The week in public services: 13th February 2020
This week: the state of the prison estate; retaining teachers in disadvantaged schools; and should we ‘nationalise’ GPs!?
Health and Social Care
Right, lots to cover this week. First off — a new National Audit Office report on the financial sustainability of the NHS finds that “the short‑term fixes that DHSC, NHS England and NHS Improvement put in place to manage resources in a constrained financial environment are not sustainable”. We agree — the increasing use of one-off measures such as selling land or delaying capital spending — cannot be a long-term solution. A helpful additional report covers trends in capital spending.
Next entry is Lawrence Dunhill’s latest (£) in his series analysing what the data tells us about whether health and social care devolution made a difference in Greater Manchester. On first glance it looks like they’re doing well on reducing waiting times for children and young people’s mental health. Glad someone is trying to do this work!
In other news, it looks like new hospital targets are definitely coming, according to NHS England chief operating officer Amanda Pritchard. Expect new targets to come into play (alongside the old ones) from April 2020 this year.
Lastly from HSJ — an interesting interview with Jeremey Hunt, who I think demonstrates a good grasp of the problems facing the NHS. For what its worth, I think he’ll make a good select committee chair.
In general practice, Phil Whittaker has written an interesting blog on how much of the general practitioner — NHS England standoff is being driven by GPs opposition to the specific new contractual measures (not the principles of Primary Care Networks, which most view positively). The new contract is simultaneously “impossibly ambiguous” while “specifying in inordinate detail the processes networks are to follow in every area of activity, together with the onerous bureaucracy they will have to engage in to prove they’re doing what they’re told”.
A (timely?) new Institute for Public Policy Research report argues that it time to offer general practitioners “the right to NHS employment” and create ‘Neighbourhood Care Providers’ to provide more appropriate care. An interesting read — albeit one that is not very different to the government’s own proposals for Primary Care Networks, in my view. Health policy journo Shaun Lintern sparked off a massive twitter debate about whether replacing the partnership model with salaries, effectively ‘nationalising’ primary care, would be a good idea. Strongly recommend — I learned more from this than from the report.
If that’s not enough on general practice, Reform have also published a report arguing that the general practice estate, of which over half is “unfit for purpose and ill-equipped to meet future patient need”, needs to be at the top of the government’s agenda — prioritised above building more hospitals.
Last but not least, Dave West has written an article arguing that the government should curb NHS England’s powers and responsibilities — but by devolving them, rather than taking them into their own hands.
Over in social care, the ONS have released new analysis of adult social care productivity, finding it fell last year. I think this is unsurprising — and actually reflects government policy decisions to try to shore up the financial sustainability of care providers, and increase the National Living Wage.
Talking of minimum wage pressures, backdated sleep-in payments continue to be a problem in social care. Matthew Wort’s analysis of the problem and advice to private providers — to renegotiate or exit unviable contracts — seems like an accurate prediction.
Nina Hemmings has written a good blog on why the Migration Advisory Committee’s proposals fall short for social care, and what the UK should learn from the way Australia, Canada, and New Zealand have managed care workers under their migration rules.
Great Financial Times longread about private equity’s role in social care, analysing how much, if at all, we should be concerned about social care providers’ rising debt. Even some former private equity financiers are now calling on regulators to require care home chains to hold a certain amount of capital. It also contains a fascinating chart on the share of social care spending financed privately and by the public sector — showing that a larger share of people receiving formal care are now paying for it themselves than were in 2007.
Children and Young People
Great new bit of research from the Centre for Education Policy on the impact of paying teachers in disadvantaged schools more. TL;DR — teachers stay for longer but there is no statistically significant effect on student achievement. In France, at least.
NatCen have published an analysis of why early years workers join and stay within the profession. Would be fascinated to see a version of this research for care workers in adult social care — where many of the problems (insufficient government funding, for one) are similar, if not the same.
The government has proposed banning councils from placing children in unregulated placements, owing to concerns about the risks to children. Under the plans, Ofsted would be given powers to issue notices to councils, or remove children’s services from their control. A victory for the children’s charity campaigners and the Children’s Commissioner?
More controversially, a new joint report from the University of Oxford Rees Centre, Alan Turing Institute, and What Works Centre for Children’s Social Care has cautiously endorsed using machine learning in children’s social care — but warns of the dangers of relying too heavily on the machines for fear of “false negatives” — missing children in need of help.
The 2020 annual Local Government Information Unit survey has been published. They find that 97% of councils intend to increase council this year — but 12% still worry that they will be unable to meet their statutory duties — the services which the government says they have to provide.
Law and order
On top of rumours that the government are considering a U-turn on bail reforms, the Home Office are planning to publish quarterly updates on the government’s progress in recruiting 20,000 police officers, on top of their biannual workforce statistics — this should aid scrutiny, and is (admirably) transparent!
The Ministry of Justice has said it will increase the number of Crown Court sitting days for the first half of 2020/21 in order to “serve justice in a timely fashion”. Even with the increase, the total number of sitting days for 2020/21 is still fewer than in 2019, however.
A huge and (predictably) great National Audit Office report analyses the condition of the prison estate, how it’s changed, and why the government didn’t manage to build the 10,000 additional prisons places that it thought it would. (The current one should probably be paying attention on that point).
For a more colourful take on life on the inside, the Guardian’s review of Chris Atkins’ new book about his recent time in HMP Wandsworth makes it sound like it will certainly be worth a read.
In light of the Streatham attack and debates about prison rehabilitation, this Spectator article by former prison governor Ian Acheson is well worth reading. He argues that new prison officers “emerge from one of the shortest training courses in Europe to work in one of the most hostile environments outside a war zone” — and concludes that the ‘quality’ of incarceration, and the effectiveness of rehabilitation programmes, matter much more than the number of years. Let’s hope the government are paying attention. To get up to speed on the debate about prison rehabilitation, this episode of the Briefing Room is a great listen.