The week in public services — 23rd April 2019
This week: safe staffing failures in hospitals, increased off-rolling in schools, local government and Brexit and CPS workforce worries.
General
The IPPR are undertaking a piece of work on how to end austerity (and how to pay for it), due to be published at the end of the year. Part of the work will estimate “the ideal level of government spending to address four killer ‘social deficits’” — areas where government spending fails to meet the level of service the public wants. One to keep an eye out for.
Health and Social Care
NHS staffing problems are, unsurprisingly, not going away. A study by the University of Southampton estimates a quarter of NHS wards are routinely operating without a safe number of staff on shift. A “downward shift” in skill mix means the current “balancing act” is unsustainable: “substitution of [registered nurses] with less well trained staff is unlikely to represent an efficient or effective solution”.
And it will henceforth be more difficult to discern how many nurses are on shift in hospitals, since the publication of nurse staffing levels has been quietly dropped, as the HSJ has reported. “Clearly, the lessons of the Francis reports have been forgotten”…
The NHS mandate has joined the social care Green Paper in the pile of stuff that’s been delayed for some reason (read: Brexit). The Health Act 2012 requires the Government to set out NHS England’s objectives to Parliament “before the start of each financial year”. Who knows what NHS England will get up to without the Government’s instructions.
What happens when no one wants to fund an increase in NHS public health staff pay? Some trusts will likely miss financial targets and fall into deficit. The Government promised an annual pay rise for these staff totalling over £50m, but neither the Department of Health and Social Care nor NHS England are willing to fund it. Negotiations are apparently ongoing.
The HSJ’s Dave West has trawled through the submissions to the Health and Social Care Committee’s inquiry into NHS England’s proposals for legislation and pulled out the key points.
From last month, Independent Age published its annual assessment of care home performance across England. Tl;dr: it’s not great. 37% of local authorities have seen care home ratings from CQC get worse in their area. The report does include some potential lessons that care home could learn from schools.
A meta-review of studies about the impact of adult social care on healthcare has found that improved availability of social care has the potential to reduce demand on secondary health services, and that insufficient care home places may result in delayed transfers of care — though the authors cannot quantify the size of the effect.
Sharon Allen, the outgoing chief executive of Skills for Care, has said that spending cuts have hit learning and development particularly hard “because people see them as ‘the nice-to-dos’ rather than ‘the must dos’”. She identifies recruitment and retention as the biggest future problems facing the sector.
Here’s a good summary of the current state of social care and possible ways forward — social insurance, a hypothecated tax, increasing income tax — all of which include people paying more. Our paper from last year set out how the Government could fix health and social care funding.
Children and Young People
Rachel Dickinson, the new president of the Association of Directors of Children’s Services, will focus on child poverty during her one-year term. She is enthusiastic about social work apprenticeships, which could help ease recruitment problems.
Council applications to take children into care have been falling over the last three years. The chief executive of the Children and Family Court Advisory and Support Service puts this down to “concerted edge-of-care support programmes in an increasing number of local authorities and the government’s focus on understanding why demand peaked in 2017”.
A senior family barrister has argued that cuts to early intervention services were responsible for the increase in court applications up to 2017, and has created an “overwhelmed and overwhelming” environment for social workers.
The Education Policy Institute has waded into the debate on ‘off-rolling’ — “the practice of removing a pupil from the school roll without a formal, permanent exclusion or by encouraging a parent to remove a child from the school roll, when the removal is primarily in the interests of the school rather than in the best interest of the pupil”.
Unsurprisingly — measuring students leaving schools, and whether they did so under school pressure, is hard to measure — but the key takeaways are:
· The number of pupils leaving school (where their reason for leaving was unexplained) rose from 47,225 in 2011, to 49,051 in 2014, to 55,309 in 2017.
· Pupils in contact with social care, eligible for free school meals, and in the lowest prior attainment quartile (i.e. educationally when starting secondary school) were over-represented in unexplained exits.
Off-rolling also features in this piece from John Harris, which digs into school spending and demand and laments the impacts that cuts are having on the quality of education.
The latest Sutton Trust polling on school funding, budgets, and use of Pupil Premium funding has been published. One in four (27%) secondary school leaders report that their pupil premium funding — “a grant given by the government to schools in England to decrease the attainment gap for the most disadvantaged children” — is being used to plug gaps elsewhere in their budget.
Neighbourhood Services
Sensible recommendations from the Housing, Communities, and Local Government committee on how to engage local government about Brexit, including recommending that the MHCLG monitors workforce shortages in construction and social care.
This is an interesting read on how faith-based and religious groups are working with local authorities to deliver services, and have taken on some community service functions altogether.
Law and Order
Workload and work-related stress are common themes in Performance Tracker for workforce retention across public services. The CPS has launched a new work-related stress policy in partnership with the FDA. Analysis of CPS data by the FDA has found that stress and mental health issues were the single highest reason for both short and long-term absence.
Cuts to the Crown Prosecution Service have damaged its relationship with criminal barristers, who are ready to walk out of trails and refuse new work over a pay row. “There has been no investment for 20 years, nothing, it is unsustainable to carry on like this.” The Performance Tracker chapter on criminal courts has a great summary of spending on the CPS and its performance.
On judges’ workload, expecting them to play judge and juror in the same case might be a step too far.
The Huffington Post had a great piece this week on the closure of magistrates courts, and the consequences this has on access to justice in rural communities. Since 2010, 165 of the 323 magistrates courts in England and Wales have closed.
The Parliamentary Office of Science and Technology has produced a very helpful note on how early interventions can help to reduce violent crime.
Finally, the Centre for Crime and Justice Studies has put out its brilliant policy review, which chronicles all policy and data developments across crime and justice in the UK.
