stood alone (bar maybe Liverpool?) as the anti-England – a clued-up, well travelled, diverse support that was everything England’s support wasn’t with its small town mindset, shit songs about the IRA and fondness for forelock tugging. Some would have it that FC United has become just another football club in recent times but I’m not having that as, despite our recent wake-up calls, there are still so many ways in which we differ hugely from a typical football club. But it’s apparent that over the last few seasons our support, away from home in particular, has gradually become a little less irreverent and inventive and a little more mainstream and Salzburg highlighted that. I know there was a cracking sing-sing post-match (which I missed) but, like belting out songs in the Bishop’s before a United match, it’s all very good and looks ace on social media but it’s in the ground during a match when it really matters. And for large chunks of the match in Salzburg, and on many occasions away from home over the last couple of seasons, it’s felt like we’ve been little different to any other travelling support in the country.

Let’s (not) talk about six, baby

When it happened in 2007 I hid in a cinema and watched a film about Joe Strummer. It was a cracking documentary with a rollicking punk soundtrack and being more than a couple of hours long was pretty much the perfect length to avoid what was going on elsewhere that particular evening in a far-flung corner of Europe. The campfire vibe relaxed me and being hidden away in a darkened room with only a big screen to focus on meant that I was safely out of range of any sights and sounds from outside. Perfect. In fact, such was my mood, that I would happily have sat and watched Love Actually or some such tosh for a couple of hours. After the events of two years before it felt like the most sensible course of action to avoid further suffering.

When the film came to an end shortly after ten and I emerged from the cinema, crossed the road and headed towards the bus station, I noticed straightaway that there were only two blokes left in the first pub that I came to and they were both wearing the same red and black striped top and were smiling broadly as they chatted. And when I peered through the window at a large television screen that lit up the far wall I began to smile too and almost skipped onto the 76 bus that was waiting for me when I got to the station. I didn’t have a smart arse phone back then, only a blue mini-brick of a thing that I used only for phone calls and texts, so I would have to wait until I got home to check the details. But really all that mattered was that the unthinkable hadn’t happened – the number six had been avoided. Nice one.

Then a few weeks ago it happened again. This time it was on a Saturday, rather than a midweek, evening and as it was a lovely warm early summer’s day we decided to head to the seaside – to Margate to be precise where we spent an afternoon boozing in micro-pubs (of which the Thanet coast has many wonderful examples), scoffing fish and chips and cake and wandering round the Turner art gallery. But even by mid-afternoon I’d seen several people who merely by their choice of crimson leisurewear I knew would be at the opposite end of the emotional spectrum from me when it came to that evening’s main event.

So, rather than linger on the seafront where the pubs were already doing a brisk trade we opted instead to find a small Good Beer Guide recommended backstreet pub about a mile or so away from the beach and the harbour. It was almost empty when we got there and as the sun was still out we opted to get a couple of pints and sit outside at the front of the pub. It was a perfect spot to get away from it all. Or so I thought. But after about ten minutes and with the evening’s event that I was steadfastly trying to avoid rapidly approaching a group of people emerged from round the corner and headed in our direction. Two families with the four children kitted out in similar, but more up to date, red leisurewear to that I’d seen around the town earlier. Instead of paint and electrical appliance manufacturers bankers were now to the fore – a sign of the times indeed.

And my heart sank as they all trooped into the pub and promptly asked for the big screen telly, that filled almost an entire wall of the pub, and that I had patently failed to notice earlier, to be switched on. The kids were by now getting very giddy. The number six might only be a couple of hours away. We promptly supped up and headed back into town where we got another couple of pints at a television-less harbour side pub and gazed out to sea and watched the setting sun. From across the harbour there was a muffled cheer and then, a few minutes later, a louder cheer and I began to fear the worst. Later on as darkness descended we meandered back to the railway station and, after boarding a London-bound train, I checked my phone for the first time that evening – it must be almost over by now surely.

