The Week in Public Services, 9th April 2019

This week: Councils’ spending on agency social workers; reforming prisons; and a riddle: when is £2.1bn not £2.1bn?


In pope-possibly-catholic levels of predictability, the Chancellor has confirmed that ‘ending austerity’ does not mean every department will see a real-terms increase in funding. What does it mean? Still up for debate. His full letter to the Treasury select committee is here.

Health and Social Care

“National bodies — the Department of Health & Social Care (the Department), NHS England and NHS Improvement — painted an overly positive picture of the future financial sustainability of the NHS, lacked detail on delivering the NHS Long Term Plan, and underestimate[d] the challenges”. The latest Public Accounts Committee report is not a ringing endorsement of the Department of Health and Social Care and NHS bodies’ performance. But, it does, at least pick up on many of the problems. A problem (definition) shared is a problem halved, right?

And when is £2.1bn for NHS hospitals not really £2.1bn? When it’s accompanied by some head-spinning accounting changes that only Sally Gainsbury can explain. Great blog on why NHS Improvement’s proposal to cap NHS Foundation Trust capital spending undermines the Sustainability and Transformation Fund (STF) promises. The STF said that NHS Trusts and Foundation Trusts would be rewarded with money from the Sustainability and Transformation Fund (which in practice they’d have to spend on capital) in exchange for making savings beyond breaking even, in order to bring the overall NHS provider sector out of deficit and into financial balance.

To be fair to NHS Improvement: their proposal would end the odd convention that NHS Foundation Trusts are free to invest their own surpluses in capital whilst the Department of Health and Social Care are responsible for the capital spending totals — which NHS Foundation Trust spending contributes towards. However: if Foundation Trusts are no longer free to determine what they do with their surpluses, why should they bother making them at all? IMO, Sally’s conclusion — that “Whitehall [appears] willing to potentially junk so much clinical trust, rather than contemplate the alternative remedy of seeking a marginal increase to the health department’s capital spending allowance to absorb the risk that continued foundation trust freedoms might pose” — is bang on.

Meanwhile, the chair of Health Education England has said that the Treasury removed money from Continuing Professional Development (training) budgets in order to increase the number of nurses in training. He also argued that public services are “insufficiently flexible” when it comes to recruitment, and aren’t doing enough to retain existing staff. Worth reading in light of the growing focus on recruitment and retention.

On a more encouraging note, Natasha Curry’s latest Nuffield Trust blog — outlining what a good social care system would look like — is a good read. She argues that any system should prioritise: consistent eligibility, clarity on benefits, stable provision, and a sustainable vision — drawing on how social care is funded in Germany and Japan.

Children and Young People

The Department for Education have announced that they will create a new register of children not in school, including those educated at home. The Local Government Association are supportive. Worth reading alongside this SchoolsWeek article on whether interventions ‘cause’ poor mental health or vice-versa.

The Department for Education have also finally got their website to advertise teaching vacancies online today! Might seem like a minor announcement, but the Government has been promising this for a while, and it should help schools cut down on some recruitment and advertising fees. Good news.

Meanwhile, the Children’s Commissioner has written a good set of blogs about what both the NHS plan and the Government’s Internet Safety white paper mean for children. TL;DR — clearly more of a focus (there are several specific commitments to improve services for children in the NHS plan, for example) but the Children’s Commissioner still see some shortcomings. This year, the Commissioner will “work closely with 12 local authorities to understand how much they spend on different groups of vulnerable children, in order to inform the Government’s Spending Review”. Worth keeping an eye on as spending on care and protection increases whilst spending on preventative services is cut, which we have detailed here.

A new report from the Institute of Public Policy Research North analyses changing levels of support for people with learning disabilities. They find that rising demand has meant that increases to the schools high-needs funding block led to “a substantially reduced offer” and “a hollowing-out of wider SEND provision”.

Knife crime is no longer across all headlines, but discussion about what explains rising youth violence continues. Here’s two good pieces to read.

The Guardian has sent Freedom of Information requests to councils and found that councils spent at least £335m on agency staff in 2017/18. If the figures are comparable with this BBC investigation from a few years ago, that would suggest spend has roughly doubled since 2012/13 (when spending on agency workers as £180m). But is £335m a big number? It’s about 4% of annual council spending on children’s social care (£9.2bn in 2017/18) — so not huge, but big enough to have an impact.

Last but not least, The House of Commons Library have published a comprehensive new briefing on children’s social care — which cites our very own Performance Tracker (always proud whenever we get cited by the great and the good that constitute the House Library!)

Law and Order

“Inefficient, ineffective and unsustainable”: the Justice Select committee’s verdict on the Government’s prisons policy. The whole report, though, is much more detailed and insightful — on current problems, the Government’s current reform plans, and what could be done to make prisons financially sustainable at the Spending Review. I’m a fan — I think the biggest revelation is just how much the Ministry of Justice think prisoner numbers would have to fall in order to maintain “business-as-usual”. Sentencing reform alone won’t be enough…

Responding to the report, two good articles — by Rob Allen and Simon Jenkins — explore the practical challenges of sentencing reform. MPs often endorse the principle of shorter sentences, but in practice — normally under significant media pressure to ‘do something’ — vote to change laws to increase sentences which result greater use of prison.

Neighbourhood Services

Three very different stories this week:

Firstly, the New Local Government Network’s latest survey of council leaders finds that their confidence to deliver adult social care and children’s services has ticked up since last quarter — possibly the effect of the recent spending announcements — but is still much lower than for all other council services, such as environmental services and economic development.

Secondly, Simon Parker of Redbridge has written an interesting blog on whether we’re really undergoing a ‘paradigm shift’ in public services. His take? Cautious optimism that there is greater acceptance that “the goal is nothing less than to shift our focus from delivering services to shaping better places that produce fewer social ills in the first place”.

Last but not least — it’s council elections (for 8000 councillors) next month!

This BBC article explores why turnout tends to be so much lower than national elections.

Last year, my colleague Emily explained the five things you need to know before you vote in the local elections — and questions to ask prospective candidates. Things have changed in local government — and for the latest on local public services, you should read Performance Tracker, obviously — but I’d still suggest that asking any prospective door-knocking candidates how they will manage (and prioritise between) services given a tight spending settlement and rising demand, would be a useful exercise.



A weekly publication from team public services @instituteforgov — a non-comprehensive overview of what’s going on in public services in the UK

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Graham Atkins

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