The week in public services — 22nd May 2018
This week: although the big public service this week took place at Windsor Castle, there’s lots to report on NHS outsourcing contracts, nightmarish prison conditions and local government financial pressures.
This is a non-comprehensive overview of what is going on in public services by the performance Tracker team at @instituteforgov. Did we miss something important? Let us know below.
Health and social care
Kicking off this week is the NAO report on the outsourcing of public care support services by NHS England to Capita, and it’s a doozy. According to the NAO’s findings, the £330 million contract was entered into with neither Capita nor NHSE fully understanding “the complexity or variation of the service being outsourced”. While this crossing of wires had the potential to “seriously harm patients”, there was no evidence that any patients had been harmed as a result.
In the most ambitious crossover event in health, the long-awaited Health Foundation and The King’s Fund collaboration on social care funding reform was published this week. Their report sets out the problem, considers various options for reform and their palatability with the public, but stops short of recommending a particular answer. The standout figure is the projected cost of free personal care, which would onlyrequire £14 billion. Despite the persistent lack of public understanding, it reiterates that inaction is indefensible, and that the forthcoming Green Paper must lead to a major improvement. The Health Foundation’s modelling for various options can be found here, and Polly Toynbee’s helpful roundup of social care funding issues is here.
Labour MP Frank Field has drawn attention to the under-doctoring of poorer communities in the UK. Data shows that the number of GPs working in the most deprived areas is falling, just as the number in privileged areas is rising. The “golden hellos” do not yet seem to be having the desired effect in reducing health inequality.
Despite the GP shortage, data obtained by the Campaign for Science and Engineering shows that over 1,500 extra-European doctors were refused Tier 2 visas so far in 2018. An annual cap of 20,700 for skilled-worker Tier 2 visas keeps the doctor away, apparently.
Rebecca Thomas at the HSJ reported on the High Court ruling in favour of NHSE over Accountable Care Organisation contract. The case was brought against NHSE by campaign group 999 Call for the NHS, which claims whole population payments through the ACO “impose budgetary control at the expense of being demand led”. 999 Call for the NHS will appeal the decision.
A bleak new report on dementia by Alzheimer’s Society shows that many sufferers are struggling to access care in the first instance, and when they can they are too often faced with catastrophic costs and a poor quality of care.
Sticking with community services, NHS Providers this week published their latest report on community service providers. The report lists reasons for the failure to shift appropriate treatment from an acute setting to a community or domiciliary setting, including lack of funding, increased demand and the low profile that community care services carry relative to acute services.
CQC is preparing for a significant decline in standards of health and care services in the coming years, according to outgoing chief executive Sir David Behan (h/t Shaun Lintern). CQC models are projecting a 10–50% deterioration.
For those interested in how STPs and ICSs are getting on, a blog from The King’s Fund has a useful check-in on how their neighbourhood, place-based and system work is progressing.
IPPR published a report on end of life care in England, encouraging the Government and NHS bodies to facilitate the difficult conversations families must have. The other takeaways are the familiar call to integrate health and care commissioning and service provision, and a plea for sustainable funding for social care (on which the IfG is reporting next month).
The HoC Library released their latest NHS Key Statistics briefing. TL;DR, it’s more of the same.
The dividends of the special relationship seem to be drying up, as US Health and Human Services Secretary Alex Azar has indicated a tougher line on cheaper US drug prices abroad. No more Mr NICE guy.
Finally, the Health Foundation and the BMJ are teaming up to launch a series of papers focussed on improving the delivery of healthcare, with plans to “discuss the evidence for systemic quality improvement [and] provide knowledge and support to clinicians”.
Law and order
HMIP Peter Clarke released his damning assessment of HMP Nottingham this week, with some very concerning details. Having issued an urgent notification letter after his announced visit in January (requiring a public response from the Justice Secretary), his report suggests that the eight self-inflicted deaths at the prison since its last inspection in 2016 might have been caused by desperation to escape the “violent, drug-ridden jail”. Press release here.
The Police Foundation published a new report on the future of neighbourhood policing, which sets out a framework of principles for proactive, preventative local policing.
BBC analysis of Home Office data found that the number of criminal charges is decreasing (down by 65,000 between 2014–15 and 2016–17), while the number of reported crimes is rising quickly (up 750,00 in the same period). Police claim that cuts and limited resources are making crime more difficult to investigate, with cases sometimes being shelved if the victim cannot provide the investigating officers with a lead.
Local government and neighbourhood services
The cost of last year’s waste dispute to Birmingham City Council has been revealed, as a council cabinet paper showed that £6.6m was spent to resolve it. This was a fraction of a £20.9m overspend last year, and the council used £63.1m of its reserves “to structurally deliver the 2017–18 budget”.
Continuing with financial pressures on local government, Somerset County Council has heard that its finances are in “a very challenging position”. Despite planned cuts to children’s services (which saw a £22.7m overspend last year), learning disability services and library closures, there are still concerns that it might follow Northamptonshire into bankruptcy, although councillors are determined to prevent that.
An interesting NLGN blog highlights the problems with prevention, which has become a bit of a buzzword in public services. The suggestion is a shift of focus in the way prevention is framed: from deficits to assets, from services to systems and from patients to people.
After its six tips (referenced in last week’s WiPS), the LGC posted an entertaining and useful summary of the items in James Brokenshire’s office in-tray in MoHoCoLoGo. His status as minister for nominative determinism is yet to be verified.
Schools, education, children’s services and young people
London schools are struggling to retain and attract teachers, a new report from NFER has highlighted. London has a higher rate of young teachers quitting the profession than other large cities, more vacancies and fewer new additions to its teacher workforce, and a much quicker acceleration of early-career teachers into middle leadership positions.
As part of an effort to plug the leaks, the London Mayor’s Office launched Teach London, designed to support London teachers present and prospective. Sadiq Khan has challenged ministers to rethink school funding.
Calderdale Council’s Adults and Children’s Services Director Stuart Smith has described the new local Positive Choices programme. The programme offers support to vulnerable pregnant women identified as being at risk of having a child removed; still in its infancy, the programme has been successful in helping 7 out of 9 women change track and avoid their children being taken into care. From a national perspective, this week the HoC Library published a progress update on social care and child support policy changes and consultations.
DfE has announced a pilot scheme that will pay a £500-per-pupil upfront basic maths premium to colleges and other post-16 providers in areas that are currently underperforming. The scheme will run for 2 years and will be evaluated by NatCen.
A survey that asked students for their views on their international classmates has been withdrawn by the Migration Advisory Committee. The survey included some problematic questions, such as asking if international students on a course of study had a positive, negative or neutral impact.
Finally, as if SATs weren’t painful enough for young people, some Year 6 students have been required to strike poses only usually seen performed by superheroes and senior members of the Conservative Party.
