The week in public services — 26th February 2019

This week: new ways of thinking about public services, NHSX (it exists!), the Fair Funding Review’s failings and some helpful reviews of David Gauke’s proposed sentencing reforms.

General

Austerity (still) isn’t over! As it gets harder to make public services more efficient, the conclusions of Performance Tracker 2018 hold true. WiPS guru Graham argues the Government must make reality explicit: higher taxes, lower expectations of services, or more individual contributions.

Always-useful Resolution Foundation Living Standards outlook. Concerningly, (relative) child poverty is projected to rise by a further 6 percentage points by 2023/24, which (on existing data) would mark a record high — and probably translate into higher demand for children’s social care.

If we can’t make more technical efficiencies — reducing input costs, or getting staff to do more for less — in public services, what next? The New Local Government Network have an answer — a new ‘community paradigm’ — placing the design and delivery of public services in the hands of the communities — to address what they see as the biggest problem facing public services: rising demand. To establish this community paradigm, they call for: unconditional devolution (devolved pooled budgets without strings attached); participatory and deliberative decision-making; ‘collaborative service delivery’ shared by communities and public servants; and community commissioning — “taking budgets currently controlled by public services and transferring them to the control of organisations formed directly by service users or members of the local community”. These arguments have been made many times before. But it’s the case studies of councils empowering communities — from Wigan to Cambridge to Bromley — that make this interesting. Worth reading.

It pairs well with Adrian Brown on the advent of the new “enablement mindset” in public services. Will this — and not efficiencies — become the new paradigm for thinking about public services?

Last but not least, lots of people discuss sharing data to improve public services, but how are people overcoming the numerous legal and cultural barriers? Lee Pope and Paul Blake explore, drawing on data-sharing arrangement for troubled families to illustrate how sharing can help public authorities identify individuals or households that face two or more disadvantages.

Health and Social Care

NHSX gon give it to ya, if ‘it’ is a way of siphoning off NHS England resources and powers to a new NHS body without primary legislation, and ‘ya’ is Matt Hancock. NHSX (no, really) will subsume NHS Digital and steal some of NHS England’s staff to “deliver on the Health Secretary’s tech vision”. The King’s Fund’s Harry Evans wrote a good thread on it, and there is already a parody Twitter account.

We do not talk enough about the social determinants of people’s health, according to a new briefing from the Health Foundation and the FrameWorks Institute. ‘Cultural models’ might offer a better way of understanding and communicating the evidence for these social determinants, and help people lead healthier lives.

The HSJ has revealed that two out of three requests from NHS trusts for capital investment have been rejected in the last two years: of £8.7bn capital requested, £2.3bn has been approved.

The 2018 NHS staff survey was released today. John Appleby writes that the unwellness of NHS staff it shows will affect patient care.

Good tips from the Nuffield Trust on how to make sure health research and evaluation can influence spending decisions, without cutting corners. Also from Nuffield: a study on young people’s health and wellbeing, with a helpful summary thread.

Devolved health in the north is in a bit of trouble. Greater Manchester has consistently struggled to meet the national A&E waiting times targets, and has fallen so far behind national performance that NHS England and NHS Improvement are taking formal action.

Should the success of integrated care models be judged on whether they reduce hospital admissions? Dr. David Oliver of the RCP argues that looking at the benefits these programmes can accrue, rather than just the savings they make, should determine our judgements of them.

In social care, we appear to have a fresh problem. The Government is now so divided that it can’t agree itself how to tackle social care funding in the green paper — let alone build a parliamentary (or even public) coalition for change. Matt Hancock worries that the proposal from the 2014 Dilnot Commission — to cap the amount of money an individual would spend on their own care — would disproportionately benefit the wealthy, and would prefer an insurance system based on auto-enrolment and payments from the middle-aged and over-65s to fund social care. Philip Hammond is concerned that an insurance system will reduce people’s take-home pay.

This won’t be resolved shortly — the green paper is looking greener than ever. The politics of this matter, but there are a lot of problems with the proposed insurance system. It doesn’t tackle the immediate funding shortfall. Or working age adults who need social care. And it doesn’t pool risk — so individuals may not be nudged into saving enough, especially if the existing low cap before the state pays remains. Most importantly: other countries who have insurance systems make them compulsory — they are not opt-out, as Hancock’s proposal appears to be.

