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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.

Missing the ap-point-ment

As accountants we are taught, during years of professional training, to be right miserable bastards. Pessimists. Doom and gloom merchants always looking to spoil someone’s fun. We give it a fancier title though and call it being prudent. And a consequence of this prudence is that we learn to treat numbers, especially ones with pound signs in front of them, with a dose of scepticism. If we think something looks odd then we examine the evidence and challenge it if necessary. That’s our job.

And it’s no different for those of us who crunch numbers for a living in the NHS; poring over our spreadsheets and budget statements we are there to assist clinical colleagues to manage the increasingly limited resources at their disposal as well as they possibly can. All of the time being careful not to deliberately over-state or under-state a number to make it look better or worse than it actually is. So when these figures that we’ve sweated over for days, weeks and sometimes months are released into the public domain and are, in some cases, misused and abused you’ll excuse us if we get a bit annoyed.

So it was disappointing to say the least to see the recent Guardian headline “patients missing their appointments cost the NHS £1 billion last year” merely repeating, word for word, the comments of NHS England’s chief nursing officer Professor Jane Cummings. You’d like to think that when journalists are presented with a large number like this that they would perhaps do a little bit of digging to verify its accuracy. Even a five minute search on the internet would begin to cast some doubt on its robustness.

To put this figure into some health-related context for starters; it cost just over one billion pounds to run the trust that provides hospital care for the adult population of Sheffield in the 2016-17 financial year which includes two large city centre hospitals and a total workforce of around 16,000 staff. Which begs the question, if more of us turned up for our outpatient appointments or gave sufficient notice of any cancellations would we really save enough money to provide hospital care for one of the largest cities in the country for an entire year? Really? Alternatively, according to NHS England the money “wasted” by missed outpatient appointments could fund one million more cataract operations or 250,000 hip replacements in some make believe health service where doctors in, say, cardiology sat twiddling their thumbs as a result of patients not turning up to their clinics could scurry on down to the operating theatres and knock out a few cataract or hip operations.

At times it really does feel like we’ve entered a so-called “post-fact” age where anyone with more money than sense can make up a big number, plaster it on the side of a bus and drive it round the country and no one’s going to go “hang on a minute mate, how did you work that one out?” Or have we simply become too inured to the mind boggling array of numbers that are scatter-gunned at us on a daily basis that they cease to have any real meaning beyond looking large and, occasionally, quite scary? £45 million pounds for a bridge across the river Thames that they never started building? £100 million pounds for a half decent footballer? A one billion pound bung to the Democratic Unionist Party to prop up the government? £5 billion for the rights to televise twenty two men kicking a bag of wind around a patch of grass? £133 billion of taxpayers’ money to bail out the banks following the 2008 financial crash? A billion pounds worth of missed hospital appointments? Oh, go on then, I suppose that seems reasonable.

So where does this £1 billion figure come from then? Well, NHS England have derived this number by multiplying the 7.9 million missed hospital appointments in 2016-17 by the average cost of an outpatient attendance (£120) in the same year. But if we take a peek at both of those figures it’s apparent that this calculation is barely more than a quick multiplication on the back of a fag packet. Two figures plucked from the mountain of data that is collected annually about NHS services and multiplied together, with scant regard for how the figures are calculated or what they represent, to produce a figure that is ridiculously misleading and blatantly incorrect.

Firstly let’s look at the number of missed appointments. Figures compiled by NHS Digital (formerly the Health and Social Care Information Centre) show that there were 118.6 million outpatient appointments in 2016-17 with 7.9 million (or 6.7%) of those missed by the patient. That’s a combination of patients that simply didn’t turn up for their appointment and those that turned up late and were unable to be seen. Those in the latter category may have been stuck in traffic or struggled to find a parking space or couldn’t get to hospital because of bad weather and through no fault of their own missed their appointment. It could happen to any of us.

