The Week in Public Services: 21st May 2019
This week: the ongoing social care policy vacuum; integrating mental health services; and probation services renationalised
Health and Social Care
A King’s Fund blog on social care argues that it is the “zombie” of modern policy debate — the policy equivalent of a dead man walking. Though surely “standing” would more accurately reflect the political inertia surrounding the matter…in any case, Simon Bottery has reviewed the most recent social care proposals from Damian Green and Labour, and found them both wanting.
Former First Minister Damian Green proposed that social care should be funded in the same way as the state pension — at an estimated additional cost of £2.5bn, decidedly less than the £7bn the King’s Fund and Health Foundation came up with. If all that was required to solve social care was an additional £2.5bn, then the problem would probably have been solved by now…
Interestingly, Damian Green’s proposal is not a million miles away from Labour’s proposal of a national care service — but recent announcements have been more of a “shopping list”. Though welcoming Labour’s commitment to spend an additional £8bn on social care in the next parliament, they point out that announcing spending proposals for individual aspects of social care does not amount to, y’know, actual policy.
At Public Health England, it’s all about integration, integration, integration. As well as releasing details of a case study for how joining up mental health, alcohol and drug misuse services in a Derby hospital, they also released a report on a case study in North Yorkshire, where the council commissioners set up a programme to provide consistent services across the county for young people through a nurse-led model that combines clinical elements with psychological interventions — all provided by the same practitioner.
Given the number of nurse vacancies, consolidating services so that everything is provided by the same practitioner could be a practical solution — though with referrals for this service having grown by 170% from 2013 to 2017, we might be nearing the limit of how these efficiencies can cope with the number of nurse vacancies.
New figures from the Royal College of Nursing show that NHS England has lost 6000 mental health nurses in 10 years. Despite commitments by both David Cameron and Theresa May to boost mental health services, the total number of mental health nursing staff has decreased by 10.6% since 2009. The NHS plans to recruit more mental health specialists by targeting mature students studying the subject, with the aim of having 4000 more people in training by 2023/24.
The Royal College of Psychiatrists have found that that adults with eating disorders are facing long waits for NHS care. They found that adults were waiting up to 41 months for treatment, with adults waiting on average 30% longer than children under 18.
The Children’s Commissioner for England are arguing that too many children are being unnecessarily admitted to mental health hospitals, because many are unable to get adequate support. They find that children with learning disabilities are disproportionately affected, despite NHS England’s Transforming Care programme — which aimed to improve the quality of care for people with learning disabilities.
At the other end of the generational spectrum, new research by Age UK shows that more than a million over 65's live in parts of England where there are no care home beds.
Last but not least, a joint project conducted by researchers at University College London, Cardiff University and the International Longevity Centre UK on health inequality among LGBTQI+ people has found that, even when accounting for other factors, members of the LGBTQI+ community aged 50+ experience worse physical and mental health, poorer access to health and social care and greater levels of social isolation and loneliness than non LGBTQI+ adults.
Children and Young People
All work and no play makes Jack a dull boy, right? Yes, says new research — but it seems such received wisdom is studiously ignored. A Nuffield Foundation study found that school break and lunch times are getting shorter, as school staff and policymakers consistently disagree about the purpose and value of break times. The study discusses the implications for children’s mental health and finds that primary schools with larger proportion of pupils receiving free school meals generally had less total time for breaks.
Meanwhile, the Children’s Society has also issued a report calling for a cross-departmental taskforce to tackle the various challenges facing vulnerable young people as they journey into adulthood. In addition to encouraging cross-departmental cooperation, the report suggests integrating services available to young people — for example improving coordination within Clinical Commissioning Groups between mental health service providers and other key agencies to provide support for young people aged 16–25 who are transitioning to adult mental health services.
Meanwhile, EPI analysis has confirmed earlier IFS work that funding for 16–19 year-olds has been hit harder than any other age group, finding that cuts in real-terms funding for this age group have been more considerable than for early years, primary, secondary and higher education phases. This reverses the trend of previous years, where funding was more generous for 16–19 education.
Moving on to higher education, the Higher Education Policy Institute are arguing that a more nuanced approach is required. As mental health and well-being in higher education are different, they argue that it’s important to treat them separately. Periods of low mental well-being caused by a mental health problem are not mutually exclusive with periods of good well-being and policy-making should better reflect this.
Law and Order
The Ministry of Justice has announced that probation services will be brought back in-house. This is absolutely the right decision but, as my colleague Tom points out, the new service will still face many challenges. This helpful analysis from Russell Webster discusses options further.
Finally, a select committee report on prisons in Wales has highlighted the complexities involved with introducing devolution, highlighting that the UK and Welsh governments should work more closely together — in particular in areas where there is overlap with the criminal justice system, namely health, housing and education. It also stresses that any new prison development in Wales should be specific to Welsh requirements and would have to be managed in full collaboration with the Welsh government. A thorough analysis of the myriad of questions devolution poses — and how they should be approached — can be found in the Institute for Government’s Devolution at 20.
