The Week in Public Services: 4th March 2021

This week: Budget reaction; the vaccination programme so far; and the educational attainment gap at age 16–19

Budget reaction

The main headline from yesterday’s budget is that the Chancellor did not allocate any new money to public services. The Chancellor did specify some money from the Covid reserve fund will be spent on vaccine rollout (£1.7bn) and education ‘catch up’ (£0.4bn). However, the 2020 spending review included a large reserve fund for Covid-related costs in 2020/21 and 2021/22, and this gives the Chancellor some flexibility moving forward. Read Graham’s first reaction here.

There has also been a lot of post-budget day noise about NHS funding being cut. This both does and doesn’t make sense. Here are the four points you need to know:

• NHS funding is only being ‘cut’ because the government’s allocation for Covid-19 next year is £15bn lower than it was in 2020/21. Core NHS funding continues to increase in line with the NHS five-year funding plan announced in 2018.

• As mentioned, the government has a Covid reserve fund (with £44.1bn left for next year, following yesterday’s budget announcements) — so if there are any extra Covid pressures on the NHS, there is some cash set aside to deal with it already.
• The big story here isn’t that NHS funding is being cut next year, but that there is no provision for Covid costs after 2021/22, and no change to the NHS five-year funding settlement. That is extraordinarily unrealistic for two reasons. First, it is almost certain there will be long-term impacts of Covid on spending, such as likely annual vaccinations, an ongoing Test and Trace programme for suppressing outbreaks, and support for people struggling with mental illness as a result of the pandemic. Second, the government has ambitions for a more resilient health service so that it can respond better to future crises.
• The ultimate resolution to this is either that the government scales back its ambitions (and Labour hammers them for waiting time performance) or that it increases the core NHS funding settlement (in which case, hello higher borrowing, higher taxes, or lower spending on other services). This autumn’s Spending Review will be where the difficult decisions come, and will be much more consequential for the NHS than yesterday’s budget.

Some further points about the budget:

• Excluding emergency coronavirus spending, the government plans for day-to-day spending to increase by 2.1% in real terms each year after 2021/22. Given existing commitments to the NHS, schools, defence, and aid, this implies a decrease in real-terms spending for all other ‘unprotected’ areas of government spending in 2022/23.
• The budget failed to provide additional funding to tackle backlogs in public services — most notably NHS backlogs for elective procedures, and backlogs in the criminal courts.
• Paul Johnson thinks this is unrealistic: “In reality, there will be pressures from all sorts of directions. The NHS is perhaps the most obvious. Further top-ups seem near-inevitable. Catching up on lost learning in schools, dealing with the backlog in our courts system, supporting public transport providers, and fixing our system for social care funding would all require additional spending. The Chancellor’s medium-term spending plans simply look implausibly low.”
• Ben Zaranko (IFS) agrees: “Given the substantial and mounting pressures on the NHS, schools and other services, one has to wonder whether these spending totals have been set implausibly low so as to flatter the public finance forecasts.”
• Social care was, once again, notable by its absence… will the government announce something this year? Or maybe next year?
• New Local have a handy guide to the frankly baffling number of place-based funding schemes — there’s now a Towns Fund, a Levelling Up Fund and the UK Shared Prosperity Fund.

General

The Institute for Government has a new report on how to be an effective commissioner. Recommended reading for those interested in the new role of Patient Safety Commissioner in England and in Scotland. These positions are being created after they were recommended by the Cumberlege review. As this blog discusses, Wales and Northern Ireland have not yet announced similar positions — but if they do, it would be sensible to think about how the Commissioners can co-ordinate and learn from each other.

Health and Social Care

An excellent Health Foundation long-read presents analysis of the vaccination programme so far, covering effects, inequalities and logistics. There are emerging issues of inequality: “Those who live in the most deprived areas are less likely to be vaccinated than those who live in the wealthiest areas, despite being at greater risk of death.” The IfG held an excellent event earlier today, ‘How to build on the success of the vaccine rollout’ — if you missed it the recording will be available shortly.

As discussed in the budget section, expect a lot of focus on waiting times for elective care. Over 200,000 people have waited for more than a year (as of December 2020). However, there are patients with higher clinical needs who will need to be treated first. It is also vital to give staff time off to rest and recover after a year of Covid pressures. This isn’t an easy problem to fix. One point worth noting — we may see the number of people waiting more than a year for elective procedures improve in April to June, because of the dramatic decline in referrals during the first lockdown.

Some worry that the NHS will ‘never catch up’ with the ophthalmology backlogs that developed during Covid — although some Trusts have set up regional centres to speed up how quickly patients can be seen.

Isabel Hardman argues that ministers are not facing up to the reality of the NHS backlogs: “Between their warm words about protecting the NHS and saving lives, ministers seem to have less time to talk about what this backlog means. Put baldly, it means that many people will be sicker when they receive treatment.”

In the recovery phase of the pandemic, the Health Foundation argues that this is a good time for policymakers to start planning for the long-term. The authors give three examples where long-term planning is needed: strengthening health care capacity and resilience to shocks; addressing widening health inequalities; and fundamental reform of social care. On that last point, Conservative councillors are about twice as likely to support more funding for social care compared to MPs, reports The Times (£)… but it seems doubtful their support is enough to bring about ‘fundamental reform’. Ultimately the government needs to commit to a reform plan (with more funding).