What’s perhaps more interesting though is that if we delve into the NHS Digital outpatient statistics for 2016-17 it’s apparent that the real story isn’t the one that’s generating the headlines; the percentage of missed hospital appointments has actually decreased over the last ten years from 8.4% in 2006-07 and, for the first time in the last decade, more appointments were cancelled by hospitals in 2016-17 (8.3 million) than were not attended by patients – a huge increase in hospital cancellations from 3.0 million in 2006-07 that is indicative of an under-funded healthcare system that is struggling to cope with the demand for services. But clearly that’s not the message that the government and NHS England want you to hear – it’s your fault, remember, for missing all those appointments.

As for the cost of any missed appointments, it’s probably worth noting to begin with that hospitals are not actually required to cost missed appointments. Instead, to come up with that £1 billion figure NHS England has looked at the publicly available annual reference costs that are collected from all hospital trusts. But the first problem with that is that the costs submitted in the annual reference costs exercise are those of an appointment that the patient actually attended – that’s why we refer to an average cost of £120 per “attendance” rather than per appointment.

The second problem with this calculation is that the average costs of hospital attendances taken from the reference costs are “full” costs i.e. they include not only the costs of the doctors, nurses and therapists who deliver care to a patient but also the costs of running and maintaining the buildings in which those services are provided and the “overhead” costs of an array of hospital staff who, whilst they do not treat patients, support those staff who do by providing expertise in areas such as finance, information technology and human resources. Typically these overhead costs can account for around 30% of the total cost of an outpatient attendance. But clearly if a patient does not turn up for an appointment this doesn’t impact directly on the workload of someone, say, working in the hospital’s finance department. So, again, it’s nothing like a true reflection of the actual cost of a missed appointment.

The true cost of a “did not attend” really boils down to the cost of any action that is required as a result of the patient not attending the appointment. For instance, a consultant will probably need to review the patient’s notes and decide whether another appointment should be booked or the patient should be referred back to their GP. In addition, there will be the administrative time spent typing letters and confirming the ongoing course of action. All of this is likely to cost closer to £20 per missed appointment rather than the £120 used by NHS England. Indeed, many hospitals, particularly those that over-book clinics to allow for some patients not attending in the same way that airlines over-book flights, see the costs associated with missed appointments as being relatively immaterial.

Not turning up for hospital and GP appointments clearly risks wasting precious NHS resources and we all have a role to play in turning up to our hospital appointments or, if we can’t make it or the appointment is no longer required, cancelling them in good time. As a result, many hospitals now send text messages to patients in advance of their outpatient appointments warning them of the cost to the NHS if they do not turn up and a study by Barts Health NHS Trust in London in 2014 revealed that sending a text message that specifically referred to the cost incurred by the NHS as a result of a no show reduced the level of missed appointments by 23%. But trotting out meaningless figures like the £1 billion risks deflecting attention away from a government that is simply not committed to a publicly funded health service and since 2010 has systematically under-funded it.

Since the NHS was established spending on health care has grown by an average of 4% per year yet the Department of Health budget will have grown by an average of 1.2% in real terms between 2009-10 and 2020-21; the longest squeeze on NHS funding since it was established seventy years ago. Yet I’ve lost count of how many times I’ve seen Tory politicians on the box boasting of how they are pumping “record levels of spending” into the health service without being pulled up on it. The health service requires additional spending each year to simply stand still and cope with inflation, technological developments and the additional demands that are placed on it by an ageing population and not least by the failures of government policy on social care and the increasingly obscene levels of inequality. A GP in Salford estimates that poverty is a major factor in around 60% of the patients that she currently sees.

The real story here is not that we, the patients, are endangering the NHS by failing to turn up to our appointments but that the health service has been deliberately under-funded since 2010 – yes, spending has gone up but by nowhere near enough to cope with demand. It’s time we all, particularly those whose job it is to investigate and report on such matters, turned into right miserable accountant-like bastards and began questioning what’s happening to our NHS rather than simply regurgitating the “facts” that are presented to us.

