The Week in Public Services 1st July 2020
This week: testing woes; supporting vulnerable children; and local government finances (again)
General
Starting off on a cheery note, the world should think better about catastrophe and existential risks warns The Economist. It argues that seeing how well or poorly countries have handled one (the coronavirus pandemic) raises the question of how they might cope with truly novel catastrophic events such as a huge volcanic eruption or geomagnetic storms from the sun. Novelty is not the only way in which the latter are different from our current crisis: as any airline will tell you, you can do a lot to slow the spread of a pandemic. The same does not apply to the millions of tonnes of charged particles the sun might one day throw at the earth, or a huge volcanic ash cloud enveloping it.
While many are looking back at the impact of austerity on Covid preparations, historian Hugh Pemberton — who has written a word or two on the civil service in the past — looks at the changes to the British state during the 1980s and 90s and argues that relentless cost-cutting and a reliance on private providers of public services have “produced a state that has plainly struggled to cope.”
Resilience is still the new buzzword in public services. But organisational resilience is not separate from ‘digital’ insists Cassie Robinson at The National Lottery Community Fund. Digital, we’re told, is something you are not something you do. “Rather than stick digital in a box, make sure every team member can work digitally with confidence and competence” is the advice. While some orgs have always been ahead of the curve, understanding early the transformative nature of digital technology, others have been hampered by a lack of resources.
Talking of digital, we finally have a more user-friendly presentation of the key coronavirus data in a new dashboard format…though still with some pretty massive flaws, such as not providing Pillar 2 — community testing — data. Jen Williams has explained why the lack of this data matters so much in Greater Manchester — without it, local officials were not able to really complete the ‘local outbreak management plans’ which they had been asked to.
Last but not least: measuring success in the public sector is not easy (if you’ve heard of Goodhart’s Law you’ll know why). Some argue that this top-down accountability which became fashionable as part of new public management means that you should leave public servants alone, trusting them to get the job done. That doesn’t sound entirely ideal either. John Burgoyne posits a third way — measuring not for control but for learning. He’s correct to say that measuring for accountability in complex systems is not helpful, so instead we should be continuous learning from the data we gather and make iterative improvements based on those insights. Want some examples of this in practice? So do I. Read on for them.
Health and Social Care
Two must-reads this week. First — the Independent’s Shaun Lintern has investigated testing failures. His judgement is damming: local public health directors side-lined; legal claims of 1,000 false negatives a week, and seven day waits for NHS staff. Many of these points have been made individually before, but reading it all together is quite something.
Second — this FT story of the UKs contact-tracing app. They cover the rise and steep fall of the app that was meant to be but probably won’t come for months — complete with expletives you’d also utter if you’d seen the news and read the app you’re trying to build would be rolled out in a week’s time. Field tests comparing the NHSX app with Google-Apple’s system say it all: the former detected 4% of iPhones it came into contact with. The latter? 99%.
Taking a step back from immediate coverage, HSJ editor Alastair McLellan has given a fascinating interview on covering coronavirus. Interestingly, he says that the government media handling has been nothing like as controlling the New Labour years, but that’s about where the praise ends.
In think tank world, the Health Foundation have produced an interesting insight into the use of the NHS 111 service during the pandemic. The phoneline received an unprecedent number of calls in March (good) but it looks as if a large proportion of them went unanswered (bad). And what can be done beyond clapping for carers? They suggest three priorities for addressing staff welfare in the coming months: using staff experience to make changes for the better, increasing opportunities for reflection; and providing supportive and compassionate leadership.
Keeping busy, they’ve also produced a masterful summary of the recent work that has been done on the unequal impact of the pandemic. There is a real risk all round that coronavirus will only exacerbate existing inequalities and the government responses should be designed to mitigate this.
The OECD has done some research on the long-term care workforce, which ONS stats here have already shown is particularly vulnerable to coronavirus. The international group says more investment in the workforce and decent working conditions are required. We agree. Hopefully this is part of the government’s plan for social care, which the prime minister said this afternoon (and prime ministers have said for years) is nearly there. Though, as Simon Bottery points out, it doesn’t look promising.
And while senior care leaders have come together to call for a national care service in the wake of the sector’s pandemic experience, it’s worth pointing out that that wouldn’t be an complete fix. However social care is structured, the head of the Migration Advisory Committee has (correctly) pointed out that care workers need ‘proper wages’, in a clear message to the government.
