The Week in Public Services: 3rd November 2020

This week: hospitals disrupted by second wave; lower school attendance for disadvantaged pupils; and backlogs in the courts.

General

The news in the last few days has been dominated by the government’s announcement of new national restrictions in England, but away from the rolling headlines there has been lots of new writing and research.

Reflecting Institute for Government bias, I’m going to start with the publication of Performance Tracker 2020, our report on how public services coped with coronavirus from March to October. We found that coronavirus significantly disrupted public services, leading to growing backlogs which the government needs to address. However, some changes made in response to the pandemic, such as increased use of technology, improved public service performance, and the government should provide targeted funding to make sure these changes work effectively in the future. If you’re interested in finding out more, co-author of this blog Graham was on the panel at the report’s launch event.

NatCen’s 37th British Social Attitudes has launched, providing lots of interesting public opinion graphs for perusal. The data comes from July-October 2019, so reflects public attitudes before the pandemic. In that context, it is interesting to see a continuing trend of more positive attitudes to welfare. “It looks as though the pandemic has occurred at a time when there was already more empathy with the circumstances of the low paid and unemployed of working age — and that voters may therefore be looking to the government to make adequate provision for those whose livelihoods are threatened by the pandemic.” Another finding that caught my eye is the level of trust expressed in the UK government: a record low 15% said that they trusted government to place the needs of the nation above the interests of their party. In addition, a record 79% said that the system of governing Britain could be improved either ‘quite a lot’ or ‘a great deal’. It should of course be noted that the survey was conducted before the 2019 election, so it will be interesting to see if levels of trust increase in the 2020 survey. If you’re interested in the issue of trust, I recommend this fascinating piece by David Brooks in the Atlantic from a few weeks ago, which looks at falling levels of social trust in the US — relevant regardless of today’s election result.

Thiemo Fetzer (University of Warwick) has written a paper which examines a possible link between the ‘Eat Out to Help Out’ scheme, and an increase in Covid-19 infections. The headline finding is an 8–17% increase in local infection clusters linked to the scheme, but the research itself is very interesting for its use of rainfall data — read the paper to find out more.

Health and Social Care

One of the reasons for tighter restrictions across England was the increasing impact of Covid-19 on hospitals, reducing their capacity to carry out surgeries and treatments for non-Covid patients. Nottingham University Hospitals Trust has postponed some surgery for cancer patients, for example. Meanwhile the relationship between NHS England and Liverpool University Hospitals Trust appears to have become very tense, with Liverpool leaders accusing NHS England of delaying deciding whether to allow hospitals to undertake fewer elective appointments. More than 30% of the trust’s beds are occupied by Covid patients. The Healthcare Safety Investigation Branch has published recommendations on mitigating the risk of transmission within hospitals, and the NHS is starting to publish data on the number of Covid cases caught by patients and staff in hospitals. Finding a way through the second wave to give high quality care to both Covid and non-Covid patients is clearly a huge challenge. Since the new restrictions in England probably won’t have a significant impact for several weeks, NHS England should be more flexible and if necessary remove targets and associated payments for elective activity.

This has been another week filled with discussion about the Test, Trace and Isolate (TTI) system, which has manifestly failed in its aim of helping avoid the kind of restrictions that have now come into force across the UK. Adam Briggs argues that local contract tracing is vital, and suggests there needs to be a better partnership between local teams and NHS Test and Trace. Mengdie Zhuang and Ed Manley have argued that the government should improve TTI data handling (for example, publishing the time between someone receiving a positive test until their contracts are traced — a statistic which I was surprised to learn isn’t currently published). The Parliamentary Office of Science and Technology (POST) highlight the importance of people’s behaviour for the effectiveness of the TTI system, especially with self-isolation, which currently may be as low as 18%: unless people actually isolate when told to, the whole system doesn’t work. This is presumably one of the reasons why blanket restrictions have become necessary.

The possible link in the first wave of the pandemic between hospital discharge of untested patients and the spread of Covid-19 in social care settings remains controversial. This week Public Health Scotland published a report analysing Covid-19 outbreaks in care homes. The most significant factor for Covid-19 was the size of the care home — larger care homes were more likely to have outbreaks. By contrast, hospital discharge was a less significant factor: “Hospital discharge is associated with an increased risk of an outbreak when considered on its own. However, after accounting for care home size and other care home characteristics, the estimated risk of an outbreak reduces and is not statistically significant.”

Covid-19 is not the only consideration when thinking about hospital discharge. A Healthwatch and British Red Cross report, based on survey research, found problems with the accelerated discharge process used in the first wave. They found that 35% of people were not given a contact who they could get in touch with for further advice after discharge, despite this being part of the guidance. Providing resources to ensure a safe hospital discharge process was one of the recommendations we made in Performance Tracker 2020.

The Health Foundation is launching a new programme of work, focusing on the long-term implications of Covid-19. This is important for government too. Once we are past the immediate crisis — at some point in 2021, we all hope — the government needs to ensure that it overcomes short-termism and makes long-term thinking an important part of policymaking. The Institute for Government’s Jill Rutter has responded to questions on this topic, explaining some of the barriers that prevent effective long-term planning.

