The Week in Public Services 6th August 2020
This week: How fit public services were for coronavirus, Scottish exams controversy, and local test and trace schemes
General
How fit were public services for the pandemic? This week, we the Public Services Team at the Institute for Government published our latest paper asking exactly that. We looked at how prepared and how resilient the nine public services we cover in our annual Performance Tracker report were and uncovered a mixed picture. This RAG table gives you the overall picture:
For excellent summaries and interesting highlights, check out threads from my excellent colleagues Nick Davies, Graham Atkins and Benoit Guerin.
Lawrence Freedman — who was on the panel of the Iraq Inquiry — has written about the kind of inquiry we need into the country’s response to the pandemic. He outlines a model different to the familiar inquiry paradigm with a need for speedier lesson-learning and a focus on hearings rather than interrogating witnesses. It chimes with what IfG’s Director of Research Emma Norris has previously said: while a full-scale public inquiry is inevitable, a rapid review is also essential to prepare for a second wave.
If you think things are bad now, they have the potential to get a lot worse in coming months. An unholy mix of a coronavirus second wave could be joined by winter flu, winter flooding (remember this last year) and significant disruption from the end of the Brexit transition period, potentially without a deal. The public might not be so understanding if similar mistakes are made a second time round. My colleague Nick looks at what we’ve found about how prepared services are for a so-called second wave. Labour leader Keir Starmer has set out how he thinks the government should up its game.
Katy Balls in the Guardian gives a good overview of the medium-term challenges facing the chancellor, whose reputation so far has been enhanced by the pandemic. A ‘new normal’ is unlikely to involve the austerity of the coalition era which leaves tax rises and internal Tory arguments to come about who they should fall on. There’s an example in New Statesman as John Elledge walks through the knotty problem of paying for social care.
It’s official: Britain had the highest excess death rate in Europe in the first half of this year. The international data comparison from the Office for National Statistics showed that while Spain had the highest peak mortality, England had the longest continuous period of excess mortality of any country compared. David Spiegelhalter has written a good article looking at some of the reasons why but there are no simple answers.
Health and Social Care
It’s a sign of the times we’re in that Matt Hancock opened his recent speech to the Royal College of Physicians by talking about the Great Fire of London. The wide-ranging speech included the structural (health care reform) as well as the practical (tele-consultations to be the norm), but as my colleague Nick observes (yes, he’s been writing a lot lately), it’s not clear how much will survive contact with reality and it all seems to be at odds with Number 10’s desire for more central government control of healthcare. ‘Nothing about how’ is the verdict from Andy Cowper to the government so fond of three word slogans.
On the tele-consultations point, there’s been a hive of activity looking at the effectiveness of using technology for GP appointments. A team led by Professor Trisha Greenhalgh has been awarded £750,000 from the Economic and Social Research Council to study the technology GP surgeries use, while one study already says that a digital-first access policy to primary care could increase GPs workload ‘unless stringent conditions are met.’ A survey of GP patient experience shows that while many find remote consultations convenient and quicker, there is no one-size-fits-all solution. GPs themselves have cautioned against the government’s enthusiasm for technology here, accusing the health secretary of failing to understand ‘the importance of human contact’.
The government also published the NHS People Plan, which it says has NHS staff wellbeing at its heart. While there are some good measures in there, especially when it comes to collecting more data on BAME employees, there’s a sense that it ignores the elephant(s) in the room. Organisations such as The Royal College of Nursing have criticised the fact that it doesn’t address the fundamental issues of staff pay or nursing shortages. The Nuffield Trust takes a look at NHS staff pay across the board in their chart of the week showing just how worse pay is compared to 2010 (in real terms).
Away from the armchair epidemiologists, a project founded by The Health Foundation last year has turned its attention to the use of data in the pandemic. The Networked Data Lab has found that linked data — where available — has been crucial to local COVID-19 responses. Meanwhile, timely and inclusive communication is paramount in situations where standard operating procedures are being developed every few days, argues this HSJ piece. It warns: ‘We have a brief window of opportunity to reflect on our initial local responses, listen to our teams and resolve issues we identify before the second wave hits.’