I must admit I’m a right wuss when it comes to looking up football scores on the internet as, rather than cut straight to a website where I’ll see the score instantly, I prefer to fumble around on Twitter instead – if there is pain to be dealt with I’d rather it be softened a little by the cyber-embrace of others that are feeling it too – it’s like an online support group really. You can ease yourself in gently by seeing a scoreline filtered through the thoughts of like-minded people. So when, fearing the worst, I began scrolling through my timeline I was surprised to almost immediately hit upon a “happy Treble day” message (the 26th May is, of course, our day). Ah, someone’s just trying to make the best of a bad evening I thought – fair play to them. But then a few tweets on the scoreline from the thing I’d been trying to avoid all evening zapped into my eyeballs – Real Madrid 3 Liverpool 1. Get in there you fucking Franco-supporting bastards. Somehow, it appeared, a sixth European Cup win for Liverpool had been avoided again. Later the match report with its tales of goalkeeping howlers and Spanish subterfuge would make for beautiful reading.

Which is all a bit daft, not to say third year infant playground stuff, when I think about it in the cold, non-footballing light of day as one of my best mates is a Liverpool supporter. He lives abroad these days but usually the Whatsapp messages flow between us on music, football, politics and books but for the last few weeks since the 26th May the airwaves have gone a little quiet and we still haven’t exchanged thoughts on Liverpool’s quest for a sixth big pot.

On Monday morning when someone at work asked me if I’d watched the match and I told them how I’d spent my Saturday they likened it to that famous episode of The Likely Lads. But this wasn’t anywhere near as likeable or amusing as Bolam and Bewes. In a televisual sense it was more akin to watching Doctor Who when you’re a kid and shitting it behind the settee when the Daleks appear. Pure unadulterated fear. At times like this the energy that we invest in football rivalries and watching (or not watching) twenty two men kick a bag of wind around a patch of grass is completely irrational, utterly absurd and totally bloody emotionally exhausting.

Still, at least the scouse bastards didn’t win number six, eh 🙂

Running on empty?

A look back at FC United of Manchester’s 2017-18 season

Possibly inebriated and no doubt a little emotional having just witnessed FC United’s stirring second half comeback to draw 4-4 at Spennymoor Town last December, FC United board member George Baker volunteered to run this year’s London marathon to raise a few bob for the club’s Development Fund. It was George’s first ever marathon – in fact, until he started training he’d barely run for a bus, so to get from Greenwich to The Mall via the Isle of Dogs, on a warm April day, in little over six and a half hours and, in the process, raise three thousand quid for the club was a tremendous achievement. Typical of so many fund raising initiatives, big and small, by supporters down the years that have contributed to us building and now developing our own ground. And as if that wasn’t enough endurance-busting punishment for one week George was at the club’s monthly board meeting barely twenty four hours later. Running a marathon? Pffttt. Try running a supporter owned football club when you’re skint.

The American anti-slavery campaigner Frederick Douglass reckoned that “if there is no struggle, there is no progress”. He may be right but heaven knows what old Fred would have made of FC United of Manchester’s thirteenth season which, apart from a brief winter interlude, felt like one long monotonous slog on and off the pitch with plenty of struggle but precious little in the way of progress to show for it. It was a season where it felt like we were always one-nil down to someone or other whether it was Curzon Ashton, Telford, Chorley, Nuneaton, Leamington or Alfreton. Even Manchester City Council. The list went on. One bloody nil. Here we go again. You could have swapped the reports from the matches against any one of those teams and no one would have noticed; an early-ish goal conceded and then much huffing and puffing as FC tried to string a few passes together and move, with limited success, in the direction of the opposition’s goal. It didn’t make for pretty viewing.

Yet there was a brief, glorious spell in December and January when FC took on the best sides in the division and the football was a joy to watch – a youthful FC side, with marauding wing backs and two up front, playing attacking football and seemingly not knowing when it was beaten. It was a purple patch that coincided with supporters (finally) being allowed to enjoy a beer or two in view of the pitch which certainly did the Broadhurst Park atmosphere no harm at all. For a few weeks it felt like we’d got our mojo back on and off the pitch. Harrogate were well beaten at Broadhurst Park in early December after a magnificent second half display and, after hard earned draws with play-off chasing Brackley and Spennymoor, Salford were vanquished 3-2 at Broadhurst Park on Boxing Day and then in the return fixture on New Year’s Day FC twice came from behind to grab a well deserved point at the eventual champions.

But apart from that spell the football was grim and through February and early March it felt like we’d given up scoring goals for Lent as we failed to score for five consecutive league games culminating in a 6-0 tonking at Harrogate, the club’s heaviest ever defeat. In fact away from home we managed only a couple of victories all season and went almost a year without winning away from home on a Saturday afternoon before clinching a crucial late win at Tamworth in early April.

