The Week in Public Services: 26th August 2020
This week: the COVID ‘long-haulers’, widening educational disadvantage gaps, and council spending pressures
General
First up, a fascinating thread from Danny Buerkli on public administration. Lots of the problems with new public management are well-rehearsed, but this is one of the best explanations of what comes ‘after’ new public management that I’ve seen. It’s hard to describe what this new system might be called, but it seems to relate to subsidiarity (devolving decision-making to the lowest possible level), emphasising personal relationships, experiments, and continuous learning.
Some interesting stuff has been coming out of the Government Outcomes Lab in Oxford which I’m late to. First, this post about what we can learn about accountability from those areas where traditional accountability measures have been paused during the pandemic vs other areas where there’s been more command and control. There’s an inherent tension between having flexibility for learning and accountability of public funds but perhaps this is the moment to really think about how accountability can enable — rather than hinder — learning. It builds on this earlier collaboration which identified seven principles for a new approach to learning and accountability.
Health and Social Care
Now that Public Health England is being reorganised (prompting this metaphor from Nick Timmins), King’s Fund Senior Fellow David Buck takes a look at the questions now needed to be answered — from the immediate and operational to the long-term. Given we’re in the middle of a pandemic, the new National Institute for Health Protection will have ‘weeks if not days’ to prove itself. Another David — Rowland, Director of the Centre for Health and the Public Interest — has a similarly thoughtful blogpost on the need for an overall strategy as well.
Ed Yong has a fascinating profile in The Atlantic of the so-called COVID “long-haulers” — those who are suffering from the virus months after contracting it. The piece is a rich picture of personal descriptions of how symptoms have continued for months interwoven with how the medical and scientific communities have been approaching this subset of sufferers. Long after many people recover, this group is going to need the attention that many others with chronic illnesses are denied. You should read the piece here.
There’s a new survey of care home nurses and their experience of delivering care during the pandemic: 43% of respondents reported receiving residents from the hospital with an unknown Covid-19 status during March and April 2020. One nurse said they were under “constant pressure to admit people who were Covid positive.” Eek. The Queens Nursing Institute, who carried out the survey, think that care homes need to be more closely involved in winter planning. Though some care homes might not be in business come the winter as falling occupancy rates have not helped the already-fragile market. These recently-built care homes in Liverpool are set to shut after just a year of operation.
For a more in-depth look at how adult social care as a whole has fared, check out this long read from King’s Fund Senior Fellow Simon Bottery. He takes a look at what’s changed in the eight key problems that the King’s Fund diagnosed with social care last year. In six of them, the virus ‘has brought significant change and, if anything, exacerbated these challenges.’ There is excellent synthesis and analysis of the data that’s out there with the problem of increased unmet need for social care given the attention that has been sometimes lacking elsewhere.
More money means that until March next year the NHS can carry on funding up to 6 weeks of care and support for people discharged from hospital. Nearly £600m follows £1.3bn of funding for the NHS when the 6-week funding policy was instituted in March.
An evaluation of video consultations mainly for hospital care in Scotland shows promising signs. Fieldwork done before the onset of the pandemic shows a majority of patients listed saved travel, saved time and convenience as benefits with the technology itself holding up pretty well (76% of patients reported no technical difficulties). As with the increase in video consultations since the pandemic, it provides some much-needed data on which types of appointments clinicians think work best via video link.
In hospitals, the Nuffield Trust has an outstanding review of the new A&E “basket of measures”, which are set to replace the 4-hour target in England. One of the new measures is a mean waiting time, which is currently closely correlated with percentage of patients admitted, transferred or discharged within four hours. Interestingly, there is no threshold for the mean waiting time measure — will be interesting to follow what happens. In theory, having a basket of a few different measures should reduce some of blunt incentives to prioritise certain patients inappropriately, but the authors conclude that “whether this benefit will be realised will depend on whether there is a ‘first among equals’ measure in the basket. If the mean time in A&E becomes the de facto main measure, then we may find there is very little change from the current target regime.” Plus ca change?
