The week in public services: 21st January 2020

This week: devolving public health to local government; prison problems; and the four-hour furore over A&E targets

Health and Social Care

The biggest story last week ended up being the four hour A&E waiting time target, after Matt Hancock (inadvertently) kicked off a fascinating debate by seeming to pre-empt the findings of a government-commissioned independent review into NHS standards and targets. There’s some reason to think trialling new A&E targets would be valuable and provide the centre of government with a better understanding of the problems in hospitals. There’s some reason to think that scrapping the four hour target is cynical politics, given how far below the target the NHS now is. In any case, tweaking the target alone will probably not make a big difference. I learned lots from this twitter debate.

Richard Murray from the Kings Fund wrote a longer article for The Guardian, arguing that “the review must not […] a clandestine attempt to improve wait times by watering down standards in A&E, in the hope the media and public will then forget the current crisis”. George Stoye from the Institute for Fiscal Studies summarised their analysis of the costs and benefits of the A&E target here. They calculate that it increases hospital admissions and treatment costs, but reduces patient deaths (by reducing waiting times for treatment). Fascinating stuff.

Last but not least, Anoosh has a great take about the politics of the announcement, pointing out that, regardless of clinical benefit (or not), the government’s new electoral coalition — and it’s desire to show to it is improving public services — mean that it “can’t seek to move the goalposts without eventually scoring an own goal”.

In other news, Shaun Lintern interviewed Robert Francis, the former chair of the influential Mid Staffs review into nursing, who argued that safety risks remain unresolved, and senior NHS managers should be regulated so that “people who are judged to be incompetent or unsuitable [are not moved] from one place to another”. He is particularly concerned about hospitals not publishing complaints data — Healthwatch England, a patient charity, found just 12 per cent of NHS trusts were compliant with all the rules on publishing patient complaints and hospital responses.

On a more academic note, Ben Goldacre and his open-data crusading pals have set out what they’ve found to be the key barriers in making NHS data more open and useful — “longitudinal datasets that change their structure without warning or documentation; near-duplicate datasets with unexplained differences; datasets that are impossible to locate, and thus may or may not exist; poor or absent documentation; and withholding of data for dubious reasons”. I can sympathise — well worth a read.

In actual policy news, the government has fleshed out its election promise to reinstate maintenance grants, announcing that it some students studying for shortage medical specialities will receive up to an additional £3000 each academic year. A step towards tackling recruitment gaps.

In social care, the Office for Statistics Regulation published a good report on adult social care statistics, pointing out lots of key gaps which the government needs to fill. Anne-Marie at Future Care Capital blogged about why the government needs to improve data on social care, so that it truly understands and can improve performance, here.

And remember when Carillion collapsed two years ago? They were building (and partly financing) two PFI hospitals in Birmingham and Liverpool at the time, whose construction was delayed. A new National Audit Office report looks at what happened both. My biggest takeaway? Using PFI meant that the private sector ended up shouldering most of the cost increase. Sometimes transferring construction risks works…but patients have still ended up waiting much longer than expected to access new hospital facilities. My colleague Tom wrote a good piece on why, two years on from the Carillion debacle, the government needs to push on with outsourcing reform.

Children and Young People

Over at the Education Policy Institute (EPI), Jon Andrews has been doing clever stuff with spreadsheets. Specifically — he’s looked at trends in teacher numbers and spending on teachers. Both pieces are worth reading in full — the most surprising things I learned was that there is some evidence that larger academy trusts reduced spending faster than local authority-maintained schools*. It’s not entirely clear why, but it could be because large academies:

• Made greater use of ‘curriculum-based financial planning’ (deploying staff to deliver the curriculum most efficiently)
• Cut back on middle and senior leaders in schools and placing those roles in academy trusts (although other research finds no difference in levels of spending between maintained schools, single academies, and multi-academy trusts)
• Used more early-career teachers, who earn lower average salaries

*I should also point out that, on average, they increased their spending faster than maintained schools, prior to 2010.

In better news for teachers, the Conservatives have confirmed that starting salaries will increase to £26,000 this year, and existing teachers will receive a 2.5% pay increase. The real test will be whether that’ll be enough for the government to finally hit teacher recruitment targets next year.

Another new EPI report looks at what impact New Labour, the Coalition and subsequent Conservative governments’ policies have had on the early years workforce. The minimum GCSE specification and entitlement expansions brought in under the coalition and Conservative governments did not lead to an improvement in staff qualifications, although New Labour’s “Graduate Leader Fund” policy did.

Sara Bonetti argues that the government should learn from this and set a long-term vision. She also argues that the government should establish an online system for collecting data on early years practitioners which would act as “a one-stop-shop for practitioners, providers, researchers and policy-makers to access information regarding training and qualification, employment trajectories, qualifications and their equivalencies”, allowing the government to monitor the impact of its policies. Strikes me as sensible.

At Education DataLab, Dave Thomson has analysed variation in attainment between schools carefully, and found that performance isn’t that different, particularly once you take pupil characteristics into account. There is more variation between pupils in schools, rather than between schools. The implication? Improving poorly-performing school departments and helping low-attainment pupils in all schools would be more effective than focussing efforts on entire schools.

In children’s social care, James Thomas from ADCS has written a good blog on reasons why the number of children in care is rising, and what might be done about it. Part of it, James argues, is about cutbacks in preventative services, such as youth centres. This (rather timely) number-crunching from the YMCA finds that local authority spending cuts after 2010 led to 750 youth centres closing and the loss of 4500 youth workers.

Law and Order

Reform have published a new report about what to prioritise if the government spends more money in prisons. Interesting to note that many of their recommendations were policies under David Gauke and Rory Stewart (presumptions against short custodial sentences and additional funding for prison security measures in particular). I was also not aware of the ‘two-tier’ payment system which was effectively created by introducing ‘Fair and Sustainable’ (less generous) pay bands in 2012, and not forcing all staff on old pay bands to convert over. I think they’re absolutely right that “siloed decision-making about the recruitment of police officers and sentencing reforms have the potential to put sustained pressure on prisons and probation, by putting more people in prison for longer” — as we at IfG have said before.

Local Government

At the Kings Fund, David Buck has written a interesting report on the effects of devolving public health to local government. His conclusion is that “the overall story is one of a successful transition, and an increasing penetration of public health into the work of local government, beyond being commissioners of public health services through the public health grant — but the journey is not complete”. Summary blog here.