Includes booklet 'Good practice in managing the use of temporary nursing staff' (39 p., 21 cm) on inside back cover.

Properly managed, the use of temporary nurses can play an important role in helping hospital achieve flexibility. However their high use can have a detrimental impact on patient care and satisfaction. In 2001 the Department of Health anticipated that a growth in the NHS workforce would lead to a decline in the use of temporary staff but in spite of this intention temporary nurses still account for the same percentage of the nursing budget (around 9%). On the basis of a report by the Comptroller and Auditor General, the Committee has investigated the extent of the use of temporary nurses; whether the process is properly planned and managed; and whether there are safety and quality implications. One of the conclusions is that there has a lack of planning and it is only as a result of the problem with deficits that the NHS has taken a more co-ordinated approach

Committee of Public Accounts treasury minutes are on the following reports: HCP 113, 06/07, 27th report (ISBN 9780215034311); HCP 179, 06/07, 28th report (ISBN 9780215034373); HCP 142, 06/07, 29th report (ISBN 9780215034304); HCP 189, 06/07, 30th report (ISBN 9780215034489); HCP 309, 06/07, 31st report (ISBN 9780215034496); HCP 91, 06/07, 32nd report (ISBN 9780215034571); HCP 275, 06/07 33rd report (ISBN 9780215034786); HCP 43, 06/07, 34th report (ISBN 9780215034830); HCP 729, 06/07, 36th report (ISBN 9780215034823); HCP 812, 06/07, 37th report (ISBN 9780215034878); HCP 261, 06/07, 38th report (ISBN 9780215034991); HCP 377, 06/07, 39th report (ISBN 9780215034922); HCP 368, 06/07, 40th report (ISBN 9780215035066); HCP 892, 06/07, 43rd report (ISBN 9780215035172); HCP 246, 06/07, 44th report (ISBN 9780215035271); HCP 250, 06/07, 45th report (ISBN 9780215035387)

Following serious concerns about clinical and organisational failures in the NHS during the 1990s (such as Alder Hey, the Bristol Royal Infirmary and Shipman), the Government identified the need for a more systematic approach to improving quality and safety in healthcare. The Department of Health introduced clinical governance, a framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care. Primary Care Trusts (PCTs) are responsible for providing primary care services and commissioning services on behalf of their local health economy. This report examines the Department's progress in implementing clinical governance in primary care; the lessons learned; and the risks that will need to be managed if quality and safety are to be embedded in the new PCTs. that clinical governance is not as well established in primary care as in secondary care, largely because of the complexity of PCTs role in both commissioning and providing care; and the independence of contractors delivering healthcare, particularly General Practitioners (GPs). Primary care has also been slower in adopting a structured approach to quality and safety, evident for example in the lack of compliance with national systems reporting of clinical incidents. There is a lack of clarity between PCTs and their contractors as regards accountability for ensuring quality and safety, and scope for greater involvement of patients and the public in ensuring that primary care services are safe and of high quality.

The Assets Recovery Agency (the Agency) was set up in 2003 to recover assets from criminals using new and unique powers of civil recovery as well as criminal confiscation and taxation. It was also tasked with the training, accreditation and monitoring of financial investigators. The Agency is to be disbanded in 2008. It was set up with insufficient preparatory work. There was no business case setting out the expectations for the Agency, resulting in unachievable delivery aims. It is reliant on cases being referred to it by other authorities, but only 707 cases have been referred from 129 out of 696 potential referral partners. The Agency did not develop effective work processes: it failed to keep a comprehensive database of cases referred to it; it did not invest in a time-recording system to manage and monitor staff time and the cost of cases; and it failed to put in place processes to enable management to monitor the progression of cases effectively. Receivers' fees accounted for almost a quarter of the budget but fixed price contracts were not introduced until April 2006. The Agency's office is in central London, heavily reliant on temporary staff, and with high levels of staff turnover. The Agency had recovered assets amounting to only £23 million by December 2006 against expenditure of £65 million, and it has not met its target of becoming self-financing by 2005-06. Asset recovery has been slow because in most cases the full value of the assets was pursued through the courts rather than seeking settlement for a proportion of the assets. The Agency has not been adequately monitoring the accreditation of trained financial investigators. Of the 4,500 financial investigators trained at almost £700 per place, only 1,400 of those were active in the role by summer 2006.

Since it was established in 1993, the Child Support Agency has consistently underperformed, plagued by enormous backlogs of unprocessed cases and uncollected maintenance. Where it works well, the Agency has secured regular contributions from non-resident parents and helped lift an estimated 100,000 children out of poverty. It has to administer complex assessment, collection and enforcement processes and deal with complicated emotional, financial and legal issues to bring about a degree of financial stability for children and parents. Following on from a NAO report (HCP 1174, session 2005-06; ISBN 9780102938692) published in June 2006, the Committee's report examines the implementation of child support reforms, focusing on why the problems in implementing the reforms arose, the impact on the quality of service, the remedial action taken by the Child Support Agency and the lessons learnt. The report finds that implementing the reforms has cost the taxpayer £539 million since 2000, with plans for a further £320 million to improve service levels over the next three years; but the money has failed to deliver improvements in efficiency and quality of service. The Agency still performs less effectively than its counterparts in Australia and New Zealand, with higher average costs per case and lower rates of compliance. The Government published its White Paper (Cm. 6979, ISBN 9780101697927) in December 2006, drawing on the recommendations made by Sir David Henshaw in his report "Recovering child support: routes to responsibility" (Cm. 6984, ISBN 9780101689427). Amongst the reforms announced, the Government will replace the Child Support Agency (CSA) with a new organisation, the Child Maintenance and Enforcement Commission (C-MEC) by 2008.

The 2002 report Tackling pensioner poverty: encouraging take-up of entitlements (ISBN 0102919577) examined efforts by the Department for Work and Pensions to increase the take-up of benefits by pensioners. It was followed by a report from the Committee of Public Accounts (ISBN 0215009347) that made a number of recommendations. This report looks at the changes the Department have made against those recommendations and the challenges that remain. The overall conclusion is that the Pension Service has made substantial progress in helping pensioners secure their entitlements, using new and thought through approaches. However there is more to be done. This report is accompanied by a technical report that describes the methodology and findings in greater detail.