The Week in Public Services: 1st October 2020
This week: false news on false positives; a childcare system on the brink; and the cutting of county lines
General
The question on everybody’s mind: how close are we to a vaccine? This free-to-read explanation from the FT shows the progress of various trials and explains the biology behind different types of vaccines for those of us who aren’t actually scientists. Once you’ve read it, you’ll be able to impress everyone down the pub (so long as it’s before 10pm).
Talking of the provision of scientific advice, former cabinet secretary Gus O’ Donnell (with the enviable initials GOD) offered some poignant thoughts in a lecture to the IFS. He argues that the government lacked (and still does) ‘a policy framework that can properly assess the costs and benefits of different measures.’ The whole thing is a considered intervention from the former top mandarin and well worth a read. The IFS have produced a clear summary of how the pandemic has blown up the government’s spending plans and the options available to the chancellor.
One of the prime ministers O’Donnell served has been making a different kind of intervention. David Cameron has said he thinks that austerity left the country better prepared for the pandemic, which given he written it in the paperback edition of his book, is presumably not a mis-speak. The reality is quite the contrary, as we reported back in August. The New Statesman’s leader this week is unforgiving of the remark, calling it ‘nonsense’ and saying that rebuilding national resilience ‘will be the work of the next decade.’
And if you’ve been following the coronavirus test false positives discourse on social media, my advice would be to ignore it all and read this piece by Tom Chivers instead. It’ll help to break the transmission of ignorance, which is currently being pushed by many who from what I can tell have not done much thinking about science or maths since they left school.
Health and Social Care
The Health Foundation has published a history of the test and trace programme that was promised to be ‘world-beating’ and is currently… not. With so many twists and turns in the past few months, having all the developments in a single place is a very useful resource. It includes problems which are already well known, such as the effectiveness of the tracing and problems with incentivising isolation for those who test positive. A key point it makes which has not got as much attention elsewhere is how unclear it currently is whether/how the difficulties in accessing tests in recent weeks have differed between different groups of the population aside from on a regional basis. There’s some excellent data-viz from Billy Palmer at the Nuffield Trust which complements the Health Foundation’s explainer nicely.
Add to it all the development that NHS hospitals will not be given free rein over the testing of their staff and patients — any testing will require prior approval from the test and trace programme. Current testing capacity in the NHS is around 55,000 per day, which will be extended to a cap of 100,000 a day. For the latest insights with a heavy and admirable dose of sass, Andy Cowper’s columns are the must-read.
Siva Anandaciva at The King’s Fund takes a look at the tendency for fewer, larger organisations in the NHS and the prospect of ‘a genuine super-trust’ with the proposed merger of Guy’s and St Thomas’ NHS Foundation Trust and the Royal Brompton and Harefield NHS Foundation Trust. While larger organisations aren’t inherently bad, the conflation of size with success can underestimate the disruption of structural changes on staff, among other concerns. New research from the Health Foundation with NHS England and NHS improvement takes a long-term look at the Mid-Nottinghamshire’s Integrated Care Transformation Programme. It provides more clarity than some short-term evaluations where the evidence is mixed, indicating that reduced hospital admissions take longer than thought (or hoped) to materialise.
The Commons Public Accounts Committee has published a report into the NHS nursing workforce, looking at how well the government is doing to fill nursing vacancies. There is a heavy list of criticisms, ranging from the government’s scrapping of the NHS bursary in 2017 (no prizes for guessing what that did) to its lack of details on the much trumpeted 50,000 nurses target. I could go on all day about the perils of input targets more generally, but the report does a much better job of it. It’s clear that the target was devised before the demand for nurses had been modelled while nursing for social care remains ‘an unaddressed afterthought’ for DHSC.
Pritesh Mistry at The King’s Fund takes a step back and considers the advantages and disadvantages of digital technology alongside, rather than instead of face-to-face delivery. One excellent point he makes is that there are more similarities between the two types than are often acknowledged: navigating digital tools might be difficult but so is negotiating traffic and finding a parking space for a face-to-face appointment, for example. A case for balance when it comes to digital vs face-to-face GP appointments is also made thoughtfully by Rebecca Rosen at the Nuffield Trust, offering four principles to bear in mind while we wait for further research.
The pandemic has confined us to our homes more than any of us would have anticipated at the beginning of the year, with being cooped up having predictable effects on our wellbeing. But what about the effect of the home itself? More than four million homes don’t meet the minimum requirements of the government’s Decent Homes Standard. The Centre for Better Ageing and The King’s Fund have partnered to produce this report on the impact of poor-quality housing on health during the pandemic. Cold and damp homes this winter will provide an additional risk to many already vulnerable to the virus.
