The week in public services: 6th May 2020
This week: targeting 100,000 tests, BAME deaths, care home pressures and backlogs in the criminal justice system
General
Katy Balls on why the government’s electoral coalition means it is unlikely to pursue another round of austerity based on public spending cuts. A return to austerity would be a hard sell not just to Tory MPs but for Tory MPs in the ‘red wall’ seats that gave the government its comfortable majority. The party is more likely to focus on growth and relax its attitude towards government borrowing instead.
Important Centre for Public Impact story on how public services are changing at the frontline — starting with children’s social care. It features conversations with three children’s social care workers and asks what can be learnt about the care system now to make the best possible changes in the recovery and rebuilding stages of the crisis.
And a good (£) article from Rob Shrimsley on how the health and work divides that coronavirus has exposed are unlikely to go away as some sectors won’t be able to practice effective social distancing and more regulation will be an added burden to already-struggling firms. What’s more, remedial public policy can suffer from an ‘empathy gap’, e.g. ministers had not considered the high numbers of staff who did not have a car and couldn’t use drive-through test centres.
Health and Social Care
If you like this Venn diagram there are a few more from Tortoise’s resident cartoonist Edith you’ll want to check out.
Right, so let’s talk about that target to hit 100,000 tests a day which the government was supposed to hit last Thursday, shall we? We wrote a blog, arguing that although the target probably focused civil service on how to increase testing capacity, we can’t say whether 100,000 is the right number of tests — because we still don’t understand what the government’s exit strategy is.
Whatever comes next, the government needs to make sure it uses that target to learn about how testing is going — where capacity is needed, why it’s not on track (if it isn’t), and what interventions have worked to boost testing take-up — not just shout at officials for missing/hitting an arbitrary number. They will need to look at more granular data than the top line number of tests per day.
Along similar lines, Colin Talbot argued on Twitter that “an arbitrary target — 100k tests — replaced a clear idea of what, and who, we needed widespread testing for.” For the full detail about what NHS leaders think of the target, check out this NHS Providers briefing.
For more material on targets:
· Why targets are a terrible way to do government from Jessica Studdert, Deputy Director at The New Local Government Network
· This post from the civil servant in charge of testing at PHE, Professor John Newton:
Of course a test-and-trace strategy requires more than just targets, as Phil Whitaker points out in the NS: “Hancock’s 100,000 tests a day will be pointless unless we have the manpower and organisational structures to do the necessary contact tracing for those proven to have Covid-19”
The government made every effort to tell people that it had hit its target last week. Andy Cowper has dug deeper and produced another forensic examination of the government’s comms.
There has been increasing talk for some time now on how different communities are faring. An IFS report on the effects of coronavirus on BAME communities is a must-read. It finds that the impacts of the crisis are not uniform across ethnic groups and that per-capita coronavirus hospital deaths are highest among the black Caribbean population and three times those of the white British majority.
With an increasing focus on deaths in care homes, what do the numbers tell us? Nigel Edwards and Natasha Curry from Nuffield Trust explain here. Plus this from The King’s Fund on how care homes have adapted to the virus and what staff working in care homes need. But there’s also some nice news for a change: this Guardian story covers heart-warming cases of committed care home staff who have moved in to protect their residents.
In hospitals, the chief executive of the London Nightingale hospital — which is now to be mothballed — has called on the government to double intensive care unit capacity “on a permanent basis”. Meanwhile, HSJ report (£) that NHS England have set out a six-week plan to restart non-covid care. Lawrence Dunhill and Dave West’s summaries here and here are helpful. Lots of unanswered questions though — how far is it possible to run acute services while allowing patients to keep a safe distance from one another? Will mental health services get more money to provide additional services? Who is responsible for identifying and writing vulnerable patients who need to ‘shield’ (self-isolate)? The new NHS guidance is available here — and HSJ’s take on the “complex, uncertain and controversial” restart is here.
This comes as delays to cancer screening programmes are apparently widespread, according to this document from NHS England.
And now to GPs: Is NHS England encouraging general practice to flip reverse it? They estimate that 85% of GP appointments are now remote, compared to 90% of appointments being face-to-face normally (sorry).
