The Week in Public Services: 20th January 2021

This week: vaccine rollout progress; the difficulties of self-isolation; and when might schools reopen?

General

As the consequences of high cases and hospital admissions at the end of December and early January are now starting to translate into higher deaths, there is some light: More or Less, the BBC’s brilliant radio show about numbers in the news, is back! Highly recommended — the section on vaccine efficacy is incredibly clear.

Taking a broader look at the pandemic, Aris Roussinos has argued that the pandemic demonstrated the British state does not function in practice, and that the British state is now closer to the developing nations than to the rest of Western Europe. He also looks at what Dominic Cummings ‘got right’ in another piece. Controversial but thought-provoking.

Coming back to the current crisis, Neil O’Brien has set out why he thinks it’s important to counter the Covid ‘sceptics’ (sidenote: ‘sceptic’ is a misnomer to describe entrenched views that rarely change in line with changing evidence). A forceful — and justified — tirade.

And remember Brexit? You should — this excellent essay collection summarises the implications for well, everything (it has 70 essays!) Readers of this weekly update will want to check out the chapters on health and social care at least.

Health and Social Care

Lots to cover this week but the single best explanation of the current pressures is this excellent episode of the Briefing Room, which covers how the NHS is coping this winter. To understand the pressures in social care, read this from the Association of Directors of Adult Social Services. This from Nuffield is a good summary of the key November and December stats.

The volume of new analysis and research is a bit overwhelming at the minute, so I’ve focused on three different topics this week.

Lockdown compliance and self-isolation:

Following well-rehearsed concerns about public compliance with lockdown rules (‘why are so many people outside, this isn’t like March’ etc.), it’s worth checking how true these stories actually are.

A good thread from Sky’s Rowland Manthorpe looked at data from UCL’s Covid social study survey, and found that self-reported compliance with most rules is high… but not with self-isolation. Almost 30% of people with symptoms self-isolate for 5 days or fewer. This is the clearest evidence I’ve seen that the government’s focus should be on making it easier for people to self-isolate.

On which note, a Newsnight investigation found that many councils were rejecting applications for £500 self-isolation support payments. One director of public health thought that the eligibility criteria (set by national government) was too narrow, and that financial hardship was preventing many people from properly self-isolating.

The Nuffield Trust are here to cheer us up though, with an analysis of different countries’ policy measures to improve compliance with self-isolation. They find that “the UK performs towards the bottom of OECD countries in terms of the generosity of its sick pay […] the average mandatory sick pay in OECD countries covers 70% of an eligible employee’s lost earnings during a quarantine period, but in the UK this on average is only 10%”. The UK also doesn’t do much to provide supplies or accommodation directly to people self-isolating. A really valuable comparison — there are always lessons from other countries!

Vaccination progress:

Starting with the global picture, studies from Israel suggest that the Pfizer vaccine reduces transmission — subjects who got both Pfizer vaccine shots developed high levels of antibodies. Tentatively good news!

Back in the UK, Matt D’Ancona has a great audio essay on the UK’s procurement of the vaccine, and the logistics of the rollout, starting from decisions all the way back at the start of the crisis. Recommended. (It is behind the Tortoise paywall — but I think you can listen for free from most podcast providers).

It’s still harder to piece together details about the vaccine rollout from various government plans and statements than it should be. At IfG, we’ve pulled together what we know here. This explainer from the Association of Directors of Public Health is also very useful (see also Greg’s helpful thread).

My colleague Tom wrote a blog last week arguing that the government should be wary of overpromising (good advice), and that “focusing attention on highly ambitious targets creates risks”. Focusing a lot on the number of people vaccinated could mean losing sight of whether those at most risk are being vaccinated. I couldn’t agree more. This builds off Anna Powell-Smith’s excellent point (and comparative report) about the risk of only publishing headline information. Duncan Robertson made much the same point a week ago. The solution, in my view, is more granular data to track the rollout among priority groups and — as ever — to not get obsessed about any one particular indicator.

Simon Briscoe wrote a good blog on what additional data would be useful. I agree that it would be extremely useful (and boost public confidence!) to have more information about supply. Also, a genuine question: why does the government claim this is commercially sensitive? I honestly don’t understand why that’s the case — but I may be missing something very obvious. Greater Manchester are able to give a more detailed breakdown — as are some areas in Wales — so it doesn’t seem to be impossible.

At least we’ve had daily data since the 10th January — although you still have to go to each individual nation’s statistics if you want breakdowns by age and region. I strongly endorse this Office for Statistics Regulation call for the government to improve, and to provide “information about how to compare the statistics from each administration”.

Moving away from the data for a second, John Hawksworth has created a nice straightforward model to estimate how much vaccine capacity the government needs to meet its objectives. It’s a useful resource for outlining what different vaccination rates would mean. For example, if 2 million doses per week is maximum capacity (hopefully not!), “you might have vaccinated all over-65s and other high priority groups by late March, but after that most capacity would need to be used to give second doses […] getting first vaccinations to most of those under 65 might have to wait for a couple of months and the government would not meet its objective to vaccinate all over-50s and other high priority groups by the Spring, even if this is interpreted as end of May rather than end of April.” To ensure there is no delay in the rollout (and to ensure no-one has to wait longer than 12 weeks between vaccinations), he estimates that the government would have to hit 4 million doses by early April.

The other controversial vaccines story has been the rollout strategy. An interesting thread from Becks Fisher explains one problem — that the current vaccination strategy, principally based on age, discriminates against poor people because poverty reduces life expectancy (meaning deprived areas have fewer over 80s). Charles Tallack from the Health Foundation shows the problem in charts, here.

For all those thinking this sounds quite dry, these decisions really matter on the ground. Some GPs in deprived areas want to able to vaccinate more people in cohort 4 (70+), rather than wait for other areas to catch-up.