Football taught by Matt Busby

For a few years at school I was into drawing. Although I wasn’t particularly creative so mainly ended up sketching cartoon characters or copying pictures from books. So when Manchester United brought out a magazine to commemorate the 25th anniversary of the Munich air disaster in 1983 I was instantly drawn (if you’ll excuse the pun) to the picture on the front cover of a smiling Matt Busby overlooking various scenes from United’s past and present; Duncan Edwards, Bobby Charlton, George Best and Norman Whiteside were a few of the figures that stood out. It was cracking picture and I bought a large piece of card and tried to copy it with a view to sticking the finished product on my bedroom wall. I didn’t finish it though – it took me several weeks just to sketch Matt’s head and by the time I’d made a right horlicks of Norman Whiteside’s nose I gave up and for years the unfinished picture sat gathering dust at my mum and dad’s with all my United programmes and other memorabilia.

But what was of more significance is that it was only when I delved inside the magazine and started to read the various articles that I began to fully appreciate the scale of what happened on that Munich airport runway on 6th February 1958. My dad had been due to go to his first United match the Saturday after Munich and although he never saw the Busby Babes in action he still recalls his giddiness at the prospect of seeing the likes of Duncan Edwards and Eddie “Snakehips” Colman in the flesh. Whilst my own first United match was only nineteen years after the Munich disaster (the same as the gap back to the treble season now) for an eight year old it might as well have been ninety years ago.

So the enormity of the tragedy didn’t really sink in until the day of the 25th anniversary when, lying on my bed, I read through the magazine cover to cover blubbing my eyes out well before I got to the end. Being an out of town fan our football-daft school playground was full of kids that supported Liverpool and Forest and as they seemed to be celebrating a trophy or two almost every season, whilst United won nowt, I’d be lying if I said that there weren’t moments when I had more than a few doubts about this team that my dad had saddled me with.

But that Munich commemorative magazine changed all that and made me begin to appreciate the glorious, yet tragic, history of this football club. Learning for the first time about how Matt Busby had built a team brimming with youthful talent and how he had defied the Football League and taken United into Europe, the first English side to play in European competition, filled me with pride. But there was overwhelming sadness too at how a group of young players with so much to look forward to never got the chance to fulfil their undoubted potential. Eight of that team, the pioneering champions of England, died in the Munich disaster and Busby himself was so badly injured that he was given the last rites at one point before eventually recovering.

Which makes it odd that after expunging that teenage self-doubt thirty five years ago that I now spend Saturday afternoons watching a different football team. Although they also play in red and have Manchester and United in their name. Whilst many FC United of Manchester supporters no longer go to Old Trafford there remains a red thread that connects us to Manchester United and back to the Busby Babes like a footballing umbilical cord. That’s why on their way to the match at Nuneaton on Saturday a group of FC United supporters visited the cemetery in Dudley where Duncan Edwards is buried and, as they have done in previous seasons whenever FC have played in the West Midlands, paid their respects to Big Dunc. And it’s why some FC United supporters have travelled out to Munich this week to join hundreds of other Reds in remembering those who lost their lives in that plane crash sixty years ago. And why those of us stood on a cold, damp terrace in Warwickshire on Saturday were singing songs about football taught by Matt Busby. And why too that the superb 1878 Manchester United nostalgia magazine, it’s latest issue devoted entirely to the Busby Babes, is sold at FC United home and away matches as well as at Old Trafford. Two United’s, one soul.

As I headed home from Nuneaton on Saturday night and boarded a Northern Line tube train at Euston on the last leg of my journey I couldn’t help noticing the two clear plastic bags that the young couple sat opposite were carrying which appeared to include a small black book with the words “The Flowers of Manchester” on the cover. I pointed to one of the bags and asked if they’d been to the United match and whether I could have a quick look at what was inside.

