The week in public services: 3rd September 2019

This week: a big Week in Public Services ahead of the SpendingRound featuring: what to look out for in Javid’s speech; no-deal and the NHS; £ for staff development; how education £ stack up; and Johnson’s promise to fix social care…

Spending Round rumours

The biggest waves in public services wonk-world is today’s spending review and all its implications.

The one thing you should definitely read is our new briefing on which public services faces the biggest pressures to restore performance back to pre-austerity levels. We reckon that’s adult social care and prisons — and that if the Government is committed to ending austerity in public services, they should be first in line.

That’s not to say additional funding in other public services isn’t necessary — after nine years of austerity face some pressures (from falling teacher retention rates to an increase in how long it takes the police to charge offences) — which well-targeted additional funding could ease. Just that if the aim to restore public services to where they were in 2010, it’s prisons and adult social care that should be at the top of the priority list.

If you want more, this is a great breakdown from the BBC giving the low-down of how tomorrow we’ll find out how much money departments will get to spend in the 2020/21 financial year — with the exception of schools and the NHS, whose budgets will stretch beyond this.

Hate the (fiscal) rules, not the game? After cancelling his speech last week, Sajid Javid’s spending review tomorrow is set to stick to the line that a one year review, as opposed to the usual three, is required so that extra funds are available in case of a no-deal Brexit.

And uncertainty over Brexit certainly makes it hard to make economic and fiscal forecasts. Richard Partington argues that this afternoon will just be splash-the-cash short-termism — warning that a no deal Brexit would make it exceedingly difficult to end austerity.

On top of that problem, both the Institute for Fiscal Studies and Resolution Foundation have warned that funding current spending pledges may require raising borrowing above the fiscal rules that the Government is currently tethered to…

Equally, Javid may not be too worried about increasing borrowing — as Hamish McRae points out, historically low interest rates are conducive to borrowing and argues that borrowing to take advantage of this would be in keeping with the global trend. We’re personally a bit more sceptical that low interest rates should be used to fund day-to-day spending on services — but I suppose the key point — that low interest rates make this a better time to borrow — holds up.

And if you’re wanting to just escape all of today, the Centre for Public Impact have written a really interesting case study of New Zealand’s public financial management reforms and how ‘new public management’ improved public services through smaller departments and effective accountability arrangements.

Health and Social Care

As the debate surrounding a no-deal Brexit intensifies, the King’s Fund, Nuffield Trust and the Health Foundation have issued a joint letter identifying the four major areas that will be impacted if the UK leaves without a deal on 31st October. Potential staffing crises, supply shortages and price rises , providing care for returning emigrants, and funding shortfalls (gulp) are their biggest concerns.

What could the Government do to prepare for these problems? Ahead of the Spending Round, Sajid Javid announced an increase in planned spending on NHS staff development — including £1,000 “personal development budgets” for nurses, midwives and allied health professionals.

That’s not the only commentary on NHS staff this week. Elseswhere, an interesting blog shows that the number of junior doctors taking up specialist training jobs is on course to fall for a third year in a row — with an increasing number becoming locums. The author’s conclusion? That medicine is increasingly turning into “a career for quite clever people who aren’t especially interested in money or status, but want part time work with ultimate flexibility”. And analysing both workforce and earnings data, this interesting thread from Billy Palmer concludes that GPs need more support in order to increase their participation — but that the answer is probably not to pay them more. Controversial!

In other think tank news, the King’s Fund have produced analysis looking at past trends in healthcare expenditure and what has driven this — and why there have been different trends for different kinds of care. The Health Foundation have also provided an integrated analysis of how policies across all sectors and levels of government have an effect on health, with global case studies examining how the wider determinants of health need to be factored into policy-making.

Back in the immediate world of the Spending Round: the Health Service Journal claims that a “scandalous” lack of capital investment means that clinical professionals are not able to deliver the standard or quality of care they would like. And arguing that saving the NHS will require “more than just a cash injection”, Denis Campbell points out that problems like the falling number of Full tine equivalent GPs will not be solved by short-term, pre-election handouts.

In social care, quietly, at the G7 international conference, Boris Johnson announced that his immediate plan to fix the crisis in social care will be unveiled “in due course”. Leaving aside how “immediate” this really is, this will require *cough* er… *checks notes* consensus. With this government’s confrontational approach to *checks notes again* just about everything, there shall have to be a radically different approach to build the cross-party agreement required to tackle to social care crisis.

The pressures in social care have been made all the more urgent by councils in England warning that they will be forced to decommission services unless the government provides more than £2.4bn in funding for elderly and younger adult social care next year (also detailed here).

