The week in public services - 30th April 2019
Health and Social Care
In his Spring Statement the Chancellor, Philip Hammond, did not reveal the amount of money — or ‘total envelope’ — he intends to spend at the 3-year spending review this autumn. With Brexit stymying the Chancellor’s ability to push the proverbial envelope when it comes to policy, there is not only uncertainty as to how much money shall go to unprotected areas where spending has not been pre-decided — there’s a policy vacuum that caused a sensation when it was finally photographed:
The need for coherent policy is acutely felt by the social care sector. Keen to demonstrate that Brexit is not the only thing they can kick into the long grass (consistency is, after all, a virtue), the government’s green paper into social care has been continuously delayed. This is against a backdrop of many councils cutting their local services back to the legal minimum, as demand from an ageing population continues to rise in a situation the King’s Fund describes as “critical”.
In a recent survey, the charity Independent Age found that fewer than 1 in 4 homeowners are saving for their future care needs — with one third of those surveyed facing total care costs of an estimated £100,000 per person. The ability of individuals to fund their care is a major worry, with concern that the government’s proposed cap on care costs may not be low enough: given that the average length of time spent in care is only 22 months, many individuals may not live long enough to see their care costs capped.
A report by the IFS revealed the difficulties of saving for one’s old age, noting how tax thresholds not keeping pace with inflation is “dragging” people into tax. Combined with a reduction in the pension annual allowance, some high earners are facing a marginal tax rate of over 100% on their pension contributions. This is especially bad news for doctors, who cannot ask for additional salary in return for smaller pension contributions.
A lot of this feeds into the debate as to where the burden of financing care should fall: on individuals or the state. In a report for the Centre of Policy studies, Damien Green — who, living up to his name, proudly commissioned the “Green” paper on social care when First Secretary of State — argues that the care system should mirror the state pension, with the government setting up a universal care entitlement that people can then top up with a care supplement. However, the report’s suggestions for filling the immediate funding gap include taxing the winter fuel allowance and imposing a 1% National Insurance surcharge on those over 50. Given the political sensitivity surrounding the welfare of older generations — the Conservative’s proposal to move from a “Triple” to a “Double” lock on pensions at the 2017 election was quietly ditched — it will be interesting to see how warmly the government greets these proposals.
To address the labour shortage faced by the social care sector, the Centre for Ageing Better has proposed that the government legislates for paid carer’s leave and to ensure that they have the right to return to the same job. On the other hand, the Taxpayer’s Alliance believes the priority should be more technological: releasing a report (using IPPR data) claiming that increased automation would save the social care sector £5.9Bn through increased productivity and the NHS £12.5Bn — collectively giving £18.5Bn in annual savings by 2030. However, given the lack of detail on the cost of investing in this technology or any discussion on how the implementation period would affect productivity, the extent to which these figures can be used to estimate efficiencies in the care sector is pretty limited.
Children and Young People
Nick Gibb, School’s Minister for England, has publicly stated that spending on schools should increase when the spending review takes place this autumn. Whether this is a touching faith that the 3-year spending review will take place as planned, or is motivated by Jess Philip’s thoughts on “Little Extras” for schools, his assurance that it’s only this darkest “hour” that needs to be weathered is unlikely to impress head teachers. Though time is, after all, relative, the political pressure to commit to the narrative that “austerity is ending” is hard to square with the uncertainty surrounding the Treasury’s Brexit-dependent spending plans.
Meanwhile, 13 children’s charities are campaigning for a cross-governmental body responsible for helping 16 and 17 year olds who are classed as “vulnerable” but not in care. The Mental Health and Equalities Minister, Jackie Doyle-Price, responded to the campaign (which is supported by about 35 MPs and Peers) by announcing that she would ensure 70,000 more children would have access to mental healthcare. Quite how this will be achieved was not mentioned.
Law and Order
A report by the Centre for Social Justice has clocked up an impressive 59 recommendations to restore “control, order and hope” in prisons. The reason for the lengthy list is perhaps partly explained by their disagreement with David Gauke (Secretary of state for Justice) and Rory Stewart; they do not propose sentencing few people to prison, but instead recommend a cash injection of £2Bn; a massive increase in support for frontline staff (including the creation of a new National Prison Officer and Staff Welfare Service) and greater Ministerial oversight of assaults within prisons.
Their proposal that the focus should not be on decreasing the number of people going to jail in the first place may be some way off, though: the BBC report that 43% of crimes in Greater Manchester are not being fully investigated, in what is thought to be the first time a chief constable has put a figure on this practice. The delicacy of how police should engage with communities was shown in a study by the college of policing which found that, unless a “public health approach” is taken, various groups in society risk being alienated — especially with regard to knife crime.
Finally, The Guardian have revealed through an FOI request that 2,500 prison staff have been disciplined over the last 5 years for incidents including bringing drugs into prisons, relationships with inmates, assaulting inmates and racism. Breach in security was by far the most common offence requiring discipline. The findings provide an interesting context for the Centre for Social Justice’s recommendations — many of which centre around increasing the support available to prison staff. Whether the recent launch of a counter-corruption prison unit is able to provide aspects of this support in addition to cracking down on malpractice remains to be seen.
