The week in public services — 17th April 2018
This week: councils’ finances (again), ghost wards and personal health budgets (featuring canine cameo).
This is a non-comprehensive overview of what is going on in public services by the Performance Tracker team at @instituteforgov. Did we miss something important? Let us know below.
Health and social care
The current regulatory framework for the NHS was devised in a time before integrated care — and it’s not keeping up. That’s the key message from the new NHS providers regulation report, which also contains this (unsurprising) nugget: the majority of their survey respondents feel “the national policy direction for the overall system architecture” is “unclear”.
The Association of Directors of Adult Social Services are having their annual conference, where care minister Caroline Dinenage acknowledged “the current model cannot be sustained without additional public investment”. You can follow the debate here.
The care minister also told The Times this week that she would like personal health budgets to be extended to take the number of those eligible to 350,000 (there are currently 23,000 users). The NAO published an interesting investigation into Continuing Healthcare (or CHC) funding last year, DHSC is running a consultation here, and a profile of Kingston the black Labrador (whose training was paid for by a public health budget) is here.
Are tax rises the answer to NHS funding pressures? Significantly more people think the NHS faces a funding crisis and support tax rises for NHS funding than did in 2014 and 2016, according to a King’s Fund-sponsored BSA survey. Here’s the TL;DR.
A colourful article by Richard Humphries argues that health and social care need to be covered in a joined-up plan to avoid the mistakes of the 2010 Spending Review. If the Better Care Fund was the equivalent of “taking the wire cutters to the NHS ring fence to let some money through for social care”, making the same mistake of routing money for social care through the NHS again would lead to the BCF “on steroids”.
Public Health England have written a good blog on the apparent paradox of why cost-effective public health interventions often do not mean short-term financial (immediately cashable) savings.
The Guardian reported on data obtained by Shadow Health Secretary Jonathan Ashworth from hospital trusts across England, which recorded 82 “ghost wards”, containing 1,429 empty beds, in September 2017. Dr Nick Scriven, president of the Society for Acute Medicine, attributed these unused beds to the accustomed shortages of staff and cash.
This week it was the LGA’s turn to bang the drum for greater attention to be given to adult social care. In a briefing for the House of Lords, the LGA set out the familiar lamentations of the reductions to local authorities’ public health budgets, and the inappropriateness of delayed transfer of care targets as focussing only on a narrow part of the system.
Local government
The IFS dutifully continues to outline the likely implications of business rates retention by looking at the 10 councils piloting 100% business rates retention — starting this month! The pilots may help maintain momentum on local government finance reform, but scope for learning is limited because: (1) the pilots weren’t randomly selected, and (2) local authorities are likely to behave differently than they would under full business rates retention, as they know that the pilot is only guaranteed until the end of 2018/19.
The issue of councils’ financial reserves was in the news again this week, this time following analysis by the FT indicating that 48 per cent of local authorities reported real-terms reductions in their reserves between March 2015 and March 2017.
Keeping pace with last month’s reproachful independent report into Northants’ governance, an investigation for LGC has uncovered a Cipfa review of Worcestershire County Council’s financial resilience which is less than complimentary. The review described the county’s financial planning as “overly optimistic”, “counter-intuitive” and needing a “radical overhaul”.
Schools, education and young people
A DfE report on school leadership trends between 2010 and 2016 showed small increases in the proportion of senior leaders and middle leaders in both secondary and primary schools. An increase in the number of teachers retiring has also seen a reduction in the median age of headteachers from 51 in 2010 to 48 in 2016. Women and BME people are underrepresented in leadership roles, but it is improving. If none of this sounds surprising, IfG’s Emily Andrews found and tweeted the most enlightening line from the report.
According to a Community Care survey, only one in five children’s social workers (shockingly) think their current workload is manageable, while the Government’s figures continue to underestimate the average caseload of social workers.
Outgoing Children and Family Court Advisory and Support Service (Cafcass) chair Claire Tyler argues that Cafcass improvements will not be meaningful unless family justice and children’s social care are also reformed, and fewer cases end up in court. Cafcass are handling an increasing number of local authority care order applications (53% over the last 8 years).
The latest Cafcass data showed a decline in 2017–18, though Cafcass does not expect sustained reductions. A Family Rights Group review (supported by ADCS and the Children’s Commissioner, amongst others) of the causes of the increase is due to be published before July. In the meantime, former children’s minister Edward Timpson has been appointed Cafcass’ new chair.
HCLG have published their annual evaluation on how the Troubled Families programme is performing. Amongst other things, HCLG’s internal review reckons that the programme is reducing demand for children’s social care, based on controlled before/after comparison of the Troubled Families cohort to families with similar characteristics. Techy report here.
A week into the new job, Yvette Stanley, Ofsted’s new national director for social care, sets out her (evolutionary) priorities, including building on Ofsted’s new inspection regime for children’s services.
Schools Week submitted an FOI request to DfE and received data that showed a quarter of all trainees quit the Troops to Teachers course without qualifying. The same FOI data indicated that DfE has thus far spent £8 million on the initiative, which 106 former military personnel have completed, but DfE has no way of knowing whether those course graduates are in teaching jobs.
Law and order
The government’s privatised probation service, Transforming Rehabilitation, has not involved the voluntary sector in the way the MoJ expected. The National Probation Service generally isn’t buying services from Community Rehabilitation Companies (CRCs), and CRC concerns over contract viability are leading them to cut third sector organisations out of their supply chains.
An interesting MoJ gov.uk blog outlines how the department intends to increase the (net) prison officer workforce by 2,500 by December 2018. “Quality data” has improved recruitment through better-targeting marketing and resourcing.
EIF have analysed the evidence base for early intervention to prevent serious violence, a cornerstone of the Home Office’s new strategy. The article argues that the Government’s evidence assessment and stated commitment has not been matched by the action taken, which has not been a step change, but more of the same.
Stephen Bush explains the politics of spending on criminal justice, arguing that Corbyn is awkwardly stuck out of step with the public, but also not particularly radical in his proposals.
The IMB’s report on HMYOI Feltham highlighted a shortfall of 50 prison officers, which has led to teenagers spending too much time in cells, and not enough time in educational or purposeful activity. As a result, there has been “increased and sometimes explosive violence”.