A report from the Public Accounts Committee strongly criticised the discharging of patients into England’s care homes without prior Covid-19 testing. It said this illustrated the ‘years of inattention, funding cuts and delayed reforms […] compounded by the Government’s slow, inconsistent and, at times, negligent approach to giving the sector the support it needed during the pandemic.’ If you think that’s brutal, consider the story of one hospital trust CEO who claims he was pressured to delay hospital lockdown measures, perhaps causing 25 unnecessary deaths. You can’t help but think that behind the huge death toll will be numerous stories like this.
The National Care Forum said the report didn’t come as a surprise and asked whether the UK’s response was world beating — or beaten by the world? In case the rhetorical nature passed you by, SAGE committee member Professor John Edmunds told BBC’s Newsnight ‘I honestly couldn’t care less whether it’s world beating or not […] I just wanted it to be virus beating’ (h/t POLITICO’s London Playbook). Also from the BBC is this must-watch Panorama on ‘the forgotten frontline’, showing how care homes struggled to cope with the pandemic.
In another crisis waiting to happen it seems as if ministers have abandoned their pledge to regularly test people in care homes throughout the summer. Some adult care homes won’t be able to order test kits until the end of August. If I weren’t typing my hands would be on my head. In case you needed reminded, Full Fact have a handy tally of the government’s… chequered history on meeting testing pledges.
A new study suggests that additional public adult social care expenditure yields a relatively small increase in the care-related quality of life of patients. It puts the cost of a social care-quality-adjusted life year at over £322,000 which is considerably higher than other studies (although they do not account for the varying costs of different types of care) and would have value-for-money implications for public policymakers.
The World Health Organisation has published a policy brief examining the prevention and management of COVID-19 across long-term care services. It warns that concerted action to tackle COVID-19 in the long-term care sector is a necessary step to controlling the virus overall and offers sensible, if slightly vague, steps to mitigate it in care settings. Meanwhile, a report from Digital Social Care and the Institute of Public Care at Oxford Brookes examines how technology has been used by adult social care providers during the pandemic. Increased technological use has brought improved communication and reduced administrative effort for some, but this step change needs better understanding of digital literacy across the adult social care sector to be sustainable.
And new analysis from The Health Foundation looks at the social care response beyond care homes where social care policy has been concentrated. Excess deaths of those in domiciliary care have been greater proportionally then those in care homes (which have been well documented).
From the oldest to youngest in society, a report from UCL looks at the impact of the pandemic on health visiting in England. Unsurprisingly, health visitors have been redeployed, with workload increasing for the remaining while traditional face-to-face contact has been limited. The report warns that health visiting services need to be prepared for future waves of the virus with a clear workforce plan to avoid vulnerable children slipping through the net.
Finally, a thoughtful piece from King’s Fund Senior Fellow Simon Bottery who makes the excellent point that near-instant, knee jerk reactions to possible social care reform policies means they are ‘shot down unmercifully before they have really been considered.’ There’s a long history of this but there is no secret about how studiously some in Number 10 follow initial reactions to policy ideas.
Children and Young People
The release of exam grades in Scotland has caused widespread anger as thousand received grades lower than they were predicted by teachers. With no exams, teachers submitted estimates which were then moderated nationally, resulting in 125,000 lowered grades. Among individual tales of heartbreak and thwarted plans, it appears as if the poorest pupils have had their grades lowered more than the richest pupils.
While unmoderated grades would have resulted in a stunning set of results across the board, Stephen Bush makes a compelling argument for why a slightly more optimistic assessment could be justified — a one off set of inflated grades produces some ‘overqualified’ students which higher and further education courses can distinguish between. On the other hand, downward revisions shut off doors to pupils which are hard or impossible to reopen again. Meanwhile in England, Labour have called for clarity on English exams after what’s happened north of the border and Ofqual have reported that some types of schools had submitted more optimistic GCSE and A Level grades, but wouldn’t say which. Some analysis from FFT Education Datalab suggests that it’s lower attaining schools who have tended to submit more optimistic grades compared to previous years.
