Week in Public Services 11th May 2021

This week: the Queen’s speech; options for tackling waiting times; and academisation

General

It’s the Queen’s speech today! My colleague Sarah has a great short paper out about how much progress the government has made on its 2019 manifesto tracking every. Single. Manifesto. Pledge. Well worth a read to put the government’s new legislative agenda in context. The health and social care, schools, vulnerable children, are probably most of interest to readers of this publication.

Health and care

Big news last week was Simon Stevens, chief of NHS England, announcing his retirement (See coverage here). Looking back in reflection, Andy Cowper’s HSJ column was about Simon Stevens’ legacy. I think he’s right to argue that much as Stevens made a difference, the funding settlements in 2000 and 2009 (effectively a lot versus a little) have been the biggest factors determining NHS performance over the last two decades.

There is now lots of ink being spilt over who might be the next chief executive of the NHS. Richard Sloggett makes a persuasive case that it would actually be in the government’s medium and long-term interest to pick a reasonably independent candidate to replace Simon Stevens.

Policy Exchange are now arguing that patients need more info for the government to better deal with the rising backlog. I’m not totally sold the “voice of the consumer” is the missing piece of the puzzle — but their argument that it might reduce health inequalities by making information more accessible is interesting. I think the evidence from the rapid reductions in elective waits in the 2000s in England suggests that the main factor was making performance and ranking of different hospitals transparent — rather than “targets and terror” as it’s sometimes called. Reasonable people can disagree — for a longer discussion check out the performance section of our NHS devolution chapter here. In five years, maybe academics will be doing difference-in-differences analyses of the various strategies the four nations put into place to tackle rising waiting times. We’ll have to wait and see. The full Policy Exchange report is due out soon — will be worth reading to see its recommendations on how to bring waiting times down, and not just how much that might cost!

I also picked up on a lot of interesting primary care research this week. First off — this thread on general practice appointments and staff from Becks Fisher, who notes that there has been an increase in appointments and a greater share of appointments done by GPs (and this doesn’t include covid vaccinations). Using data from the Clinical Practice Research Datalink, the Health Foundation analysed changes in appointment and referrals up to January 2021, finding a similar picture — following a big decline in activity during the first lockdown. To my mind, the big questions are:

This is particularly pertinent as some people think phone and online appointments were under-recorded before, and NHS England issued new guidance for recording these kinds of appointments in August 2020)

  • If there has been an increase in activity, is this a permanently higher level of activity or the result of some opening during March and vaccination inquiries?
  • If there has been an increase in activity, how much due to improvements in online access?

Steve Black, the chief analyst at AskMyGP, thinks that this depends on how GPs use these tools. If it’s for changing processes, it might help manage demand more appropriately! His longer blog is also well worth a read.

A good blog by Rob Findlay considers what it would take to reduce elective waiting times to pre-pandemic levels. He argues that the priority should be reducing the first phase of the decision (from referral to decision rather than decision to treatment) because there is “significant unknown risks” for undiagnosed patients. This would, however, mean that waiting times for treatment would rise further, at least initially.

Speaking of data, another good blog — this time on bed occupancy — argues that we need better metrics for understanding how busy hospitals are. I was struck by the point that the number of people waiting to be admitted from A&E following a clinical decision to admit is a better metric of bed availability than bed occupancy levels. As the authors say, “if hospitals had true spare capacity, they would have minimal wait from the decision to admit in the Emergency department to moving to the ward be”. A good point.

In other news:

  • Big Lancet report on the NHS workforce, which concludes that “the highest priority is to improve recruitment, retention, and morale by taking action to enhance career development opportunities, promote staff wellbeing, tackle discrimination in the NHS, and provide good pay and conditions”
  • Thought-provoking article from Axel Heitmueller on what long-term benefits from Covid might be — how to use, for example, some of the new lab capacity set up
  • Interesting thread from Jeremy Hunt on the ongoing problem of hospital-acquired Covid, and the importance of airborne infections — an important point to remember when thinking about how to design hospitals to be resilient to future pandemics…
  • Tania Burchardt argues that policymakers need to take a wider understanding of ‘unmet need’ — considering the social structures people find themselves in and the relationships they have with others, rather than lacking some specific goods or services.
  • The Health Foundation have published an update on their inquiry into the consequences of coronavirus, and its unequal impacts on mental health
  • Chaminda Jayanetti on worryingly large reductions in the number of people assesed for dementia and the number of dementia patients having care plan reviews in February 2021 compared to February 2020

Children and Young People

This week in schools: Gavin Williamson seems to have snuck a big policy change under the radar: the government now wants all schools to be part of a multi-academy trust. This would have been massive news five or so years ago. The argument is that “strong multi-academy trusts are the best structure to enable schools and teachers to deliver consistently good outcomes for all their pupils”.