In vaguely-terrifying-but-actually-good-news, London hospitals are being asked to plan for a Covid surge in late 2021. At least planning is happening now, with plenty of time (we hope) before any third wave might occur.

Discussion about planned NHS reform carries on: have a look at this thread for the legal complexities of the new Integrated Care Systems… and how much is really different. Meanwhile Fraser Battye (The Strategy Unit) hopes that the reforms present an opportunity for more localism in the NHS.

The Centre for Progressive Policy has a new paper which argues that key workers, such as those working in the social care sector, should receive better pay after enabling the country to keep functioning during the pandemic. Care workers and home carers had a death rate from Covid over three times higher than the average working age person, yet their hourly earnings are nearly 30% below the median.

The Alan Turing Institute conducted an interesting research project to assess who is most vulnerable to coronavirus misinformation, based on a group of 1,700 people from the UK. “Our results show that individuals with lower digital literacy, numerical literacy, health literacy and cognitive skills fare worse at assessing the veracity of health-related statements. Unexpectedly, most sociodemographic, socioeconomic and political factors made little or no difference.”

Children and Young People

The Education Policy Institute have a fascinating new report on the educational attainment gap among 16–19 year olds. Most previous research has focused on the attainment gap among primary and secondary children, so this is a valuable addition to the research landscape. The report finds that on average, disadvantaged students are around three A Level grades (or equivalent) behind their non-disadvantaged peers. These gaps are largest in academic qualifications such as A Levels: “disadvantaged students on average achieved half a grade less in every A level entered compared to non-disadvantaged students.” Lower prior attainment of disadvantaged students is the largest factor behind the attainment gap, but does not explain all of it. The authors argue that targeted funding for disadvantaged students aged 16–19 could help close the gap.

The Local Government Association commissioned a literature review on the experience of children and young people during the pandemic. This reported several negative impacts, for example worsening mental health and a decline in physical activity. On the other hand, some children reported positive experiences of learning from home, and have enjoyed spending more time with their family.

Discussions about longer school days continue. This interesting Times Red Box piece suggests that longer school days could actually increase, rather than decrease, educational inequality. This is because middle-class parents are generally positive about the idea, but poorer parents are already concerned about their children’s mental health and worry that longer school days would add extra stress and anxiety.

On a related theme, Jonathan Simons (Public First) has a great blog on a problem with the government’s tutoring programme — in focus groups, parents simply don’t know it exists. He argues the DfE should increase communications to parents, in order to improve take-up of its tutoring scheme — a key part of the overall strategy to help disadvantaged children recover after such a disrupted year.

The latest DfE children’s social care survey was published yesterday (it has been running since May). This shows that the number of staff not working due to Covid-19 has stabilised, but that the total number of children who started to be looked after since May is around 28% lower than the same period in previous years. Despite this, the total number of looked-after children is actually 2% higher than in 2019–20, because of a reduction in children leaving care. These would appear to be results of Covid disruption.

FFT Education DataLab have analysed A Level subject combinations — the most popular combinations are (unsurprisingly) STEM subjects, probably reflecting career path requirements.

Finally — and tangentially — this blog by Matthew Yglesias is very interesting on why the debate around school closures has been different in the US compared to most European countries.

Law and Order

Some research on the police this week:

• The Police inspectorate HMICFRS has published a new report, which says that “police forces must explain the disproportionate use of police powers such as stop and search and use of force on Black, Asian and Minority Ethnic people or risk losing the trust of the communities they serve.”
• A blog by Stephen Walcott (Police Foundation) looks at diversity in the police service, arguing that more radical reform is required so that police officers are representative of the communities they serve.
• Why are more police offers voluntarily resigning? Dr Sarah Charman and Dr Stephanie Bennett (Institute of Criminal Justice Studies, University of Portsmouth), using a small-scale survey, find that the most common reason is “poor leadership and management.”

And some news we missed from a few weeks ago — the ONS released crime statistics for the year ending September 2020. Danny Shaw analyses the figures for Crest Advisory. Police recorded crime fell 6% for the year, with burglary (down 20%) and robbery (down 16%) recording the biggest falls. This primarily reflects lockdown restrictions in the period of April to June. Drug offences rose 16%, driven by a large increase in the same April to June period when police were more proactive and had more resources available. It will be interesting to see if the same kind of pattern is observable in the first few months of 2021.

Local Government

Another one we missed recently — the IFS published a report on the implications for council tax of the pandemic’s effects on employment and income, and variation across England. “While council tax revenues increased 0.4% in the first half of the 2020–21 fiscal year compared with 2019–20, pre-COVID forecasts were for an increase of 5.4%. This suggests a shortfall in revenue of almost £0.9 billion in the first half of the fiscal year, with LAs predicting a full-year impact of around £1.3 billion.”

The Local Government Association commissioned BritainThinks to research how public opinion has changed as a result of Covid-19. Based on a group of 50 people from England and Wales, they find that most people’s perceptions of their local areas have not been significantly changed by the pandemic, although “there is widespread appreciation for the additional community spirit generated by the pandemic.”