This all deserves some real analysis and thought in the coming months because this year might not be quite the one-off some are saying it is. Unions have accused the government of having its head in the sand over next year’s GCSE and A Level exams, which are also likely to be severely impacted by the pandemic. The National Education Union has said that next year’s results ‘will become more a measure of which groups of students lost the most access to learning under Covid’ if course content is not set at a realistic level.
A comprehensive study from the Royal Society looks at the balance of risks in reopening schools, saying that the evidence on the negative impact of keeping schools closed is high. This is true: the economy cannot fully reopen while schools are shut and the longer they are shut the more damage is done to educational inequalities. It also argues that the evidence on the infection risk from schools reopening is limited but where it does exist, suggest that the risk from school reopening will not be as high as restarting other activities. The Covid risk is immediate and dominating decision-making across the country, while the damage to children’s education is plainly less apparent right now. Ultimately, it’s a balance of two risks of a fundamentally different nature.
Children are being failed by a body designed to protect them is the worrying summary of a report into the Children and Family Court Advisory and Support Service which is meant to assess and protect the welfare of children in court cases. More then 200 pages details structural failings where its workers ‘could ignore, dismiss, or sometimes misrepresent or manipulate children’s views’. Family law journalist Louise Tickle has a writeup of an organisation that is clearly not fit for purpose.
Other childcare workers aren’t faring much better — one in eight of them earn less than £5 an hour in England, according to a new report from the Social Mobility Commission. The average wage is significantly less than the average pay for female workers who make up 96% of the sector’s workforce.
Law and Order
Government U-Turn Klaxon! Ministers have been told that collecting nationality information from defendants at the beginning of trials — a policy introduced in 2017 as part of the ‘hostile environment’ — breaches privacy laws. A damming 90% of legal practitioners felt the policy had ‘a negative impact on perceptions of fairness.’ It’s not hard to see how.
Meanwhile the Home Office is facing a legal challenge after cutting financial support without warning to trafficking survivors. Legal challenges of individual cases have resulted in the support being re-instating on a case by case basis with lawyers and charities now working on overturning the cuts for hundreds of others.
A new report from the Police Foundation’s Strategic Review of Policing in England and Wales takes a look at how policing has changed over the past two decades. It finds that three interconnecting factors of technological change, globalisation and the rise of more complex social problems have transformed public safety challenges. A second phase of the review will examine how policing should evolve over the next 20 years.
And the Centre for Crime and Justice Studies has a new report out looking at preparedness, prevention and control of COVID-19 in prisons across Europe. It makes particularly good use of tables for each area so you can easily compare how different countries have responded to the crisis.
Local Government
Councils across the country unhappy with the NHS Test and Trace scheme (price tag £10bn and counting) are setting up their own to try and curb local flare ups. Greater Manchester is following Blackburn and Darwen — where infection rates are some of the highest in the country — in launching a local, bespoke scheme to trace those who haven’t been contacted by the national scheme. This was the approach taken by Sandwell Council in the West Midlands, which cited particular concerns with the national scheme contacting people who did not speak English.
The claim that local authorities are better placed to track down people in their own area seems a pretty reasonable one. Some of the staff on the national scheme seem to agree, with one saying that ‘the whole thing would have made more sense if it had been local from the beginning.’ Professor of public health Allyson Pollock blames the government’s shunning of local systems on its desire to outsource to large private companies such as Serco. The details of these contracts haven’t been published.
And finally, on top of all of that, some people in Cheshire, no wait, Greater Manchester are having this additional worry. As someone living in a London Borough with a Kent postcode I know the sort of identity crisis these revelations can provoke.
