20/03/2017 Inside Out East

It failed spectacularly, so what went so wrong

with a contract to deliver health care older people in Cambridgeshire?

So how could such a high profile and expense of contract go so wrong?

Tom Barton has been finding out.

I have been finding out why this hugely important contract collapsed

and what it means for the future of the health service in Cambridge.

A Norfolk dog trainer takes us to Africa, using the latest

weapon against poachers.

And how this 23-year-old turned his passion into Special Olympic

standard figure skating, despite having severe autism.

Revealing the stories that matter closer to home,

that is tonight's Inside Out.

This week- in Norwich, welcome to the programme.

When the NHS in Cambridgeshire signed a contract for older people's

health care two years ago it was the most expensive in

the history of the health service.

But it failed, Tom Barton investigates why it went so wrong

and what harm has been done to the health service as a result.

This is Jack, do you remember he came yesterday to see yes.

He is just going to check you over again to see how

you are doing today.

76-year-old Jim Noble has a high fever, and this

morning also had a fall.

Normally, someone his age in his condition would be taken

to hospital but instead today Jim is being seen at home by Jack,

a trained paramedic from Cambridgeshire's

joint emergency teams.

Turn and face me, that's it.

Pushing the hearing aid into your head, aren't I?

These teans saving all the patients from unnecessary hospital stays

are a real success story.

Despite the fact that the project is set them up has now collapsed.

The joint emergency teams are one of the few things to have survived

from the Uniting Care partnership, a massive contracts to provide

health service for older people in Cambridgeshire.

It was worth ?800 million and was supposed to last for five years.

In the end it collapsed after just eight months in a project

which should have saved the NHS money ended up wasting millions.

I have been looking at why this hugely important contract collapsed

and what it means for the future of the health service in Cambridge.

This video was produced to promote the project

and it was a pretty good idea, bringing together the different

parts of the system that looked after older

people in Cambridgeshire.

That should have made it better for patients

and also cheaper to run.

And according to this Cambridge University health expert,

the area's health service desperately needed to save money.

In about 2-3 years they had to increase their costs

by about 250 million pounds so when you think about that much

pressure that you have on the system, we had to do

something really very creative and they had

to do something very big.

That creative solutions sought to NHS trusts,

the one which runs Addenbrooke's and Cambridge's a mental health

trust joining forces to form a company called

Uniting Care Partnership. That company was then given this

massive contract to look after the health of the county's

elderly population.

But very quickly problems started to emerge,

within a month Uniting Care

had gone back to commissioners to ask for more money.

A lot more money.

The contract was supposed to be worth ?160 million in the first

year, but Uniting Care asked for an extra ?20 million,

that over the course of the contract would have taken it from almost

?800 million to nearly ?1 billion.

Dr Erhun helped write one of the reports into what went wrong.

Given that the contract was signed without having some idea

of what the total value was going to be,

that is absolutely mad.

But commissioners did not agree to the extra money

and the at the start of December 2015 after just eight

months Uniting Care

said it was close to going bust and could not afford to carry

on doing the work.

A few days later the contract collapsed.

So how could such a high-profile and expensive contract be allowed

to fail so spectacularly?

Well big expensive contracts are extremely complicated to put

together and whether you are in business or with the NHS they often

rely on expert advisers.

The problem is that some of the advice that the NHS received

on this contract contains some pretty big mistakes.

Key to ensuring that the NHS commissioners had all

the expert advice they needed was the strategic projects team.

It had been relied on to help put together some of the biggest

contract in the health service and it did have success

is like setting up the friends and family test to monitor patient

satisfaction.

But when it came to the Uniting Care contract key details were missed.

Like VAT.

If you or I buy something from a business, a coffee

for example, we pay VAT, so this coffee would cost ?2.40

of that 40p goes straight to the government in tax.

One part of the NHS I is something from another part of the NHS,

they don't pay VAT.

But if the NHS by something from a business then they do.

Although Uniting Care was owned by two NHS trusts,

legally it was a private company and that meant VAT was due.

But the problem is that no one took account of that when commissioners

and Uniting Care agreed a price and that added ?5 million

to the bill in the first year alone.

These top advisers also fails to pass on some key legal advice

that would have protected the commissioners if

Uniting Care went bust.

On top of all that, the strategic projects team failed to check

whether Uniting Care could deliver everything it had promised

for the price which had been agreed.

As it turned out they couldn't.

As a result of the Uniting Care disaster NHS England close

the strategic projects team down last year.

Look East can reveal that the consultant team

at the heart of those plans is being scrapped.

