The Week in Public Services — 14th March 2019

This week: the Spring Statement; the Brexit void swallows the social care green paper; and what to read about knife crime

Spring Statement

In an alternative universe where Brexit wasn’t happening, what would a bold chancellor have done this year? Abandon the target of a balanced budget by the mid-2020s; increase the spending envelope for the Spending Review; reverse planned corporation tax cuts; and reconsider property and wealth taxes. Labour party manifesto? No, this Monday’s Financial Times editorial. Which gives a sense of how widespread the rejection of austerity is becoming…

And what was in that Spring Statement in the end? Scant announcements — as predicted. £100million, to help the police tackle knife crime next year. Confirmation that the Spending Review will take place over the summer and last three years — but no confirmed changes to the spending envelope.

Read the IFS to understand the wider significance of the Statement — as well as Gemma Tetlow’s take too (obviously).

I also rounded up announcements here, and wrote about the £100m for knife crime here.

The £100m announcement is a classic example of the crisis-cash-repeat mentality that has characterised the Government’s approach to public services since the 2015 Spending Review. Patrick Butler has argued that recent funding announcements and the Spring Statement illustrate that the Government has no strategy for public services. I think he’s right — but there is a better way. If Government consistently tracked performance, it could respond to warning signs before they became full-blown crises, as I argued here.

Health and Social Care

Let’s start with social care for a change — the green paper: whatever happened to that? Hugh Pym has written a good summary of the state of play. But the basic point is: it’s lost in the Brexit void. In contrast — Wales has a weekly cap on home care costs, and Scotland and Northern Ireland provide some free personal care at home to their elderly populations. Meanwhile in England, the accountancy firm BDO estimates that more than 100 care home operators collapsed in 2018, owing to rising debt interest payments combined with lower council fees.

Unpaid carers are the under-discussed backbone of social care in England. So this story — a Freedom of Information request which revealed that only 17,000 people were claiming carers’ credit, despite an estimated 200,000 people eligible — is concerning. If the Government doesn’t have the political capital to reform social care funding, one option would be to increase the ways the State supports people providing unpaid care for elderly relatives and loved ones, with the aim that could replace some state-provided care. Simple tweaks such as an awareness-raising campaign are surely worth exploring.

In the same vein — these two blogs from PwCs UK healthcare team share valuable insights about the (paid) social care workforce. Their survey of 2000 workers found that most were concerned about the working environment — from an excessive focus on financial performance, to reductions in numbers of frontline staff, and lack of training opportunities. Full report, and recommendations on how council commissioners and private providers could improve, here. On a similar note, Mark Britnell has written about what the UK could learn from other countries in order to recruit and retain enough healthcare staff.

And are we happy with health and social care? The results from the annual survey of the public’s opinion of the NHS and social care from the British Social attitudes are out! Ruth Robertson has tweeted the key findings. Respondents loved that the NHS is free at the point of use, but didn’t like waiting times and staff shortages. Overall satisfaction with the NHS dropped, which appears to have been primarily driven by perceptions of quality, access, and negative media coverage. Interestingly, respondents were split pretty much 50–50 on the impact leaving on the EU will have on the NHS. Full Kings Fund analysis here.

In the world of the NHS, the big news is NHS England’s proposal to drop the 4hr A&E waiting time target and replace it with five new measures. (There are also some other new targets). Our own Chris McNulty has commented here, arguing that the waiting times review is a positive start to clarifying the trade-offs in the Government’s spending plans — but it is just the start of the tough choices the Government faces ahead of the Spending Review.

The latest — and worst yet — A&E waiting time data reinforces this point. These trade-offs. Not. Going. Away.

We also now know that rural communities wait longer for responses to 999 calls. On the one hand — an entirely predictable conclusion; on the other — a very good bit of careful data analysis from Nick Triggle and colleagues at the BBC. Worth a read.

Nick Timmins is characteristically clear and level-headed about the scope for legislative change implied in the NHS long-term plan — and what it means for choice, competition, and integration.

And in finance news, the latest NHS Improvement numbers show that NHS providers are on course for a £660m deficit this year. Stripping out one-off savings, the underlying deficit may be more like £2bn. A nice briefing from the Health Foundation looks specifically at the impact of declining capital spending. They find that cuts to capital have contributed to a rising maintenance backlog which has having direct impact on patient care. Future cuts risk not being enough to meet the Department’s ambition to be “a world-leading technology- and data-driven health and social care system”. Pairs well with this research from the University of Birmingham’s health services management centre, which found that Trusts have prioritised investments for patient safety and service viability, rather than transformation, as capital has been cut.

Last but not least, a new Public Accounts Committee report on clinical commissioning groups argues that responsibility for planning and commissioning is unclear, and that CCG under-performance — as rated by NHS England — will need to improve as they take on responsibilities for commissioning more services.

Children and Young People

As the schools spending debate starts off again, The Guardian have put together a really great explainer on school funding — reconciling the Government’s claims with those of headteachers and other analysts. Very helpful for putting this campaign from Worth Less?, a coalition of headteachers who want to raise awareness of the impact of funding cuts, in context.

In less gloomy news, Dr Sam Sims of the UCL Institute of Education has written a report for the Gatsby Foundation Trust on how to increase science teacher numbers. TL;DR? Stable teaching assignments; science-specific professional development; and flattening the pay gradient (seriously!) would all help.