If you enjoyed that, there’s this good thread from Steve about the operational data which the NHS collects — the problem, in his words, is that “the data is both irrelevant to the big problem and about as shonky as a three-legged donkey pulling a cart with square wheels”. What good is an average quarterly bed occupancy when you’d need something more like hourly occupancy to analyse patterns? (Such as whether A&E waits are correlated to bed availability).
Children and Young People
Unless you’ve been living under a rock you’ll have noticed that this year’s A-Level and GCSE results days didn’t go quite to plan (with at least one resignation as a result). The government’s initial approach placed too much emphasis on maintaining standards over time says the EPI but recognises another approach with higher grade inflation was unlikely to escape criticism either. If you’re tempted to blame the algorithm read this from IfG’s data expert Gavin Freeguard and why you shouldn’t and what the government needs to learn going forward.
The FFT Education Datalab has a rather cool and/or nerdy tool where you can compare the proposed GCSE grade distributions for this year against last year’s actual results. Once you’re done checking the subject you still harbour a particular grudge for you can read their conclusion: subjects that had historically been graded the most harshly were those that were seeing the biggest increases under centre assessment.
Even before COVID shut schools the gap between disadvantaged pupils and their peers had stopped closing, according to the EPI’s annual report out today. That’s the first time in a decade and the first time since 2007 for pupils in primary school. Disadvantaged pupils in England are now just over 18 months of learning behind their peers by the time they finish their GCSEs. Meanwhile gap between different ethnicities at GCSE for English and Maths really does highlight the limited utility of the description ‘BAME’ — Chinese and Indian pupils are ahead of their white British peers by two years and one year respectively while Black Caribbean pupils are almost a year behind white British pupils. Alarmingly, the gap between Black Caribbean and white British pupils has worsened by the equivalent of over four months of learning between 2014 and 2019. There are also breakdowns by regions and poverty levels which are well worth a delve into. There really is a lot of levelling up to do.
PHE have published their study into frequency of outbreaks following the partial reopening of schools in England in June. Not many cases, and most seem to have been brought into schools from the community which, as long as community transmission is kept low, bodes well for reopening schools. For a whole range of back to school global literature check out this post with links galore from Harry Anthony Patrinos at the World Bank’s education sector.
Also starting up again this autumn will be children’s social care visits. Yvette Stanley, National Director for Regulation and Social Care, outlines what schools, social care and early years providers can expect when inspections resume next month. Crucially, providers won’t receive an inspection grade, but findings will be published and if necessary, enforcement powers will be used.
Always nice to end on some good news: What Works for Children’s Social Care have announced that 21 English local authorities will receive funding to place social workers in schools. This extension of an earlier pilot, which will see social workers in between five and eight schools in each authority, should help to reduce referral rates to children’s social care.
Law and Order
The prison inspectorate have published a short report aggregating their findings from short scrutiny visits to prisons during coronavirus. TL;DR: “[prison] managers have kept prisoners, children and detainees safe during an exceptional crisis, and this must not be forgotten. But in prisons, there is now a real risk of psychological decline among prisoners, which needs to be addressed urgently, so that prisoners, children and detainees do not suffer long-term damage to their mental health and well-being, and prisons can fulfil their rehabilitative goals”. Check this for the key snippets.
Local Government
In the world of local government finance this from former council finance director Chris Buss lays out the difficulty of budget finance planning and the big and many unknowns for local authorities. There’s a role for central government to give perhaps not complete answers but at least some certainty.
A new paper from the IFS looks in depth at how English council budgets are being hit. It warns of a ‘perfect storm’ for council budgets with increased spending and reduced income across the board. Taking together current forecasts of pressures and spending leaves a £2 billion shortfall across the councils. If you’re thinking council reserves could take care of this you want to read this explanation from my colleague Graham who also breaks down the various spending pressures.
Sally Warren at the King’s Fund looks at integrated care systems and the potential they offer for an equal partnership between local government and the NHS to focus on population health and well being. Various responses throughout the pandemic indicate the fault lines between where that is and isn’t currently the case and with change inevitably coming, provides a chance for a more devolved focus.
