The week in public services: 9th April 2020
This week: social care and covid-19; changes in courts; and speculating about the long-term effects of this crisis
General
Insightful interview with Martin O’Malley on how states and local government in the US should structure their response to Covid-19. He thinks: unified command; tracking all relevant data in scoreboards to be able to explain to the public what’ happening; and prioritising making time for public communications.
Health and Social Care
The big story for the indefinite future is coronavirus and the government’s response to it — though I’m going to try to focus on what’s changing in response to it, rather than the day-to-day. That said, if you want to know more about the government’s day-to-day response, this Reuters article is in an-depth investigation into how scientific advice and government policy changed between January and March this year. It’s clear that testing, funding, and the scope of the pool of experts advising government, amongst other things, will be key issues in the inevitable inquiry, according to the former director of maternal and child health at the World Health Organization.
More generally, Andy Cowper wrote a good article on the ‘two cultures’ in the NHS, and rounded up last week’s major news. This article from Nick Timmins — on how governments’ responses to this pandemic are far different to the response to Spanish flu, or even the Hong Kong flu epidemic of 1969 and 1970 — also puts the current crisis into stark historical perspective.
And if, like me, you’re starting to get overloaded and confused from the sheer volume of Covid-19 statistics, this helpful explainer from Anthony Masters explains the different sources of mortality data in the UK, what they’re useful for, and why they differ. A public service, which pairs well with this Royal Statistical Society guide. This set of articles from Cambridge summarising how different countries have responded to coronavirus is also a very valuable resource.
Anyhow, onto the main thing. Starting immodestly, I’ve written about three ways I think NHS and social care funding could change after this crisis for Prospect. TL;DR — no more belt-tightening and more money for social care. Cheers to Alex Dean for letting me write this.
Richard Murray from the Kings Fund — quite rightly — warns though that government faces supply constraints in spending any extra money. Put simply, you can’t spend the money on extra nurses if there are no extra nurses around…workforce planning will have to be a priority once this crisis is over.
David Oliver has also written about the innovations that this crisis is forcing, including changes to outpatient appointments. Meanwhile, former Blair health advisor Paul Corrigan is writing an interesting series of blogs speculating about what might change after the crisis, including contingency planning and general practice. The British Medical Journal have published a useful guide on remote consultations, covering some common challenges.
Elsewhere, Nick Carding has dutifully documented how use of NHS apps and phone services is absolutely through the roof, particularly the NHS 111 phone service. There have been roughly as many downloads of the NHS app — a way of booking and accessing services online — in the last month as there have been in the last six months. NHS Digital documents similar trends — as do these useful live data tables from general practices registered with AskMyGP.
Meanwhile, remote video consultation provider, Livi, saw its remote consultations double between 1 February and 13 March compared to the six weeks before. Another provider, Nye Health, has also a rapid expansion, and says it has received interest from venture capital investors.
In data news, Matt Hancock has implemented a six-month order asking NHS organisations to share confidential patient information, effectively telling all councils, GPs and NHS bodies that they are required to share data to inform the government’s response to Covid 19.
That’s not to say all things are rosy in the world of NHS digital and technology. Jeni Tenison from the Open Data Institute is concerned about lack of transparency — particularly when it comes to the evidence behind the UK government’s strategy. She argues that the UK could learn from other countries — Italy, for example, has published mortality data on GitHub since the start of March, in more granular detail than the UK publishes. Perhaps even more worryingly, HSJ reports some hospital chief executives as worrying that NHS England is not sharing essential data on critical care bed capacity with all staff.
That is of course not all. Other interesting stuff still on my reading list:
· The Nuffield Trust’s Louella Vaughan article about the specific support smaller hospitals need to whether coronavirus
· The Kings Fund and the Nuffield Trust have published the latest figures from the annual survey of public satisfaction with the NHS and social care…
· …and perhaps strangely, public satisfaction with the NHS rose last year (John Appleby and Dan Wellings try to make sense of why, here)
· This IFS briefing on how the changes in the NHS will affect the health and wealth of the most vulnerable
And remember Brexit? It’d be easy to forget in the current context — which makes this article from Mark Dayan particularly useful. He reminds us that the NHS will still face difficulties at the end of the transition period in December if the UK and EU stick to their current timetable. What are these problems? Well, leaving potentially introduces additional barriers to moving ‘clinical consumables’ such as masks and needles between the UK and EU countries, and makes the UK subject to any EU export bans — who have already put temporary restrictions on personal protective equipment.
Mark’s conclusion? “If officials believe that the pandemic is likely to be in full force at the time we leave the single market and customs union, and that our departure will create prolonged difficulty getting supplies into the UK, any responsible government would need to think again.”
