The Week in Public Services 2nd September 2020

This week: the benefits and risks of reopening schools; devolution debates; and what do 3 billion PPE items look like?

General

It might have been a bank holiday, but there was still a (surprisingly big) lot of new research and analysis last week! Let’s start with this article (£) from Carl Heneghan of the Oxford Centre for evidence-based medicine in the Spectator, which concludes that “the real threat is not the disease [Covid-19]; it’s how we react to the emerging information”, reminding us that the second-order consequences of lockdown can be just as deadly as the virus itself…

How much of a risk does Covid-19 pose to you, anyway? Tim Harford analyses the statistics here — excellent for getting a sense of proportion.

In more concerning news, a new survey found that black and minority ethnic people trusted government scientists and public health officials less than white people did at the height of the UK’s coronavirus outbreak.

And I’m probably a bit biased on this one, but my ace colleagues Sarah, Erenie and Alex have published a great report on the UK government’s decision-making and response to coronavirus during March and April.

The long and short of it is that the UK government’s initial response to the Covid-19 crisis was hampered by the absence of a long-term strategy, lack of clarity about who was responsible for what and its poor use of evidence. But you should really read the whole thing, as it’s full of fascinating detail.

And it’s not like the government made the same mistake everywhere, either. When it comes to using evidence in policy, for example, ministers relied too heavily on SAGE when it came to the choice to lockdown — they looked to it for answers, rather than input into broader policy discussions. At the other end of the spectrum, the decision on testing was based on too little evidence — Hancock didn’t talk to the diagnostics industry, the NHS or even his own testing coordinator before making announcements. Check out the full report for more — and give them a follow on twitter.

Health and Social Care

Lots of health news over the last week. The government have announced plans to change the law to allow pharma companies to roll out a coronavirus vaccine faster which would remove some of their liabilities. It’s generated a few concerns about whether this is the most appropriate way to incentivise companies to make progress.

In testing news, this Guardian article covers exactly how the regulatory regime for coronavirus tests work, and why there have been so many ‘false starts’ when it comes to getting accurate tests.

Now, I like numbers (you might have guessed if you’ve read previous editions). But I’m not sure these new statistics on PPE items distributed to health and care organisations by the Department of Health and Social Care are all that useful. The reasons for publishing it– as a “regular summary for ministers, policy makers and external stakeholders on PPE items distributed” makes me worry that this data is being collected solely for the sake of filling in central forms and tickbox accountability, rather than to make operational decisions. (On which note, my colleague Sarah wrote a good blog about, amongst other thing, the difficulties of running things well from the centre). It’s good that this data is openly available, though.

In any case — I was able to visualise what it looks like to distribute “over 3 billion PPE items”. Which is interesting, if nothing else. I was amazed by the sheer volume of gloves distributed. The Department, in the stats notes, say that they have distributed over 3 billion PPE items for use by health and social care services in England between 25 February and 23 August, compared to approximately 2.43 billion items distributed between 1 January and 31 December 2019. That’s easily more items distributed than all of 2019 in just six months…

This data really needs some proper procurement experts to look at it and interpret it. Happy to lend my excel skills if anyone reading this has the expertise to understand it!

And how is the long-mooted, pre-pandemic NHS reorganisation going? Mark Gamsu looks at the landscape and concludes that changes on the ground (merging clinical commissioning groups so their boundaries align better with Integrated Care Systems) are driven by “a belief that accountability to NHS England or Government is more important than accountability to places”. This blog from Donna Hall and Warren Hepolette sets out strident criticisms of this approach.

On a related note, Sally Warren wrote an interesting blog about the remarkable consensus about devolving health policy…amongst those who have left office. “How do we persuade the current generation of politicians holding national office to act differently now? How do we persuade them that giving power to others will ultimately be the smart political move to make?” is a great way to frame the question.

In the research world:

• The Nuffield Trust have looked at what we already know about safety in maternity services…
• …and how Covid-19 has changed use of digital technology in the NHS…
• …and how NHS sickness absence changed during the pandemic
• An excellent Health Foundation longread explains how to interpret research about ethnicity and the risks of Covid-19. Journalists: please read.
• Becks Fisher reflected on what coronavirus has meant for primary care on the Health Foundation website. Thoughtful, interesting, and practical account — well worth a read.

