The Week in Public Services: 20th October 2020
This week: the state of social care; replacing prison sentences; and the Manchester debacle: how to centralise power & lose voters?
General
Another week, another set of headlines about the ongoing pandemic and its impact on public services in the UK. No change there then, but there is a change for Week in Public Services, namely a new author: I’m stepping in to Sukh Sodhi’s role, who has set a very high standard for me to match…
The week’s most important headlines have been about the second wave of Covid-19 in the UK, and how to deal with it. Sage — and subsequently Keir Starmer — suggested a UK-wide ‘circuit breaker’ to slow the virus down, but the UK government has thus far rejected the proposal. (Jeremy Farrar, Sage committee member and director of the Wellcome Trust, explained the thinking behind the ‘circuit breaker’ in this BBC interview.) Instead, the government has continued to pursue its localised approach, with mixed results. Three tiers replaced five alert levels, but the third ‘very high’ tier has proved controversial. The Liverpool city region and Lancashire have moved into tier three, but there has been serious disagreement between the government and local leaders about Greater Manchester doing the same, centring on a dispute about financial support. With no agreement reached, it seems likely the government will impose restrictions today (20 October). Further regions in England are also expected to move into tier three in the next few days.
Meanwhile, the devolved administrations are diverging from Westminster. With tighter restrictions already in place in parts of Scotland, in Northern Ireland a four-week period of restrictions came into force on 16 October — pubs and restaurants shut, and school half-term extended by a week. In Wales, First Minister Mark Drakeford announced on Monday (19 October) that a national ‘firebreak’ would be enforced from 23 October to 9 November. The rules are comparable to the national lockdown in March/April, a similarity which Drakeford hinted at implicitly by asking people to ‘stay at home’. The main difference is that childcare and schools for children up to year 8 will reopen after half-term — Wales following the recommendation of many in government and the scientific community that schools should be the top priority for keeping open. YouGov polling this week found that the public agree, 57% choosing schools and nurseries as their top priority under further restrictions.
Of course the varying rules across regions of the UK brings its own set of problems. As Carl Baker pointed out on Twitter, the tiers system produces some fairly bizarre looking maps (for followers of US politics, reminiscent of some of the absurd shapes produced by gerrymandering). Meanwhile in the village of Staithes in North Yorkshire, a small bridge separates residents in tier two from those in tier one.
Away from the short-term news cycle, there have been a couple of interesting pieces taking a longer-term view on the pandemic. An international study from Imperial College London published in the journal Nature Medicine analysed excess mortality data in 21 industrialized countries (19 European countries, plus Australia and New Zealand — there is a summary here). They found that England and Wales (counted as one country) and Spain were the most severely impacted, experiencing an estimated 37–38% relative increase in mortality from February to May. The researchers suggested that factors which improved outcomes in other countries included earlier restrictions/lockdowns, more effective test, trace and isolate systems, and more resilient public health infrastructure. The Financial Times has published an excellent long-read chronicling the spread of Covid-19 through data visualisation — definitely worth your time. The final graph, showing the relationship between Covid-19 deaths and fall in GDP, appears to show that an effective public health response also worked as an effective economic response. Countries that managed the pandemic well — like South Korea and Japan in East Asia, or Finland, Denmark and Germany in Europe — tended to have better economic performance as well. At the same time, the UK and Spain were two of the countries most badly affected with respect to both deaths and economic disruption.
Also thinking about the long term, Reform published a new report ‘Resilient public services in an age of cyber threats’. Highlighting the rapid pace at which digital working has been adopted in public services since the start of the pandemic, the authors argue it is crucial that services take cyber threats seriously. They argue that the UK’s National Cyber Security Centre can play an important role in helping public services mitigate this threat.
Health and Social Care
Let’s start with a summary of some recent Covid-19 stories. A new WHO report (which has not yet been officially published) suggests that remdesivir has little effect on Covid-19 mortality. This was one of the drugs administered to Donald Trump while he was ill. The latest ONS data shows that deaths in private homes in England and Wales remain significantly above the five-year average, while deaths in hospitals remain below the five-year average. It seems that some deaths that would normally have occurred in hospitals are occurring in private homes instead, perhaps because people are more reluctant to go to hospital. As cases of Covid-19 increase across the UK, Beccy Baird analyses how well prepared general practice is for the winter, writing that “with growing demand, an ever-diminishing GP workforce and difficulties in recruiting, inducting and supporting new staff while working remotely (even though funding is available), it’s going to be a tough winter for general practice.” Mark Dayan’s briefing for the Nuffield Trust looks at how Brexit will affect the UK’s response to Covid-19, suggesting that it has the potential to cause significant disruption at a time when health and social care are already under severe pressure.