And what about Brexit? Mark Dayan from the Nuffield Trust and Matthew Elliot from Vote Leave offer their thoughts on the consequences of Brexit for the NHS. Dayan warns that when it comes to healthcare, an unambitious deal with the EU would be hardly any better than no deal. Elliot says that covid has illustrated just how interconnected countries are globally, and the need for international cooperation, with regulators working away quietly in the background to try and ensure that a deal can be done.
Back on the frontline, Annabelle Collins provides a sharp reality-check. “Talking to a doctor working at a central London hospital with an ageing estate, they told me portacabins are being put up in the grounds to create more office space.” This seems like a good place to remind you that the NHS maintenance backlog is over £6bn. Also, it’s not as if accessing covid cash for new buildings has been without delay and frustration for some trusts.
This Q&A with Salford’s Director of Public Health Dr Muna Abdel Aziz is an enlightening insight into what’s happening at a local level and how everything from PPE to testing has worked. It’s… insightful to see how testing has worked in practice at a local level. Let’s hope it’s improving. In the area, the local official in charge of the contact tracing scheme gives a sober warning: “Covid-19 is going to be around with us for a couple of years, potentially, and it’s not the only pandemic that might hit us. We need to be building up our surge capacity so we have the right flexibility and number of staff to deal with it.”
On the of local testing, here’s a superb thread from Warwick academic Adam Briggs on last week’s test and trace data. There’s been a sharp drop in complex tier 1 cases (from outbreaks and high-risk settings e.g. care homes) with non-complex cases (i.e. those from testing the general public) staying around the same as previous weeks. Much more detail in the thread.
In other news, there’s nothing like a crisis to embrace new technology — which the NHS has certainly done. Some of it looks here to stay: 88% of GPs want to keep offering remote consultations after the crisis according to the BMA. And if technological changes appear to be permanent, we should start scrutinising the contracts used to purchase them.
Speaking of new technology, the Institute for Public Policy Research have thoughts on upgrading the spread of innovation in the NHS. It recommends that the centre sets the rules of the game (e.g. minimum standards, accountability) and then provide much more active support for local providers and commissioners.
And what should we learn from this crisis? A thoughtful blog from Nicola Close, Chief Executive of the Association of Directors of Public Health, reflecting on the heroes of the pandemic in light of recent discussions about who in history deserves a statue. Government messaging has deliberately emphasised the role of the NHS — somewhat understandably — but like in history, there are other heroes too.
The Royal Society of Arts think that we can learn from Christchurch in New Zealand when we start to think about the long term. The city has suffered a devastating earthquake and terrorist attack in the past decade — it’s never too early to be mindful of the psychological impacts. According to Nick Hassey, who has spent some time reading pandemic plans, New Zealand’s was pretty good. He concludes that “what really stands out is a) how much more of an actual *plan* this is than ours”, so there you go. Similarly, the experience of war (WWII permanently changed nursing in the UK) could provide some tips into how nursing could change.
Former secretary of state Jeremy Hunt offers a wide range of suggestions for a post-covid NHS in this HSJ comment piece including recommending scrapping national waiting time targets and replacing them with waiting times standards. Maybe he’s been listening to some of our internal conversations on targets (report coming soon) and if he has, he’ll know that’s easier said than done.
What’s next for healthcare providers? This controversial take says they are facing a fork in the road, with the option for radical, democratic reform in local systems. If that interests you, read on…
Moving away from the abstract, David Oliver has sensible and practical recommendations on how to ensure care homes can better manage a second wave. There’s lots to learn from the first. One lesson is surely the lack of real-time information and data.To date there has been no national, systematic approach in the UK to develop care home datasets or to exploit their full potential to enhance residents’ care” — which goes some way in explaining just how little we know about the sector. Other countries have care home minimum datasets and related measures. It’s high time that the government collected some decent intelligence on some of the most vulnerable population.
Children and Young People
‘It’s a shame about the decay in maths and reading skills, but look on the bright side: penguins!’ The brilliant Tim Harford on the dilemma about how to reopen schools safely.
School closures have undoubtedly increased inequality. Three in five teachers are reporting that vulnerable pupils are less engaged than their classmates according to a new report from the National Foundation of Educational Research (NfER). It also says that more than half of senior leaders are reporting significant concerns for the safety and wellbeing of vulnerable pupils. Despite high levels of collaboration between schools and other agencies, NfER think that there is scope for agencies to work together more closely to provide social and welfare support.