The season’s pivotal, and arguably most controversial, moment was Tom Greaves’ appointment as manager towards the end of October as we parted company with, up to that point, our one and only manager Karl Marginson. After a woeful pre-season our early season league form was relegation material as a mere eleven points were gleaned from the first fourteen matches with only a free-falling North Ferriby below us in the table. Only the two FA Cup ties against Stockport County had set the pulse racing – a nine man FC eventually emerging victorious in a third qualifying round replay. But it was the limp exit from the FA Cup in the next round at Telford, a golden chance missed to earn a decent pay day in the first round proper, that was perhaps the final straw. The story went that chief executive Damian Chadwick wanted Marginson out a month earlier but the board dithered and, with one eye on supporter reaction on social media, let him have another few weeks. It didn’t work.

A refreshing emphasis on youth was apparent from the beginning of Greaves’ period in charge, with the average age of the side that played Telford in November only 22, and this was born of a vision shared by the board and chief executive that in the long run football success and financial sustainability could only be married by building an exciting young team, in the best United tradition, and providing opportunities for those players to go on and play professionally whilst earning the club a bob or two in transfer and other fees.

Indeed the transfer fees from the sale of Nathan Lowe and Jason Gilchrist to Southport enabled the club to generate an operating profit, no mean feat at this or any level of football, but the size of the profit was nowhere near enough to service the club’s debts some of which are due to be repaid very soon. Urgent action to boost revenue and/or reduce costs was called for but board meetings, too often, were bogged down in operational detail whilst any strategy for steering the club through choppy financial waters was lacking. And as discussions with the council regarding the more restrictive elements of the lease and section 106 agreement moved at the pace of an arthritic snail we remained seemingly unable to sneeze too loudly at Broadhurst Park if there was so much as a game of tiddlywinks going on within a six mile radius of Sport City. Meanwhile the Middle Eastern human rights abusers and their footballing project, long since granted the freedom of east central Manchester, continued to cash in on money spinning early summer concerts at the Etihad.

That Greaves and his inexperienced management team managed to keep FC in National League North after that start to the season and with little room to manoeuvre on the transfer front is to their credit. But the overspend on the playing budget which was wildly out of control by October and persisted for the remainder of the season was a cause for concern particularly with the repayment of loan stock totalling more than £300k due in 2019 not to mention interest payments on the half million pound loan from Manchester City Council – both loans taken out to meet rising costs when Broadhurst Park was being built. Hence the commotion the evening before the final away match of the season at Alfreton as, with safety from relegation secured with a win against York earlier in the week, it was deemed financially prudent not to continue overspending on the playing budget and those players not on contracts were informed that they would not feature in the side for the rest of the season. Two players took to social media to vent their anger whilst three others offered to play for free.

The pressure was evident too in the boardroom as three board members stepped down in the spring with two of them citing the difficulties of juggling home and work life with the considerable demands of being a board member and a third firing a departing Keano-in-Saipan-esque broadside born of frustration with missed targets and the perceived failure of the board to properly hold the CEO to account and act in the club’s best interests. The need for the board to focus on strategy eventually came to a head as the season closed as an independent report that initially reviewed the relationship between the board and the chief executive also made a number of recommendations regarding its future structure.

Despite the scrap to avoid relegation and the sizeable financial challenges ahead there was a heartwarming reminder in March that we are still able to offer a helping hand to some of the most vulnerable people in our local community. The club again opened it doors on Christmas Day to offer some festive comforts to local homeless people but this year that commitment expanded as the club’s community team worked alongside a number of initiatives to help homeless people across the city including providing support (in the form of warm clothing, food and blankets) for a local mosque which had opened its doors to provide warmth and shelter for rough sleepers during bitterly cold weather. Meanwhile other initiatives such as the Sporting Memories group continued to excel (and there are plans to take this on the road to care homes and sheltered housing and work with those who can’t necessarily make it to Broadhurst Park every week) and the twelfth annual Big Coat Day was again a success.

The women’s team, under Luke Podmore’s guidance, built on the success of 2016-17 and had a remarkable season that culminated in an illustrious treble; finishing as champions of the North West Women’s Regional League Division One South and retaining both the Manchester FA Women’s Cup and Argyle Cup. In doing so they scored an incredible 175 goals in 28 matches across all competitions with centre forward Jess Battle netting 47 times. What was equally as impressive was how all the players took the initiative of securing sponsorship for themselves thus ensuring that the women’s team paid for itself. Next season the women will compete at the fifth tier of the women’s game and will play on the main pitch at Broadhurst Park.