They said that yes they’d been to Old Trafford, passed one of the bags over and as I flicked through the book and the commemorative programme (which had been given out free to all supporters attending the match, the closest United home match to the 60th anniversary of the Munich disaster) there followed one of those oddly asymmetrical Saturday night conversations that I’ve grown familiar with over the years; them telling me about the match at Old Trafford, who scored, who played well, what the atmosphere was like before asking me which league FC United are in. After briefly informing them that we’re five divisions below United and had lost to Nuneaton Town today I think they decided to take pity on me and offered me one of their commemorative packs.

They explained that one was enough for the two of them and that they would be happy for the other one to go to a good home. To be honest, I was a bit taken aback by this kind gesture, reduced to gibbering “are you sure?” and “that’s very kind of you” several times before getting up to leave the train at my station with an unexpected plastic bagged gift. I have a tendency to generalise about many of those who go to Old Trafford these days which is a shame as most of the match going United fans I’ve met in London over the last decade have been sound.

Later on as I sat with a brew flicking through the slim black Flowers of Manchester book and the commemorative programme that had been very generously given to me I realised that sometimes, just sometimes, the football club that I adore but ultimately parted company with as a result of its overbearing commercialisation can still get some of the important things right. Opening the programme (the first time I’ve browsed a copy of the United Review in many years) the repetition of the Glazer name in the section informing supporters of the names of the directors of the club undoubtedly jars but both publications are well presented and a wonderful tribute to the memory of those who died at Munich. As is the smart pin badge adorned with a picture of the Old Trafford Munich clock that was also in the plastic bag. And giving them out for free, as a commemorative pack, to all supporters attending the match was a touch of class.

So as we commemorate the 60th anniversary of the Munich disaster this week and remember the twenty three people who lost their lives (including eight of the Busby Babes) I hope that there are more than a few young United supporters reading through that small black book that they picked up at the match on Saturday and, perhaps with tears in their eyes, learning about the proud history of their football club and the football taught by Matt Busby. RIP the Busby Babes. We’ll never die.

From Fylde to Finchley – where I watched football in 2017

For a few years now the editor of the award winning Doncaster Rovers fanzine Popular Stand has published an ace end of season collection of photographs of all the matches that he’s attended that season. You can take a peek here. Although I’m mostly useless with a camera I love gazing at football photographs so, partly inspired by the Donny fanzine, I’ve been snapping away at all the matches that I’ve been to over the last year and below is a selection of those photos; one from each of the matches that I attended in 2017 and all taken on my phone (with the exception of one that I’ve shamelessly nicked from someone I was at the match with).

They’re mostly nothing to do with the action on the pitch because, let’s be honest, going to the match is not really about watching the actual match is it. In fact, looking back through them I think they probably feature more trees than players – the conifers at Tadcaster were particularly striking. Anyway, aside from watching a live stream of the second half of the Europa League final on my phone these thirty one matches represent pretty much the entirety of my consumption of live football over the last twelve months. Enjoy.


Match 1 – Fog at Fylde

AFC Fylde 3 FC United of Manchester 1, National League North, Mill Farm, Saturday 7th January 2017, Attendance 2,821











Match 2 – Fan-owned football across the river from the bankers

Fisher 0 Whitstable Town 2, Southern Counties East Football League Premier Division, St Paul’s Sports Ground, Saturday 14th January 2017, Attendance 149


Match 3 – Art Deco fan-owned football at Enfield Town

Enfield Town 2 Grays Athletic 0, Isthmian League Premier Division, Queen Elizabeth Stadium, Saturday 21st January 2017, Attendance 575


Match 4 – We’ll carry on through it all

FC United of Manchester 0 Salford City 3, National League North, Broadhurst Park, Saturday 28th January 2017, Attendance 4,158


