The Week in Public Services — 5th March 2019
This week: rising concern about knife crime; Spring Statement rumours; and how Brexit will affect public services
General
On the one hand, the impact of Brexit for public services isn’t too hard to predict: all else being equal, a lower tax take and less Government revenue means less money available to fund public services. And a more restrictive migration policy will reduce the pool of labour for public service workers, whilst lowering demand from migrants for public services. But on the other hand, I haven’t seen anyone think through the implications systematically…
Until now! This great LSE paper does just that. Their conclusion? “The (net) effects of a reduction [in migration from EU countries] are likely to be more significant in terms of the delivery of high quality services than in relieving pressure on these services”.
We hear a lot about the transformative potential of technology in public services — but a lack of suitably-qualified IT professionals could slow the speed of digital change in public services. An issue to bear in mind when talk of transformation starts rearing its head at the Spending Review.
Spring Statement: rumours
A temporary section this week covers what we know so far about this March’s set-piece fiscal event. Next week will cover what actually happened. So far, the key points are that:
- The independent Office for Budgetary Responsibility (who produce the official forecasts for public finances at fiscal events) are likely to revise tax revenues slightly upwards — giving the chancellor a little extra money to play with
- There will be no new policy announcements (so the Treasury have briefed)
- We may or may not get the spending envelope — the amount of money the Government intends to spend over the next few years — for this year’s Spending Review. Mixed rumours.
If that’s not enough for you, Matt Whittaker’s typically great pre-Statement briefing is…great. Again!
Health and Social Care
The super-wonky, super-interesting Nuffield Trust annual summit covering everything from the welfare state to integrating health and social care was last week — you can catch up here. Health inequalities was one theme from the summit — and 10 years on from the Marmot Review into health inequalities, Sir Michael Marmot argues that the Government needs to now focus on the social determinants of health — early years and education; work and income; and housing, places and communities. The NHS workforce was another — and this good blog from Michael West explains the growing recruitment and retention problems. To improve, the workforce plan should focus on the basics, such as providing somewhere to get food and hot drinks on night shifts, he argues.
In wonkier news, the latest NHS board papers are out. Sally Gainsbury explains what the technical detail means — that the regulator NHS Improvement has proposed capping independent Foundation Trusts capital investment, by introducing spending controls — in her usual eloquence. (Point 14 here). And Simon Stevens, current chief executive of NHS England, has apparently figured out a way to be in charge of both NHS England and NHS Improvement. Sort of. Concerns about centralising power and conflicting roles aside, I think my colleague Chris has the best take.
“Paid off still going on!!” This verdict, on a man who managed to get NHS-funded social care for his mother with Alzheimer’s following an arduous process, is not a good look for a Clinical Commissioning Group (CCG). A Telegraph investigation of Continuing Healthcare — social care for people with long-term complex health needs arranged and funded solely by the NHS — finds that CCGs are increasingly refusing to fund claims for it. They argue that CCGs are deliberately restricting eligibility where they would once not have done so in order to make planned savings. Concerning reading — though despite concerns from the Telegraph and the Mail, I’m (still) yet to see any of the right-leaning papers whole-heartedly endorse any option to increase funding to address limits to eligibility. Hm.
And a good article on the A&E waiting times targets. Even if the clinical review this (or next?) month recommends removing the 4 hour target, the author argues that it would still (technically) require a change in law as it’s enshrined in the NHS Constitution. (Authorial sidenote: I think the Government can effectively make the target toothless without changing the law, by removing penalties, as they have done for most Trusts since April 2016). Changing the target might “manage public expectation and help focus finite resources”. But if NHS Trusts are given the thumbs-up to ignore it in practice by NHS England and NHS Improvement, there is a concern that patients could end up waiting longer.
Last but not least, wouldn’t it be nice if we could all agree on something in health policy, given the divisions which have become more pronounced since Brexit? Turns out we do — on health funding! Jon Sussex and colleagues from RAND have found “remarkably consistent views across all age and income groups of the population, all levels of education and states of health, and in all four countries of the UK […] on funding health and social care“. What do we want? A progressive tax system, it turns out. Full paper, as commissioned by the Health Foundation, here.
