The week in public services — 24th October 2018

This week: the pre-budget briefing bonanza, Matt Hancock’s first foray into health policy, and new data on adult social care.

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.

Budget shenanigans

It’s the traditional pre-budget leaking and briefing week — so more stories about spending on public services than normal.

We’ve already argued that promising to “end austerity” isn’t credible — and is actively unhelpful if it dodges harder questions about trade-offs between taxes, co-payment, service reductions, or radical service changes — before. Now, our favourite public finance geeks at the IFS have crunched spending numbers to demonstrate that “promises to end austerity and to balance the books by mid 2020s are unlikely to be compatible”. See the full detail here.

Similarly, Resolution Foundation have argued that “meaningfully ending austerity” (no real-terms cuts to departments, cancelling the benefit freeze, and investing in Universal Credit’s work allowances) would cost £31bn in 2022/23, meaning the Chancellor will have to raise taxes by then in order to reduce the debt:GDP ratio. They reckon cancelling planned corporation tax increases and freezing income tax thresholds have the best chance of being implemented without political rebellion.

The Telegraph are reporting that Liz Truss and Philip Hammond are pushing back on across-the-board increases in public sector staff pay, instead favouring pay rises linked to retention, performance, and efficiency. Details are still to be confirmed. But as Performance Tracker shows, workload and working conditions matter as much as pay — and not all public service workers under pressure are employed by the public sector.

In other budget news, spreadsheet Phil’s job has been made slightly easier by better-than-expected tax revenues. For those of us scratching our heads as to how public finances can seemingly randomly improve, Chris Giles has written a helpful explainer. It’s all about the cumulative impact of minor Office for Budget Responsibility forecasting errors and revisions.

Paul Johnson has outlined the political and long-term economic constraints still in play, and Philip Inman has a good piece about the politics of the chancellor’s “deal-dividend” contingent spending for public services here. Elsewhere, Adam Lent from the New Local Government Network has argued this is the budget that needs to refocus spending on prevention, away from acute services.

Health and Social Care

Matt Hancock’s first policy paper as secretary of state is on…digital. Obviously. His four priorities are: establishing digital infrastructure; making digital services user-friendly; promoting innovation; and developing staff’s digital skills and capability. All seems sensible on first skim but, personally, I’d like to see some numbers attached to claims like “money could be saved”. Without these estimates, it’s hard to really understand how much more efficient better use of technology and data could make services. Available here.

Meanwhile, the indefatigable FullFact have fact-checked Philip Hammond’s claim that the Government has announced a £84bn real-terms funding boost for the NHS. Their verdict? “The increase is £20.5 billion in real-terms for the NHS in England between 2018/19 and 2023/24. There is a way of calculating the figures that gets £84 billion, but it’s unhelpful and contains some potentially misleading figures.”

In any case — a lot of that cash boost might be eaten by paying off hospital debts to the Department of Health and Social Care, before it can be spent on improving services warns Paul Carter, ex-chief exec of the Royal College of Nursing.

In a similar vein, the King’s Fund’s Anita Charlesworth has argued that the NHS spending boost will still basically leave healthcare in the same place, rather than provide for improvement. The spending increase amounts to 3.4% annual increases. The King’s Fund estimate that maintaining access and quality requires 3.3% annual increases — that extra 0.1% isn’t a lot of money to play with, especially as it doesn’t include capital investment, public health, or social care.

At Nuffield Trust, Mark Dayan and William Palmer have looked at the data on community nurses and found that data on nurses is too sketchy — and potentially inconsistent between areas — to conclude that there is a simple “plummeting numbers” problem. The British Medical Association meanwhile warn that changes to pensions could deepen problems recruiting GPs if consultants taking on additional work end up pushing them over their allowance for pensions tax relief.

The Public Accounts Committee have issued a damning report on the interface between health and social care, calling on the Government to set out a costed 10 year plan for social care in April 2019, to accompany the 10 year plan for the NHS expected at the end of this year. Pairs well with Richard Humphries’ article about the Better Care Fund (a Government initiative help integrate health and social care) — its history, limitations, and successes to date.