Match 5 – Stop mad cow disease

FC United of Manchester 3 SV Austria Salzburg 0, Friendly match, Broadhurst Park, Saturday 4th February 2017, Attendance 1,562


Match 6 – Going to the match

Stockport County 2 FC United of Manchester 1, National League North, Edgeley Park, Saturday 18th February 2017, Attendance 5,630


Match 7 – Second half comeback

Gloucester City 2 FC United of Manchester 3, National League North, Whaddon Road (home of Cheltenham Town), Saturday 25th February 2017, Attendance 795


Match 8 – Pre-match beer under the arches at Piccadilly station

FC United of Manchester 1 Kidderminster Harriers 0, National League North, Broadhurst Park, Saturday 4th March 2017, Attendance 2,456


Match 9 – Hamlet prove a handful for Merstham

Dulwich Hamlet 5 Merstham 0, Isthmian League Premier Division, Champion Hill, Saturday 11th March 2017, Attendance 1,564


Match 10 – Under grey Derbyshire skies

Alfreton Town 2 FC United of Manchester 1, National League North, North Street, Saturday 18th March 2017, Attendance 898


Match 11 – Pre-match art battle at Malcolmses

FC United of Manchester 0 FC Halifax Town 3, National League North, Broadhurst Park, Saturday 25th March 2017, Attendance 3,149


Match 12 – Last minute equaliser

FC United of Manchester 2 Stalybridge Celtic 2, National League North, Broadhurst Park, Saturday 1st April 2017, Attendance 2,375


Match 13 – If the Reds should play

FC United of Manchester 1 Brackley 2, National League North, Broadhurst Park, Saturday 15th April 2017, Attendance 2,823


Match 14 – End of season party

Nuneaton Town 1 FC United of Manchester 4, National League North, Liberty Way, Saturday 22nd April 2017, Attendance 777


Match 15 – She wore a scarlet ribbon

FC United of Manchester 1 Stalybridge Celtic 0, Manchester Premier Cup Final, Boundary Park (home of Oldham Athletic), Thursday 4th May 2017, Attendance 1,592


Match 16 – Allez les rouges

FC United de Manchester played in a futsal tournament at the L’Aeronef concert hall in Lille, Saturday 10th June 2017


Match 17 – Bohemian like you

Bohemian FC 1 FC United of Manchester 2, Friendly match, Dalymount Park (Dublin), Saturday 8th July 2017  










Match 18 – Here we go again

Brackley Town 2 FC United of Manchester 1, National League North, St James’s Park, Saturday 5th August 2017, Attendance 654


Match 19 – Forget 4-4-2 check out those cloud formations

FC United of Manchester 1 Kidderminster Harriers 2, National League North, Broadhurst Park, Saturday 12th August 2017, Attendance 1,946


Match 20 – Brewers drop points at home

Tadcaster Albion 1 Prescot Cables 2, Northern Premier League Division One North, Ings Lane, Saturday 26th August 2017, Attendance 262


Match 21 – Revenge for 1995

York City 0 FC United of Manchester 2, National League North, Bootham Crescent, Monday 28th August 2017, Attendance 3,411


Match 22 – Red rebels and spa town blues (again)

FC United of Manchester 1, Leamington 2, National League North, Broadhurst Park, Saturday 2nd September 2017, Attendance 2,380


Match 23 – Are we still in London?

Hampton & Richmond Borough 1 Concord Rangers 1, National League South, Beveree Stadium, Saturday 23rd September 2017, Attendance 496


Match 24 – Out of the cup

AFC Telford United 3 FC United of Manchester 1, FA Cup 4th Qualifying Round, New Bucks Head Stadium, Saturday 14th October 2017, Attendance 1,451


Match 25 – A new era begins

FC United of Manchester 2 Nuneaton Town 1, National League North, Broadhurst Park, Saturday 28th October 2017, Attendance 1,781


