The week in public services — 6th March 2018
This week: satisfaction with GP services drops; funding concerns for children’s services; and worries over the impact of Brexit on local government.
(This is a non-comprehensive overview of what is going on in public services by the Performance Tracker team at @instituteforgov. Did we miss something important? Let us know below.)
Health and social care:
The big news from last week was the latest public satisfaction data. New King’s Fund and Nuffield Trust analysis of the latest BSA survey highlighted a big drop in satisfaction with GPs, down 7 points from last year to 65%. Overall public satisfaction with the NHS was down 6% on last year to 57%, paired with a 7% increase in dissatisfaction to 29% — the highest level since 2007. Nuffield chief economist John Appleby also blogged about data on party allegiances showing that party supporters are more satisfied with the NHS when their party is governing, although this drops after a post-election ‘honeymoon period’.
Also last week, the NAO looked at emergency hospital emissions and concluded that the NHS has reduced the impact of rising emergency admissions by shortening length of stay, but we don’t yet know whether this will achieve lasting results: increased readmissions may be a sign that people are being discharged too soon. The NAO’s report includes recommendations for how DHSC, NHSE and NHSI can improve their data management.
In other research news, the King’s Fund have explored how to tackle clusters of ‘unhealthy behaviours’ (smoking, drinking, lack of exercise), making recommendations on how service providers can develop and share evidence, and how DHSC and PHE can support service innovation. And FullFact checked how much the NHS ‘internal market’ (the split of purchasers and providers established in 1991) actually costs, finding that no-one has really tried to calculate the impact. Whatever the impact, it’s probably not the £10bn figure that’s recently been doing the Twitter rounds after Chris Williamson MP said it on Question Time.
Nuffield Trust held their annual Health Policy Summit with some high-profile speakers, including Matthew d’Ancona on evidenced-based policy making, Julien Mousquès on integrated care, and NHSE chief executive Simon Stevens. Stevens discussed winter pressures, the need to reconfigure general practice to address GP numbers and figures for A&E admissions that stay overnight.
The wider context for this week is the upcoming Spring Statement — will the Chancellor spend the public finances windfall on health? Paul Johnson reckons he won’t, and that this is no bad thing. Yesterday, he praised the Chancellor’s announcement that the Spring Statement will start consultations on longer-term fiscal challenges, arguing that this, rather than big-bang tax and spending announcements at fiscal events, is the right approach to tackle the increasing health costs of an ageing population.
Education and Young People:
In schools, TES comments on research from Education Datalab which claims the performance gap between disadvantaged pupils of secondary schools in the north compared to London is based primarily on demography, rather than school effectiveness. According to the research, 58.5% of the ‘Progress 8’ gap between the north and London is explained by pupil characteristics, such as ethnicity and first language.
In children’s social care, a CommunityCare FoI investigation has found that agency social workers may be earning more than permanent social workers working the same hours, despite government legislation to prevent this. In the Guardian, former care minister Paul Burstow has proposed that social worker recruitment and retention problems mean that should be a priority for the new What Works Centre for Children’s Social Care. He argues for a workforce strategy for children’s social care, as well as learning from best practice.
The level of funding remains the elephant in the room. Last week, ADCS warned the Government that current funding arrangements for local government (and children’s services) are inadequate, citing the £2 billion funding gap by 2020 identified by the LGA last year. Their solution? A “long-term, sustainable funding solution […] underpinned by a relentless focus on earlier intervention and moving in and ‘out’ of families lives”. Responding to the Family and Childcare Trust’s annual childcare survey, which revealed a shortage of childcare alongside childcare costs rising faster than inflation, the LGA again emphasised that early intervention is valuable, but cash-strapped councils struggle to fund free early interventions such as education and childcare.
What’s the Government been up to? Yesterday, in response to consultation feedback, the Government announced it would not introduce new laws to force mandatory reporting of any concern relating to child abuse by practitioners, which the LGA welcomed. Despite calls for cash, the new children’s minister, Nadhim Zahawi, has argued strong leadership, rather than extra cash, is the key to turning around failing services.
Law and order:
What’s needed to reform criminal justice in the UK? Howard League chief executive Frances Cook writes in the Guardian that better investment in communities, as modelled in the US and New Zealand, will do more to reduce crime than the MoJ’s current priority of cleaning up prisons.
Yesterday, the LGA warned that reductions in central government Youth Offending Teams grants (which now make up only a third of YOT funding) will mean that council spending on youth offending will be increasingly competing with the rest of local government services, risking a shift away from preventative towards more short-term statutory spending.
Justice Secretary David Gauke spoke at the RSA this morning, where he announced a £14m investment in intelligence and technology to tackle organised crime in prisons, but rejected an artificial target for prison population reduction. PT’s Alice Lilly live-tweeted the event.
Local government:
Moving on to local government, Public Finance’s Emily Twinch writes that local councils are dipping into their reserves, which PT highlighted last year. Without better data, shrinking reserve levels are the best measure of how local councils are managing spending reductions.
The fallout from Northamptonshire continues (again). Sam Reed, the BBC Northampton politics reporter, meticulously live-tweeted the council’s meetings to try to agree a balanced budget. At The Guardian, Patrick Butler reports that pressures on Northamptonshire’s ‘skeletal’ adult social care provision led to spending and service reductions in other areas, including libraries, trading standards, rural bus services, and road repairs. A government-appointed inspector, stationed at the council since January, will produce a report on Northamptonshire’s governance and financial arrangements later this month.
Looking at the bigger picture, last Thursday the IFS warned that the planned full business rates retention may lead to funding divergences without promoting growth. The report found no relationship between changes in business rates tax bases and local economic growth, undermining the argument that business rates retention would create incentives for local authorities to pursue policies which boost local economic growth. And an NLGN survey of council leaders and local authority chief executives found that 61% believe Brexit will negatively impact their regions. In majority-leave North East, 100% of local authority leaders thought the impact of Brexit would be negative, compared to 48% in the majority-remain South East.
Finally, Joanne Fry questions the benefits of the merger of nine Dorset councils, announced last month. Fry argues the decision was purely political; she concludes the reorganisation will be disruptive and distracting for the authorities involved.
