The Week in Public Services: 3rd February 2021

This week: vaccination variations; the cost of lost learning; and a grim milestone

General

Following the news that the number of deaths 28 days after a positive Covid-19 test hit over 100,000 last week (of which half occurred after 11th November* — well after the first wave), the debate about what the government could and should have done differently is in full flow.

For what it’s worth, the prime minister has said that now is not the time to learn lessons. At the IfG, we disagree. A full, independent, statutory public inquiry should wait until the crisis has passed but during a crisis like the Covid-19 pandemic it is essential to learn timely lessons and not repeat mistakes. Think of the consistent halfway-house measures between measures to stimulate the economy which increased social contact and measures to control the virus which tried to reduce them. The tension between lockdowns and the cost to the public purse and in particular, the limited support for isolation. Repeated optimism bias that case numbers could be held down and postponing decisions to lockdown in March, October, and December. These decisions fit into a pattern which would have been clearly identified in a rapid review. My colleague Emma puts it best: “the problem for the UK government is not the absence of lessons. It is the denial that this is the time to learn them.”

There’s been a lot of coverage of the total deaths — here are some other pieces I found interesting:

• Therese Raphael’s Bloomberg article on ‘how Britain got it so wrong and so right’
• This Times longread (£)
• Tom McTague on how the crisis will end up being remembered

Health and social care

Back on the frontline of the pandemic, an interesting Strategy Unit analysis looked at changing attendance at emergency attendances during the pandemic by ethnic background and found that “the biggest drop-offs were among patients of Bangladeshi (75.3%), Chinese (74.5%), Pakistani (71.8%), Indian (64.9%), and Black African ethnicities (63.5%)” — again highlighting the very unequal impact of the pandemic.

In hospitals, the Health Service Journal reports concerns that children’s operations are being cancelled or reclassified as lower priority because of coronavirus pressures — another stark reminder that the impact of this pandemic doesn’t just fall on patients with covid themselves. Looking at public health data in 2020, Jenny Davies similarly found that some activity — such as the number of NHS health checks and consultations at sexual health services — fell dramatically at the start of the pandemic, although others such as childhood vaccines and flu vaccines continued at normal rates.

While cancelled operations wreak havoc for patients, workforce burnout is just as big a problem, as it will slow down the rate at which the health service can get back to normal levels of activity. Andy Cowper summarises the problem nicely in his latest column: “ changing employment approaches and contracts to address staff fatigue, stress and frustration is probably more doable but less ultimately pertinent than changing the culture. Changing contracts is not easy, obviously; but changing the NHS workforce culture is as essential as it is difficult. And it is apparently very difficult.”

In better news, a neat summary of two papers on how to increase compliance with restrictions find that positive messaging & role models are the most effective way to get people to follow guidelines, and where people’s circumstances put them at high risk of infection, support (financial and otherwise) works better than fines and threats.

And rejoice, accounting nerds — the Department for Health and Social Care’s 2019/20 accounts are finally out! This has been a bit of a long-running saga (the accounts normally come out in July, so these are six months later than in a normal year). Perhaps oddly, the Department did not exceed its Expenditure Limits for 2019/20, though it is very likely to do so in 2020/21 which will better capture the full impact of coronavirus.

The big story, of course, remains vaccines and in vaccine news, the Guardian has summarised how the UK managed to vaccinate so many people so quickly in comparison to the rest of western Europe. They point towards the partnership between the University of Oxford and AstraZeneca, and the decision to pay AstraZeneca partly upfront, so that they could build manufacturing centres. My colleague Tom also looked at where the government learned from past mistakes in the vaccine rollout — principally, logistical preparation and the autonomy given to the vaccine taskforce.

That’s not to say all is fine. Simon Briscoe is correct to point out that we still don’t have data on vaccinations by whether a person is a care home resident or not, so cannot judge the claim that all eligible older residents at care homes have been offered a vaccine. Scotland, interestingly, provides much more granular data than England that makes it possible to say that Scotland is close to having all care home residents vaccinated. Helen Buckingham has also updated her blog on the ongoing challenges, from logistics to communications. And that’s before we get to the did-they-didn’t-they EU-UK diplomatic row about the Northern Ireland-Ireland border and the (unlikely) risk that an EU-NI-GB vaccine smuggling route could be established last Friday night. The whole episode was a bizarre back-and-forth which both the EU and UK need to learn from — as my colleague Jess’ blog explains.

