The week in public services — 7th November 2018

This week: fallout from the Budget; new children’s services research; and Matt Hancock wants people to take back control…of their own health

Public Spending

But first, an experimental new section! We write about public services here, not public spending — but it seems odd to exclude the big political debate about the level of public spending we want and the ‘end of austerity’ when this directly impacts on the public services we cover.

The big question: did spreadsheet Phil’s flurry of spending announcements buy public support? Sort of. Polling from Ipsos Mori indicates that public opinion is turning against austerity — across party lines — but few believe the Chancellor will actually increase spending. Personally, I thought the range of announcements disguised a lack of large spending changes. The current spending trajectory implies a ‘famine’ Spending Review for public services outside the NHS, but the Government hadn’t made that clear (and that’s a problem)!

Health and Social Care

Take back control…of your own health, says Matt Hancock, who wants people to take greater responsibility for making healthy lifestyle choices. Reaction so far has been…mixed. There’s no new legislation on the cards, but Hancock says he is aiming to allocate more of the NHS budget to preventative activity. You can read the full strategy here, which promises to make social prescribing available in every part of the country by 2023, and halve childhood obesity by 2030.

My excellent colleague Chris points out the strategy doesn’t have much to say about funding for public health. Matt Hancock is keeping us in suspense until the 2019 Spending Review but important to remember that public health was also a priority in the 2014 Five Year Forward View…after which funding for public health was significantly cut. Public health expert Greg Fell’s thoughts are also well-worth reading. The Health Foundation have crunched budget numbers to show that the wider health budget is falling as day-to-day spending on the NHS increases.

It is, however, not all about spending with us — we also care about services. The UCL Institute of Health Equity have found that two out of five people with learning disabilities are not diagnosed in childhood, and people with learning disabilities are likely to die 15–20 years sooner than the general population.

Similarly bad news in prison healthcare. The uncertainty of waiting for a hospital appointment is difficult enough; but imagine if you knew that, when the time came, you might not actually be able to go. That’s the situation being faced by many prisoners — according to an interesting blog from the Nuffield Trust.

In social care, data from the National Association of Care Catering show that a quarter of councils have stopped providing a meals-on-wheels services since 2014. And we may have reached the tipping point in the adult social care market. The sector regulator, the Care Quality Commission, has warned that Allied Healthcare, a major homecare provider, is “at risk” of being unable to continue to operate — the first time they’ve issued a warning about a specific company, and not just a sector. This comes in a context of other worries about and sustainability of care homes, which I outlined.

Finally, an interesting National Institute of Economic and Social Research (NIESR) blog on how exposed social care is if the Government follows the advice in the autumn Migration Advisory committee report. NIESR are not convinced that British workers will fill vacancies if wages are made more attractive, given that there is little evidence of this happening following the introduction of, and increase to, the minimum wage for over 25’s (the ‘national living wage’). Their full report also finds a correlation between waiting times and NHS Trusts which are losing European workers. On a similar note, Paul Corrigan makes the simple argument that “single biggest problem in the NHS at the moment is that we don’t have enough people wanting to work in it”.

The report also led me to this super-interesting piece of NIESR research from earlier this year, which analysed the impact of introducing a higher minimum wage in different industries. Interviews with social care providers revealed competition for workers with other providers and the retail sector meant that even in the absence of the minimum wage, social care providers were unlikely to have tried large-scale reductions in pay.

Neighbourhood Services

Fantastic, straightforward, House of Commons library briefing on local government finance. Pairs well with this well-written New Yorker piece on the consequences of spending cuts in Northamptonshire.

East Sussex also looks to be going down the path of Northamptonshire, as their chief executive claims that even a ‘core offer’ — the minimum services the council must legally provide — can’t be sustained for longer than the next three years. Proposals in their ‘core offer’ document reveal the hard choices confronting councils in itself. Councils aren’t talking about making efficiencies any more — most proposals are either to cut services or increase charging.

Meanwhile, a new report from Demos and The Reading Agency looks at the role libraries and reading can play in addressing the ‘loneliness epidemic’ — the large numbers of older people reporting feeling isolated or lonely — which are set to grow over the next decade. They call on the Government to invest £200m in libraries, including encouraging the NHS to support “book-based interventions” as part of a social prescribing — an alternative to acute medicine — strategy.

And a really interesting story from north of the border — Scottish councils are also facing significant financial pressures and want council tax reform, and for council-run health and care services to get ‘Barnett consequentials’ — the Treasury mechanism for automatically adjusting the amount of public expenditure allocated to the devolved nations to reflect changes in spending levels allocated to public services in England.