King’s Fund policy director Sally Warren speaks to The Guardian about the government’s latest plans for social care this winter, which she thinks have been a ‘missed opportunity.’ She highlights the little focus on those receiving care outside care homes and puts the blame for a lack of sectoral reform with ministers. It’s not a happy read but a necessary one from someone with a long experience in Whitehall. Recent care home outbreaks, including the closure of one in five homes managed by the largest care home provider, are a worrying sign of what may be yet to come this winter.
The Social Market Foundation have published a report on the market for residential care, taking an in-depth look at just how the market is structured and operates. It follows a report from the Competition and Markets Authority a few years ago in calling for an independent body, run by the CQC, to oversee the residential care market, providing improved forecasting of demand and costs in the market. The human dimension to the market is explored movingly in a personal reflection from Donald Macaskill who looks at how important trust is in social care, particular between providers and local authorities.
In Scotland, the Care Inspectorate has produced a report saying that most partnerships and services providers worked well together during the pandemic but noted how staff worked hard and flexibly despite fears about their own health.
After that heavy section, here’s something more positive: this ‘jet suit paramedic’ took just 90 seconds to reach a site it would have taken them half hour to reach by foot. If I’d seen this on the morning of April 1st, I’d have thought ‘ahh, good one,’ but it’s in all seriousness so I’ll be keeping an eye on whether the idea… takes off.
Children and Young People
The IFS have produced an interesting compare-and-contrast of school spending in the four nations in the 2010s. It calls for more targeted funding to deprived schools, explaining: ‘Faster falls in spending per pupil over the last decade, slower increases under the National Funding Formula, a likely widening of educational inequalities and higher costs associated with higher teacher starting salaries, given that deprived schools are more likely to employ new teachers, all provide a case for greater targeting of funding to more deprived schools.’ To me at least, the case is well-made.
Sophie McBain takes a look at the nation’s childcare system in the New Statesman, which she says is ‘on the brink of collapse.’ This is a much-needed investigation into how nurseries and families have fared during — and before — the pandemic, containing some truly eye-watering statistics: British parents face the highest childcare costs in the OECD; The average UK family spends more than a third of their earnings on childcare. Quite honestly, I want to reproduce the entire article here so go have a read of it.
Waiting for summer exams next year to see the pandemic’s impact on learning is simply too long to wait. Especially as it’s increasingly likely that next year’s exams won’t be a return to normal. That’s why the EPI and Renaissance Learning will be looking at data in real time from assessments children already take to understand what pupil attainment is like throughout the year. More than a million pupils across the country take the Star Assessments each year, which will provide three data points throughout this academic year to compare to previous years. It’s a huge bonus that it won’t cause any extra workload for pupils or staff. If you think it’s been bad here, read a blog saying why the US should be learning from our school-reopening experiences.
Law and Order
Not hearing much about coronavirus in prisons should probably be taken as a good sign. It hasn’t been as bad as it could have been, but virus rates have still been higher than in the wider community. Miranda Davies and Eilís Keeble at the Nuffield Trust have broken down why rates might have been higher in prisons and the effects of the lockdown on prisoners. Concerns have already been raised by HM Inspectorate of Prisons on the mental health and wellbeing effects, only adding to long-running concerns over rising rates of prisoner self-harm.
Some really interesting stuff from the police about their efforts to tackle the issue of county lines drug dealing. It appears as if they’re having some success in Norfolk following a change in tactics at the end of last year, where 30 out of 75 lines out of the city to London have been shut down by police. Meanwhile a new City Hall report says that dealers were posing as key workers during lockdown to continue criminal activity as demand for drugs became ‘very high’.
Kevin Sadler, acting chief executive of HM Courts and Tribunal Service, has apologised to black barrister Alex Wilson who was mistaken for a defendant three times in a single day. An investigation has been launched, and other BAME barristers have come forward to speak about how they have also been treated in a similar way. Yet another example of what BAME people endure throughout the justice system.
Local Government
A thoughtful post casts doubt on the most recent calls to merge local councils to achieve economies of scale. Multiple research projects indicate that ‘phantom’ economies are harder to achieve in practice than theory would suggest. The post is just one in a series providing a neat summary of the local government reorganisation debate. Reform aside, councils as they are will struggle in coming months with a funding gap from falling revenues and increased spending pressures. The IFS charts some potential scenarios — none of them are good in case you’re wondering — with an ‘upper’ scenario leading to a funding gap of over £7bn in 2024–5. Ouch.
Nevertheless, someone in local government has some good news. Mayor of Greater Manchester Andy Burnham will be pleased with this write-up in The Economist titled ‘The King in the North’. He’s certainly been a calm voice of reason and forward-thinking throughout the pandemic but if you’re comparing him to the knots this government has recently tied itself in, I’m not sure the bar was all that high. What the pandemic has done is shatter the illusion that central government is more competent than local government, though I’m not as confident as Bagehot that it has paved the way for a better balance of power in the future.