And “like Brexit negotiations in miniature, some people would prefer to walk away, or refuse to budge while accusing the other side of intransigence, rather than take on the hard graft of arguing through difficulties to find a solution”. Health and social care integration, er, not going swimmingly then. Not that we should expect it to — it’s an incredibly difficult task. But it would be easier if local government retained public health responsibilities, which has helped build relationships between local government and the NHS, argues Richard Vize.

Children and Young People

How much need is there for children’s social care? Do existing services meet those needs? Dartington Service Design Lab have analysed data from 38,000 children and families and found that need is greater than council resources. Some of this gap has been met by families and local communities, but they estimate that up to “five percent of young people may be experiencing high-need, receiving little or no services and feeling unsupported by their families and communities”.

The National Foundation for Education Research’s annual teacher labour market chart-fest is out. Tl;DR: secondary schools have a big problem getting enough teachers to meet the number of students in the immediate future. New things I discovered: returners and overseas-trained teachers did not increase between 2011/12 and 2017/18, despite the growing supply problem — meaning that the Government reforms to retain more early career teachers in the UK are particularly important. And teachers’ working hours ticked up last year, according to data from the Labour Force Survey.

But what if the time teachers work isn’t…the actual time teachers work? Because the intensity of teachers’ work — how much teachers do in an hour — has increased owing to new public management reforms in the 2000, looking at changes in hours worked can miss some of the increase in teacher workload. A lovely mind-bending bit of research from Phil Wood, which serves to remind us that comparing data can mislead as much as inform.

Elsewhere in schools, an interesting bit of OECD work on the trade-offs (fewer teachers, or paying them less) that smaller class sizes imply. And there are some interesting recommendations on how the Government can improve social mobility by focusing on schools and early years from the APPG on social mobility, run by the Sutton Trust charity.

In children’s social care, an interesting survey from CommunityCare finds that one in ten social workers is considering leaving social work, up from 7% in 2016. In positive news, though, full-time permanent work is now the preferred option for 73% of respondents compared to 66% in 2016.

The Local Government Association report that council spending on asylum-seeking children almost doubled between 2014/15 and 2017/18, rising to £152m and putting financial pressure on councils. They are — totally reasonably — asking for the Home Office to announce the findings of its review into the funding of support provided by councils for unaccompanied children.

But, while the rise in asylum-seeking children is clearly putting financial pressure on councils (probably acutely in a few councils), spending on asylum-seeking children was still only 1.7% of total spending on children’s social care last year. Councils overspent their entire children’s services budget by almost 12% last year. Just so we’re all on the same page: the story here is empathetically not ‘social care pressures explained due to rise in asylum-seeking children’.

We need 10 year plans for children’s services spending to invest — not just spend reactively — argues council chief executive Ian Thomas.

The controversy over the Department for Education’s ‘myth-busting’ child protection guidance — aimed at clarifying statutory responsibilities and suggesting some duties could be reduced — is still bubbling along. The Department is now being sued by the charity Article 39, who argue that the new guidance overwrites obligations in child protection legislation. There’s an important underlying point about public service reform here, however, which is that it’s politically hard to reduce the scope of public services without generating large damaging resentment from public service professionals. If the Government (and the public) are squeamish about cutting the scope of services and efficiencies can’t be pushed further, what alternatives do you have other than to reduced demand — or increase spending?

Last but not least, we love a good dataset in team Performance Tracker, particularly one that can be used to inform public policy. This article on the Children Looked After return, which we use in our analysis, gives a fascinating overview of the data, and things academics have learned from it. Nerdy. Things we discovered: comparing children-in-need and children-in-care, early placement in long-term foster care can have a protective effect on educational attainment; and one in 30 children born between 1992 and 94 had been in out-of-home care for at least 24 hours by the time they were 18.

Neighbourhood Services

The Institute for Fiscal Studies’ (IFS) response to the council business rates retention scheme is here. Some positives, some negatives. They’re worried that proposals to protect councils from the risk of changes in the value of properties in their area are imprecise and inconsistent.

The Housing, Communities, and Local Government select committee plan to launch an inquiry into local government finance as a whole.

Right bear with us on this one: the big news is that the IFS has responded to the Fair Funding Review — the Government’s proposals for how it will distribute money from central grants to local councils. Over here, we had to read it more than once to get our collective heads round it. But — we think — we’ve got it.