In children’s social care, an interesting study from the Centre for Child & Family Justice found that one in five children in England allowed to return to home on supervision orders — where a council agrees certain responsibilities with the child’s parent or guardian, without taking legal responsibility for the child — were back in courts within five years. According to The Guardian write-up, the report found that social workers are frustrated by “lack of powers available to help them keep vulnerable children [on supervision orders] safe”.

The Association of Directors of Children’s Services have set out their position on what the Government needs to do to help the children’s services workforce — not just social workers but youth workers, health visitors, and school support staff too. And the Local Government Chronicle have a good article on whether government-imposed independent trusts have helped speed up improvement in children’s social care. The evidence still isn’t there.

Ending on a nicer note, a report to Glasgow city council found that children in care across Glasgow perform better at school than the Scottish average — and Policy in Practice show some encouraging ways councils can use benefits data to prevent at-risk children entering the child protection and social care.

Law and Order

Rory Stewart’s high-profile pledge to reduce violence and drugs in 10 prisons is looking less than honourable, after a report that he may improve conditions by…taking resources from other prisons. This is something we’ve seen before in the Week in Public Services — and something we’ll continue to keep an eye on.

Elsewhere in prisons, last week saw a great Financial Times investigative article into HMP Berwyn — Britain’s proposed prison of the future. Sarah O’Connor and Cynthia O’Murchu argue HMP Berwyn is “a story of good intentions undermined by bad decisions and bungled procurement”. Originally planned to be fully populated by now, it is 40% empty. Why? Parts of the project, including planned workshops, have veered off track, and Ministry of Justice statistics indicate that Berwyn has seen more assaults and “use of force incidents” than other category C prisons in the last year. A great expose of problems in prisons, based on a single case study.

The other big story last week, was, of course, knife crime. But what’s really behind the recent increase in knife crime? Cuts to police numbers! Reductions in stop and search! The quality of the answers in the political debate has been really low — even taking account of the fact that a lot of the debate is really jostling in the race to be the next Conservative leader. So here are five better things you should read:

• First off: this excellent myth-buster by Anoosh Chakelian (£)
• Second: This article by Robin Murray. Useful evidence-check of the argument that more punitive sentences would reduce knife crime. The recent increase in knife crime has taken place alongside an increase in sentencing severity
• Third: this in-depth read about ‘county lines’ crime — criminal networks which use children to move drugs across the country — based on drug networks between Finsbury Park and Norfolk
• Fourth: this new Ofsted report on how school leaders are dealing with knife crime in London — and how they could improve. The Chief Inspector has highlighted cuts to spending on early help and preventative services. Guardian write-up here.
• Last but not least: this by Gavin Hales — now over three years old — is still very good. Drawing on his research from Brent and elsewhere, he concludes that policy-makers and politicians need to start by “meaningfully address[ing] opportunity, esteem and the world view held by vulnerable youngsters”

In the rush to emulate other places which have successfully reduced knife crime, Adrian Brown from CPI pushes policy-makers to consider now what they did, but how they did it. Particularly important given the clear differences between knife crime in Scotland and London, as Shanae Dennis highlights in this Prospect article. One worry wonks like me have with all this praise for early intervention is a simple concern: how can we know what works? Fortunately, the Early Intervention have written a helpful guide here! A useful resource which looks fairly evergreen.

Over in probation, a rapid evidence review from the Probation Inspectorate found limited reliable evidence that remote technologies to supervise offenders (think GPS trackers) are effective, and save money. David Gauke’s ambition to replace short prisons sentences with more community sentences (using new technology) should be piloted and carefully evaluated before being rolled out more widely.

Last but not least, in the courts, Joshua Rozenberg has given a lecture on how far digital court reform has progressed. Now online here.

Neighbourhood Services

A great new briefing from the House of Commons library summarises local financial accountability, budgeting, and whether funding is sufficient to meet demand in councils. It even compares England to Scotland and Wales! An excellent primer.

Equally useful: this paper from Thomas Elston and Ruth Dixon on whether sharing back-office administrative services such as tax collection helped councils save money. Did it? Calculating councils “administrative intensity” (administrative spending relative to ‘frontline’ spending), and isolating councils which started shared services before 2015 from the LGAs Shared Services map, they find that “there was no evidence of a relationship between the degree of participation in shared services and the change in relative administration costs, either for all councils taken together or for upper- and lower-tier councils separately” — or any evidence of increased effectiveness.

They argue that this is probably because there is limited potential for economies of scale in activities which aren’t capital intensive (reliant on technology), whilst there are significant costs to coordinate staff from different councils. Good, counter-intuitive, empirical analysis.

The Chartered Institute of Highways and Transportation have surveyed 150 council highways officers on problems facing road maintenance, and how they could be mitigated. Encouragingly, 9 out of 10 supported a standard approach to collecting condition data — we agree! Comparable council data would make it much easier to have a consistent national picture of road performance — vital for assessing the adequacy and efficiency of spending.

Finally, looping back to last week — remember that story about councils selling assets and spending the proceeds on redundancies? Well, Birmingham City and Haringey councils say this was justified, owing to the need to make ongoing day-to-day savings following cuts in central government grants. It’s never as simple as it seems…