And in social care, a sad story in The Guardian covers a Healthcare Safety Investigation branch inquiry into the death of an older person receiving care at home. The report found that the care worker visiting the person “did not use PPE and had been told this was not necessary […] the patient later died, and their death was confirmed as being Covid-19 related […] the care visits occurred when the patient and other household member were not showing any Covid-19 symptoms”.

Children and Young People

As of yesterday, schools (in England) are back! I’m sure you’ve probably heard. But you may not have seen this great research from the National Foundation for Education Research which, through surveying school teachers and leaders, found that teachers in the most deprived schools were over three times more likely to report that their pupils are four months or more behind in their curriculum learning than teachers in the least deprived schools. Concerningly, schools are planning to reduce the number of initial teacher training placements they offer — which will be hard to square with the rising number of applications for initial teacher training (see Jack Worth’s excellent monthly twitter summaries). This year could be an ideal time to ‘over-recruit’ teachers to back-fill existing shortages — but not if schools are unable to offer training places. Time to get creative about how the government runs teacher training?

The Institute for Fiscal Studies have also published a great briefing on the challenges (Covid-19 transmission) and opportunities (reducing the educational disadvantage gap) of reopening schools. There is a real concern that reopening schools may not effective in tackling the latter unless the government can convince children in less well-off families to attend — during the pandemic, 80% of the richest third of parents who had the opportunity to send their child back to school sent them back, compared to only 64% of the poorest third of parents. They conclude that “there is scope to do more to inform and reassure parents about the health risks to their children and their families”.

And in case you missed it, my top colleague Benoit wrote an excellent comment on what measures the government should be putting in place as back-up plans in case they have to close schools again. Matthew Hood from Oak academy wrote an interesting blog about Oak academy’s online learning provision, pointing out areas they are trying to improve this year.

Now that schools have reopened, there is soon likely to be an increase in referrals to children’s social care (there were 18% fewer referrals between April and June 2020 when compared to the average of the same months over the last three years — and lots of referrals come from teachers in normal years). The Children’s Society have called on the government to provide local authority children’s social care teams with “the guidance and resources they need to manage the demand and ensure that vulnerable children are protected from harm”. Perhaps handily, a What Works Centre review has looked at what the UK could learn from other countries when it comes to social work during and after pandemics and disasters. Unfortunately, “there is a limited formal evidence-base for leaders in social work to draw upon when considering how best to support families and protect children during the Covid-19 pandemic”. Gah.

In non-school reopening news, Phil Nye has created a great visual tool which shows the educational outcomes of different groups of children at age 11 and 16 — lots of fascinating insights in this.

Law and Order

Lots of news this week (a lot sourced from the Police Foundation’s excellent newsletter — do subscribe to that if you haven’t already). A bit too much to summarise, so click through if any of the following sounds interesting:

• Rising police use of stop-and-search in London during the pandemic…but fewer resulting in arrests
• An Independent longread about how the police spent their time during lockdown
• A Home Office evaluation of the Violence Reduction Units set up last summer (remember that budget announcement?) — “VRUs had made significant progress in raising awareness of their mission and vision amongst all three layers of their structures […] however, they had made more limited progress engaging the wider public and young people”…
• The latest police inspectorate annual report (for 2019) — Times write-up of the political controversial bits here (£)
• The Home Office have begun a review of Police and Crime Commissioners
• A new academic paper tries to work out whether a fast police response matters for detecting crimes. (Spoiler: yes)
• And the rest: the regular MOPAC round-up of interesting crime research is out too

Local Government

In local government world, the County Councils Network have been crunching numbers and found that abolishing all district councils and replacing them with 25 new councils would save £3bn. I’m sure you could critique various assumptions in PwCs modelling (full report here), but my first though was that’s…really not a big number. Simon Parker is still right about this, I think.

Also — that £3bn is over five years — so it’s a £600m saving per year. The government shouldn’t get away with totting up annual costs over several years to make numbers artificially look big, and neither should think tanks!

The District Councils Network have shot back with their own report, arguing that “any move to scrap districts in favour of creating a series of councils larger than any found across Europe would stop residents taking back control of their lives and risks alienating them and leaving communities behind”. Expect this argument to run and run…