Part of the problem is due to low social worker pay, which is contributing to high staff vacancies and turnover, rising the cost of labour for private and voluntary providers…who pass this costs on to councils, who commission services. Pointing out that real terms funding for social worker pay is £700m less in real terms than it was in 2010/11, this blog by the King’s Fund details how retail work in supermarkets pays a better hourly rate and that social care staff are also lost to the NHS. Their analysis suggesting that the social care workforce would need an additional £1.7bn spending to pay staff equivalent rates to NHS staff, following the recent NHS pay deal.

The All Party Parliamentary Group (APPG) on social care has issued a report on how to try and resolve the crisis, calling for a national programme of work to develop a social care workforce strategy to try and recognise the skill levels of the current workforce and professionalise it further.

Meanwhile, the Health Foundation has issued a five point plan for tackling social care that includes boosting staff pay, improving public access to care and introducing a Dilnot-style capped cost model — the latter of which already lies on the statute book.

Children and Young People

Education, education, (and even some further) education. It’s almost as if there’s an election coming up…

We’re expecting more detailed plans this afternoon, but leaked plans this afternoon gave the first indication of what to expect: additional £for primary and secondary schools, and a raft of new disciplinary measures. One key question is whether the number of teaching assistants will fall. Although Gavin Williamson is now education secretary, no rumours on whether new disciplinary measures will include telling pupils to “shut up and go away”.

In addition to this, Sajid Javid also announced that £400m would be available to colleges in England to help fund the new T-level qualification for technical and vocational courses. This comes as the Education Data Lab asks whether some qualifications are scored too generously, pointing out the grade discrepancies between English and Maths and technical awards.

Shockingly, there may be more to this than merely increasing funding for schools and instigating a debate on what “reasonable force” entails when an adult is disciplining a child. Aditya Chakraborty analyses the electoral calculus behind the increased focus on schools — it was a key battleground in the 2017 election and shall be again, including in key Tory target seats.

Moreover, some believe there are some unanswered questions. As set out in Times Educational Supplement, it’s curious that none of the spending is allocated for this year (especially given the likelihood of an election) and there are concerns that, as the national funding formula will be reset to redistribute money, schools with more pupils in need (measured by, amongst other things, whether they receive free school meals) could miss out.

How do the spending pledges actually stack up? The Education Policy Unit point out schools are the only public services other than the NHS to have their funding set out for a three year period; but the headline £14bn funding package (broken down here) that was announced is cumulative, and will be under pressure from both inflation and the rising number of pupils. The Institute for Fiscal Studies best estimate is that the funding will be (almost) enough to reverse the real-terms 8% per pupil cuts since 2009/10, restoring per-pupil funding to around those levels.

However, it’s not just about the money, money, money — though perhaps about the (ASBO) tag. The government also plans to ‘crack down on’ bad behaviour and, as well as approving the use of ‘reasonable force’ against pupils, will encourage the banning of mobile phones. There are also plans to expand the number of academies and free schools and to increase starting salaries for teachers to £30,000 by 2022/23. New measures aimed at rising standards in schools will be introduced, including schools ranked as ‘outstanding’ no longer being exempt from routine Ofsted inspections.

Indeed, though most of the discussion is around funding (with some mention of inspections), Ed Dorrell points out that many core education issues — such as teacher retention & recruitment and qualification reform — are in danger of being overlooked.

But what do the children think — and how happy are they? Latest Children’s Society report on healthy childhood reports that up to a quarter of a million children aged 10–15 are unhappy overall, with experience of financial strain or poverty in childhood inked to lower well-being by age 14.

Law and Order

The thin blue line? Responding to Sadiq Khan, Priti Patel revealed that the 20,000 new police officers will be allocated “between territorial, regional and national policing functions” — with estimates this could mean up to 7,000 being allocated to the national crime agency. Though this has led to accusations that the public have been misled over the number of officers who will be in frontline roles, as my colleague Benoit Guerin pointed out a few months ago, increasing the number of frontline officers may not be not the most effective way to reduce crime — particularly violent crime.

One really big problem when assessing how much pressure the police are under is that there is not much data analysing the breakdown of how police spend their time. This report on how responding to mental health incidents costs the Welsh police £1.2m a year is therefore an interesting insight. That these incidents can occupy officers for “10–12 hours” before a doctor arrives also illustrates the pressures facing frontline forces (though this presumably depends on the remoteness of the location).

Over in prisons, analysis by my colleague Graham Atkins on the then prisons minister Rory Stewart’s 10 prisons project finds that this did indeed make prisons safer — but that this was based on significant increases in staff and capital expenditure. To continue this will require new commitments in the 2020 Spending Review.

In a rather damning article, Eric Allison points out that Mr Johnson is ignoring the evidence on how rehabilitation lowers offending rates — and is opting for tougher punishments to woo the electorate.