The team's most senior adviser on the Uniting Care

contract was this man, the commercial

director, Martin Pete.

I can reveal that when Martin Pete was working for the strategic

projects team back in 2012 his own business went bust.

That company, Martin Pete consulting Ltd, was wound up by this High Court

order which declared it insolvent and unable to pay its debts.

The reason the company was the taxman, HM Revenue

and Customs, more than ?40,000.

So the man overseeing the process of awarding the biggest contract

in the history of the NHS was someone who it seems was unable

to stop his own company from going bust, leaving

the taxpayer thousands of pounds out of pocket.

We put these points to Martin Pete and he said that he had

no statement to make.

NHS England told us that the strategic projects team's

role in the contract was restricted to procurement and that the clinical

commissioning group led the contract and made decisions based on advice

from auditors and lawyers. The doctor again is happy that we're

going to come back tomorrow.

So am I.

More than happy.

Today, Jim has been told he can stay at home.

This is better for him and better for the health service.

One of the biggest impact of the collapse of Uniting Care has

been the lack of money to invest in similar teams working

in the community.

To find out how this has had an impact on patients I sat down

with the women whose job it is to manage the

area health budget.

If United kit hadn't fallen apart what more would you be able to do

today that you are not doing?

I do think that the pace of us developing things like specialist

diabetes and respiratory teams in the community has been slower

than it would have been.

We have not moved as quickly as I think we would have done

if the Uniting Care contract had been successful.

And so there has been part of the health system

in Cambridgeshire where what patients would have expected

has not come to fruition because you just have not had

the money to do it?

I think it has not come to fruition as quickly

as we would like it to have done.

As Jack heads off to see his next patient there is already evidence

that this team is a success.

But how much more could have been achieved if the project which set

up the joint emergency teams haven't failed?

And what would that have meant for patients across Cambridge?

If you think there is something we should be looking

into in the programme then get in touch with me on Twitter.

Or e-mail.

This is Inside Out in the east of England here on BBC One.

Later on, the ice-skating superstar from Peterborough you probably

have never heard of.

It is a sad fact that this far into the 21st-century

there is still a demand for rhino horns.

Poaching is still a massive problem in parts of Africa.

Debbie Tubbie has spent the last year following the dogs

being trained here in Norfolk to protect the rhino

and other animals.

These are the latest weapon in the fight

against poachers in Africa.

They are being trained by Darryl Pleasant from Norfolk.

He has dedicated his life to saving endangered animals that

could otherwise be extinct in less than a decade.

We're losing in Africa about 100 elephant a day,

three rhino per day, we're losing a ranger a day

a lion a day, to poaching.

So it is an epidemic.

Rhino or fetching up to 60,000 per kilo, one horn can be worth up

to a third of a million.

We wanted to train a dog to British police standards,

because effectively poaching is a crime scene.

For the first time, the dogs will be trained in Norfolk so he can

monitor their progress.

But will his latest recruits make the grade at Will

they stop the poachers?

It is animals saving animals.

Humans have been trying to do it and we have failed so let's put

the animals out and have animals helping animals.

A former keeper at a local zoo, Darryl has always lived in Norfolk

and four years he was a militarily dog trainer and instructor.

I think it is an irresponsible attitude to say I want

to save the world and make a difference because no

one person can do it.

As a team across the broad spectrum of conservation we can do our part.

In August 2015 Darryl selects brothers Bo and Rogue and Polaris

from the same litter.

They are Belgian and chosen for a privileged role.

From just 12 weeks, rogue and his brothers have been learning

to track so they can sniff out weapons and even Ivory on a person.

It is hoped they will follow on the footsteps of Darryl 's other

dogs, some are protecting these, the planet last three remaining

northern white rhino.

It is six months since we last saw Bo and Roque and they are no longer

puppies, and are checking into Norwich Airport

for the next stage of training.

They need to learn to acclimatise to an EC 120 helicopter,

similar to the one they will use while working in the African bush.

We're going to rehearse in and out here now, we going outside,

we will start the engine up and do the same thing with

the rotors running.

And then if that goes well we will call for a quick circuit

of the aircraft and prove the point that they are ever the animals.

Darren Riddle, a dog trainer who is helping Darryl uses a tennis

ball has an incentive to get Bo on board.

But it is unnerving when it is the first time

he has seen helicopter.

Eventually they face the aircraft with the rotors turning

and the downdraught.

This Norfolk helicopter company is doing this for free,

but it still costs of ?5,000 to train each dog.

I have no doubt whatsoever that both of these dogs

would now into a helicopter or a plane quite happily.