And what’s happening to social care during this crisis? Shaun Lintern has been investigating for The Independent. His interviews with care providers revealed their fears that their PPE orders have been diverted to the NHS, and that a lack of nurses in care homes meant they will struggle to support older people being discharged form hospital with Covid 19 symptoms. Care homes, who already run small margins, may also need additional money from the government if large proportions of staff are off-sick and they have to hire temporary staff in the meantime. Surprisingly, Birmingham, Dorset and Worcestershire councils are reportedly making no changes in their contracts with care homes, saying it’s “business-as-usual”. Whatever this situation is, it very much isn’t that…
And how widespread is staff sickness? A new Skills for Care survey of 211 care companies suggests that, on average, 25% of the frontline social care workforce are currently unable to work. One-third of providers say that they “urgently” need more staff. Also — and this is not the main issue here — the fact that this appears to be the best and most up-to-date data we have on the social care workforce during coronavirus surely points to the fact that the government needs to collect more, and more frequent, data on social care in order to be able to make good decisions. This sounds a bit abstract. To put into context, imagine trying to design allocate NHS staff if the only data you had on NHS staff was from a one-off survey of hospitals…
(That said, estimates of NHS staff sickness due to Covid-19 range from 6% to 18% — would be good to get some public clarity on this. I do hope DHSC and NHS England have better figures available internally…)
So what should the government do about shortages of care workers now? The sector are calling on the government to amend its’ rules on furloughing full-time staff so that can work in the NHS or social care and be paid normally, on top of receiving their salary from employers.
In more practical news, the Institute for Public Care have published a useful briefing on how to quickly discharge patients in need of care from hospitals while continuing to provide high-quality care.
And a more positive note, check out these excellent entries in the Nuffield Trust data viz challenge — so many interesting ways of displaying data to tell important stories about health
Children and Young People
The government has now confirmed how it will mark GCSEs and A-levels (through a mix of teacher assessment, class rank, and school performance), seemingly with support of unions. The Department for Education have also promised the schools will be able to claim money back (up to a certain amount) from the government for any money they’ve had to spend to respond to Covid-19 (such as additional cleaning) which ‘threatens their financial stability’.
The bigger story this week though, was about this Lancet paper on school closures which, if you believe some of the more sensationalist headlines, concluded that closing schools offers little benefit against slowing the spread of coronavirus. It’s not as simple as that though — as this superb thread from Sam Sims shows. The research actually found that there is not enough evidence to say whether closing schools has a marginal or a big impact on slowing transmission. Headline writers: there is a world of difference between ‘not enough evidence’ and ‘no effects’!
(I should Sam Sims subsequently published his own briefing note on the effects of school closures for UCL which is very handy — and mercifully short!)
In children’s social care, the Department for Education has issued updated guidance which states that local authorities will be allowed to diverge from some (unspecified) statutory duties but “we [the Department] expect that they will keep clear records to capture the rationale and risk assessment for that”. Alongside this Guardian article which reports that child protection referrals have fallen by up to 50% in some areas, that’s got a lot of people worried for vulnerable children who might not be getting the support they need. In practice, some families will be left in grim circumstances — this moving report from the Manchester Evening News chronicles one such tale.
Looking from the social workers’ perspective, David Brindle has also written an article for The Guardian on the difficulties children’s social workers face trying to check if children are safe in a time when face-to-face contact is incredibly limited.
Lastly — although we don’t cover childcare in Performance Tracker — I would be deeply concerned about the financial stability of childcare providers, who look to be in a comparable situation to care homes and homecare providers. Why? The effects of a decade of tight funding where the state pays for a considerable proportion of childcare, essentially. This LSE article provides a clear summary.
Law and order
The head of the courts has written about how they are responding to coronavirus. TL;DR — fewer court openings, more cleaning, and an apparent 800% increase in use of audio and video equipment in courts and tribunals. (Sidenote: definitions and baselines probably make a lot of difference to that statistic).
Looking internationally, the Centre for Justice Innovation have a very helpful round-up of how other criminal justice systems are responding to coronavirus.
What’s happening to crime during the lockdown? As mentioned last week, residential burglary looks to be falling but The Times reports the burglars are starting to target empty shops and pubs; ActionFraud reports that incidents of fraud are on the rise; and sadly domestic violence is likely to rise too.
Truly shocking Howard League report into the shocking ways prisons are handling prisoners who might have Covid 19. Mark Johnson from the prison and probation charity User Voice argues that the only solution to stop the spread is to further reduce the number of people in prison.
Local government
“A good crisis for localism”? Richard Humphries argues the critical role public health directors have played in co-ordinating the response to Covid-19 illustrates the importance of local government in responding to crises. Meanwhile, Richard Vize* argues that councils’ response is being impaired by unclear communication from central government, on problems ranging from distributing food parcels to mortuary capacity planning.
CIPFAs Andrew Burns has written a measured take, noting that ongoing uncertainty about councils future funding means it would not be prudent to use large amounts of reserves to combat Covid 19…the options he thinks councils will be looking at include “cutting the volume or level of services provided to a statutory minimum, seeking to negotiate reductions in the prices paid to suppliers, restrictions/freezes on recruitment, delaying the implementation of IT investments, and generating additional income from increased or new charges for services”.
In more normal news, this comprehensive NAO report provides an overview of the complexities in local authority accountability, governance, and performance. None of which have gone away in this crisis…
*No, I don’t know why so many social care/local govt commentators are called Richard either.
