The week in public services: 28th April 2020
This week: new number-crunching; what’s happening to homecare; and what do we know about key workers?
General
Chris Giles has done some good number-crunching to estimate the current excess death rate by updating the daily NHS statistics with the Office for National Statistics’ (ONS) wider measure of death registration (essentially assuming a consistent ratio between the two). Full explanation of his method, here.
The Care Quality Commission — who are no longer inspecting hospitals and care homes — have promised to work with the ONS to try to better measure the number of deaths in care homes. And the BBC have also helpfully summarised what to be wary of when comparing countries coronavirus statistics. TL;DR — beware numerators, denominators, and how they’re calculated! If you’re into that sort of stats nerdery, this Health Foundation blog is a clear explanation of the main different data sources too.
In other data news, there has been lots of talk over the last week about use of personal data and technology in responding to coronavirus — particularly as the government appears to be moving towards a test-and-trace strategy to leave the current form of lockdown. My colleague Gavin has written an excellent blog on what the government needs to do to retain legitimacy while it does so, which I thoroughly recommend.
A helpful Institute for Fiscal Studies (IFS) briefing on key workers — who they are, trends in their wages, and variation between key workers in different sectors. The thing that most surprised me — even controlling for differences in age, experience and education — the gap in hourly wages between key and non-key workers has increased from 5% in 2010 to almost 9% in 2018… I guess that’s primarily the consequence of the public sector pay cap, given that a substantial chunk of key workers are employed by the state?
Resolution Foundation have done a very similar analysis, extended to ‘shutdown sectors’ (where people aren’t working), and found that key workers and workers in shutdown sectors are disproportionately likely to be lower-paid young women. Also worth reading on a similar theme: this Resolution Foundation briefing about pay in social care. They estimate that 61% of care workers in England are paid less than the real living wage…if that doesn’t give you pause for thought about whether there is enough public money for social care is enough, I don’t know what will.
Last but not least another IFS briefing speculates on how the lockdown might change children and parents’ time use, and suggests that “the Chancellor should consider extending 80% wage replacement to employees who reduce their working hours to accommodate childcare responsibilities” (because the current system encourages one parent to give up their work completely, which is likely to increase gender inequalities).
A good longread in the Times Literary Supplement (£) from Paul Collier explores why coronavirus poses such a big public policy challenge. He concludes that “there is a long history, both in Whitehall and among the UK’s main political parties, of reluctance to learn from others, especially from beyond the anglosphere”.
Over at the New Local Government Network, Adam Lent argues that the government needs a post-crisis strategy to build resilience in public services — by which he means a ringfenced fund for public services, funded from taxes on “things that weaken resilience, such as petrol and imported food”. I was struck by his comment that “covid has turned the logic of austerity on its head: the health of the economy is now reliant on the health of its population which is itself reliant on the health of the nation’s public services”. Both are worth reading in full.
Last but not least, the Centre for Public Impact have published a helpful round-up of their thinking on Covid 19 and how to manage public services.
Health and Social Care
Starting with big picture stuff, former number-two official at NHS England, Barbara Hakin, thinks that abolishing Strategic Health Authorities and Primary Care Trusts in the 2012 Health and Social Care Act is partly to blame for the state of poor emergency preparedness before Covid 19.
Camilla Cavendish’s more optimistic take in the FT is that this crisis has liberated some staff to find “pragmatic solutions”. Hm. That might be true in some areas — such as hospital discharge to social care — but I’m not convinced PPE procurement, which she focuses on, is one of them. This HSJ article describes the “wild west” that is trying to buy healthcare equipment at the moment. Sounds like there is a lot of price-gouging happening…
In sobering news, Tim Cook and Simon Lennane provide a clear analysis of NHS and social care staff deaths from Covid 19 in HSJ. In short: BAME staff are dying disproportionately compared to their representation in the workforce, but it’s not clear why. Health and social care staff don’t appear to be dying at a disproportionate rate compared to the general population. You should read the methodology in full before commenting (but you knew that already, right?)
On the frontline, hospital consultant David Oliver has answered an insightful Q&A about how Covid 19 is changing the way the NHS works.
Meanwhile, the Guardian reports that shortages of critical care nurses in the London Nightingale hospital has left the hospital turning patients away. There’s a serious implication for the public services preparedness and resilience debate in here too. Running things lean and relying on the Treasury’s checkbook to bail you out of a crisis might allow you to buy new hospitals and (some) equipment and supplies, but it can’t buy you instantly-trained new staff — where the real capacity crunch seems to be at the minute. Another reason to prioritise workforce planning when the crisis is over.
