The week in public services — 17th October 2018

This week: Your definitive guide to public service performance and pressures — Performance Tracker 2018 — has now been published! And some other less exciting things.

Performance Tracker 2018

Our data-driven analysis of nine different public services has now been released to the world!

Performance Tracker 2018 looks back at the last eight years of austerity, and asks not just ‘how much was spent on public services’ but also ‘what did we get for the money’?

Our analysis finds that almost all of the services have become more efficient since 2010. But those efficiencies have not been enough to allow services to meet all of the demand they have been faced with, leading to lengthening waiting times, persistent overspending, and in some cases unmet demand.

Those efficiencies are also looking increasingly unsustainable. There are rising vacancies in hospitals and social care. GP numbers have fallen consistently since 2015 — despite the government’s intention to boost numbers. Schools are facing recruitment and retention issues — particularly in secondary schools, particularly in certain subjects. The government exceeded its target of increasing prison officer numbers by 2,500 way ahead of schedule — so they clearly don’t have a recruitment problem — but to do so, they had to hire almost 5,000 people, because so many left.

This situation isn’t set to get easier — as demand for services is set to continue to rise. We’ve found a worrying lack of clear plans to improve efficiency, or manage demand, or reduce the service offer.

It’s clear that efficiencies have been pushed as far — or almost as far, depending on the service — as they can go. We’re now at the point where the government needs to start being honest about what can be achieved. Serious trade-offs lie ahead: whether higher taxes, more co-payment, service reductions, or radical service changes. In that context, vague statements about the ‘end of austerity’ aren’t just meaningless, they’re counter-productive.

We have also rated our services by levels of concern. The picture it presents is pretty clear:

The ‘end of austerity’ pronouncement from the PM prompted a flood of interesting analysis from the New Statement team. Stephen Bush and George Eaton have written their takes on the politics of it — while Anoosh Chakelian and Patrick Macguire have looked briefly at the impact of austerity. For the full picture, you should still read Performance Tracker 2018, obz.

Health and Social Care

The latest Care Quality Commissions report on the state of health and social care in England is out, drawn from their inspections of providers. This year’s report strikes a less alarmist note than some previous years, but bears out our findings: the quality of care has been broadly maintained, but the pressure is coming out in problems with access. They also find a lot of local variability.

More murmerings about the 10-year NHS reform plan this week — will it really spend £13bn on IT? The Nuffield Trust have put together a tight set of lessons from past NHS reform efforts. The main take-away I took from their event on the subject was that the government is too constrained to make this an NHS reform plan in the usual mould (ie. a massive institutional reorganisation) and that’s not bad thing…

Let’s finish with some art shall we? Hospital beds have been popping up over the UK to raise awareness of older people stuck in hospital for longer than is necessary.

Children and young people

All change at Ofsted: Chief Inspector Amanda Spielman has laid out proposals for a new inspection framework. Results will be de-emphasised, breadth of curriculum will be assessed alongside the quality of teaching, and personal development and behaviour will get specific, separate attention.

That makes sense to your author: performance tables operate as an accountability mechanism in their own right, and it’s a waste of time if Ofsted simply repeats what those tables already tell you. But Ofsted is already highly subjective — will de-emphasising the one bit of hard performance data we have (albeit flawed) make it more so?

Interesting Children England submission to the Lords economic affairs committee’s social care inquiry, including a good discussion of whether treating children’s care placements as a market really secures best value.

In The Guardian, Louise Tickle has looked at the lack of transparency around taking children, in particular newborns, into care.

And Labour MP Vicky Foxcroft has called for after school youth work programmes to be reinstated after the Youth Violence Commission heard evidence that knife attacks are most common on weekdays in the period after school finishes and before parents come home from work:

Neighbourhood services and local government

Local services are headed towards a cliff edge, and decisive and swift action is needed to steer them away from it. That’s the starting point for Solace’s (the representative body for local government chief execs and senior leaders) new call to action. Their practical 10-point plan for improvement includes a commitment to multi-year funding settlements for local government, the minimisation of one-off spending pots, and greater freedom to capitalise one-off spending.

In a similar (but shorter) vein, public health expert Greg Fell is angry on the internet about local government finance.

In team Performance Tracker, we care about bins. But the problem with local waste services — as with most neighbourhood services — is that we don’t have good national-level data on what has changed as a result of spending reductions. That means the first warning sign we have that cuts have gone too far is when rubbish starts piling up on the street — which is apparently what is happening in Manchester.

Law and order

Another week, another damning prison inspection report. The inspection of HMP Chelmsford found that ‘Levels of violence were very high and not enough was being done to address the underlying causes’ and that ‘force was used very frequently’. The pictures tell a similarly grim story.

HMIPP have also done an interesting one-off report on ageing in prisons — an issue we’ve drawn attention to in our prisons analysis. Hardeep Matharu has a thread highlighting the key points.

There was an intense session at the Public Accounts Committee last week, with chief constables, the Home Office and the Chief of HMICFRS, covering the impact of budget cuts, how to evidence demand and preventative work, lines of accountability and the performance of the Emergency Services Mobile Communication Program.

Again we heard one of the key messages of our Performance Tracker being echoed: by Durham’s Chief Constable Michael Barton