The week in public services: 29th January 2020

This week: mapping health inequalities; the annual Ofsted report; and is giving teachers more freedom the solution to retention problems?

Health and Social Care

Less news than last week. A brilliantly accessible bit of work from the Health Foundation and Nuffield Trust analysed health inequalities — looking at how accessible care is in areas of greater/lesser deprivation. Sarah Scobie and Jessica Morris summarised the key finding — that across most key indicators, people living in the most deprived areas of England experience a worse quality of care than people living in the least deprived areas — in a blog. Interestingly, the inequality gap tends to widen where overall quality is getting worse (A&E waiting times; experience of booking a GP appointment) and narrow where quality is getting better (recovery rates from psychological therapies; unplanned hospital admissions for asthma).

In a stark illustration of the relationship between the NHS and social care, there was a 35% jump in the number of people with dementia admitted to hospitals between 2017/18 and 2018/19. Of those people admitted, 40,000 stayed in hospital for longer than a month — which the Alzheimer’s Society believe is due to lack of adequate social care.

In primary care, GPs have warned the government that the new GP contract, which would give them new responsibilities such as regularly visiting care homes, are “completely unworkable” given current staff shortages in general practice. Some GPs think that imposing the new contract would lead them to reduce the number of appointments they hold with existing patients. GPs in Humberside have called the proposals “the single most repressing document for a decade […] didactic, central command and control that does nothing to alleviate workforce pressure”. NHS England are now in negotiations with the BMA over the contract. It’s all going very well…

In social care, this week’s big debate is about the government’s new migration proposals, and the potential effects of different migration regimes:

  • Care workers have called for an exemption from the government’s ‘Australia-style points system’ so as not to exacerbate existing recruitment and retention difficulties
  • The Migration Advisory Committee’s report on the government’s proposals repeated their early analysis, that the underlying problem in social care is pay, and terms and conditions — which are ultimately due to insufficient public funding, not migration rules
  • Jonathan Holmes from the King’s Fund has a very helpful summary — and a link to an absolutely fascinating paper about migrants’ motivations for working in social care in England

(TL;DR — many don’t move here in order to work in social care, so putting care workers on the shortage occupation list might not make much of a difference if most aren’t expecting to work in care)

Children and Young People

This year’s annual Ofsted report is out. The Chief Inspector, Amanda Spielman, is particularly concerned about some schools ‘hollowing out’ (reducing the breadth of GCSEs, or entering pupils for ‘easier’ ones) education to ensure pupils get 5 A*-C GCSEs. When it comes to children’s social care, the Inspectorate is particularly worried about children’s homes as “there is no […] strategy to manage the supply of children’s home places at a national level […] result[ing] in a lack of homes in the expensive cities and regions, and an oversupply in areas where property is cheaper. This encourages local authorities to send children far away from home, and indeed sometimes makes it very hard for them to do anything else, especially for teenagers with complex needs.”

Yvette Stanley, Ofsted’s social care director, has highlighted some of the biggest issues in children’s social care — she argues that local government funding cuts raise “difficult questions about how far an already stretched sector can bend before it breaks”. Good CommunityCare summary here. One encouraging note is that the proportion of staff in children’s homes with relevant qualifications is rising — which is the right direction, at least!

In schools policy, Natalie Perera argues that the 2019 Conservative manifesto suggest that there isn’t much appetite to radically reform public services — despite the significant changes brought in under Gove in the 2010s, and the ongoing ‘disadvantage gap’ between in results between pupils eligible (and not eligible) for free school meals.

Elsewhere, fascinating new research from the National Foundation for Education Research finds that teacher autonomy is strongly correlated with job satisfaction, perceptions of workload manageability, and intention to stay in the profession. Autonomy over setting professional goals is most associated with higher job satisfaction. Relevant research with clear policy implications. More of this, please.

New Education Policy Institute research looks at boys studying modern foreign languages in secondary schools. Interesting insights: I had no idea that the gap between boys and girls performance was so large that gender is a stronger predictor of success in languages than a pupil’s level of disadvantage.

Education DataLab have been busy, too. Dave Thomson has been (correctly) pointing out that it’s too simple to say schools in the North and the Midlands perform worse by virtue of their geography without taking into account the backgrounds of students in those schools. Worth reading the blog in full.

Last but not least, John Jerrim has a fascinating blog on his new paper on trends in teachers’ mental health. He finds that reported mental health problems among teachers have more than doubled in less than a decade, from around 2% of teachers in 2010 to 5% of teachers in 2019. (This is comparable to other professions such as accountants and nurses). Oddly though, teachers’ self-reported wellbeing, anxiety, and happiness is basically unchanged between 2011 and 2018. A puzzle, which John reckons is explained by a greater willingness to report mental health problems.

Local Government

Remember when Northants went bust (twice) in 2018? The government sent in commissioners to oversee reforms, who’ve now issued their fourth report on progress to government. The key finding? “Spending on children’s social care remains a significant financial risk to the Council”, and improvements in other services basically depend on improving the performance (and reducing spending on) children’s social care. This summary from Sarah Ward is useful.



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Graham Atkins

Graham Atkins

Senior Researcher @instituteforgov: public services, infrastructure, other things. Too often found running silly distances in sillier weather.