And what has the Better Care Fund actually been spent on? An interesting new bit of analysis from MHCLG looks at what local authorities have spent their improved Better Care Fund grants on in 2017/18. On average, local authorities spent most (40%) on meeting adult social care needs and roughly equal amounts (30%) on reducing pressures on the NHS, and supporting the provider market. I’ve tweeted my key takeaways here. Pairs well with this Local Government Association survey of what council chief execs think about social care, the Better Care Fund, and how to integrate health and social care.

Elsewhere in social care, Matt Hancock has told Parliament that any solution to social care funding will not be fully-funded by taxpayers, and Channel 4 have looked at the effects of the social care cuts in Northamptonshire.

And new numbers! The latest adult social care stats from NHS Digital are out here. TL;DR? Spending on adult social care increased marginally between 2016/17 and 2017/18 (0.4% in real terms), but the number of adults receiving long-term care at home or in care homes declined.

This decline was due to a reduction in older people receiving long-term care; the number of working-age adult receiving long-term care actually increased.

Higher spending and lower activity most likely reflects local authorities both a change in the mix of care purchased (more intensive support), and local authorities paying more for the same care packages. This shows up as an increase in the unit — average — cost of weekly residential and nursing care placements.

Interestingly, requests for support increased almost 2% over the last year, back to near their 2014/15 levels. Has local authority ‘signposting’ — encouraging older people to look to friends or charities before formally requesting state-funded services — reached the end of the road?

Finally in a rare positive story for social care from the chief social worker at the Department of Health, Lyn Romeo. A new “social work model” pilot, which appoints a single named social worker to a family for continuity, to help them navigate and connect with other services, appears to have had a positive impact — for the people supported, social workers, and other professionals.

Continuing the positive tone, Greater Manchester mayor Andy Burnham’s recent speech on public service reform in Greater Manchester is interesting reading even if a lot of the ideas in the speech have been outlined elsewhere before.

Children and Young People

The Association of Directors of Children’s Services (ADCS) have found that local authorities now have almost 300 statutory duties to provide services for children and young people, a significant increase compared to about 200 in a 2011 Government review. Also at ADCS, John Freeman has blogged insightfully about whether we should be worried about using algorithms in children’s services. The old maxim of ‘garbage in, garbage out’ holds up: the data being fed into the machine is as important as the analysis itself. The Society of Local Authority Chief Executives and PwC will have a report on children’s services and how councils can improve outcomes for children next week. Keep an eye out.

At The Guardian, Sally Weale has investigated special needs funding and found that increasing demand for specialist support is putting local authorities under financial pressure. Analysing the rise in appeals to the Special Education Needs and Disabilities (SEND) tribunal, she finds this appears to be linked to the new responsibilities which the Department for Education placed on local authorities under the 2014 Children and Families Act. The Department for Education allocates high needs funding to local authorities, but if this is not enough to meet demand schools or local authorities have to make efficiencies or cut provision. Makes for some messy accountability.

Civil Service World have an interesting interview with Jonathan Slater’s on his tenure as permanent secretary at Department for Education — and how the department is trying to improve policy-making by drawing in insights from frontline practitioners. The Department now expect policymakers to spend time shadowing social workers and teachers on the frontline, and is working to involve analysts more in policy-making, by embedding them in teams with policymakers.

Elsewhere in education, the OECD have published a fascinating new report on equality, looking at children’s numeracy and literacy rates. In England, they found that a ‘disadvantage gap’ exists in schools, but becomes significantly wider for people aged 25–29, suggesting a large decrease in educational equity in post-16 education.

Back in budget-land, 120 children’s organisations including are campaigning for more money for schools and children’s services (both those provided by local authorities and NHS mental health services) ahead of the budget, calling on the chancellor not to “ignore” children and young people in spending plans.

Law and Order

A quieter week this time, though police chiefs are reporting that having to cover a greater part of officer pensions without increased budgets will mean they have to cut officer numbers to back below 1970s levels.

Neighbourhood Services and local government

Beyond the (important!) political and campaigning noise for local government at the budget, permanent secretary at the Department for Homes, Communities, and Local Government, Melanie Dawes, has said the lifiting council tax limits are “in play” for the 2019 Spending Review. And the Local Government Association have analysed outputs and outcomes for services delivered by local authorities, and found that 70% saw improvement, 8% hadn’t changed, and 22% had worsened. ‘Economy and transport’ indicators saw most improvement, whereas ‘culture’ saw the fewest. Well worth reading.

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Graham Atkins

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