The Week in Public Services 17th June 2020
This week: returning to some normality in the NHS; the impact of school closures; and criminal justice across the world
General
A thoughtful Policy Exchange paper discusses what Whitehall could learn from the military in responding to crises. It argues that the planning capabilities of the Armed Forces are more practiced than Whitehall’s and should be integrated into resilience and contingency planning within Whitehall departments.
George Eaton at the New Statesman argues that the UK has been left in the worst of all worlds in the pandemic with a higher excess death rate than others and a worse recession predicted too. He argues that Britain had time to learn from the experiences of countries such as Italy and made the universally-recognised bad choice of discharging thousands of patients into care homes without being tested first.
Health and Social Care
A brutal but fair contrast between the government’s claims and the reality of testing on the ground from Andy Cowper. He recommends reading in full the letter the UK Statistics Authority sent to the health secretary, criticising the inadequacies of the government’s testing data. We do too.
Professor Donna Hall has collated an invaluable list of things we have learned from coronavirus responses across the globe and how they can inform a re-imagined health and care system. One suggestion is that public health and wellbeing should be at the heart of all public policy-making including when it comes to areas such as licensing and local infrastructure. Few will disagree but the detail and trade-offs are where it likely to become trickier.
A House of Commons briefing shines light on an under-discussed area of the pandemic: its impact on those with learning disabilities. Shockingly, until 5th June, care homes for younger people with learning disabilities couldn’t access testing kits because the government had prioritised older people.
The president of ADASS James Bullion is not happy with the lack of attention on social care during the pandemic, saying: “We have found ourselves these past three months a secondary consideration, whether that’s about testing, PPE, or discharge. We have found it very hard to influence NHS England policy with particularly tragic consequences.” While some might be thinking the crisis is coming to an end with lockdown easing, that is not the case in care homes. Looking forward, the country needs a social care system stronger than COVID-19.
Continuing to focus on social care: this is the best simple summary of the care home discharge debate:
· There were more discharges than in 2019 during the first half of March
· Discharges fell below 2019 levels after that
· Discharges fell because of the fall in admissions as the virus took hold, which is likely to be the reason why fewer people were being discharged overall
Here is a useful summary of an LSE event about the health and social care policy response to coronavirus in the UK — lots of interesting analysis of how the pandemic has affected social care in particular.
And in Parliament last week there was a fascinating evidence session about the UKs social care funding and workforce problems. I learned lots. The UKs level of public spending on adult social care is around the OECD average, but this ignores that southern and northern Europe have very different welfare policies and labour markets. Broadly — southern European countries spend less but have long traditions of family-based support (and comparatively low levels of women in formal employment). The UK, perhaps predictably, is “wanting to spend more like a southern European nation but [has] labour market structures that are more northern European”. Of course. (H/T Anita Charlesworth).
Meanwhile, Mina Akhtar makes a powerful point in the Guardian, arguing that family carers aren’t a ‘hidden army’ — they’re ignored, not invisible. Scotland has announced extra payments for family carers but no such similar policy in England.
Over in the NHS, the NHS Confederation have published a briefing about the practicalities of reopening, and what support they want the government to give the NHS. To try to reduce the growing backlog of surgeries, they want the government to extend the contracts it has signed with the independent sector until the end of this financial year (March 2021) at least.
The latest data from NHS England shows that waiting times for elective treatments have risen about a month in a month following the decision to stop routine elective activity at the outset of the pandemic.
In better news, the large fall in GPs referring patients to hospital started to pick up at the start of May, but it is still considerable below the number of referrals in January and March. You can find at more from the excellent data viz that is NHS Digital’s dashboard.
Here’s one example of the scale of the problem: hospitals do not have enough pathologists to analyse the expected increase in samples coming from cancer screening services. But perhaps there’s a good news story buried in there…the Royal College of radiologists think there is scope for more work to be done remotely — although “it would cost up to £400m to create a digital pathology service allowing lab samples to be scanned into high-resolution images allowing pathologists to work remotely and transfer images between labs instantly”.
And here’s why reconfiguring the hospital estate matters: hospital-acquired cases of Covid are on the rise in two hospitals in the Midlands. More than 60 per cent of new covid cases diagnosed at two hospitals in the Midlands in recent days were caught at least two weeks after the patient was admitted, which is very worrying news.
So, post-crisis — more staff and a different estate. But resilience is more than just new equipment, Sally Warren argues in this King’s Fund blog. TL;DR “the concept of what makes the health and care system resilient needs to be about much more than stockpiles, supply chains and hospital beds […]about capacity across the system, flexibility in the workforce, system-based action (backed by data and behaviours) and community capacity”.
And finally, Sebastian Payne at the Financial Times shares a personal tale about care home covid deaths, calling the epidemic among in elderly care the worst of all the government’s mis-steps.
Children and Young People
The big news this week has been the government’s U-turn on providing free school meals during the summer holidays following a campaign from that well-known Westminster figure Marcus (not Daniel) Rashford who captured the attention of the nation.
Elsewhere, Ofsted discusses secure children’s homes in its latest blog and the challenges of caring for children with more specialist needs during the pandemic. There aren’t enough places, with the number of children waiting for a placement doubling in that time. As local authorities struggle to find places, the use of unregistered provision is increasing. Read more here.
And UCL has issued a briefing note on what the government could do in response to some of the problems school closures will have had on the mental health and wellbeing of young people. Among other recommendations, school leaders should prioritise social and emotional learning alongside academic skills.
The Economics Observatory posits that an extensive but time-limited programme of small group tutoring could help to repair some of the educational damage done by school closures. It argues that the method has proved effective at a modest cost.
A paper from the Lancaster University Management School looks at how parents make secondary school choices for their children, modelling the trade-off between school proximity, school quality and probability of admission. The findings suggest that parents are prepared to allow their child to travel an additional 0.9 km (when the mean distance is around 2.5 km) to achieve a 10 percentage point better quality school — considerable burden that households seem to be willing to pay. There are some more interesting findings in the fairly long paper neatly summarised in a one-page conclusion.
And lastly, ten things you may not know about education inequality from UCL. A point on predicted grades particularly stands out: 16% of applicants’ to the UK University system have predicted grades that are accurate and while 75% of applicants have their grades over-predicted, high-attaining, disadvantaged students are significantly more likely to receive under-predictions.
Law and Order
The Centre for Justice Innovation has been monitoring the coronavirus response of eight common-law jurisdictions across the world and have reported on their findings. Quite predictably, jurisdictions have restricted access to court buildings and the types of cases they are hearing. The interesting stuff is on what the impact of remote hearings have been, where the evidence is mixed.
Local Government
The County Councils Network have warned of dire financial pressures on local authorities even if there is no coronavirus second wave. Some councils have started planning emergency cuts as the £3.2bn of emergency funding from central government has already run out.
Last but not least, looking to the future Nick Forbes, Leader of Newcastle City Council, argues that locality is the front line of the pandemic. In a RSA post he argues that a fundamental reimagining of the economy and society should be informed by the critical role local government and its partners have played in responding to the crisis.
