The week in public services: 2nd October 2019

This week: party conference Season; raising the roof on Department for Health and Social Care capital spending; and why most police forces don’t record ‘stop and account’

General

The Office for National Statistics has published an interesting article on flexible working in the public sector, finding that it is most prominent amongst teaching assistants, administrative roles, and primary and secondary teachers.

With both Labour and the Conservatives pledging to increase public spending, read our very timely report on how the Treasury can improve the way it plans and manages public spending to maximise its intended impact.

Writing in the LSE Impact blog, John Burgoyne reflects on how best data can drive impact, concluding that more data doesn’t necessarily mean more impact. He argues that frontline staff are — by virtue of experience — a resource of data and knowledge themselves, and that outcomes aren’t achieved simply through more rigorous measurement.

Conservative Conference

Though there has been some criticism that the Conservative party conference has been slightly lighter on policy announcements than usual, given the main focus of getting Brexit done (that slogan…), but there have been some notable exceptions, especially the increase in the national living wage to £10.50 an hour for all workers over the age of 21, and a new programme of hospital building. In addition, they’ve also provided some helpful reminders of what was announced at the spending round…

Here’s a rough summary of events thus far, courtesy of the BBC and The Guardian:

The NHS

• A ‘Health Infrastructure Plan’, saying they will spend £13bn to build 40 new hospitals in England. As for what is meant by ‘new’, this is defined as ‘entirely new buildings or gutting existing structures to create state of the art facilities’.
• Six schemes have been announced, along with an initial £2.7bn of funding, with plans including £200m to replace MRI, CT scanners and breast cancer screening equipment.
• The remaining projects are to be completed over the second half of the next decade.
• For the other 34 hospitals health bosses can, erm, presumably draw up plans — but not actually build them…
• £100m will be provided in ‘seed funding’ to said bosses of 21 trusts to develop these plans — including up to a dozen community hospitals in Dorset

There are only two constituencies (there are 8 in total, all Tory) in Dorset that have a majority less than 10,000 (both just under 8,000), so it’s hard to say that this is targeting a marginal constituency. But, given the Lib Dem’s historic success in the west Country, could this be a way of trying to head off their resurgence? We can but speculate. Another key question is: how much will the budget for building hospitals be increased in order to pay for all this? Currently, the backlog of maintenance — hospital building repairs — is £6bn and the amount of that which is deemed “high-risk” is £1bn…

The Conservatives also (re)announced that they will provide £2.3bn a year by 2023/24 to improve mental health care (it was in the NHS long-term plan from January…)

Schools

• As announced at the spending review previously, school funding will be £7.1bn higher by 2022/23. All secondary schools will receive at least £5,000 per pupil, while primary schools will receive at least £3,750 per pupil, later raising to £4,000
• Gavin Williamson also announced that there will be a ‘revolution in technical education’ and an increased focus on vocational courses, claiming that England will overtake Germany in the opportunities offered to those who pursue technical education by 2029. What does this mean? Answers on the back of postcard, please…
• The government will also establish a new board to provide strategic advice on the skills and qualifications needed for new T-levels and technical and vocational courses; provide £120m to open 20 ‘Institutes of Technology’, so that there is one in every major city in England; and work with Durham University and Durham sixth form to open eleven new sixth form free schools specialising in maths.

Labour conference

Preceding the current goings-on of the Conservatives in Manchester, Labour had their party conference in Brighton. Many more policy announcements — almost as if they don’t want the focus to be Brexit… as distilled from inews:

Schools

Abolishment seems to the main theme here — private schools, Ofsted, Tom Watson…

• Labour plans to replace Ofsted with new two-stage inspections with regular ‘health checks’ by local government and more in-depth inspections by a national inspectorate in response to concerns raised by local authorities.
• On private schools, Labour would end tax breaks and charitable status, redistributing their land and assets as they are integrated into the state sector. McDonnell is reportedly reticent, so most expect that that this will be watered down if they get into power…
• Another part of the plan is to create a ‘Sure Start Plus” as part of a ‘National Education Service’ — details rather thin on the ground

More GPs

• A national care service to provide free personal care. Estimated to cost £6bn a year, to be funded by general taxation — see last week for more analysis.
• Labour would increase the number of trainee GPs by 50% — and claim this would allow for 27 million additional GP appointments, and will be fully costed in the general election manifesto. This is also assumes that, once trained, they stay in the profession full-time — which recent surveys of trainees suggest will not be the case….