One of those long-term issues which urgently requires reform is social care. The University of Birmingham has published a new paper, which looks at how local authorities can effectively shape social care markets: the researchers find that ‘open market’ and ‘partnership’ approaches are more likely to be effective in responding to individual needs. The paper also includes the perennial recommendation for long-term sustainable funding from central government. Sam Dalton has written a blog arguing that ‘housing-with-care’, providing a combination of independence for older people with on-site care, can play an important role in the future.

Rebecca Fisher at the Health Foundation has also published new research exploring what the GP patient survey tells us about access to general practice — one of the key findings is that “the more deprived the area that a person lives in, the less likely they are to report a positive experience of accessing general practice and a good overall experience of general practice.” The survey was conducted before the pandemic, and consequently there have been major changes to general practice since then, particularly with the rapid uptake of technology. It is therefore important to understand how health inequalities may be impacted, or perhaps widened, if remote medicine has similar effects to remote learning.

The King’s Fund have published an informative briefing on new medicines in the NHS, which explains the processes for deciding whether NHS services in England will pay for patients to receive new, patented drugs, from the initial development and testing of drugs, the role of the National Institute for Health and Care Excellence, and negotiations between the NHS and pharmaceutical companies to agree prices.

Even though it feels like a very, very long time since the start of the pandemic in December, there remain a lot of unknowns about the virus. A column by Julian Tang explores the three main ways the virus spreads — droplets, aerosols, and surfaces — and suggests that aerosols may be more important than initially thought.

Children and Young People

Much of the focus this week has been the impact of the pandemic on children. Last week’s attendance data from the DfE showed that school attendance has declined due to Covid-19, with secondary school attendance dropping from 87% to 82%. More than half of secondary schools reported that they had one or more pupils self-isolating. Analysis of these attendance figures shows that, unsurprisingly, lower attendance in schools is observed in regions with higher infection rates. Liverpool secondary schools only had 67% attendance. In Scotland, attendance rates are lowest in the most deprived areas. In addition, lower school attendance within some regions, for example the north-west of England, is correlated with disadvantage (as measured by free school meals). This is very concerning given evidence suggests that disadvantaged pupils have spent less time learning during the spring lockdown. With case numbers continuing to rise, it is likely pupils will continue to miss out on significant learning time. The Education Policy Institute sum it up well: “this has particularly strong implications for pupils in exam years, who are more likely to be absent from school through being older. Coming on top of variable losses in learning time during lockdown, continuing COVID-related absences are going to make it incredibly hard to implement a fair exam process anything like that in a normal year. Policymakers designing assessment process for 2021 will need to recognise and account for the huge variations in lost learning time, and the continuing unpredictability of lost learning time and its actual impact on pupils.”

That issue of 2021 exams, a topic we’ve covered on this blog the last few weeks, is not going away. The qualifications regulator in Wales this week recommended that all timetabled 2021 exams should be cancelled, apart from one paper per subject for A Levels. They recommend that GCSEs and AS Levels be replaced by a combination of coursework and external assessments taken during the year, with schools given flexibility over when these take place.

In this context, the government’s National Tutoring Programme is particularly important. The scheme which aims to support disadvantaged pupils launched yesterday, on 2nd November.

Free school meals are another component of the debate about how best to support disadvantaged pupils. Jill Rutter wrote a great blog exposing the lack of clarity regarding which government minister or department is responsible for this policy issue, showing a massive co-ordination failure. Christine Farquharson from the IFS has analysed the cost of various different policy options for extending free school meals, finding that extending holiday meals until Easter would cost around £85m, and a permanent change to providing holiday meals would cost around £270m (based on the number of pupils who were eligible pre-pandemic). In Christine’s words, “that would be a substantial extension to spending on free school meals, though it could also have some wider benefits for children’s health and attainment. But any debate on whether this should be done will hinge on whether the COVID-19 pandemic has put exceptional stress on the budgets of the very poor families who are eligible for free school meals — or whether it has simply laid bare the challenges that families on very low incomes will continue to face even in more normal times.”

The IFS has also published their annual report on education spending in England. An important finding is that further education colleges and sixth forms have seen the largest falls in funding of any sector of the education system since 2010–11, which will be problematic given that the pandemic and associated economic downturn is predicted to lead to more pupils wanting to start courses in both.

Ofsted have published their inspection data for 2019/20 — although inspections were suspended from March 2020, so the number of inspections was lower than in previous years. Ofsted used a new inspection framework in 2019/20 for the first time. In general, however, there weren’t many dramatic changes compared to previous years. It remains the case that schools with the most deprived pupils are more likely to be graded as ‘requires improvement’ or ‘inadequate’ than schools with the least deprived pupils.

John Jerrim has written a helpful blog summarising a research paper on the mental health and wellbeing of teachers. It is common to hear the claim that teachers have worse mental health and wellbeing compared to other professions. However, according to Jerrim and colleagues, this isn’t the case. Their analysis suggests that “teachers do not have worse wellbeing and mental health outcomes than similar individuals [i.e. individuals with similar background characteristics such as age, gender, marital status, and education level].” While this is an interesting finding, it does not, of course, solve the ongoing challenges with teacher recruitment and retention.

