The week in public services — 24 April 2018
This week: funding social care; Government’s council finance reform; and some good news for prisons.
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.
Special cross-public services section
It’s rare that commentators consider public services together (our Performance Tracker being one of the exceptions). The National Institute of Economic and Social Research’s latest report was therefore particularly interesting to us! They argue that public services cuts, ‘austerity fatigue’ and an ageing population put strain on public services, and estimate that government would need to spend £300 billion on top of what it is planning to spend in the next 7 years to meet ‘reasonable’ demands.
Health and social care
Parliament launched ‘citizens’ assemblies’ on social care as part of the joint Housing, Communities & Local Government Committee and Health and Social Care Committee inquiry on long-term social care funding. Representative groups of up to 50 individuals will meet in late April and late May to hear from experts and to come up with recommendations. Their findings will be considered by the Committees.
Meanwhile Nick Boles, Liz Kendall and Norman Lamb have published principles for the long-term funding for health and care. These include a regular assessment of resources needed to run the NHS and social care, and converting National Insurance into a specific NHS tax, an idea which Health Secretary is supposedly open to (even if ‘spreadsheet Phil’ is less keen). There is at least some cross-party support for a long-term funding solution.
Out in think tank land, collaboration matters, the King’s Fund are arguing in a new report on primary and acute care system (PACS) vanguard sites. The PACS care model was designed so that hospitals, GPs, social care and other professionals can work better together. Based on first-hand insights of those involved, the King’s Fund highlight the importance of relationships and mutual interests to deliver local change. Likewise, Anna Starling from the Health Foundation highlights that the most successful pilots built local capability to continuously develop and test new ideas.
But there are still pressures. New NHS Providers research on the scale of challenges facing NHS Trusts finds that only 5% of Trusts are confident their area can meet the 4hr A&E waiting target. About 55% of trusts are worried they won’t contain the size of their elective surgery waiting lists next year.
In adult social care, the new head of the Association of Directors of Adult Social Services, Glen Garrod, has argued that recent NHS staff pay rises may undermine social care’s ability to recruit home-care workers.
Remember that time in 2016 we all thought the care market was about to collapse? Well, another major home care provider is teetering on the edge. Allied Healthcare, who have contracts with 150 local authorities, are undertaking a ‘Compulsory Voluntary Arrangement’ allowing them to take a break from repaying their creditors, and paying their pension contributions. Not a good sign for market sustainability.
But does social care even make an impact? An interesting article in The Guardian looked at NHS Digital’s estimates of “the impact of adult social care”. It found that council spending doesn’t seem to relate to impact. The authors put this down to misunderstandings in conventional understandings of “need”.
Finally, the ONS has published data on avoidable deaths. Nearly a quarter of all deaths in the UK were “avoidable”, if effective and timely healthcare had been delivered. The Bureau of Investigative Journalism, meanwhile, has been trying to count the number of homeless people that have died on UK streets.
Law and order
Her Majesty’s Prison and Probation Service published data on its recruitment to highlight that the Ministry of Justice has reached its target of recruiting 2,500 frontline officers ahead of schedule. Crime blogger Russell Webster welcomes the news but notes that these MoJ numbers include people in training and performing “operational support roles” before starting training.
The HM Chief Inspector of Prisons published a report on the close supervision centre system, which holds more than 50 of the most dangerous men in prisons. There has been tangible progress since 2015 in care and management planning. But close supervision has been put under strain following an increase in referrals related to the rise in prison violence, and staff shortages have also hampered improvements. The report found that key decisions on prisoners were evidence-based, although not independently scrutinised.
Local Government Finance
A new report by the Housing Communities and Local Government Committee concluded that the business rates councils will retain under full devolution should be extra revenue on top of existing central grants. The Committee claims this is necessary to recognise cost pressures (social care) on local authorities, and to protect local services. This goes against the Government’s intentions that this revenue should replace grants to local councils (with the aim of councils become self-funding). The Committee argue that any reformed system will have to be underpinned by central grants because councils with increasing needs won’t be covered by full business rates retention.
Also, the Financial Times look at the impact of rising social care demand on local councils’ budgets, and quotes our very own Performance Tracker.
Schools, education and young people
Sutton Trust polling found academy leaders sceptical of the benefits of the ‘academy’ status. Academies were given greater autonomy, but half of the 1,246 teachers and school leaders polled said these freedoms had no, or a negative, effect in classrooms. The poll also suggested schools are cutting teaching staff and assistants, and were using funds from the Pupil Premium to plug funding gaps. In the meantime, a new DfE pilot website to advertise teacher vacancies goes online this Spring: but how will it actually work — and will schools have to pay to use it?
Report-based news: the Education Policy Institute and UCL Institute of Education looked at the performance of disadvantaged pupils in England and other wealthy countries. They find that disadvantaged pupils lag those in several Western countries. England’s maths ‘disadvantage gap’ (the average attainment gap between disadvantaged students and their peers) puts it 27th out of 44 nations. Importantly, their results indicate that high performance and educational equity are not mutually exclusive.
A new — and highly critical — report from Reform assesses the first year of the apprenticeship levy. It concludes that since its introduction, the number of young people starting an apprenticeship has declined; that the quality of apprenticeships has declined; and that employers are gaming the system to rebrand pre-existing training courses as apprenticeships to shift costs onto government.
There are worrying signs that councils’ children services may be so financially strained that they cannot provide homeless children with temporary accommodation. The Independent reports signs that local authorities are not classifying some children as “in need” despite clear evidence that they do not have adequate accommodation (and/or lack money for basic living needs) — both of which put legal duties on councils to help. Similarly concerning, an FoI request to 50 councils in England and Wales found that nearly 2500 sibling groups in care are currently split up — which is likely to be detrimental to their wellbeing.
And politics ahoy in children’s services! At this point it’s widely accepted that local authorities have reduced spending on discretionary children’s services — from Sure Start to youth services — to manage with less. Some have claimed these reductions constitute a false economy — and have resulted in greater demand for child protection and local authority care at a later stage. Labour’s solution? A statutory youth service. Previously a Miliband policy (though not a manifesto pledge), the party looks increasingly keen — and are now consulting on it.
The new president of the Association of Directors of Children’s Services (ADCS) Stuart Gallimore gave his inaugural lecture yesterday. His two biggest priorities? A new campaign for more money for children’s services — though acknowledging that spending on school transport for all children should be reviewed. Second, investing in the early help workforce, which he believes is “the only way we can reduce the funding deficit in children’s services”.