Match 26 – 1988 FA Cup winners beat team beginning with “L” 1-0 in the cup again   

AFC Wimbledon 1 Lincoln City 0, FA Cup 1st Round, Kingsmeadow, Saturday 4th November 2017, Attendance 3,394


Match 27 – Sad news about the match sponsor at Gainsborough

Gainsborough Trinity 1 FC United of Manchester 0, National League North, The Northolme, Saturday 18th November 2017, Attendance 782


Match 28 – Tommy Greaves’ red and white army

FC United of Manchester 3 Harrogate Town 2, National League North, Broadhurst Park, Saturday 2nd December 2017, Attendance 2,394


Match 29 – Snow doesn’t stop play 

FC United of Manchester 1 Brackley Town 1, National League North, Broadhurst Park, Saturday 9th December 2017, Attendance 1,893


Match 30 – No football at White Hart Lane this season eh?

Haringey Borough 1 Leyton Orient 2, FA Trophy 1st Round, Coles Park, Saturday 16th December 2017, Attendance 1,133 (club record attendance)


Match 31 – Wingate in the wind

Wingate & Finchley 1 Needham Market 1, Isthmian League Premier Division, The Maurice Rebak Stadium, Saturday 30th December 2017, Attendance 151

Murray’s mint

I’ve never been to a tennis match and probably never will to be honest. I doubt that the close proximity to all them Pimms-upped poshos would be good for my blood pressure. And I rarely watch it on the telly either. Aside from Wimbledon there are few opportunities to see it on the box these days without lining Murdoch’s already comfortably lined pockets. Which makes it odd that I bloody love Andy Murray. It’s probably the most love I’ve felt for any sportsperson who doesn’t kick a ball around or wield willow or leather for a very long time. Possibly since Alex Higgins in his early eighties pomp.

I’m not sure exactly when this love affair was ignited but it might have been around the time that a youthful Murray was asked who he wanted to win the football World Cup and he replied, with tongue firmly in cheek, “anyone but England”. Cue little Ingerlunders flying off the handle all over the shop but I loved it. And why the hell would he want England to win the World Cup anyway, he’s a Scot after all. But it’s not only that deadpan sense of humour that I find a bit of a turn-on but also his apparent shyness and awkwardness around talking to the media.

In a world that increasingly expects all our well-paid, media-trained stars of sport, stage and screen to be “larger than life” role models always ready with an easy smile and a sound-bite quote when a microphone is thrust towards them it’s somehow refreshing to observe someone who finds the whole thing something akin to visiting the dentist for some root canal work. It might lack the intensity of the I-want-your-babies man love that I feel for a certain Franco-Mancunian footballer but this slow burning affection for a fellow member of the diffident, slightly awkward squad is powerful nonetheless.

But despite this admiration, I rarely watch Murray play tennis as I get too nervous. I’ve always struggled watching or listening to sports events on the television or radio when I’m really rooting for one of the participants; I spent large chunks of the 1983 FA Cup final riding round the block on my bike, stomach churning and even now, when I can’t make it to a match, I rarely listen to FC United on the radio, preferring instead to check the latest score on Twitter and maybe tune in for the final few minutes if we’re winning. It’s different when you’re there at the match; you can scream, shout, sing or just get pissed as a means of coping with the tension. Watching or listening from afar can be emotionally draining.

So on that Sunday afternoon in 2013 when Andy Murray won Wimbledon for the first time instead of being glued to the box like millions of others I was in full-on hiding-behind-the-sofa-while-the-Daleks-are-on mode scrolling through Twitter to check on his progress with the oohs and aahs of neighbouring flats stoking the tension; was that an “ooh” of admiration for a Djokovic cross-court winner or a relieved “aah” as the Scot clinches a break point with a well executed overhead smash?