The latest NHS England data for GP appointments also show a fall in appointments and shift to telephone at the end of March (and, yes, I know it’s probably undercounting online appointments before you tell me). The shift to remote working was clearly better than restricting appointments, but there are questions about remote appointments that need to be answered after this crisis, as Graham has written about, here.
On social care, Prof John Bolton has written a paper highlighting new problems that have emerged in adult social care during the pandemic and how they might push it over the edge.
I call app Britain: The government has announced that it will be trialing the NHS’s contact-tracing app on the Isle of Wight. However, this from Kieren McCarthy suggests that there could be a major flaw with the proposed app: it will only work when opened and running in the foreground. Quite a technical piece but well worth a read.
Lastly, Tom Chivers asks whether the lockdown is doing more harm than good. Keeping people indoors for six week and counting is not costless. But despite that and the uncertainty, he concludes yes — the lockdown is probably worth it. If you haven’t come across ‘quality-adjusted life years’ or QALYs, you will have after this.
Children and Young People
Good Economist (£) article summarising research on effects of school closures on pupils. TL:DR — it’s not good, and it’s likely to increase existing education inequalities. “Closures especially affect the poorest and the youngest school-goers. Those less likely to have access to three meals a day, an internet-enabled computer, highly educated parents, an available teacher and a safe quiet space to study will fare worst.”
Alix Robertson from the Centre for Education Youth has summarised what we learned from Gavin Williamson’s session in front of the education select committee. While SAGE is still exploring the best way to reopen schools, the education secretary told the committee that the process will definitely involve a phased approach.
The Education Policy Institute has published a new paper on the impact of coronavirus on pupil learning outcomes. It says that a doubling of the Pupil Premium is needed for poorer pupils entering Year 1, Year 7 and Year 11 to prevent a significant widening of the attainment gap.
Kathy Evans from Children England on how commissioning and procurement have changed during coronavirus, and how to make improvements stick.
There’s new Children’s Commissioner research on identifying children at risk in different local authorities. Its local area profiles of child vulnerability should be informing local authority decision making on its coronavirus response.
And there’s a useful summary of problems emerging from coronavirus that children’s sector professionals (i.e. teachers, social workers, charity youth workers and the like) have identified from Children England. Nuffield Trust also published a blog about how to support children during the crisis.
Law and order
Last week the IfG released its report on the criminal justice system, which is under pressure from both coronavirus and the government’s plans to recruit an additional 20,000 police officers. It calculates that the prison population could rise to its highest-ever level and that waiting times to hear cases could increase by more than 70% in the event of a six-month lockdown. Russell Webster at Work with Offenders has produced a good write up of it.
There’s new research from Dr Simon Cooper at the University of Essex on how the Police and Crime Commissioners’ setup affects accountability.
‘Once the Coronavirus crisis is over, the prison crisis won’t be’ — Rob Allen on changes in the criminal justice system.
The WHO published an assessment of the impact of government efforts to reduce coronavirus transmission in prisons. ‘Explosive outbreaks’ in prisons are not yet being seen and there is evidence of containment of outbreaks that have occurred.
The government has announced new tech to hear non-jury criminal trials remotely with some data on the extent of audio and video technology used in courtrooms. Latest figures for towards the end of April show 90% of hearings using video/audio technology.
Local government
The Local Government Association has called on the government to provide another £10bn to cover local government’s falling income and rising costs, as they say the £3.2bn allocated so far has not been enough. A (genuinely) funny and critical column from Nick Golding looks at why this is, and concludes that “the lame attempts to half-heartedly plug councils’ budget shortfall show [local government], as ever, awaiting scraps from the centre”.
Steve Pleasant makes the case for local government to be a bigger part of the Covid-19 response. As does Colin Talbot, in a very even-handed post.
And here’s some examples of good local organisation from NLGN.
Following last week’s stories, more evidence of how much of a shambles centralised PPE procurement has been. And seemingly more refusal to share central modelling and analysis with local resilience forums and councils…