The Care Quality Commission published its annual State of Care report, which said that pre-pandemic, the CQC thought service quality remained fairly stable, but noted continued concerns about the fragility of the adult social care sector. The report praises the incredible efforts of health and care staff in dealing with the Covid-19 crisis, as well as rapid innovation and collaborative efforts. Recommendations include reform, investment and workforce planning in the adult social care sector; urgently addressing the increased waiting lists and backlogs in the NHS; and keeping the innovations in health and social care which have been adopted during the pandemic as part of new methods of working. Perhaps unsurprisingly, commentators picked up on the stark warnings about social care. Ian Hudspeth (LGA) highlighted this, and Richard Murray (King’s Fund) said: “The most concerning aspect of this new report is that few of its findings come as a surprise. Health inequalities were already widening before the pandemic and for several years this report has provided an annual warning to governments about the crisis in adult social care. Yet still we wait for the government to act on the longstanding promises of reform.”
Moving (slightly) away from the ongoing pandemic: The Health Foundation has published The bigger picture, looking back at the last two decades of the NHS in England. The authors find that “between 2000/01 and 2017/18, the amount of NHS-funded care in England, either delivered by NHS hospitals or other providers, more than doubled”, with the largest increases in activity coming in hospital-based care. The report suggests that overcoming short-term decision-making is key, as well as making a number of other recommendations such as setting clear population health goals. Sir Andrew Dilnot’s blog for The Health Foundation argues that longer-term goals and strategy are key to improving both health and social care. David Fothergill, writing in The Guardian, makes a similar argument that the scope of social care reform must take into account its relationship with health care and the NHS. Simon Bottery has also written a piece highlighting the importance of the upcoming Comprehensive Spending Review for social care, making the case for short-term funding alongside the need for much more substantial reform in the long term. New high quality polling and analysis from BritainThinks, in collaboration with Engage Britain, finds that the UK public agree that health and care is the most important issue facing the country — Covid-19, which of course is also about health and care, is in second place.
Children and Young People
Partial school closures (with slightly differing details) have been announced in Northern Ireland and Wales, although in terms of overall policy both are prioritising keeping schools open. Last week’s figures for England stated that 21% of secondary schools have been forced to send pupils home due to Covid-19, while the equivalent figure for primary schools is 7%. More encouragingly, however, overall attendance at secondary schools was stable.
On to news about teachers. The Education Policy Institute has published new research on teacher diversity in England, showing a continued fall in gender diversity in secondary schools — only 35.5% of teachers in secondary schools are men. They suggest that reductions in real terms in teachers’ wages may be a factor here. More positively, however, the proportion of BAME male teachers has continued to rise, and for the first time reflects the overall population. The government also announced reductions in teacher training funding, mostly in response to the 30% increase in teacher applications this year. According to Schoolsweek, the cuts mean that “next year’s bursary spend will be £130 million — nearly half the sum spent this year.” Although there is some logic behind the government’s decision, it has been criticised for being an example of short-term thinking.
Footballer Marcus Rashford — recently awarded an MBE ‘for services to vulnerable children in the UK during Covid-19’ — has continued his campaign to extend free school meals, with a new petition being signed by over 250,000 people so far. In his day job, his goal helped Manchester United beat Newcastle at the weekend, so a successful few weeks all in all.
The House of Commons education select committee held a meeting as part of its inquiry, ‘Left behind white pupils from disadvantaged backgrounds’, on 13 October. As is well known, white pupils from poorer communities, particularly boys, have on average worse educational outcomes. The hearing generated headlines after Professor Matthew Goodwin said that he feared terms such as ‘white privilege’ could “send yet another signal to these communities that they are the problem”. Professor Doug Stokes, writing for ConservativeHome, sets out a similar argument to Goodwin, and also provides some of the important statistics. By contrast, Kenan Malik writing in The Guardian argues that these pupils’ worse educational outcomes are due to inequality and class, rather than race.
Finally, remember the exams crisis in the summer? With Covid-19 likely to remain seriously disruptive for some time to come, those problems with exams are not going away. Ofqual confirmed this week that, for the relatively small number of students who have chosen to sit actual exams this autumn, they will ensure that grade boundaries are similarly ‘generous’ to the eventual grades awarded to students in the summer. But others are turning their minds to the exam series in 2021. The government announced exams would go ahead in England in 2021 this week, though they will be held three weeks later. Chris Cook, however, makes the argument that this isn’t a great decision: what if students or families have to self-isolate during the exam period? How will the government ensure that students who have been particularly disadvantaged during the pandemic are not further disadvantaged by holding exams, a system which is likely to favour pupils from higher socioeconomic backgrounds? Will grades be adjusted to help disadvantaged students, and will this lead to more grade inflation, as we saw this year? Cook suggests abandoning exams altogether (perhaps with an alternative system of teacher-awarded grades). This would come with its own set of problems, but as Cook argues “this process would be honest. It does not wish away our problems. If you cannot issue a grade with the same properties as in previous years, do not pretend to.” This is definitely an issue to watch in the coming months.