Then when he was two sets up and serving for the match I finally felt comfortable enough to switch the telly on and watch that gruelling final game, its ebb and flow producing almost a match within a match, which finally ended with an exhausted Murray becoming the first British man to win the Wimbledon men’s title in seventy seven years. As he lifted the trophy I headed to the kitchen to make a brew mentally drained by an afternoon fiddling with my phone. Thankfully when he won his first grand slam tournament at the US Open the match took place in the middle of the night sparing me four hours of frenetic Twitter scrolling.

It seems a long time now since the final weeks of the 2016 season when Murray finished the season as world number one after winning what seemed like a tournament every week for several weeks in order to amass sufficient ranking points to claim the number one berth. It was an incredible effort that in hindsight may have had a longer term effect on his form and fitness in 2017. He’s been out of action since exiting Wimbledon last year and possibly won’t play again until this summer having undergone hip surgery in Australia earlier this year. By then he’ll have slipped down the rankings but hopefully will return fitter and ready to take on the world again.

Despite his lack of game time in 2017 the finest sporting moment of the year, without a doubt, occurred after Murray had been knocked out of Wimbledon by Sam Querrey. Murray was the defending champion but had gone into the tournament not fully fit and it must have irked him that, having played the last two sets against Querrey on virtually one leg, he wasn’t able to defend his title properly and exited the tournament so meekly. In the press conference afterwards he was asked by an American reporter for his thoughts on Querrey becoming the first American player in many years to make it to the Wimbledon semi-finals – the reporter plainly choosing to ignore half the players at Wimbledon and the Williams sisters’ domination of the tournament in recent times.

Murray, though, wasn’t prepared to tolerate such casual sexism and interjected with “male player” before the reporter had even had chance to spit out his question. The look on Murray’s face was an absolute picture of disgust, barely able to make eye contact with the reporter as he is asked to repeat his comment before the reporter belatedly recognises his error and guffaws nervously and goes “yes, first male player, that’s for sure”. Stick your SPOTY, aside from the football supporters of Cologne invading the Emirates en masse, this was the finest sporting moment of 2017.

It’s wonderful to hear such a high profile male sporting figure react so quickly to the sort of lazy, casual sexism that has surrounded sport for years – this wasn’t someone monotonously reciting carefully scripted lines to assuage a multi-million pound sponsor, it was an instinctive from-the-heart response from someone who is not afraid to speak out on an important issue. And it was a timely reminder too that we must all do our bit to stamp out this sort of lazy sexism – whether it be at work, down the pub, playing or watching sport or on social media.

Murray has made no secret of his support for women’s tennis acknowledging the huge influence of his mother Judy on his career and in 2014 he became the first winner of a men’s grand slam tournament to recruit a female trainer when he appointed former Wimbledon champion Amelie Mauresmo as his coach. A move that was greeted with cynicism in some quarters – the notion of a successful sportsman being successfully coached by a successful sportswoman was seemingly too much for some to contemplate.

Serena Williams however says that Murray’s efforts to ensure that women’s tennis isn’t merely treated as a glamorous sideshow to the main event are hugely appreciated on the women’s tour. Big deal you might think. But when Hope Solo, the longstanding US women’s football team goalkeeper and a World Cup winner and two-time Olympic gold medallist, states that “sexual harassment and inappropriate behaviour are rampant at every level in women’s sport and it needs to stop” you realise that, actually yes, this is a big fucking deal. Particularly when it’s set in the context of the last twelve months when barely a day seems to have passed without news of some sexual scandal rocking the worlds of entertainment, sport or politics.

It’s possible that we may be only weeks away from some allegations of tax avoidance or for him to be outed as a lifelong Tory or a Liverpool fan or summat. Or for Andy Murray to make a tit of himself on social media like Lewis Hamilton. I doubt it though, he just seems like a sound lad to me. Either way, he might not have played for ages and he’s probably missed so many tournaments that he’s not even in the world’s top one thousand tennis players by now but let’s take a moment to bask in the magnificence of Scotland’s number one male tennis player Andy Murray. We’re lucky to have him around.