In social care news, a coalition of NHS providers, including NHS Confederation and NHS providers, have called on Theresa May to set out a long-term social care settlement. Also in social care: a new Reform report on personal budgets — agreed pots of money to an individual to spend on their support needs — argues that if they are to be expanded, the Government should collect evidence on outcomes to assess their value-for-money, and ensure that councils provide the information required for citizens to make informed choices.
Children and Young People
Children with special needs statements or Education, Health, and Care plans (EHCPs) are increasingly going to special schools (independent, alternative provision, and non-maintained schools), and the number of children with EHCPs in secondary schools is projected to increase 15% between 2018 and 2027 — meaning there will be another 15,000 pupils with special needs in 2027 compared to 2018.
The Department for Education project that 9000 of these pupils will attend special schools, so they presumably think that the other 6000 can go to mainstream schools. But there has been a consistent decline in the number of pupils with special needs attending mainstream schools. 6000 children with special needs attending mainstream schools would reverse this trend — so do mainstream schools still have the expertise and funding to accommodate them? And will the Department’s new way of measuring progress act as a disincentive for mainstream schools to take them on? Great blog by Dave Thompson.
A new report from the Children’s Commissioner finds early warning signs that gang-based violence is rising, and council board for safeguarding children are not doing enough to identify children in, or at risk of joining, gangs.
Law and Order
The main story this week is rising concern about knife crime. Eight newspapers have led with knife crime stories this morning. Ben Chu from Newsnight has an excellent two minute piece rounding up the factors which could explain the rise. The timing of knife crime incidents matters too, as I’ve pointed out here.
Some commentators are concerned that school exclusions could be driving a rise. Raphael Hogarth has a great round-up of the evidence (or lack thereof) on whether exclusions drive knife crime.
It is, however, worth remembering that whilst levels of recorded knife crime are higher than in 2010 (where comparable records began), overall violent crime in England and Wales is much lower than it was in the 1990s
The rise in serious further offences (SFOs) since Grayling’s probation reforms have put probation staff under the spotlight, whilst ignoring the consequences of Grayling’s reforms, such as rising staff caseloads. Individual staff are subject to greater scrutiny whilst there is no political accountability, argues Hardeep Matharu.
Sticking with probation, the National Audit Office have concluded that the probation outsourcing “has achieved poor value for money for the taxpayer” owing to a lack of innovation and an increase in the average number of reoffences each reoffender commits. In total, they estimate that “the Ministry will pay at least £467 million more than was required under the original contracts”. This does not bode well for David Gauke’s ambition to reduce short prison sentences by using more community sentences.
In cheerier listening, Professor Alison Liebling, a criminologist at the University of Cambridge, has recorded a fascinating podcast on “What makes for a successful prison?”
Neighbourhood Services
The biggest story this week is another good Bureau of Investigative Journalism investigation. They have found that councils raised a total of £9.1 billion from selling 12,000 public assets, based on a compilation of asset sales since 2014/15. Concerningly, the Bureau found evidence of a link between asset sales and redundancies, suggesting that councils could be using the money from asset sales to fund redundancy packages. I wouldn’t put it quite so starkly — councils could have to invested money from asset sales into transformation projects — new technology or new ways of working — which improved efficiency, and reduced need for staff, necessitating redundancies. But it’s certainly an interesting finding.
For context: the Government changed rules preventing councils using money from asset sales for ‘transformation’ projects classified as day-to-day spending a few years ago, taking effect in 2016/17. The Bureau’s investigation found that since the rules were relaxed, the average number of redundancies was 75% higher at councils that made use of the new spending powers than at those which did not.
In other journalism news, the Huff Post have written a piece on the consequences of library cuts. East Sussex council is apparently considering charging for library membership.
We don’t cover planning when we talk about neighbourhood services in Performance Tracker. But the good folk at the Royal Town Planning Institute do — and they reckon austerity’s had a big impact. Worth reading this good piece from Daniel Slade.
To round off the week: the Economist have covered the trend of councils investing in commercial property to provide them with income to fund public services. Sure. I guess it’s one alternative to the Government letting councils raise council tax rates? I dare say it might be a touch more complicated…
