The week in public services: 10th March 2020

This week: nursing shortages, ghost teachers, and rounding up budget rumours

Budget chat

The pre-budget discussion has been dominated by how the government will respond to coronavirus (see this Resolution Foundation briefing), but there are some other things too! Of course the only thing you really need to read is my colleague Gemma’s great briefing on six things to look out for in the budget…but Chris Giles also has a good piece about the fiscal rules. Any government should remember what’s sensible (keeping the public finances broadly sustainable) and isn’t sensible (slavishly sticking to rules) in the fiscal rules, and what they really do (give the Treasury more control over the spending departments’ activity). His classic pre-budget briefing is here.

Want a more wonkish take? This blog from the National Institute of Economic and Social Research looks at the difference between public sector and private sector wages and finds that closing the public-private sector pay gap (currently at 3%) would cost more than £5 billion a year. That is, as they say, a big number.

We’re also expecting this week’s budget to set the spending envelope (how much money the government will spend in total over the next three-five years). Mel Stride, the new chair of the Treasury select committee, is hoping to improve parliamentary scrutiny of the spending review and has asked other select committees to ask probing questions about the spending of the departments they cover. A good move, in my opinion.

Elsewhere, an alliance of headteachers, school governors, councils and unions want £5.5bn more to provide better services to children with special educational needs — and Sally Warren from the Kings Fund has written a useful ‘cut-and-keep’ blog on what to expect from the budget for health and social care. Centre for Cities have also set out what they think a ‘levelling-up’ budget would include. In their view, the budget should: commit to annual funding increases for local government; increase funding for further education; invest in new transport within large cities; create a £5bn ‘City Centre Productivity Fund’ where councils can bid for money to “make their city centres more attractive places to do business”; and strike a devolution deal in West Yorkshire. Good luck with that last one…

Health and Social Care

Budget time means new NHS accounting hijinks. This time, new accounting guidance means that one-way NHS Trusts bought capital assets in the past — through ‘operating leases’ — will now be scored as capital rather than resource, which could reduce the number of NHS Trusts leasing buildings or equipment from the private sector. See the full Health Service Journal scoop (£).

And with pressures from coronavirus, does the NHS in England need more beds? There’s a case for it — but hospitals also need NHS England to set clear expectations, and clearly explain who is accountable for making these decisions. Ace blog from Siva — probably the most informative thing I read last week.

The National Audit Office published a good report on current vacancies in nursing, and challenges to meet the gap. The main things I learned were:

• Recent national initiatives to increase recruitment of overseas nurses have not met their targets (a Health Education England programme to recruit 2,500 overseas nurses in 2018 and 2019 only recruited 1,600)
• NHS England and Improvement pilots to improve nurse retention led to some reductions in leaving rates for the Trusts who received support from the programme — slightly more positive news!

And how are the UKs general practitioners faring compared to their commonwealth peers? UK GPs do well at using electronic medical records and data, but less well at ‘workload satisfaction’ (only French GPs report being more unhappy) and appointment lengths, where UK GPs report having shorter appointments than most international colleagues. Interesting report from the Health Foundation.

A great new report from the Kings Fund explores the best ways to provide healthcare for rough sleepers, including a clever analysis of hospital admissions data to estimate the prevalence of rough sleeping (alongside the annual rough sleepers count). Just want the headlines? The New Statesman have a helpful write-up (£).

Over in social care, David Oliver has taken a look at the state of the care home market, noting (correctly) that if care providers increase fees, then this “will hit other areas of local government spending at a time when councils’ funding has been serially cut and other local services hit in order to preserve social care capacity”. See also his helpful summary of where the government is at on social care reform (it’s not an inspiring read).

The secretary of State for Health and Social Care, Matt Hancock, has written a letter to MPs and Lords asking for their views on how to reform social care. Apparently, there will be “structured reform talks” in May…let’s wait and see.

For a useful overview of the pressures social care on local government right now (and the size of the ‘funding gap’), check out this Local Government Association briefing.

Children and Young People

The Department for Education have published an interesting analysis of ‘serious case reviews’ — undertaken by local safeguarding boards when a child dies or is seriously harmed — between 2014 and 2017. The authors find that:

• The number of children who die each year as a result of maltreatment is not increasing, but serious case reviews for “serious non-fatal harms” — such as emotional abuse, sexual abuse, and exploitation — have risen from 30–32 per year between 2009 and 2014 to 54 per year between 2014 and 2017
• There is particular pressure at “at the boundaries into and out of the child protection system” (i.e. where a child just misses the threshold for a child protection plan and regular visits from a social worker)
• “Detailed examination of neglect cases revealed the complex ways in which the links between domestic abuse, substance misuse and poverty are often inter-dependent, so that addressing a single issue does not deal with the underlying causes or other issues present”

A Times Educational Supplement has estimated that the government spent up to £123m between 2009/10 and 2015/16 on bursaries for teacher trainees…who did not go on to work in state schools.

As Luke Sibieta pointed out on twitter, this is almost certainly not the best way to spend this money, if your goal is to get more teachers into schools. Why not instead put the money into offering retention bonuses or salary supplements for existing teachers, for which there is better evidence?

Struggling secondary school? Blame the lack of buses, says new research from School Dash (sort of)*. A fascinating bit of analysis from Timo Hannay suggests that poverty and geographic isolation affect the Ofsted scores of secondary schools, and “among the relatively small number of secondary schools with high levels of both, two-thirds are rated ‘Requires Improvement’ or ‘Inadequate’.” Why? Possibly because it’s hard to attract good teachers to these schools, or possibly because there is less ‘competition’ between schools (i.e. parents can’t choose which school to send their children to if they only have one accessible…), or possibly something else entirely. The causal mechanism remains unclear — but surely worthy of further investigation.

Elsewhere, the Commons library have published a useful briefing about support for children with special educational needs (SEN) in England. Given that SEN support is one of the biggest financial pressures on schools, well worth bookmarking this one.

Law and order

In the world of policing, the police and fire services inspectorate has published a thematic report about how different public services can work together to protect children — one worth reading in light of the Department for Education research about serious case reviews above.

Good blog from Penelope Gibbs questioning how, exactly, the government will measure whether crime has been reduced, and how it will hold police forces accountable (while avoiding the perversities of the New Labour offences brought to justice target…)

Elsewhere, the Centre for Justice Innovation have published an interesting report about how the government can “improve the evidence base around women’s offending and the specific needs of women, explore what we know about effective working with female offenders, and provide examples of diversion schemes tailored for women.”

What’s really driving rising homicide rates in the UK? Is it related to drugs markets? And how is drug use — and for that matter, also homicides — defined? In the UK, it’s based on toxicology tests (which can both miss cases, and provide false positives), and whether the perpetrator is a suspected drug user or dealer. Both of these are contentious, to say the least. “Without a more sophisticated analysis of the data to properly measure and monitor how this market is actually operating, we risk using drugs as a scapegoat for violence that arises from other causes”, the authors conclude.

Worth remembering in context of this new Home Office research into long-term trends and patterns in homicide in England and Wales, which finds that the recent (since 2014) rise in homicide rates appear to be related to a ‘short wave’ increase of “male-on-male, goal-driven killings and weapons crime”. See also Dame Carol Black’s independent review of drugs.

Looking abroad, a fascinating paper about crime in Italy, and the benefits of using past crime data to predict the location of future crime…apparently criminals in Italy are surprisingly predictable!

And remember those probation reforms that David Gauke announced last year? Yep, they’re still going on. This blog from the criminal justice charity Clinks is a helpful summary of the state of play.

*This is a wild oversimplification, and you should read the methodology (but you knew that already, right?)