A new report from Action for Children argues that ‘Staying Put’, the policy which allows children in care to stay with their foster families until they are 21, is being undermined by lack of funding — no funding has been announced beyond 2020/21. These young people have often experienced trauma and are some of the most disadvantaged in our society. Since the jobs market disruption caused by Covid-19 is particularly affecting young people, there is a very strong case for government to increase funding, and announce this for 2021/22 as soon as possible to provide some certainty.

Law and Order

The government has confirmed that courts will continue to operate during the period of new restrictions in England. This is probably on balance the right decision, given the significant backlogs in courts resulting from the suspension of activity in the spring.

A new report from Crest advisory made waves late last week, suggesting a huge increase in court backlogs over the next few years. It predicts backlogs in the crown court will quadruple and backlogs in the magistrates’ will increase 10-fold over the next few years. Our own performance tracker analysis has shown that court backlogs are increasing, and that the inability to process jury trials, which take far longer than other trials, means a record backlog that will be difficult to shift. However, the Crest numbers exaggerate the problem due to a series of questionable assumptions. They do not account for the fact that courts were already processing many more cases in the summer than they were in the spring. And their projections for the number of crimes that will be charged over the next few years — the main thing that drives huge increases in backlogs after this year in their model — are based on an inconsistent data series. The number of police recorded crimes have increased a lot since 2014, but most of that is due to improvements in data coverage and quality rather than a genuine rise (the crime survey of England and Wales shows no such rise over that period). They assume the increase is real, and will continue. Furthermore, they assume the police charging rate (charges divided by reported crimes) will return to 2010–2014 levels due to rising numbers of police officers. But the charging rate used to be much higher for exactly these same data quality reasons. So overall, are the courts going to struggle to clear Covid-induced backlogs? Definitely. Will backlogs be anything like the numbers in that much-publicised report? Highly unlikely.

Going into the spring lockdown, many people wondered what the impact on people’s behaviour might be. Books and films of the dystopian variety tend to imagine pandemic scenarios or other crises featuring a gradual breakdown of social behaviour, descending into chaos and violence. As psychologists pointed out in the spring however, evidence suggests that this is broadly inaccurate, since people often respond with pro-social behaviour in the face of a disaster or crisis. New ONS data perhaps supports this. Both crime recorded by police as well as crime recorded in survey data decreased by 19% in April to June 2020. Drug offences were an exception, rising by 30%, but this may well reflect increased police activity in pursuing these crimes.

Looking ahead, Dave Thompson, Chief Constable for West Midlands Police, has written a piece about policing after the pandemic for Reform. The paper argues for a greater focus on local communities: “Government needs to create a system incentive to shift the default from ‘policy in Whitehall’ to ‘delivery in place’. […] integrated placed-based data could provide the engine for far more effective and precise intervention.”

There have been lots of new research reports on prisons:

• The Prison Inspectorate released a report Minority ethnic prisoners’ experiences of rehabilitation and release planning, which found that “male BME prisoners reported poorer experiences than white prisoners about the range of factors commonly thought to be necessary for a rehabilitative culture to exist.”
• The Prison and Probation Service published a case-study report on drug use in prisons based on qualitative research. Among the findings was that “relationships between staff and residents, and within staffing groups were perceived as fundamental, and differed between prisons with higher levels of substance use and those with lower levels of substance use.”
• Reform published a new report on the use of technology in prisons — the lack of technology in prisons has caused real hardship to prisoners during the pandemic. The report recommends that “the Ministry of Justice should develop a plan for adapting the prison estate to enable in-cell connectivity and to provide in-cell devices to the entire prison estate, starting with prisons that could already support them. Funding to enable this should be provided through the upcoming Spending Review.”

Local Government

New Local published a report on employment support, an issue which will certainly get greater attention in the coming months and years as the country tries to recover from the disruption of Covid-19. The report’s key recommendation is to move responsibility for providing employment support away from DWP in order to facilitate a new, community-based approach. “The most dynamic and effective responses to the coronavirus crisis have been facilitated by collaboration between local government, public services, the third sector, businesses and communities — adding to a growing evidence base for the value of locally coordinated responses to complex challenges. This points the way to a different approach for designing and delivering employment support for people facing complex disadvantage.”

During the debate on free school meals, the government pointed to the £63m which it provided to councils in the summer for local welfare (known as the ‘Emergency Assistance Grant for Food and Essential Supplies’). However, the government expected this to be spent in 12 weeks. A new report from The Trussell Trust finds that local welfare has provided crucial support to people in hardship, warns that councils are facing a financial cliff edge, and recommends that government should extend the Emergency Assistance Grant until the end of the 2020/21 financial year.

A useful IFS blog looks at government funding for English councils. It examines how the funding formulas for allocating grants to local government have changed, and provides good suggestions as to how the government could provide greater certainty for councils even if the Spending Review only lasts for one year. The government can do this by setting out in broad terms how it will respond to the evolving economic and fiscal environment, and by providing clarity on what reviews of social care, business rates, and funding distribution (the Fair Funding review) will mean for local government.