That these are only nine months old but they have been trained

to be like a family pet.

If I stand back they can change very quickly.

And you would not want to meet Deigo on a bad day, either.

He is one of 17 dogs Darryl has already trained in Africa.

He wants his latest recruits to be up to this standard.

Diego faces poachers armed with AK-47 assault rifles

with speeds of 30 mph and a bite like a hydraulic press.

There is no chance of escape.

And because he is so fast he is unlikely to be shot.

They are wearing armour and where there human

as he is moving through the ground you have a front profile,

with a dog you only have a side profile and with the armour as well

we have never had a problem, we have never had a dog who has even

been injured operationally in the call of duty.

Maria wasn't so lucky, shot 70 times by poachers,

her horn hacked off while she was still alive.

Her baby was less than one-week-old.

Maria died in Zimbabwe two years before Darryl's dogs arrived

here but the clock is ticking.

It takes months to train the dogs and Darryl is desperate that no more

animals lose their lives.

Three months on and we have come to Wales to see the dogs being put

through some extreme training.

We will also see if they have what it takes.

Joshua is stepping into the shoes of a poacher.

He is volunteering to be chased and bitten by the dogs

while wearing a bite suit.

Do you train the dog to bite or do you train it to just hold?

We teach the dogs to bite obviously, all of the dogs targeted arms shall

we do inside bite and outside lights and what we try and teach the dog

to do is target what they are after.

If you look behind you the dog is the way and another glance

and he is right on you.

At 30 mph the momentum lifts the dog off the ground.

What we drain the dogs to do is actually give an indication

of the direction of fire and they will actually lead

the handler in that direction so we can then give chase and get

an apprehension like what you're seeing here.

It is the hottest day of the summer, rogue and Polaris are now getting

a day trip to the zoo.

It is a chance to meet animals they will see in Africa,

but hopefully they will not be this close.

These dogs have got to find out exactly where the position

is within that environment, they must know because dogs

will generally react with either fight or flight and what we want

the dogs to do is remain stable under pressure.

We don't want a dog that will suddenly run off

and start chasing wildlife.

What's that?

This training is taking place before the public are allowed into the zoo.

We have seen the rhinos, let's see how they get

on with the giraffes.

What we try and do is make the dogs realised that lions, elephants,

rhinos are obviously things to be a little bit wary of but obviously

just as much part of the environment as the trees and the rest

of the environment itself.

After months of hard work, rogue and Polaris finally

step onto African soil.

It is August 2016.

Darryl will leave them here while they continue their training.

This is the first time they have been paired with the new handlers,

this is the first walk-out.

Your new home is this Valley Conservancy,

3000 square kilometres.

It is also home to 200 rhinos and 2000 elephants.

Polaris is sitting on the back of this truck being chased by one

of the animals he has been trained to protect.

Perhaps not quite the welcome he was expecting.

Meanwhile his brother, Bo, has been safely been deployed

to a national park in Tanzania.

But because of restrictions the we have not been allowed to film.

Polaris, speak.

DOG BARKS Five months later, Darryl has returned to Zimbabwe

to see how they're getting on.

Darryl 's dogs continue training even though

they are now fully operational.

They are the only anti-poaching dogs in Africa not on a lead

and tracking 8km at a time.

So how successful have your dogs been so far in Africa?

We have seen a definite downward turn in poaching

because there is an inherent fear of dogs in Africa.

We have sent out a very clear message to everyone else that

if you come onto the Conservancy and intent to poach then

you will not leave.

Man and dog working together to save animals that otherwise

could soon become extinct.

Within seven years we will not have rhino and elephants.

That is the simple message.

That is why I do what I do.

That is the whole purpose of what we do.

It is making a difference for future generations, isn't it?

It has to be said.

I don't want my grandchildren to look at animals in a picture book.

Our last story is about a chap called Callum.

At three years old, Callum from Peterborough

was diagnosed with severe autism.

But now he is a top athlete.

In fact he is an ice skater representing Britain

in the Special Olympics.

The skaters at this ring in Peterborough might not pay much

attention to this young man but if they knew his story

they would certainly be impressed.

23-year-old Callum Titmus is severely autistic.

The condition affects his learning and communication skills.

I have watched him as he has developed into Britain's top

Special Olympics skater.

While Callum is at ease on the ice, daily life

is not so straightforward.

Yeah.

Three.

One.

You have found a leaf?

Thank you!

As a parent you want...

I remember vividly, obviously the diagnosis and doing research,

I was upset and had just said to me, he is still Callum.

And it is so true.