Law and Order
Media reporting that the police may be given access to NHS Test and Trace data has prompted concerns about transparency. Specifically, contact details of people instructed to self-isolate are to be passed to the police on request. Unsurprisingly, there have been concerns that this may undermine people’s confidence in getting a test in the first place. In addition, there is clear potential for confusion with the NHS Covid-19 smartphone app (which is, in fact, unrelated to NHS Test and Trace — the app data is entirely anonymised). More fundamental, perhaps, is the lack of transparency, as this latest revelation came via media reporting. The Institute for Government’s Gavin Freeguard tweeted: “I would humbly suggest that, if we’re finding out about this because of good journalism and not because government is being clear up front about it, then government isn’t doing enough to earn the public’s trust.”
The Covid-19 crisis affects every public service. The Ministry of Justice has extended custody times (from 182 to 238 days) in order to try to deal with the backlog of trials. However, an equality impact statement found that this would have a disproportionate impact on BAME people. Prison reformers have written to Lord Chancellor Robert Buckland, requesting greater transparency in prisons over the next few months of continuing restrictions in prisons due to Covid-19. They also advocate making it easier to release some prisoners early, and ask the government to commit to the continuation of new policies introduced during the pandemic, such as free video calls.
The Centre for Social Justice released a new report, Sentencing in the dock, which highlights the UK’s high rates of imprisonment and recidivism. The report makes the case for a new sentence, the ‘Intensive Control and Rehabilitation Order’, which would be served entirely in the community, rather than in a prison. “The availability of new technology in the market means that we can go further than ever before in seeking new alternatives to custody, while safeguarding the public and commanding the confidence of sentencers. We consider that it is only by enabling individuals to remain in the community, that meaningful rehabilitation can be achieved.”
Local Government
The week has been dominated by Covid-19, and the localised tier system. The dispute between Manchester local leaders and the Westminster government has at times become a story of briefing and counter-briefing, a complex mix of public health, economics and politics. Jennifer Williams’ report in the Manchester Evening News is well worth reading for the details. As many commentators have pointed out (Simon Jenkins and Matthew d’Ancona among them), the localised nature of new restrictions has given increased prominence and media exposure to English mayors such as Andy Burnham, Steve Rotheram and Andy Street — a rare sight of local democracy in centralised England. For podcast listeners, this was a topic covered in the Institute for Government’s latest Inside Briefing, while the latest Briefing Room (BBC) episode takes a look at regional differences in Covid-19, featuring interviews with local leaders giving their perspectives on the efficacy of restrictions, and the importance of local test, trace and isolate systems.
The disconnect between local and central systems was perfectly illustrated this week by the bizarre story of people being sent to a non-functional test centre. On Sunday 18 October, the government website sent people to a test site in Sevenoaks, Kent. Unfortunately the testing unit was not yet operational. People vainly driving round the facility in circles seems a cruelly apt metaphor for the lack of progress made in improving the test, trace and isolate system.
Kent was also involved in an intervention made by the Children’s Commissioner Anne Longfield, who wrote this week about unaccompanied children seeking asylum in the UK. According to Longfield, Kent announced on 17 August that they were unable to care for any more children (they were already caring for almost 600). The result is that children can wait up to 72 hours in holding facilities without access to showers or beds, while waiting for staff from other counties to come to collect them. Better co-ordination to address this shocking state of affairs is urgently needed.
More prosaically, the National Audit Office released a new report looking at improving broadband across the UK. It concludes that, overall, the Superfast Broadband programme, which gave money to local authorities to spend on improving broadband in their areas, was relatively successful. Delivery under the Future Programme (2021–2025) is set to be centralised, however, to speed up the process — the NAO says the government needs to set out how it will retain local input and expertise.
Finally, the Tony Blair Institute for Global Change has published an interesting report on local government finance. As already discussed in this week’s blog, the relationship between central and local government has become a key discussion point during the Covid-19 pandemic. The authors argue that there is a fundamental problem with centralised prescription over how local government spends its money, despite deep funding cuts for local government since 2010. This means that local government has to raise taxes locally, in order to provide services prescribed by central government; “local discretionary activity has been crowded out.” The report argues that although the level of funding needs to be higher, a sustainable solution requires more comprehensive reform based on two principles: (i) “local government should be fully funded by central government to deliver the services that central government requires it to provide”; and (ii) “local government should be given broad scope to raise revenue from its own tax base along with autonomy over how that money is spent, accountable to its own citizens for its decisions.”
Expect more next week on the local/central discussion, as well as more details on how well the three tiers are working. Until then, I’ll leave you with an excellent tweet comparing Andy Burnham and co. to a pop band as they made their arguments in Manchester.