The Health and Social Care select committee have announced that they will run an inquiry into delivering care services during and after the coronavirus pandemic — timely given new guidance from NHS England has called on district general hospitals to treat stroke patients. Consolidating stroke facilities —specialising while reducing the number of places which can offer stroke treatment — might be back under the political spotlight after this crisis passes…on which note, Seb Payne’s longread about the wider health consequences of the lockdown is tough but definitely worth reading.
Another question that’s been floating in my head for the last two weeks or so: is it all quids-in for digital/remote consultation software providers now that GPs and hospitals are having to make greater use of this technology? This US perspective on what the crisis means for these companies is interesting — and not as straightforward as I thought. Worth a read — even if some of the financial and investment language is a bit jarring.
In social care, conditions in care homes remain the pressing concern. As this FT investigation (£) shows, conditions are precarious and have driven staff to desperate measures. One care home manager reported that they had “staff literally driving around trying to get gloves and face masks from tanning salons, tattoo parlours and hair salons”.
A more detailed briefing from the UK Homecare Association looks at homecare during Covid 19 which — although under just as much pressure as care homes — has not seen the same level of media attention. This line is pretty sobering: “most small [homecare] companies will run into solvency risks after 8 to 12 weeks if they have one month’s savings on hand to cover costs”.
A new Policy Exchange report by ex-Hancock special advisor Richard Slogett calls for most social care to be made free-at-the-point-of-use, and for a ‘digital lock-in strategy’ post-crisis to ensure the NHS. Interesting suggestions, and the report also includes a helpful timeline and summary of what’s changed in healthcare.
And last but not least, this Economist piece about how countries the world over are struggling to provide appropriate care to people with dementia feels like a good summary of the problems that social care in England is facing: “no country has a good plan for […] how to finance the care of such large numbers of people. Optimists point to the current pandemic to argue that it shows how much can be done when the scale of an emergency is recognised. Perhaps more realistically, it has given yet another reason for dementia to slip down the list of global priorities.” There is some evidence, already, that the peak of deaths in care homes occurred slightly later than deaths in hospitals in England and Wales — evidence of deprioritsation from policymakers?
Children and Young People
Less news this week, so here’s an idea: when lockdown measures are removed and schools are reopened, why doesn’t the government take some university graduates entering a precarious labour market and pay them to tutor in schools? Interesting suggestion from US education academic, Robert Slavin.
Law and order
More than 12,000 devices seized by police were awaiting investigation in February and March. Simon Kempton, technology lead for the Police Federation of England and Wales, said that investigators were overwhelmed — the number of devices yet to be examined has not budged from last year.
Pretty damning Home Affairs committee report on the government’s response to rising domestic abuse cases since the onset of lockdown, concluding that “a full action plan is needed covering support services, housing and the criminal justice system” — though the government has announced some piecemeal measures, such as this funding for charities to deliver remote support services for victims of sexual and domestic abuse.
An interesting article from the Suffolk Police and Crime Commissioner covers similar ground, and also notes that “when the lockdown eases, there may be a surge in cases of recorded crime” — suggesting that the Home Office should probably be thinking about how to prepare for that now. On which note, you should check out the Institute for Government website for our new report on how coronavirus will affect the criminal justice system — due for publication on the 29th.
In prisons, the Centre for Crime and Justice Studies do not think the government are doing enough to stop the spread of coronavirus in prisons and protect prisoners. Their director, Richard Garside, reckons that prisoners inability to distance themselves from others in overcrowded prisons means that “even a short sentence for a minor crime is potentially a death sentence”. He points to Austria and Germany as managing their prison populations more effectively. My colleague Nick summarised what we learned about the government’s plans from this week’s justice questions here.
Local government
It’s fair to say that central government has not covered itself in glory in its relationship with local government in this crisis — on everything from personal protective equipment, to the amount of money offered to councils to respond, to just communicating clearly. I’d read bits and bobs of this, but this summary from Nick Golding of the various failures is quite damning.
One worrying story found that some councils found themselves unable to secure PPE because suppliers were holding back stock to deliver orders to…a centrally-run system to secure PPE and distribute it locally. If this is true, I can’t even think of a mad enough metaphor to encapsulate it. On top of that, this BBC report says that lack of government transparency meant even NHS Trusts have scrambled to buy their own supplies because they don’t know whether the government will supply them or not. Full panorama episode here. Christ.
And here’s a final piece I never thought I’d read. Policy Exchange in ConservativeHome calling for the government to increase grant funding to local authorities so they can continue to provide social care, children’s services, and mortuary services. Truly a sign we are living through strange times.