He is still Callum.

But we just deal with the challenges that turn up with each day.

Touch. that turn up with each day.

Do you want to play on your huddle for a bit?

Huddle?

Yes?

You can show them how good you are at Kandy Krush.

Or one of those games.

Callum who comes from Peterborough was three years old when he was

diagnosed with autism.

The condition affects about one in 100 people in the UK.

It has an impact on the way a person communicates and how they experience

the world around them.

Over a period of time you realise there is an issue

and there is the whole guilt thing, could I have done

something different?

Have I done something wrong?

Why have we bred an autistic child?

All of those sorts of...

It is stupid.

You can't but you do.

And all those points, you have to get all of those?

And can you see the forest at the back?

The forest!

Look at the forest.

Trees and bushes, oh, wow.

Although Callum find it difficult to communicate he has a remarkable

memory for certain facts.

They tend to be about things he is a big fan of which includes

pretty much every single Disney movie ever made.

Frozen in 2013.

Is that your favourite, is it?

Yes.

I did not know that.

So Mary Poppins?

1964.

Jungle Book?

1967.

Snow-white.

1937.

Pinocchio.

1940!

Cinderella two.

2001.

Excellent!

Callum is also a big sports fan and loves taking part

in different activities.

But it is ice skating which is his favourite.

To say he gets excited about coming to Peterborough ice rink

is something of an understatement.

Do the jump, skate round and do the jump here for us.

Do you understand?

Keep the body still, Callum.

Strong.

Push!

Good man.

Callum is so good that he is a member of the British

Special Olympics team, he has won more than 30

medals for his skating and he is only getting better.

Good job, Callum.

OK.

Good job.

What are the challenges of teaching someone like him who suffers

with the condition like autism?

You just have to be patient with him.

There is nothing that he can't do that and able-bodied person can do

and it just takes time.

Time and patience.

And keeping things simple.

To give it context, how much of an achievement is this?

Massive.

Absolutely massive.

There are no words that can describe how big an achievement this is.

How good is he?

Callum is good.

He is good.

For the difficulties he has to face he is doing an amazing job.

The stuff he's doing, the technical stuff,

the jumps and spins, there are people who don't

have his difficulties and they can't do them so he is doing fantastic.

Karen what is it about ice-skating which brings out a different Callum?

I don't know.

He quite clearly enjoys it, he loves being on the ice,

and you see that in his reactions.

In his face and the noises he makes.

And he works physically and emotionally to be enjoying it.

What does it do for you and Adam watching?

I am just happy that he's happy.

Can you cut it into pieces about so long all the way through?

Wonderful.

Looking after Callum and making sure he gets the proper care

does not come cheap, the family estimate they spend

around ?20,000 every year organising care and activities for him.

I am never going to retire.

I will never retire.

We have no savings.

I am not kidding.

We haven't savings.

We find it, self-funded a lot of Callum 's things.

And what if you didn't?

He wouldn't do them.

He would be stuck in a room watching a screen 24 seven.

He would be watching Disney movies all the time.

On children's television programmes.

I don't think that is life for anybody.

And also getting bored and frustrated and breaking things.

Yes.

What do you want?

Pudding.

What pudding do you want?

I think ice cream.

You get these life affirming moments.

You have to keep reminding yourself sometimes because there

are difficult times obviously.

But you don't think in terms of all we will do this

because we get something back, we get lots back.

But you do it for Callum.

Callum is not an angel but then you get the other side

when you see him standing in front of the union Jack singing

the national anthem and I am a very proud parent.

The things he has achieved phenomenal.

Gosh.

Gosh what?

Would you like to see a photo?

Or view representing Great Britain.

And what other flags out there?

Canada and America.

The United States of America, Great Britain.

Three podiums.

And you beat all of them, Callum.

That is very good.

Callum is currently in Austria for the special Winter Olympics,

hoping his training here in Peterborough pays off.

And the very best of luck to Callum.

Next week on the programme we spent some time with Lauri Love

who is trying to prevent his extradition to the United States

on hacking charges.

It is just absurd that someone should be sent to foreign prison

system which leaves a lot to be desired.

But in the meantime if you want to get in touch about any stories

you think we should be doing then I am on Twitter or e-mail.

They all get passed on to the team.

That's it from this week.

Goodbye.

Also next week Richard Daniel investigates how often raw sewage

is being pumped into our rivers and estuaries And it is the 350th

anniversary of the first ever land battle of the predecessors

of the Royal Marines against an invading army.

It took place in Suffolk.

That is Inside Out next Monday, 7:30pm on BBC One.

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