Other useful new analysis from EPI tries to quantify how many students are likely to enter FE where they who would have gone into employment in the absence of a recession, and how many of those students will be required to take English and Maths GCSE resits. They conclude that “while we can expect numbers for those opting for further study to rise in the coming months, at the same time, the government may need to also look at whether the resits policy could result in unintended consequences, with some young people nudged into unemployment rather than further study”.
Over in schools, Jack Worth has analysed the latest new teaching application data. The number of applicants to initial teacher training in England and Wales saw an unprecedented surge in the past month meaning overall recruitment numbers are now 8% higher than last year. At the same time, the Gatsby Foundation warn that schools will need stimulus to prevent a teacher recruitment crisis. Initial disruption from the pandemic will have longer-term impacts and will mean schools need increased support to enhance their recruitment efforts.
Meanwhile, the government has announced a school rebuilding programme that will see £1bn spread over 50 projects from next year, as part of a ten-year building programme. We’re waiting to hear the rest of it. In the meantime some healthy scepticism and context from my colleague Graham.
Law and Order
New MoJ stats on prison deaths from suspected coronavirus seem surprisingly low — given overcrowded prisons could easily have been vectors for significant spread of Covid-19. There’s an interesting compare-and-contrast study with care homes from Graham here (though lots of variables still to control for…)
And how is coronavirus affecting prisoner health? While the number of cases isn’t as high as initially feared, the need for social distancing is disrupting life in prisons with prison staff stretched to maintain even a basic regime of ensuring prisoners can shower or make a phone call.
An announcement last week that the government expects to open the Medway secure school in 2022 follows a commitment from the government back in 2016 to ‘comprehensively transform youth justice.’ But they might go the way of Secure Training Centres introduced by Ken Clarke in the 90s which really didn’t go to plan.
In policing, the UCL Jill Dando Institute has a series of papers focused on the implications of the COVID-19 pandemic for police agencies and other organisations related to security and crime sciences. From policing the lockdown to pandemic package theft, you can peruse some very interesting summaries.
Local Government
Lots to go through here…local officials are (still!) not getting all the Covid-19 data on local outbreaks that they need…apparently because Whitehall still is not sharing. This from the FT spells it out, using the example of Leicester which has just gone back into lockdown. A SOLACE survey of more than 100 council chief executives has found that nearly 60% of senior professionals expressed major doubts about their ability to implement a local lockdown in their area. Predictably, more than three quarters were unsatisfied about the level of funding to councils to enforce and deliver local lockdowns.
Meanwhile local health teams trace eight times more contacts than the national service. Makes you wonder whether the reported £108m contracts to operate test and trace would have been better spent resourcing and bolstering local public health teams…
Looking at local government finances, the Centre for Progressive Policy find that “most local authorities do not appear to have sufficient funds [reserves] to make up the difference between government support and increased costs and reduced income”’ Eek. Every week, somebody or another from local government is warning of dire consequences if the government does not increase their funding. Now Manchester City Council could be in the “territory” of issuing a section 114 notice by this autumn as it battles a financial shortfall of £133.2m. Minor changes to the local government financial system could help but won’t be a full solution.
Interestingly, Sarah Calkin of the Local Government Chronicle has suggested that councils’ response to austerity may be more significant than the type of authority when considering the impact of Covid-19. The past decade has council funding become increasingly complicated, and her comment summaries the pandemic’s impact on different sources of council revenue.
Why does this all matter? Ultimately, local authorities will be implementing most of the lockdown (and unlocking) measures — so central government will need to be on good terms with them. But figures in local government are not impressed that ministers are urging the reopening of public toilets and playgrounds in a covid-safe way “after a decade of austerity and job cuts”. They’re also annoyed with guidance from MHCLG that councils should try and offer an online booking systems for outdoor gyms and playgrounds which again, sounds pretty tone-deaf.
Last but not least, Matt Hancock memorably appealed to people’s ‘civic duty’ to cooperate with test, track and trace. It’s hardly a new concept, but Paul Corrigan argues here that it’s the relationship between the idea of civic duty and a specific locality that gives it its power.
Now into month five of social distancing. Keep staying safe.