There’s a big central pot of money for local councils, which central government divides up between all the councils in the country. It could give every council the same amount of money each. But that would be weird, because councils vary massively in terms of the size and characteristics of their population. Instead they use something called the “Foundation Formula” to decide how much money each councils gets for libraries, parks, housing, trading standards (and everything else local government does besides social care). Unsurprisingly, changes to this formula are not straightforward, and can get very controversial.

Currently, the way the Government allocates this grant takes into account deprivation: how poor the population living in that council area is. So areas with high levels of deprivation — typically inner-city councils such as inner London, Birmingham, and Manchester — get slightly more grant money than those with low levels of deprivation.

Now, the Government wants to stop taking into account how deprived the population is, and allocate the money purely based on how big the population is. The Government want to just look at population numbers to distribute money allocated via the “Foundation Formula”. The Government say they want to remove deprivation from the formula because “population explains the vast majority of variation in spending and factors like deprivation explain very little”.

The IFS’ Paul Johnson says “the inferences they draw from their statistical analysis are problematic” (read: this is silly). Councils have vastly different populations: Rutland has 40,000 people — Kent has 1.5m. Kent has literally 37-and-a-half times as many people as Rutland — so of course differences in population will explain the majority of difference in spending. The relevant question is whether factors like deprivation affect spending per person — which the Government hasn’t assessed.

So the Government should just assess how much councils need to spend per person, right? If only it were that simple. Looking at how much a council spends per person relative to others might tell you how needy the population in that area is. But it also just might reflect different decisions different councils have made about how — and how much — money to spend. Even if you did want to use spending-per-person as a proxy for relative need in a council, you would find that it varies year-by-year. And there is no objective answer to what year you should pick (argh!).

That’s the complicated bit done. Phew. The essential point to grasp is that the argument the Government is relying on to make its case — that variation in population explains the vast majority of variation in spending on services across councils — is the sort of massive statistical over-reach that would get them taken to town on More or Less (you should listen to it if you don’t already). The IFS thinks the Government therefore needs to move beyond the spreadsheets, and make use of experts in local services to ask them whether there is a convincing reason to expect deprivation or other factors to drive need.

This is pretty nerdy. Why should you care? Well, the practical effect of removing deprivation from the Foundation Formula — should the Government go ahead with it — would be to take money away from (generally Labour-controlled) city councils, and send it towards (generally Conservative-controlled) county councils. I’ll leave it to you to decide whether such considerations affect ministerial decision-making. Also: are you a local government expert/irritated analyst/general know-it-all? Have we got the above wrong? Tweet and correct us!

Also worth reading: the SOLACE submission, which makes many good points. Several things stuck out to us: homelessness and flood spending are both included in the formulation formula (how the central grant will be distributed), which seems strange; and they point out that “the formula used to provide Clinical Commissioning Groups their indicative funding allocations between 2019/20 to 2023/24 is based on population, age profiles and deprivation” — so removing deprivation from local government grants exemplifies a “lack of coherence in decision-making across government”.

Also: are you a local government expert/irritated analyst/general know-it-all? Have we got the above wrong? Tweet and correct us!

Here’s a rarity: actual food safety is in the news! Councils are worried that there won’t be enough environmental health officers — staff qualified to protect public health, by administering and enforcing legislation to minimize health and safety hazards — to enforce checks at ports if food coming in from the EU has to be checked on entrance to the UK.

We don’t know the exact number of environmental health officers, but we do know that in food safety (an overlapping field), the number of professionally qualified food standards and food hygiene staff in England — workers who investigate complaints, inspect businesses and enforce compliance through licensing — declined by 60% and 17% respectively between 2009/10 and 2017/18.

Law and Order

Prosecutions have fallen to their lowest number on record, and austerity is to blame, according to Rob Ford at The Times. I added a bit of Performance Tracker context to the story on Twitter.

Former prison governor Ian Acheson says David Gauke is wrong about short prison sentences: sentencing fewer people to prison won’t help until prisons are decent, safe, places which contribute to rehabilitation. And here’s some analysis that compares Gauke’s proposed reforms with Ken Clarke’s.

Following last week’s furore about probation, our own Tom Sasse has written a supremely clear comment piece on what the collapse of Working Links means. In 2013, “the Ministry of Justice ignored warnings about the readiness of the market and its ability to contract services successfully. In deciding what comes next, it must not repeat the same mistakes.”