The Week in Public Services: 28th May 2019
This week: radical solutions to social care, children in need, further probation woes and big, scary numbers.
Health and Social Care
Seemingly the hottest topic amongst politically-aligned think tanks, a new report from Policy Exchange has some ideas on how to fix social care. They recommend that “complex long-term social care needs to be largely free at the point of use and principally funded through general taxation”.
Meanwhile, at the other end of the political spectrum, the Institute for Public Policy Research (IPPR) have published a report calling for free personal care, funded either by an increase in national insurance or an increase in income tax.
The basic idea in both — to pool risk by having the State provide some social care free at the point of use, funded by general taxation — is the same. (Handy tip — the Nuffield Trust have put together a brilliant explainer allowing you to easily compare different social care funding proposals).
As Richard Humphries from the Kings Fund has noted, there appears to be a growing political consensus that some variant of state-funded care, free at the point of access, funded by general taxation is the best solution.
In that light, it’s worth noting that Damian Green’s recent Centre for Policy Studies report contained a proposal for a “Universal Care Entitlement”, which recommended making some parts of social care free at the point of access, funded by general taxation.
Last year’s joint select committee report on social care also recommended — you guessed it — that the Government should “as funding permits, [move towards] universal access to sustainably funded social care, free at the point of delivery”. To do this, the committee concluded that “extra revenue will need to be raised nationally”.
If you can get Ladbrokes et al to give you the odds, I’d put some cash on the latest House of Lords inquiry coming to a similar conclusion.*
So that radical, complex, solution to social care you’ve been searching for? Turns out Dilnot’s proposal to cap the amount any individual would pay is as dead as a dodo. Sorry, Sir Andrew — more tax and spend is firmly back within the Overton window.
But even if everyone agrees we need a system that is partially state-funded and free at the point of use, that doesn’t mean the controversy is done with. My best guess is that over the next year, the debate will shift to focus on how generous the free-at-the-point-of-access state-funded should be.
Despite a slew of think tank reports on social care, it remains relatively under-discussed in politics and policy. David Brindle of The Guardian explains why. TL;DR? Lack of leadership and no agreement about the story ‘the sector’ should tell about social care.
This week BBC’s Panorama programme uncovered shocking abuse of vulnerable adults at a specialist hospital. Similar units across the country provide care to almost 2,300 adults with autism and learning disabilities.
In more positive news, stroke mortality rates fell by 55% between 2001 and 2010, according to a new study published in the BMJ. The authors conclude that the decline was probably driven by improvements in stroke care.
A new report from the Kings Fund looks at how changing technology and buildings are affecting the NHS estate: hospitals will look different, but won’t necessarily be smaller. Read the full report here or just read Harry Evans’ great summary thread.
Children and Young People
The Guardian has an article quoting several charities which argue that local authorities are unlawfully denying support to destitute children due to the immigration status of their parents. The claim is that local authorities are failing to assess children under section 17 of the Children Act. The councils quoted deny failing to provide support, but this is far from the only evidence that councils are raising the threshold for qualifying as a ‘child in need’.
New report from the Children’s Commissioner on what we know about children held in secure accommodation. TL;DR? The data is very patchy — but the Children’s Commissioner has lots of recommendations on how to improve.
The Department for Education have found some cash to expand Family Drug and Alcohol Courts, ‘problem-solving courts’ which aim to keep families together. £15m isn’t much in the grand scheme of things (more than £1bn has been spent on the Troubled Families programme to date) but it’s heartening to see that the Government is taking an evidence-based approach to rolling out the programme rather than just splurging hundreds of millions on a minister’s hunch.
The Gatsby Charitable Foundation have recommended eight interventions to help retain science teachers in schools. The Royal Society of Chemistry have written an interesting analysis of how cost effective and easy to implement these proposals would be.
A new report by the Institute for Social & Economic Research has found that parents are less likely to provide help to their children if they receive good news about the performance of the child’s school. Sadly, parents do not provide increased support if the news about their child’s school is bad.
Dave Thompson has written two interesting blogs following the recommendations of the Timpson Review. The first shows that not all pupils who end up in state-funded alternative provision schools have been permanently excluded. The second shows that not all pupils who have been permanently excluded end up in state-funded alternative provision schools.
Law and Order
HM Inspectorate of Probation has published an analysis of supervision for short-term prisoners. Given last week’s announcement that probation services will be brought back in-house, it’s not surprising that HMIP is unimpressed by the performance of Community Rehabilitation Companies. With no evidence of a tangible reduction to offending and reoffending rate of 64%, the report calls the probation reforms “an expensive merry-go round”. Russell Webster has some further helpful analysis on the report.
Given the poor performance of probation, it’s probably just as well that 2018 saw the lowest number of offenders in 50 years.
Local Government
The County Council Network estimates that local government faces a cumulative £52bn funding gap over the next six years. The gap is still estimated to be over £30bn even if councils raise council tax by the maximum permissible amounts each year. Note, the annual figures (£12bn and £7bn respectively) are sufficiently sobering that there’s little need to inflate them by providing the cumulative figure.
The Transport select committee have published their recommendations about the bus market outside of London. They find that financial pressure on non-statutory council services is putting council-subsided bus routes at risk. They argue that “the Government [must] consider how funding of bus services could be reformed to give local authorities and bus operators greater certainty about funding”, given that roads and rail both have longer funding settlements.
Interesting interview with Donna Hall, chief executive of Wigan Council, about the ‘Wigan Deal’, and transforming council public services. That’s part of a bigger — and fascinating — case study of the ‘Wigan deal’ by the Centre for Public Impact. If you’d like to read more about local authorities trying something different then you might also be interested in this piece about how Gloucester City Council focussed on “community-building” to mitigate the impacts of austerity.
Really interesting new report from Localis on how to reinvigorate localism recommending, amongst other things, a Royal Commission to further devolution, and creating a British Investment Bank to replace the European Investment Bank. Worth reading in full.
Another IPPR report finds that council tax in London needs to be reformed. Another one to add to the ever-growing pile of evidence that property taxes are not a great way for councils to raise money given the range of responsibilities they have.
*This is not actual advice. We take no responsibility if you gamble on this. Obviously.