For the men’s team, although there was another Manchester Premier Cup win to savour, the bare statistics of the league season were a sixteenth place finish on 50 points – a mere four points above the relegation zone. And as we cast an eye over the teams in this division next season the job looks arguably tougher and, at this stage, it’s difficult to identify three teams that will definitely be worse than us. It’s going to be another tough season on and off the pitch no doubt. But maybe, with much hard work over the summer to assemble a decent squad that can compete strongly at this level whilst playing attractive football and, for the first time, to construct a business plan worthy of the name, there’s a glimmer or two of hope that the struggles of recent times might finally produce some progress on and off the pitch.

The next five years, like the mid-section of a marathon, will be crucial to the long term future of the club. Will we hit the wall between now and 2023 as financial commitments sap our energy levels? Who knows. It’ll take more than a few jelly babies and an isotonic sports drink to see us through our next running challenge but, like our marathon fundraiser, don’t bet against us.

EY, oh why, oh why

The recent collapse of Carillion not only threw a long overdue spotlight on the billions leached from the NHS and other public services by the Private Finance Initiative but also severely dented the notion that “private knows best” when it comes to running public services which has seen the public sector’s use of management consultants grow exponentially since the early 1990s to the extent that the use of consultants by the public sector now accounts for over a fifth of the total turnover of management consultancy firms. For as long as I’ve worked in the NHS (I joined as a trainee accountant in 1990) a view has persisted that, whether we’re caring for patients or supporting those who do, no matter how hard we work or how good at our jobs we are we’ll never quite be as efficient as our private sector counterparts; forever the lower league journeymen to their Premier League superstars.

I’ve lost count, down the years, of how many times I’ve seen management consultants (more often than not from one of the Big Four accountancy firms) brought in, at considerable expense, to do jobs that people in the NHS with vastly more experience in the relevant area could have done much better for a fraction of the cost. The sums involved, when viewed in isolation, often aren’t headline grabbing but collectively they add up to a substantial flow of money out of the health service and into the coffers of huge multinational corporations. How much exactly? Well, precise figures on how much the NHS as a whole spends on management consultants are difficult to come by but in December 2014 the British Medical Journal reported that NHS spending on management consultants had risen to £640 million per year (compared to £313 million in 2010) as they cashed in on the chaos created by the implementation of the Health and Social Care Act with some consultants charging a whopping £4,000 per day for their services.

To illustrate the impact of the health service’s often unnecessary use of management consultants here’s a recent example from my own experience working in an NHS finance department. It comes nowhere close to the scandal of PFI but it’s typical nonetheless of how the NHS has become reliant on the private sector to do work that could quite easily be done in-house. I’ve chosen this particular example as it’s the most recent but, to be honest, there are dozens of others that I could have drawn from ranging from project managers on eye watering sums per day brought in to lead the implementation of new systems or inject commercial rigour into dull old NHS accounting practices to poacher-turned-gamekeeper consultants drafted in to advise on the impact of government policy that they’ve already had a hand in writing (the current work on sustainability and transformation plans (STPs) being the latest in a long list of examples of the latter).

NHS Improvement, the body responsible for overseeing the financial performance of NHS trusts, is currently driving a move towards trusts identifying the costs of individual patients, rather than averages, under its costing transformation programme which is a major focus for me in my role as the costing lead at a mental health trust. One strand of this programme involves independently assessing the accuracy of the costing information that trusts produce and in 2016 NHS Improvement awarded a three year contract to perform this work to EY (in previous years the work had been undertaken by PwC and Capita). You might know EY better as Ernst and Young, one of the Big Four multinational accountancy firms who were rebranded in 2013 and are headquartered in smart offices close to Tower Bridge in London. In October of last year EY were fined £1.8 million, by the UK’s financial watchdog the Financial Reporting Council, for “failures to obtain reasonable assurance” about whether the financial statements of global technology company Tech Data “were free from material misstatement”. Not particularly reassuring for the NHS but, hey, away from the beady eyes of the FRC a handy NHS contract like this is money for old rope for the likes of EY. Firms can typically walk away from NHS contracts such as this without any repercussions no matter how shoddy the work.

