The week in public services: 4th June 2019
This week: Tory leaders make new school funding promises; the benefits of Sure Start; and radical council tax reform?
Public services in the Conservative leadership election
A special temporary section for this week. As candidates jostle for the Tory throne, we can expect to see a fair few pledges on public services.
Schools are in the spotlight this week, as Michael Gove has pledged £1bn extra for schools, restoring per pupil funding to the level it was in 2015. Whether this is enough to restore his popularity with teachers remains to be seen. Matt Hancock has gone one further and pledged a £3bn uplift over the next five years — thought details on exactly how that figure was reached, and how it will be distributed are scant.
Boris Johnson has also pledged to increase the level of per pupil funding, to ensure that every secondary school in England gets £5,000 per pupil. This sounds more generous than it is. Analysis by Schools Week finds that the pledge could be met for just £48.6m, a 0.1% increase in overall school funding. Johnson has also called for greater powers for heads to exclude pupils, parity of esteem for vocational training and apprenticeships, and greater focus on maths and languages in school.
This should all be seen in the bigger context of a renewed debate about the Conservative’s economic and fiscal strategy. Last month Onward, a centre-right think tank, called for “a new approach to the public finances”. This included a looser fiscal rule committing the Government to have the UKs debt:GDP ratio to “fall gently in normal years”, and increasing spending on public services including schools, the police, and prisons. A chunk of the party is in favour of this, following the prominence of schools and social care in the 2017 general election. Tellingly, Gove, Hancock, Hunt, Javid, and McVey have all come out in support of the report.
Public service transformation
We like data in Performance Tracker. But we also like to think we’re aware of the shortcomings of relying on it. So the Centre for Public Impact’s work banging the drum for a shift away from a ‘delivery’ (think hard targets, measurement, and management) to an ‘enablement’ (think of a focus on outcomes but with less process and structure) mindset was a good read. It pairs well with the essay on shortcomings of Delivery Units in solving complex problems.
Health and Social Care
Everyone’s talking about it already, but just to reiterate — this Panorama investigation into social care in Somerset, exposing the daily difficult decisions social care staff have to make, is excellent.
Meanwhile, the Health Foundation have analysed public spending per person on social care and found it is higher in Scotland and Wales than in England — presumably partly because of Scotland’s more generous system, where personal care is free at the point of use. They find that if funding had grown in line with demand in England after 2010/11, spending would have been £6bn higher than it was in 2017/18. Without additional government funding, they project that councils will face a gap between spending pressures and available resources of at least £2.7bn in 2023/24.
Outside of social care, Lawrence Dunhill at HSJ makes a convincing case (£) that new NHS chief finance officer Julian Kelly has inherited a “tinderbox” when it comes to hospital capital funding. All options involve annoying some NHS hospital leaders. Rock, meet hard place.
Over in general practice, a Freedom of Investigation survey by the magazine Pulse found that GP closures rose from 18 in 2013 to 138 in 2018. NHS England, however, disagree. The main point of dispute is how to count GP practices merging. Another Pulse survey of GPs found that 51% of GPs said they were working “beyond safe levels”.
Secretary of State Matt Hancock has pledged to remove immigrations restrictions for medics so that more doctors and nurses can come from abroad to work for the NHS. This is in response to the publication of the Interim NHS People Plan. Saffron Cordery of NHS Providers has welcomed the publication of a single plan that clear sets out the scale of NHS workforce challenge.
The ‘People Plan’ also involved Matt Hancock promising to reform GP pensions following well-documented problems earlier this year, which saw some doctors face large unexpected bills (a marginal tax rate of over 100%…) when they exceeded their pension annual allowances. The Government is consulting on whether to allow clinicians to halve their pension contributions in return for halving the rate of pension growth. This is important given that an independent review of general practice earlier this year found that pensions were often given as a reason for GPs taking early retirement.
