The Week in Public Services: 2nd December 2020

This week: Spending Review fallout; ongoing exam debate; and what we can learn from Croydon council

General

It’s Chriiiiiiiisssssssstmmmmmmmaaaaaaaasssss. Well, it’s not, actually. But I had four mince pies over the weekend. And the vaccine news is really encouraging — you’ll have to forgive my burst of uncharacteristic optimism.

The biggest news last week was, of course, the Spending Review. As ever, your required summary reading should be:

• Our Institute for Government super-short summary of what we learned from the 2020 Spending Review
• The Institute for Fiscal Studies’ ever-useful summary (Ben’s presentation on public services spending is particularly useful)
• Resolution Foundation’s detailed analysis

In coronavirus news, new ONS data shows that weekly deaths were 21% above the five-year average for week ending 20 November. The excess deaths were entirely due to covid — deaths from non-Covid causes were below the five-year average: the impact of the second wave is pretty drastically clear. Meanwhile, the government published their analysis of the effects of the tier system yesterday. A good summary of the impacts but, as my colleague Giles pointed out, the analysis didn’t — couldn’t? — deal with the counterfactual of no restrictions, so it’s not clear what we should make of this.

The guidance for the new tier system was also published last week, leading to a rather silly debate about what constitutes a “substantial meal”. Scotch eggs to the rescue? Maybe. As a veggie I have one burning question, though: does a scotch egg with a falafel coating count?

Health and Social Care

As above, the big story was the spending review. Siva’s King’s Fund analysis was a typically detailed foray into the weeds of the detail — lots of money for NHS to deal with Covid-19, big capital announcements, but a lot of overlooked areas: no mention of public health funding; limited detail on adult social care (as always); and workforce funding only given one-year funding boost.

Quote of the week, however, has go to this excellent analogy from Ben Zaranko, who has managed to link the council tax precept for social care with Diego Maradona’s football career. More of this please, IFS.

The other focus has, unsurprisingly, been the effects of the Covid second wave in hospitals. There’s a lot of back-and-forth and somewhat dubious analysis doing the rounds on twitter on this, so cut through the noise with these analyses:

• The Health Service Journal’s analysis of pressure on hospitals — where the basic picture is that hospitals are still under pressure even though cases are falling
• Chris Hopson’s twitter thread arguing that national statistics on hospitals aren’t particularly useful and Covid creates lots of extra pressures on the NHS

And in case you missed it, NHS England’s quarterly board meeting took place last week too, which laid out NHS England’s vision for legislative change. As my colleague Nick pointed out though, even if these reforms have NHS England backing, there is scope for a big legislative bunfight here…

In the world of research:

• Jenny Davies at the Nuffield Trust looks at what impact Covid-19 has had on mental health services. She finds that symptoms of anxiety spiked in March and have remained higher than 2019 ever since — while fewer people accessed mental health services during the first wave. Of course, not everyone who experiences symptoms will need professional support — but the increase in symptoms suggests that mental health services will have to prepare for a surge in demand
• The Health Foundation have published a briefing what the public health system should look like now Public Health England has been abolished, which calls for a cross-government ‘levelling up’ strategy, an independent body to report to Parliament, a national agency, and more cash.
• The National Audit Office have published a report about PPE procurement with some frankly mind-blowing figures…but the real question is whether the UK looks that different from other countries
• Billy Palmer has analysed the relationship between Test and Trace effectiveness and which tier local areas were in before the second lockdown. He seems to show that Test and Trace has some influence…but maybe the causation runs the other way? A classic chicken-and-egg problem
• John Appleby has looked at the economic assessment for vaccines, arguing that the way NICE assess new medicines might need improvement: “Covid-19 may be unusual (to say the least) but it draws attention to a debate for NICE (and its ongoing review of its assessment methods) about the extent to which we want it to broaden its perspective. As the world has painfully learnt, health (and care) and our economic lives are (and always have been) inseparable”
• A general medical council report found that four-fifths of GPs reported that they struggled to provide appropriate care during the pandemic
• A very interesting Health Foundation analysis of enhancing primary care which found that two complementary integrated care team initiatives for adults with complex chronic care needs increased emergency hospital use, at least in the short term

Children and Young People

The latest data on school attendance shows continued decline in England, though the national picture conceals big variation — attendance rates are of course much lower in parts of the country where Covid-19 is more prevalent. The decline in school attendance is really notable. For the last five years, the overall absence rate in primary schools has been about 4 per cent and about 5–5.5 per cent in secondary schools — so these figures show a big dip in attendance, particularly in secondary schools*.

Going back to the 2020 exams fiasco: a new Education DataLab analysis of centre-assessed GCSE grades finds that attainment gaps have not widened. The gap between disadvantaged pupils and non-disadvantaged pupils has stayed about the same. Ethnicity data shows that, in most cases, results improved the most among low-attaining ethnic groups. An interesting finding — “the early results give a degree of confidence that disadvantaged pupils and those from ethnic groups that on average have lower attainment won’t be further disadvantaged if centre assessment grades have to be used again in 2021.” However: using centre assessed A-level grades meant private schools had an advantage compared to state schools — so not a totally rosy picture, here.

So all-in-all — going back to normal exams in England next year? Well — maybe. ‘Conventional’ exams in 2021 could also be unfair due to different amounts of time missed in education in different schools and regions. You will not be surprised to hear the schools and colleges are unhappy about the lack of direction on next summer’s exams…

Meanwhile, in the research world:

• Results from in-depth research looking at early learning and child wellbeing (ILES) in England found that children on free school meals had 4–8 months’ less development across a range of measures — but few differences were observed by type, intensity or age of attendance at early childhood education and care. Tweet thread summary here
• Ofsted’s annual report for 2019/20 was published here
• John Jerrim analysed the relationship between working hours and teachers’ wellbeing and found that longer hours are associated with lower wellbeing, particularly where longer hours were spent on lesson preparation and marking
• Somewhat niche new research on the science technician workforce in English secondary schools, which found that there has been no significant improvement in the pay and employment conditions of school science technicians over the past decade, and that things are worse in schools with larger intakes of deprived children

Last but not least, the Department for Education have publicly acknowledged that the boost to teacher recruitment from pandemic looks to be temporary…but are still reducing some teacher bursaries.

Law and Order

The Ministry of Justice published new prison population projections, which show a significant increase in the size of the prison population, up to 98,700 by 2026.

This is mainly because of the effects knock-on of recruiting more police officers (more charges, more court trials, more prisoners), which Nick explained here. This blog by Danny Shaw is also good. On the same topic, this blog by the chief executive of criminal justice charity Nacro argues that building more prison places is not an effective way to reduce crime.

In the courts, Tom updated our analysis of the growing backlog of cases waiting to be heard in criminal courts — though Robert Buckland didn’t give too much detail on the government’s plans when pressed on it before the justice select committee.

Local Government

It’s been a few weeks now but last week I blogged about Croydon council’s bankruptcy, and why the UK government should see it as a canary in the coalmine. Croydon may have entered the pandemic in a poor state — but it’s far from the only council under severe pressure. Long-ish twitter thread summary here. Chris Cook makes the moral hazard argument in even starker terms for Tortoise, here (£).

In research news, New Local published a report on post-16 skills and training in England. They conclude that “only a more comprehensive form of skills devolution will enable local areas to respond with immediacy to the changing impacts of the COVID-19 crisis on employment, as well as the other forces of transformation still quietly working in the background.” Summary blog here.

*Excellent chart from my colleague Andrew