The week in public services: 24th March 2020

This week: how Coronavirus is changing the NHS; what will happen now GCSEs and A-levels aren’t going ahead; and comparing social care in the four nations of the UK


Interesting blog from Toby Lowe about what coronavirus might mean for managing the public sector, and public services, in the future.

Health and Social Care

Health Service Journal folk have helpfully summarised the implications of the latest NHS guidance, including last Tuesday’s health select committee meeting.

James Illman, Dave West, Anabelle Collins, and Lawrence Dunhill (and the rest) are all must-follows if you want the latest info on how the Covid-19 outbreak is reshaping the relationship between the government and the NHS. Performance-based pay has been ditched in hospitals, and general practice. This week’s editorial by Andy Cowper is also very sensible.

For more sensible commentary, these Lancet articles on lessons (or not) from history for dealing with coronavirus, and why some countries health systems have proved more resilient are good.

When it comes to the frontline, pressures are already mounting. A major hospital in Harrow is already having to transfer patients who need critical care to other sites. And to help speed up discharge, hospitals have been given new instructions to suspend all eligibility and funding decisions, and a target do discharge patients within three hours — these stories are about to get a lot more common.

Outside of the NHS response to coronavirus, this Commons briefing is a good explainer of the challenge of preserving equal access to care in small (often rural) hospitals is good.

In social care, the Commons Library have provided a useful overview of the support the government is offering local authorities to help social care providers deal with the pressures from coronavirus. Read with this important BBC story about the extra support that social care providers need from local government. The international long-term care network have also published helpful guidance on how other countries are providing long-term care in a time where Covid 19 is ever-prevalent.

Beyond the immediate pressures, the Nuffield Trust have published a fascinating series of explainers comparing adult social care in the four countries of the UK. Lots to learn from these comparisons…my biggest takeaways were:

  • England’s means- and needs-tested social care system is the least generous because Wales, Scotland and Northern Ireland all offer additional support outside of the means test
  • England is the least generous when it comes to public spending on social care per head
  • England is estimated to have the highest proportion of people paying for their own care

There’s a theme emerging here…which is also nicely summarised by Camille Oung.

Children and Young People

Now schools are closed, and exams are off, what should the government do? Award results based on predicted grades, says John Jerrim. There are few other credible options, he reckons. Holding exams in September might not be possible, and even if it were, who would be available to mark the tests!?

But beware — disadvantaged children will do worst from using predicted grades because among the highest achieving students (receiving AAB+ in A-levels), those from disadvantaged backgrounds receive lower predicted grades than those from more advantaged backgrounds. Great new paper from the UCL Centre for Education Policy & Equalising Opportunities, rapidly becoming one of my favourite places to read up on new economics and education research. For an alternative option, see this Education DataLab blogpost.

In any case, this discussion is now somewhat academic as the Department for Education have confirmed that Ofqual, the exams regulator, will develop a process to provide a calculated grade to each student which reflects their performance. The exam boards will ask teachers to submit their judgement about the grade that they believe the student would have received if exams had gone ahead, with an option for students to sit exams in September 2021 if they feel the mark they have been awarded isn’t fair. John Jerrim has written a smart proposal for Education DataLab, making use of the National Reference Test, to check whether teachers’ judgements are biased for or against certain groups. Worth a read.

Over in children’s social care, chief social worker Yvette Stanley has blogged about what the best local authorities are doing. Not exactly a priority right now — but it feels important to look for the positives right now.

Not forgetting about early years and childcare providers, Josh Cottell from the Education Policy Institute argues that being forced to close poses a particular problem as childcare businesses tend to right on tight margins, and they were already facing unavoidable cost rises due to the National Living Wage. There is (justifiable) concern that the ‘development gap’ between the children of more and less affluent parents could be expanded if early years providers stay closed for long periods of time.

Law and order

In courts, jury trials of longer than three days have been suspended, and there are concerns that delaying hearings would deny justice, both to claimants, and to the accused. There are similar concerns that restricting the working hours of family courts could make it harder to hear local authority applications to take children into care in a timely way.

There have now been three confirmed cases in UK prisons, and there are concerns that prisons that are more crowded — such as those in England and Wales — could see a faster transmission of cases. The ageing prison population in England and Wales will also impose another pressure. In light of this, Reform are calling for an extension to home detention curfews, and scrapping short sentences.

Local government

Interesting reflections from Plymouth director of finance Andrew Hardringham on what it means to set a “robust and adequate” council budget. The cost of providing round-the-clock support to a couple of children with extremely challenging needs could easily add up to the maximum allowable council tax increase…sobering.

Meanwhile, the Asphalt Industry Alliance have still released their annual survey of local road quality. Which I’m finding weirdly comforting in a time of massive uncertainty — though I suspect that’s not the main takeaway — that local authorities filled in fewer potholes in 2019/20 than they did in 2018/19.



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Graham Atkins

Graham Atkins

Senior Researcher @instituteforgov: public services, infrastructure, other things. Too often found running silly distances in sillier weather.