The week in public services: 6th August 2019
This week: (Han)cocking up the Green Paper; Boris’ spending spree; and why social care reform is worth waiting for
General
Boris is promising a spending spree! All the details are well covered in the Financial Times. For how he’ll fund it…less clear. Our own Gemma Tetlow has the best explanation of what we know, here.
And a data scientist who is sceptical of data? Though this sounds like the sort of existential crisis that a doctor might get if they eat an apple, this blog raises salient points about the extent to which we conflate data with truth and the need to look at the bigger picture. Data is only as useful as the quality and skills of the person wielding it — though how reassuring this really is is up for debate. Perhaps it depends on whether one bytes off more than one can chew…
Health and Social Care
The big news this week was the new (sort of) capital funding for the NHS.
The best single piece you can read on this is Sally Gainsbury’s excellent analysis of Johnson’s announcement, revealing that, £1bn of that ‘new money’ is cash that hospitals were already promised — earning it in incentive payments for cutting their costs — but were previously not allowed to spend.
Another good article from Anita Charlesworth covers the same ground. As well as shiny new hospitals, she argues that that money could helpfully be put towards: surgery space in general practice; building maintenance; and IT upgrades. Less sexy, but equally important?
In slightly older news (politics moves fast…), rumours abound that Matt deliberately ‘Hancocked’ up the release of his own Green Paper in an apparent damascene conversion to shelve his support for so-called ‘sin taxes’ after Boris Johnson dismissed them.
And elsewhere, one of the most important bits of the NHS Long term Plan is the creation of new Primary Care Networks (PCNs) — hiring more healthcare professionals who can see people in primary care in order to relieve pressure on GPs. This King’s Fund blog looks at how mental health services fit into this.
In a Nuffield Trust blog, Helen Buckingham analyses the latest NHS long-term plan, based off of what we have learnt from past problems. Reasonably, she calls for consistency in approach and a plan that staff can actually understand…
Equally important in primary care are community pharmacies. If you’re in need of some, erm, light reading, the government has published the community pharmacy contractual framework — the 5 year deal designed to help deliver the NHS Long Term Plan. In addition to more money, it also outlines a range of reforms to reimbursement arrangements, aimed at delivering a smoother cash flow to community pharmacies.
Meanwhile, Public Health England have issued new guidance offering a ‘whole systems approach’ to obesity. Acknowledging that there’s no single solution when it comes to promoting a healthy weight, it calls for a system-wide approach that is tailored to local needs and works across someone’s life course.
Over in the world of social care, he chair of the Lords economics affairs committee, Lord Forsyth, reiterates the main message of the committee’s recent report into social care funding in an interview with The Guardian. Private insurance will not fix the social care crisis and a taxpayer funded, NHS-style overhaul is required
And an interesting article about how limits on publicly-funded social care affect older people’s employment, describing how one in four 50–64 year-olds in the UK are not in employment because of he informal care they provide.
When Boris announced that he was going to end 20 years of policy failure and fix the crisis in social care, was he setting himself up for a fall? Given the financial — and political pitfalls — he should be wary. As the Institute for Government’s own Nick Davies points out, massive political damage can be inflicted by poorly thought through social care proposals, as Theresa May found out to her cost in the 2017 general election…
More haste, less speed? The interesting, counter-intuitive yet well-considered case for why social care reform should be proceeding more slowly. Sally Warren, a former senior civil servant who sat on the Dilnot Commission, reflects on how Governments moving alone have rarely made lasting reforms — especially not in social care.
Children and Young People
I think the best work this week was Jon Andrews’ analysis of Johnson’s school pledges, and what ‘levelling up’ funding really means. The burning injustices are still very much burning — so how will the new PM’s proposals address them?
Please mind the (attainment) gap: interesting blog by the education data lab on the increasing gender gap in schools at key stage 2. How do you solve a problem like boy’s reading?
In a stark reminder that incentives matter, Labour MP Emma Hardy revealed that there is some evidence of state schools deliberately choosing expensive school uniforms to exclude poorer children.
Over in children’s social care, this great article by the children’s commissioner describes how, whilst the number of teenagers in care in England has risen, the number aged under five fell. This may be putting additional pressure on children’s social care, as teenagers typically have “vulnerabilities that require specialist support”. Further analysis on the faster growth of older children in care, why it’s happening and what it means can be found on this thread.
And how would we know if children’s social care is making a positive difference? In an excellent report, the Nuffield Centre tackles this issue head-on, with chapter 4 in particular providing via excellent tables suggesting how we can practically measure and understand improvements.
And an interesting parallel with another public service! There’s some evidence that new nurse registrations from EEA countries has been falling since June 2016, but as uncertainty surrounding a No-Deal Brexit grows, there seems to be a similar problem in the teaching profession. The number of European teachers given qualified teacher status in England has dropped by 35% since the referendum, with a leaked report estimating that a No-Deal Brexit could cost schools up to £85 million.
Law and Order
Hours after his predecessor David Gauke resigned, Robert Buckland was promoted to Lord Chancellor and Justice Secretary. According to the Law Gazette, we can expect business as usual — with Buckland set to continue with his predecessor’s agenda.
Buckland and his new ministerial have a lot on their plate. In an interesting report on the evolving nature of crime, Onward have detailed how a smaller number of criminals are accounting for a larger proportion of crimes committed — and how too few of these ‘super prolific criminals’ are being jailed.
Elsewhere in the realm of crime and policing, the Home Affairs select committee has argued that the Government’s serious violence strategy is inadequate and should be replaced with a ‘Youth Services Guarantee’ — a statutory guarantee which would ringfence funding for youth services. They also call for a greater role for the Home Office, and for the prime minister to make reducing serious youth violence a priority:
Out with a bang — or at least a parting salvo: in an interview to mark his retirement, the former national police lead for race argues that spending cuts to local services must end to restore the social fabric of society and allow police to concentrate on the most serious crimes.
In what makes for even more gloomy reading, Public Health England have released their annual Health and Justice review, analysing the long-term health trends in prisons. Covering everything from drug use, communicable diseases and bacterial wound infection, it is a roller coaster of a ride of the state of health behind bars.
Prisons remain one of the public services under most pressure. This fascinating interview with the governor of HMP Liverpool on turning around one of the country’s most troubled prisons points to the importance of the mundane: from fixing windows to controlling rat and cockroach infestations, it provides an insight on some of the simple measures required to help tackle some of the problems prisons face.
Last but not least, interesting reflections on 70 years of legal aid from Faith Gordon and Daniel Newman in The Conversation. Will this Government choose to give legal aid as big a 70th birthday present as the last Government gave the NHS? Safe to say lawyers aren’t holding their breath…
Local Government
A parting salvo about local government. In their report ‘Five stories about local authority planning’, the Royal Town Planning Institute investigate the effects council spending cuts have had on planning through five case studies. Safe to say spending cuts were not entirely offset by efficiencies…