Working smarter, not longer?

• A four day working week, with no loss of wages and the aim of ending in-work poverty. Aim to have a 32 hour week in four days and simultaneously increase the real living wage to more than £10 an hour, as well as ending the opt-out of the European Working Time Directive, and banning zero hours contracts (all of which would have big implications, particularly care workers who work in the independent sector)
• Extra time off for menopausal women — and more flexible working for this demographic. Aims to ‘break the stigma of menopause’.

Law and order within 100 days!

• Restore legal aid cuts and expand it within 100 days of taking office

Health and Social Care

Remember that time the government got into a fight with NHS Trusts about whether it had given them new capital funding, or whether it was merely letting them spend money they had accumulated earlier? Yeah, it’s now nominally committed to creating a legislative power which would let NHS England stop Foundation Trusts’ capital spending if their spending risked breaching the Department for Health and Social Care’s capital budget. I foresee this going down…badly (h/t Sally Gainsbury for the excellent spot).

Given this, it’s probably a good thing that the government agreed to raise the Department’s capital spending limit by £1bn, which has allowed NHS trusts to resume their original spending plans for 2019/20 — as detailed by the Health Services Journal.

Looking at whether scrapping prescription charges should be a priority for the health service, The King’s Fund have looked at Labour’s pledge to abolish charges. Nick Timmin’s conclusion is that abolishing the charges should not be a priority — though he praise Labour for their ‘remarkably honest’ assessment of the cost of this proposal. Which for a conference announcement is (genuinely) quite something, to be honest (c. £750m).

In what makes for very jolly reading, the National Audit Office have analysed how the health and social care sectors will be supplied post-Brexit. They found that, although ministers have been asked to be prepared for a ‘reasonable worst case scenario’, there are still significant gaps and extra shipping capacity may not be ready by the 31st October.

The largesse from the end of austerity continues, as ministers are considering a U-turn that would re-instate financial incentives to support student nurses, given the serious shortfall of nurses in the healthcare workforce (in 2015, George Osborne replaced bursaries with loans).

From Dutch courage to Dutch care? Looking at the Buurtzorg model of care in the Netherlands, the King’s Fund looks at what lessons can be learned from a pilot study in Suffolk that provided this type of integrated health and social care. Their findings? That working out what the model can provide is more important than replicating it and that, to work as a non-hierarchical team, roles and responsibilities must be repeatedly clarified.

Children and Young People

Unphased by its potential abolishment under a Labour government, Ofsted have published a blog on how the new model for inspecting local authority children’s services (ILACS) is working. The main findings are that the feedback thus far has been positive — with the review concluding that the new system is ‘a more appropriate and efficient inspection system’, with the introduction of ‘non-judgement’ and more ‘practice focused’ visits being received well by social care providers.

Meanwhile, Schoolsweek report that academy leaders are concerned about the trade-off between expanding the number of schools in their trust and their Trust’s financial viability. Though there are pressures to grow trusts in order to reach economies of scale, 51% of trust leaders believe that this will have a negative impact on the schools currently in their trust and their ability to support them…

Mind the gap… the Education Data Lab report on how England’s schools segregate by ability more than almost any other country in the world. Even though countries including the Netherlands, Germany and Northern Ireland separate pupils into different schools based on ability, England stands out for setting and streaming pupils, leading to much higher rates of within-school ability segregation than in other countries.

Law and Order

Stop and search, stop and…account? No, this isn’t the requirement to suddenly divulge one’s life history, but rather a technically voluntary procedure not covered by law where the police can — without need for reasonable suspicion — stop you and ask you to account for your presence. This interesting missing numbers blog gives a brief history of the procedure and reveals (through Freedom of Information requests) that only three police forces have collected data on this since the requirement to do so was made optional in 2010.