The week in public services — 19 December 2018
This week: In our last WiPS of 2018 — everything that isn’t Brexit is, in fact, Brexit; some tricky social care questions get answered; and The Wire comes to Berkshire.
This is a weekly round-up of research and happenings from the team at the Institute for Government that put together Performance Tracker — a data-driven analysis of the performance of public services.
General stuff
Reading the front page of the Times, you would be forgiven for thinking there were no public services this week. They list the social care green paper, vocational “T-levels” as likely victims of the Brexit black hole, as the looming possibility of no deal forces a Whitehall ‘reprioritisation’. Over the weekend, The Observer also listed the local government fair funding review, an internet safety strategy, and various housing consultations as things that had already been delayed.
My take: the diversion of civil service resources is important, but isn’t the biggest issue. The bigger problem is the lack of political energy or capital to tackle these big domestic policy challenges. I wrote about that here. What that means is that all non-Brexit issues are actually also Brexit issues :/.
In other Brexit-related news, the immigration white paper is out — and public service nerds are starting to work out what it means for their areas. The removal of a cap on skilled migration will be good for the NHS, but the social care workforce will have to make do with time-limited 12-month visas.
Health and Social Care
Continuing on from the above — Matt Hancock has tweeted that reports of the death of the green paper are greatly exaggerated; that it’s just having the ‘final touches’ applied. We’ve heard that before…
IPPR and health consultancy Carnall Farrar have tried to put some numbers to one of the key NHS reform questions: is there enough money to meet demand, reduce waiting times, get rid of the deficit and reform services? Their answer, based on modelling three scenarios, is ‘no’. We’ll have to wait until after Christmas to see if the NHS reform plan contains something they haven’t thought of…
Sensible stuff from David Williams of NHS Providers on the allocation of capital grants in the NHS. There is no clear statement of what priorities for investment are, and how decisions are made — so busy people are wasting time filling out unsuccessful bids. Shouldn’t be hard to fix, right?
Some cold water is poured over optimistic claims made about health and social care devolution and integration in this new report from Manchester Business School. They argue that the initial architects of Manchester’s health devolution ‘may have overpromised’ on its benefits, particularly around savings — and that what happened there can’t really be called ‘devolution’, while the NHS remains so heavily centralised. That ‘may have’ caveat leaves me a bit unconvinced by both the report and Manchester’s healthcare revolution…
A reminder from Ben Goldacre that the NHS saying something should be so does not mean the multiple actors in an incredibly complex health system will make it so. The Implementation Gap is real.
West Sussex council has been told off by the Local Government Ombudsman for not providing alternative education for a pupil with high levels of anxiety; illustrating an important point from a good King’s Fund blog from earlier this week — that many non-medical needs have been ‘delegitimised’ as councils have sought to make savings in other services during austerity.
What do commissioners and providers think of homecare — the provision of care in people’s homes — in England? According to a new King’s Fund report, the biggest issues are predictable: recruiting and retaining staff; commissioners and providers disagree on the impact of cutting fees; and use of technology in homecare is still in the early days stage.
Some stuff I1 found particularly interesting in that report: there is a positive relationship between fee levels charged and CQC quality ratings, although there is still significant variation within the same fee levels. And some councils have built in clever contractual clauses to ensure an increase in fees translates into an increase in care workers’ wages. TL;DR — if you want to know about what’s going on in homecare — and why it can be true that some councils are being taken to the cleaners while others are squeezing providers’ margins below the costs of care — you should read it.
Children and young people
Natalie Perera of the EPI rounded up the year in education policy for Schools Week. Key line: ‘if next year’s spending review is going to require a further tightening of belts [in schools], then ministers need to be braver about what they consider to be inefficient.’ More thoughts from me on that on the twitter.
Underspending in schools will be reallocated to SEND budgets, the DfE announced over the weekend — meaning an extra £350m over two years. Good news for schools — although there have been complaints that it is being allocated based on number of young people, not number of young people identified to have high needs.
We wrote in our analysis of schools this year that anecdote told us that schools were having to take on more work that might previously have been done elsewhere, increasing pressures. The latest anecdote? A school foodbank ☹.
Meanwhile, the new-and-improved social mobility commission is going to kick off looking at schools: specifically at the impact of funding and teacher recruitment and workforce on social mobility. That analysis is going to be harder than it sounds…
Neighbourhood services and local government
The local government finance settlement is here — and only a week late! The IFS have laid out what happened: local authorities will have £1.6 billion more in 2019/20 than they were expecting — though that will still leave them with 1.4% less money than they had in 2015/16. The extra comes from a range of places — including the one-off social care grants announced in September, and cancelling a plans to claw back council tax raised by the richest councils. This reinforces an existing trend: local government funding cuts are still falling most heavily on more deprived areas.
Law and order
Hamsterdam is coming to the home counties. In a pilot programme, the Thames Valley police will not be arresting people possessing small quantities of drugs, but instead pointing them to support services. Great quote from the Assistant Chief Constable: “there is nothing soft about trying to save lives”.
The NAO is brilliant, isn’t it? This letter to the Justice committee — despite modestly describing itself as ‘not comprehensive’ — sets out in fascinating detail the events leading up to MoJ ‘stepping in’ to run HMP Birmingham from G4S this summer.
Most interesting bit: there were regular meetings between the G4S prison managers and the MoJ throughout this period, where G4S assured the department that recommendations made in previous inspections were being completed. But when the inspectorate came back in 2018, they said very few had been implemented. How were MoJ so fooled? At the rather less enlightening committee hearing this week, G4S said it was because they had taken action, but that action had not actually been sustained — so no lasting change had resulted. Hmm. Sounds like an issue for our accountability team.
The extra money for courts announced at the Budget has now been allocated. £15m will be spent on specific court refurbishment projects. Good to see a focus on getting the basics right.
1’I’ in this case in fact referring to perennial WiPS ghost author Graham.