As the EU-UK row demonstrated, it’s pretty clear that the speed of vaccine rollout will be a new front in 2021 politics… which makes it all the more important to understand what actually explains variation in vaccination rates. This great blog from Billy Palmer looks at variation (adjusted for size of 80+ population!), and lists possible explanations:

• Whether areas stuck strictly to the prioritisation list (e.g. ensuring all care home residents were offered first) or ensured the vaccine was delivered at pace even if that meant someone from a lower-priority group receiving a vaccine first
• Delays in clinical commissioning groups approving practices to provide vaccinations

It’s important to note that variation between areas within the four nations — not just between them — is also extensive, and doesn’t seem to be the result of the size and/or proportion of the 80+ population in different places.

Last but not least, an interesting Nuffield Trust blog looked at evaluation during the pandemic and highlight the potential and key challenges (primary data collection and qualitative interviews when staff are knackered…) of rapid evaluation to inform decision-making during a crisis.

Children and young people

Right, big news this week — the IFS have estimated that the cost of school closures is an eye-wateringly big number: £350bn of lost earnings in the run. I’m not sure what size bus that would go on, but I’m pretty sure it’d be a big one.

But, as ever, it’s worth asking how that number was calculated and what it means. In essence, the IFS have measured the impact of school closures by calculating an estimate of the loss of earnings from one year of schooling, and then multiplied that by the fraction of one year of schooling lost to covid. There are 8.7 million children in the UK who’ve lost time in school in the last year, so it doesn’t take particularly radical assumptions to get a large figure. Some of that £350bn would have ended up as taxes, so there’s also a hefty hit to the public finances (£100bn over the long run, the IFS estimate).

You can get different numbers by altering any of the assumptions (future earnings lost; amount of learning lost) in the model — but the point here is that the impact could be massive, and policymakers should be thinking about how to cushion it. The four governments have so far allocated £1.5bn for catch-up funds which is roughly about the cost of running all schools in the UK for 3–4 days. That’s not very ambitious. Luke’s conclusion is that “everything should be on the table and we should be engaged in a national debate about the merits and feasibility of all [possible proposals]” from additional tutoring, to extending the school year, to lengthening the school day, to repeating years.

The real question for policymakers is, I think, are there the resources (not cash, but buildings, teachers, and tutors) to actually teach children and increase their time spent learning and, if not, how can they put them in place. Another question policymakers should be asking: what are other countries doing to combat learning loss? The Dutch are trying a large-scale tutoring programme but I’m not sure what’s happening elsewhere. Answers on the back of a postcard, please.

Of course, long-run lost earnings are not felt evenly, as Paul Johnson points out here — making interventions all the more important if the government doesn’t want to the disadvantage gap to grow further. This summary article by Christopher Richardson goes into detail on the unequal impact, and explores options for ameliorating it, such as reducing the amount of content to be covered in exams.

Since then, the National Foundation for Education Research (NfER) have published even more evidence on the unequal impact of school closures, comparing a representative sample of Year 2 pupil maths and reading attainment in November 2020 to Year 2 pupil maths and reading attainment in November 2017. In their words: “overall performance in both reading and mathematics in autumn 2020 was found to be significantly lower compared to the 2017 cohort, with pupils, on average, making two months less progress in both subject areas compared to the standardisation sample […] a very large number of pupils were unable to engage effectively with the tests.” Unfortunately, we can’t see if the disadvantage gradient expanded because NfER didn’t analyse results by level of disadvantage in 2017. (N.b. eagled-eyed readers will have spotted the dates — this doesn’t account for the impact of the school closures in 2021 — so the eventual learning loss is likely to be larger).

Moving to the summer, the Education Policy Institute have published their proposals for awarding exam grades in 2021, arguing for standardised assessments in May and June to inform teacher judgements, and giving schools (teachers) greater guidance on how to award student grades without exams. One radical option would be to cancel exams entirely, although it’s worth noting that in most other countries students continue with maths until age 18.