The contract involves auditing the costing information produced by around one-third of NHS trusts each year over the three year period. In December 2015 NHS Improvement invited tenders to undertake this work and stipulated a maximum price of £3.9 million but details are sketchy on the actual price agreed with EY with NHS Improvement’s board papers from around the time being rather coy and indicating only that six companies were invited to tender and that EY had won the contract. Later on the board papers from its meeting in July 2016 referred to a saving of 36% on the contract value after the initial costs and activities within the scope of the audit were challenged. Which represents quite a saving and looking back at footage of the meeting (the public part of NHS Improvement’s board meetings are filmed and available to view on their website) there is more than a little surprise amongst board members as this substantial saving is noted.

Such cost cutting is often a false economy though and usually means cheaper, less experienced members of staff being employed on the contract and this was evidently the case when EY visited our trust in February last year as very early on in the audit it became apparent that, beyond the basics, the auditor’s knowledge of NHS costing processes and mental health services was scant. In the end, the auditor spent a mere two and a half days on site and this was followed up with a handful of telephone conversations and email queries which barely skimmed the surface of the figures being audited.

A first draft of the audit report, when it eventually turned up, after much chasing, over four months later was strewn with errors including reference to “urology IAPT services” which given that IAPT refers to improving access to psychological therapies makes the mind boggle. The errors were eventually corrected and a second draft was sent out a month later, in the middle of July, requesting our formal management responses to each of their audit recommendations within two working days. That this tends to be the busiest time of the year for anyone involved in NHS costing (the deadline for submitting the annual reference costs return is usually towards the end of July) was seemingly completely lost on EY. The report itself, once published, was lacking in any real insight, full of half-baked recommendations and with the overall feel of a piece of work that had failed to get to grips with the topic that it was meant to be reporting on.

It’s staggering that at a time when the health service is enduring the longest squeeze on its finances in its seventy year history that it can afford to spend a few million pounds on poorly executed work such as this. In the absence of knowing the actual cost of the contract let’s assume, not unreasonably, that EY’s original tender value was close to the maximum price of £3.9 million. In that case a 36% saving would suggest a contract value of around £2.4 million. Now, in the context of an overall budget for the NHS of more than £120 billion that may sound like small beer and indeed when you spread it, rather crudely, across all the trusts that will be audited during the contract period the cost works out at around £10,000 per organisation. Not too bad, you might think, but it’s a frankly ridiculous sum for barely a week’s work and a report that told us nothing about our costing process that we didn’t already know.

Yet we have been told repeatedly down the years that the expense of management consultancy is more than off-set by the beneficial effects it has on the efficiency of public sector organisations. However a recent study by a group of academics at Bristol, Seville and Warwick universities on the impact of the use of management consultants on public sector efficiency, perhaps the first of its kind to measure the quantitative impact of using consultants, concluded that far from boosting efficiency the use of management consultancy actually decreases it. And this didn’t even take account of the, often ignored, demoralising impact on NHS staff of continually seeing management consultants brought in to perform tasks that they could and already are paid to do. One of the authors of the report, Ian Kirkpatrick from Warwick Business School felt that in the current financial climate the NHS must consider “whether it is appropriate to continue using external consulting advice at the current level”.

It’s disheartening to say the least to see others brought in, time after time, to work on “exciting” projects and produce work of questionable benefit whilst we get on with our day jobs and are invariably left to pick up the pieces when external consultants depart. Much of this work could be brought in-house and would offer talented, experienced and dedicated NHS staff the chance to look beyond their day jobs to improve the quality of care that patients receive at a fraction of the cost of using the private sector. We might not be as good at spouting the fancy management-speak and preparing the snazzy Powerpoint slides but at least give us a chance. EY’s work on the costing assurance programme could, and should, have been performed by costing leads at other trusts – a form of peer review that would subject the costing processes of each trust to proper scrutiny and offer valuable insights into how those processes might be improved. All this for a mere fraction of the cost of involving the private sector.

So it’s refreshing to read the Shadow Chancellor John McDonnell refer to Carillion as a “watershed moment” and promise that a future Labour government would end the “private knows best” rip-off. For too long huge multinational corporations like EY, McKinsey, PwC, KPMG and Capita have been riding this NHS gravy train. Only last week it emerged that NHS Improvement has awarded a £500k contract to McKinsey to apparently help it define its “purpose”. This comes less than two years after a similar deal, worth £1 million, was struck with yet another management consultancy firm KPMG on defining NHS Improvement’s role. Enough is enough, it’s time to bring this nonsense to a halt and let NHS employees get on with what we are paid to do.