Last but not least, the Institute for Public Policy Research have put out a new report on public health and prevention, ahead of the Government’s anticipated Prevention green paper. They want to see additional spending on the public health grant, ‘locked-in’ spending on prevention as part of the NHS 10 year plan, and for all new policies to go through a ‘health audit’ — akin to equality impact assessments.
Children and Young People
New Institute for Fiscal Studies (IFS) research has found that Sure Start children’s centres had a positive impact on children’s health outcomes. Specifically — greater access to centres is correlated with lower hospitalisations amongst primary school age-children. Most of the reductions were in children admitted for infections and injuries, with the biggest reduction in hospitalisations amongst children living in disadvantaged neighbourhoods.
So — time to reverse the spending cuts and bring the number of centres back to 2010 levels? Maybe. The IFS found that the reduction in primary school children hospitalisations offset 6% of the total cost of Sure Start. There are of course other impacts not measured — such as the effect of Sure Start on demand for children’s social care and child protection — but it’s worth thinking back on this year’s earlier National Audit Office report which found that “local authorities which have closed children’s centres have not had any consequential increases in child protection plans”.
The IFS themselves think the work raises two questions. Firstly — is the Sure Start budget enough, given evidence of the health benefits? Secondly — should Sure Start target disadvantaged areas to deliver greater value-for-money? More research is (as ever) needed — so it’s fortunate the IFS are working on it…
The latest Department for Education statistics show an increase in the number of children with Education, Health, and Care plans (support for special educational needs) in 2019, up from 2018. The number of those plans issued within the 20-week time limit also fell — suggesting councils are struggling to organise 0–25 plans within statutory timescales. After providing councils with an additional £250m for 2018/19 and 2019/20 to meet demand last December, the Department for Education are now consulting on the evidence of the need for additional funding.
The other big story is the publication of the independent Augar Review into post-18 (further and higher) education and funding. Whilst it’s beyond the scope of Performance Tracker, it’s making headlines as May’s final ‘legacy project’. There have been a little claims and counter-claims flying around the impact of the recommendations this morning, and how progressive/regressive they are. The things you need to read to understand what the review recommended are (mercifully) shorter:
· The Institute for Fiscal Studies’ quick reaction piece. TL;DR — the effects of the proposed changes to Higher Education would be regressive, although the overall system (with high-earning graduates paying back more of the cost of their degree) remains fairly progressive
· The Education Policy Institute’s reaction
And if you’re more interested in how likely the review’s recommendations have gone down with politicians and in the further and higher education sectors:
· Collated round-up of reactions from key organisations in the Times Educational Supplement
· BBC education editor Branwen Jeffrey’s tweet thread on the politics of the announcement
Labour are considering changes to council tax as part of wider land reforms. A new report commissioned by the party recommends replacing council tax with a “progressive property tax” to be paid by owners rather than tenants.
Conveniently, the latest Institute for Fiscal Studies briefing on council funding summarises all their existing work into one convenient package. Their leading message? Any Government faces big choices about the level and distribution of funding for local government (and local public services). The Government — and the public — will need to accept higher taxes or cutbacks elsewhere to pay for rising demand for public services, they argue. The former of which echoes precisely the conclusion of last year’s Performance Tracker — I’m counting this an endorsement we’re happy to receive!
On a similar note, the data-crunchers at the BBC Data Journalism Unit have identified eleven councils which will exhaust their reserves within four years if they continue to draw down on reserves at the same rate as they have over the last three years.
Could more insourcing help councils square the circle between rising demand and falling funding? A new report by the Association for Public Service Excellence finds that insourcing is becoming more popular — though there is limited quantitative evidence it can help councils save money or raise revenues, beyond a few interesting case studies. (One could also say the same for outsourcing…)
Law and Order
A comparatively quieter week this week. The Law Society published a new report on the use of algorithms in criminal justice, calling for a clear legal framework in which the police, courts and other public services can use algorithms.