The week in public services — 26th March 2019
This week: Spending Review hints; how to fund local government; and the NHS biggest challenge yet — pension regulations
Spending Review
Liz Truss has put out the clearest articulation yet of principles for the upcoming Spending Review — though it’s not clear if the Chancellor and prime minister buy into her vision. There are some inconsistencies between her ambitions to prioritise “core public services”, and the need for public services to do a better job for vulnerable and marginalised people. (The latter implies more money for things like children’s social care and homelessness services of which most people are not users, and don’t deem “core public services”).
Largely under-covered, the Chancellor announced at the Spring Statement that the Government has committed to using Michael Barber’s ‘Public Value framework’ to inform the Spending Review. Over at the Institute, we think this is a good idea. My colleague Martin Wheatley has argued that this is a step in the right direction, but the proof will lie in whether it actually improves the political fights which Spending Reviews usually descend into, here.
Health and Social Care
The biggest news this week was that the three health think tanks have teamed up once more and published a new report entitled NHS Workforce: Closing the Gap. The report charts how the supply of NHS staff has failed to keep up with demand, and the shortage could grow to 250,000 FTE staff by 2029/30.
Its recommendations suggest a £900m annual increase to HEE’s budget over the next five years. Specifically, they want: more money for workforce training; money to cover the costs of international recruitment; and money to restore living grants for nurse trainees. Rising recruitment and retention difficulties in England are part of a broader global trend, as Mark Britnell argues for The Guardian here.
Money for workforce recruitment and training was of course not included in the extra money announced for the NHS last summer (see my colleague Chris’ thread here).
Y’know what’s really going to cause a staff crisis, though? Something much more mundane — pensions (yes, really). A large number of consultants are turning down shifts because they fear being landed with large tax bills following changes to tax allowances on pension contributions, the Financial Times reports.
Meanwhile, Nuffield have done a data-driven analysis of what individual ‘patient journeys’ — how patients actually experience different services — actually look like, with some analysis of what that means for joining up services.
In last year’s Performance Tracker we said that one way hospitals had made efficiencies since 2010 was by making economies — buying inputs, particularly drugs, at lower prices. So this article, which finds that an increasing number of Clinical Commissioning Groups are buying generic drugs above the nationally-negotiated tariff rate, was an interesting turn. A story to monitor.
And has payment by results worked to improve care in the NHS in England? TL;DR — not as much as hoped. Latest Kings Fund report contain a wonderful sage warning for health policy (and many other policy areas): “despite the disappointments, successive governments have remained convinced that their latest round of payment reform would finally create a self-improving system”. Evergreen.
In social care, Chris Hatton — a.k.a. the man who knows everything about social care for working age adults — is blogging about Transforming Care — a programme which was designed to reduce the number of people with autism and learning disabilities in inpatient units, due to end this month. Beyond the topline figures, he finds worrying signs of adults “churning” through the system, bouncing between inpatient units.
Children and Young People
If Performance Tracker is your essential data-driven analysis of the consequences of fiscal austerity, Anoosh’s articles in the New Statesman are arguably the qualitative equivalent. This week, she has an insightful interview with the head of the Worth Less? schools funding campaign, detailing how cuts to other council services have left schools less well-equipped to help pupils who require extra support.
As if directly responding, an independent report commissioned by the Department for Education has found that there are insufficient educational psychologists to meet demand for assessing and supporting children with special educational needs.
After all the furore over the last few weeks, a good BBC explainer examines whether rising exclusions are really driving rising knife crime.
In children’s social care, a very good report from the Public Accounts Committee has set out sensible recommendations for the Department for Education and it’s plans to improve children’s social care. I agree with most of them — they’re informed by a sensible of analysis of spending and performance data, as I said here.
Will greater use of technology prove part of the solution? A sensible, measured, take from Helen Lincoln here — with a focus on the deeply practical, such as improving record-keeping.
And concluding (for now) a story we’ve been following for a while on the Week in Public Services, the Government has now official backed down on it’s additional guidance for children’s social care, which critics argued would have watered down the services councils have to provide to vulnerable children.
Last-but-not-least, following the Government’s evaluation last week, David Halpern has written an interesting blog on the history of the Troubled Families programme, and why the data-linking behind the evaluation is (genuinely) a big step forward.
Neighbourhood Services
Do you like big dense reports about the options for local government tax in the future? You (and the other three — maybe four? — of us) are in luck!
The Institute for Fiscal Studies (IFS) have analysed options in a new briefing, and concluded that devolving a local income tax would be the most sensible (read: least-economically-distorting) way to raise revenues
Their preference is a flat rate above the personal allowance to avoid highly unequal distributions of tax revenues, revenue volatility, and reduce the likelihood of race-to-the-bottom style tax competition.
This isn’t likely to make them popular in the Treasury. But their dismissal of ‘tourist taxes’ — taxes councils could levy on holiday visitors, popular amongst some local government types — isn’t going to make them popular there either. Impartial analysis won’t please everyone. The UK is still an international exception in terms of how little tax is devolved, as we’ve analysed before.
To be fair, the IFS note that devolving any tax risks making some places better off than others. Some parts of the country have a greater ability to raise revenues than others. Some mechanism to equalise revenues would therefore be required — unless the Government is willing to tolerate inequality in council funding between areas.
This is the exact same problem that business rates devolution poses — and it’s is a pretty fundamental trade-off. Even if — and it’s a big if — devolving tax-raising powers creates better incentives for councils to pursue economic growth, and increases council revenues such that everywhere is better off in the long-run, the short-term impact will make some councils better off than others.
It’s perfectly reasonable to think that’s not a bad thing, and that the benefits outweigh the costs — but it’s unavoidable. If we keep saying it, people will eventually take notice — right? Right!?
Meanwhile, it’s potholes day today as the Asphalt Industry Alliance publish their annual independent survey of the quality of the local road network. Compared to last year: councils filled more potholes, paid out less in road user compensation claims, and reduced the overall time they estimate it would take to clear backlog maintenance on roads.
But: the share of “poor quality” — with fewer than five years of life remaining — roads continues to tick up, particularly in London. The injection of emergency cash at the last budget “was out of kilter with best practice and effective highway asset management plans […] much of [the money] has been used for patch and mend, which does not provide value for money or improve the underlying structure and resilience of our roads”.
Law and order
Last but not least, the Police Foundation has published a report on data-driven policing. The research includes some fascinating case studies of how different police forces have used data, as well as some examples of misuse. The Foundation recommend bringing uniformity to UK police data standards and practices, and building up the capacity within police forces to use data to their advantage.