In other news, the Education Policy Institute have released a report about the mental health of young people aged 11, 14 and 17 and found that “the experience of the pandemic is likely to continue to exacerbate existing mental health and wellbeing problems among young people […] national estimates show that 1 in 6 young people now have a probable mental illness — up from 1 in 9.” New research from Francis Green has looked at teachers in England’s changing job quality and satisfaction and found that several indicators of wellbeing are falling, even as hours remain stable — suggesting that job quality needs to be a focus of the Department for Education’s recruitment and retention campaigns. Upcoming research from Ambition Institute, the UCL Institute of Education and CfE research will try to identify the characteristics of effective professional development for teachers. The latter is definitely worth keeping an eye on!

In children’s social care, the What Works Centre have set out their asks (take a wide view of evidence and don’t limit yourself to what is already known!) of the upcoming care review. Their review of ‘Signs of safety’ — an approach for social workers to undertake child protection case work which is “strengths-based and safety-organised” — unfortunately suggests that it “there is no strong evidence that [Signs of Safety] significantly impacted outcomes for children and families [and] the analysis found moderate strength evidence that, contrary to the aims of the programme, SoS decreased the probability of a child being looked after through kinship care (compared with non-kinship care) […] the study found no strong evidence of SoS affecting the duration of assessments, the probability of a child being re-referred within 6 months or the probability of a child being re-referred and their case escalating.” This is not a case to stop doing it — but should cause local authorities who expect adopting it to reduce costs or improve outcomes to stop and think twice.

Finally, a new briefing from the Children’s Commissioner finds that many at risk children are still not known to the state — which is another concern of leaving schools closed for a long time.

Law and order

Less news this week, but always worth keeping an eye on what’s going on in prisons. Former BBC Home Affairs correspondent Danny Shaw argues that prison officers haven’t been given the credit they deserve for their work during the pandemic — with fewer visits from the Home Secretary compared to police officers, and having been left off the Labour party’s call for the vaccine to go to “key workers in critical professions”.

Ian Acheson has also written about prisons during the pandemic in a piece worth reading in full: “I am in touch with front line prison staff daily and they are scared. The initial strategy seems to have worked, but, like the virus, it must adapt now to rapidly changing circumstances. Some of the ills of violence and suicide that have plagued our criminal justice system have receded in the face of draconian restrictions. But they have not fully disappeared.”

Local government

In an interesting longread for New Local, former King’s Fund chief executive Chris Ham argues that “centralised decision making is necessary but insufficient in responding to a challenge like Covid-19. Much more needs to be done to draw on expertise and intelligence from all levels of government and from within the NHS. More work is also needed to strengthen partnership working through local resilience forums, integrated care systems and other mechanisms focused on places and communities.” Which is convenient, as New Local and Power to Change have a new report out on how to rebalance power between communities, local government, and central government, including an interesting comparison of England, Wales, and Scotland. Both worth reading.

In local government finance news:

• Adrian Jenkins explains how reforms to the distribution of local government funding in England will create a new set of winners and losers (and points out that the reforms due to be implemented in 2022/23 were originally set for 2019/20…)
• In a new twist to the local-authority-financial-challenges story, local government heads of finance are apparently waiting an increasingly long time to hear back from the Ministry about whether they’re allowed to count some day-to-day spending as capital investment (“capitalisation”) which is causing problems as some authorities are relying on the thumbs-up from the Ministry about capitalisation in order to sign off their financial reserves as adequate

* Stats nerds will correctly point out that the true Covid-19 death toll is probably much higher because of the limited testing during the first wave (many of those deaths will not be counted in the headline metric of ’deaths within 28 days of a positive test’), and that excess deaths are a better metric of the overall impact of the pandemic. I agree with both of these points, but however you cut it, the UK has been extremely hard hit by the virus — and the 100,000 deaths figure (whatever its merits as a way to count the impact) was clearly a talking point. (For more interested/nerdier readers, David Spiegelhalter’s explanation of these points and more was excellent on last week’s More or Less).