There is definitely a logic to this, even if it violates people’s intuitive sense of not wanting a ‘postcode lottery’. Rereading the Public Health England report on disparities in Covid-19 outcomes, they clearly show that “people who live in deprived areas have higher diagnosis rates and death rates than those living in less deprived areas […] poor outcomes from COVID-19 infection in deprived areas remain after adjusting for age, sex, region and ethnicity, but the role of comorbidities requires further investigation”.

The demographic differences between areas also helps explains the difference in over-80 vaccination rates. Some areas have a lot more over-80s than others, some of whom may be harder to offer the vaccine to (those in care homes, those hard to contact etc.). So — contra the Daily Mail — it is unsurprising that vaccine rollout is proceeding at different speeds in different areas.

That’s a lot of vaccines material for one week — but if you fancy even more, this Tortoise reading list (£) is your best bet.

Long-term problems:

The immediate pressures of coronavirus and vaccine rollout have not diminished the importance any of the long-term impacts of the pandemic, or longstanding pressures, which are well-covered in new research on:

• How the pandemic affected social care usage and older people’s wellbeing
• Social care commissioning
• The challenges of an ageing society
• The crumbling NHS estate
• The importance of community healthcare post-pandemic
• The volume of internal health bureaucracy
• Emerging evidence on impacts of long covid
• The psychological impacts of the pandemic on health staff
• What people think about sharing their health data
• Aaaand the pitfalls of NHS reorganisations and legislative changes

Children and Young People

In the schools wonk world, most attention is still devoted to school closures and reopening . This very good piece (£) from Chris Cook explains how the government came to the bizarre decision of insisting schools would stay open only to close them and cancel summer exams after one day of opening in January. Lots of fascinating details, including this nugget from a senior civil servant: “I don’t blame colleagues for not coming forward with ideas. Frankly, you might as well let [ministers] push their agenda, fail and then come to you. Why have the fight, lose — and then have them resent you when you’re cleaning up their mess?”

In many ways, this was quite predictable as these analyses from the Education Policy Institute (on school attendance across England) and Nuffield Trust (on infection outbreaks in educational settings) show. When students and pupils returned to schools, colleges and universities, acute respiratory infection outbreaks in educational settings rose hugely, and school attendance dropped dramatically in the final week of term in December.

Moving on to when schools might reopen, Devi Sridhar makes the case that “instead of thinking about schools as zones of transmission that cause case numbers to rise across the population, it’s more accurate to think of them as reflections of the existing rate of transmission: when cases rise in a community, so do the number of outbreaks that occur in schools.” In short — think about how to get community transmission down to a manageable level, rather than focusing on school-level precautions.

Tom Chivers tentatively suggests reopening primary schools first — given that the risk of transmission and severe symptoms seem lowest amongst the youngest children (and that it is harder to home school younger children).

Of course, back in December mass testing was supposed to allow pupils to return to school safely… safe to say it has not gone well. On Tuesday 12th January, the Medicines and Healthcare Products Regulatory Agency (MHRA) told the government it had not authorised the daily use of 30-minute tests due to concerns that they give people false reassurance if they test negative. On Friday 15th January, unions and MPs started publicly asking questions about the government’s use of said tests despite the MHRA warnings. And on Tuesday 19th January, the government announced it would pause the programme. Full circle!

The other big story has been free school meals, which the government came under fire for when parcels sent to pupils contained small amounts of low-quality food. This has been analysed a lot, so I’ll only link a few pieces.

• The case for why increasing Universal Credit/cash transfers would be a better approach
• Sam Freedman on why “the success of the Rashford campaign is driven not just by his winning persona but his own personal experience”
• A very interesting blog about the governance implications i.e. why did it take a Marcus Rashford tweet for the government to act. “The government should have been representing the people in its care, yet there seems to have been no mechanism for monitoring the quality of delivery, for getting feedback from the people actually using the service. And this has knock-on effects: if I’m delivering a service for a client, and the client isn’t bothering to evaluate how good that service is, then even if I’m not actively trying to be terrible, I’ve got less incentive to peer closely at the cracks, or spend time and money collecting feedback of my own.”

On 2021 exams, the Department for Education and Ofqual have started a consultation to decide how exams and grades are going to work in England, specifically looking at whether externally set and marked papers can work, which is the approach Wales has adopted. The Department has also launched a review of children’s social care, to be led by Josh MacAlister, the chief executive of the social work charity, Frontline.

Looking at the bigger picture, a group of academics and charities have called for an inquiry into the effects of the pandemic on children’s life chances…perhaps they could learn from Scotland, where a group of academics and others have already started to think about what they need to measure.

Law and Order

In the world of criminal justice, some police officers are worried that potential new Home Office crime targets could lead to perverse incentives, in particular the risk that high-profile crime targets do not create incentives to avoid criminalising young people or encourage diversion. On which note… this handy blog from Penelope Gibbs argues that avoiding prosecution leads to less crime.

The big story of the week is the latest Criminal Justice Joint Inspection report on the impact of the pandemic, which focuses in particular on court backlogs. They say that “our greatest concern… remains the situation in courts, and the consequential effect this has on all our inspected sectors. The need to take urgent and significant action to reduce and eliminate what were already chronic backlogs in cases, and to make sure courts are secure and safe for all who attend and work in them, is urgent. Without this, the implications for victims, witnesses, defendants and prisoners are severe.” This of course chimes with our analysis of the impact of the pandemic on courts at the Institute for Government.

In prisons, sadly the second wave of Covid-19 appears to have been much deadlier than the first.

Local Government

Less news this week, but the government has responded to council concerns about vaccine data after Nadhim Zahawi promised to share “granular data”.