Law and Order

The new report from the PAC echoes our own findings on police pressures and performance: large cuts to both spending and staff appear to have been mostly absorbed in the early years — but public dissatisfaction is on the rise, and the government has insufficient understanding of what the police actually do with their time. One place their access allows them to go further: the Home Office is ‘not showing strategic leadership of the policing system’ — which will make it much harder for them to fathom a reasonable settlement at the 2019 Spending Review

Children and Young People

Snuck out after their budget analysis, the IFS published a fascinating report on education spending last week. There are now no socio-economic differences in total education spending, which was previously skewed towards the better-off (children in higher income households). This owes to a range of trends: targeting school funding towards poorer pupils and poorer pupils’ increasing participation in 16–18 education were particularly significant. Pairs well with this excellent 30 min radio show from Professor Becky Allen on the impact of Pupil Premium — targeted funding for disadvantaged students introduced under the Coalition government.

We need to talk about teacher retention. Rising turnover rates, coupled with evidence that most teachers leaving the profession take a pay cut suggest that teaching workload is becoming a serious barrier to retaining teachers. Are politicians taking it seriously?

There are signs they are — on Monday, Damian Hinds wrote to headteachers to reiterate his commitment to reducing workload, promising to “reduce the need to collect unnecessary or excessive pupil data” in response to the final report of the Teacher workload advisory group. Chair of the review, Professor Becky Allen, has written about her experience of writing it here, which is well worth reading. Also published on the same day: the Teachers Working Longer Review. That review’s recommendations can be found here (pp. 20–23).

Moving onto those “little extras”. Schools will get an extra £400m for capital investments — but it won’t be going on any new PFI or PF2 contracts. The chancellor promised no new PFI or PF2 contracts last week — but ones already signed will continue until their contracts are up. Schools are concerned, however, that putting the centre for best practice in managing PFI contracts in the Department for Health and Social Care means they won’t have access to it.

In children’s services, youth services spending cuts have led to drastic service deteriorations, according to evidence from the All Party Parliamentary Group on Youth Affairs’ youth work inquiry. The Local Government Association claim that more than 600 youth centres closed between 2012 and 2016, according to 2016 Unison data derived from freedom of information requests. Councils are also failing to offer support to children with irregular immigration statuses because they are not identifying them, say children’s charity Coram.

The sorts of projects the £84m announced for children’s social care in last week’s budget will fund will look to Leeds, North Yorkshire, and Hertfordshire for inspiration. (These councils have attempted to reduce numbers of children in need and children in care through projects which aim to keep families together).

But can early intervention actually reduce the number of children in care? A thoughtful blog from chief social worker Isabelle Trowler tries to answer this. She argues that unevidenced or poorly-targeted early help services are unhelpful if sold as a panacea to reducing child abuse and neglect, setting public and political expectations “too high”. A longer version of her argument is available here: there is a particular lack of services designed for highly vulnerable children on the edge of care e.g. for children and parents in the pre-proceedings court stage.

It’s reasonably well-rehearsed now, but this explanation of pressures facing children’s services from the Director of Children’s Services and Education at Kent County Council is a very succinct and helpful primer. Worcestershire county council has started a voluntary redundancy scheme — though excluding children’s social workers — as it’s currently in the red owing to social care overspending. Rumours that Cornwall council would sure up its’ children’s services by introducing means-tested charges for family support services are apparently not going ahead — but illustrate the increasing trend of charging which we highlighted in Performance Tracker.

The big news, however, is the latest edition of the Association of Directors of Children’s Services’ regular Safeguarding Pressures report — one of the biggest sources of evidence on demand and activity in children’s social care beyond Department for Education statistics.

The whole thing is (obviously) worth reading, but my biggest takeaways were: cost shunting between other public services and children’s social care, and reforms in other services increasing pressures on children’s social care.

Children’s services departments are picking up the cost of supporting families with no recourse to public funds. Increasingly risk-averse courts are asking for evidence that all routes other than separation have been explored, incurring extra costs for councils. Reforms to special educational needs and disability (SEND) policy led to a growth in complex Education, Health and Care (EHC) plans requiring more input from social care and health professionals. And difficulties accessing Children and Adolescent mental health services led to an increase in early help assessments due to concerns about children’s mental health, for examples.

Qualitative responses to questions suggest that the biggest workforce recruitment and retention problems are in child protection, referral, and assessment teams. Alison Holt at the BBC and Children and Young People Now have covered the findings here (putting them in longer context) and here. You can read the Association of Directors of Children’s Services’ response to the budget, here.

Last but not least — a heart-wrenching tale of a family’s struggle to find support for their daughter’s special educational needs (SEN). Vital reading to put serious SEN financial pressures in human context. If you read one link from this week’s edition, make it this.

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Graham Atkins

Graham Atkins

Senior Researcher @instituteforgov: public services, infrastructure, other things. Too often found running silly distances in sillier weather.