The problem, though, is that that isn’t quite true. Williamson is correct to argue that “through the support of strong multi academy trusts, we have seen many previously underperforming local authority-run schools transformed after becoming sponsored academies”. Indeed, the evidence we have shows that the sponsored academies (which converted previously poorly performing local authority-maintained schools into academies) did generally improve performance faster than similar non-academy schools in the 2000s. But for middling or well-performing schools, the evidence is more ambiguous. Schools that performed extremely well before seem to benefit a bit from becoming an academy, but other schools in the middle do not (and it’s not clear that multi-academy trusts will always want to expand — it may not always be in their interest, as Chris Hampshire points out in this Schools Week column).

Look, I’m not saying this is necessarily a bad idea. It fills a void where a Department for Education strategy for schools probably should have been. But if Williamson wants to improve pupil attainment, fiddling about with school structures might not be the best thing to do. Also, if we’re expanding academies then we really, really, need to think about the Department’s relationship with schools and to whom academies are accountable. Neither the Department, nor its regional schools commissioners, has the capacity to regulate and intervene among coasting academies in the same way that local authorities did back in the 1980s.

In research news, Emily Hunt published an interesting EPI blog about school choice from, concluding that “my main takeaway is that being plugged into the data and evidence on school choice might demystify the process but it doesn’t make it any easier, less stressful or emotional”. I did not know that 70% of parents nominate fewer schools than they could by their local authority. Elsewhere at the Education Policy Institute, Jens Van Den Brande and James Zucollo make the case for high-quality continuous professional development to improve the quality of teaching and boost retention.

The Education DataLab publish they key findings of a new study about teachers mental health and wellbeing in England from John Jerrim, Becky Allen, and Sam Sims. To simplify their long and very good work: teachers in England are more stressed and anxious than teachers in other countries; it’s got worse over the last decade — but this is in line with other professions, not just teaching. Loic’s summary thread is good for skimming.

A new Education Endowment Fund report has analysed how the attainment gap between disadvantaged pupils and their classmates in primary schools changed over the pandemic. They find it increased in maths but broadly stayed the same in reading. Concerningly, they found no associations between any school responses (offering live lessons, calling pupils etc.) and changes in the attainment gap. Good summary on the DataLab website here. Over at the Early Intervention Foundation, Tom McBride helpfully summarises the learning loss debate, and how much the government might want to spend to ameliorate it, here.

Providing a good summary of the overall debate, Jack Worth wrote a really excellent summary of the practical challenges in recruiting more teachers to deliver catch-up schemes here. One of the major blockages is the time it takes to train and induct new teachers, particularly as the 2020 cohort of new teachers didn’t get the same training and help as in a typical year. The Department for Education has already relaxed Initial Teacher Training requirements in order to ameliorate squeezed placement capacity in schools.

In other news:

  • The latest Sutton Trust analysis of pupil premium funding finds that 34% of school heads report using pupil premium funding to plug other gaps in their budgets
  • SchoolsWeek interviewed Sarah Lewis, the recently-departed DfE director of early years and schools, and the relationship between the DfE and the frontline. The author concludes that “perhaps all civil servants, and many more teachers, would benefit the whole system by spending more time in both camps”. A good suggestion
  • Interesting paper from the UCL Social Research Institute on what the government should change in ‘Progress 8’ — its preferred metric for assessing secondary school performance — including reporting a multiyear averages for Progress 8 alongside current single year summaries to illustrate and combat the instability of school performance over time (Wales are ahead of the game here — having changed their banded league tables to assess school performance over three years rather than one in 2015)

Law and order

In the criminal justice world, the Police Inspectorate reviewed the police’s overall approach to the pandemic and found that the police generally responded well but “the fast-paced announcement and introduction of new legislation affected some forces’ ability to produce timely and clear guidance for staff”. They also analysed custody services during the pandemic in more detail, and found that “forces anticipated staffing shortages and developed plans to manage demand for custody services […] mainly involv[ing] avoiding arrests to keep detainee numbers as low as possible”.

In prisons, The Times have acquired information which reveals that prisons are “fire disasters waiting to happen”. They found that over 1,000 repairs that compromise fire safety are waiting to be fixed. Other outstanding structural repairs have been neglected for over a year, highlighting poor state of prison estate.

There have been questions raised over the lack of regular data on vaccinations in prisons. Inside Time’s leaked figures suggest the rate of vaccination in prison is half that for the public. Meanwhile, Secretary of State Robert Buck still disputes that the risk of dying for prisoners is higher than for people of the same age and sex living in the community.

On a research focussed note, an interesting Criminal Justice Alliance blog looked at improving mental health in the criminal justice system and provided useful summaries of groups working in the field and their ongoing research projects.

The debate about what Covid-19 technology changes should be kept has started in earnest. Three charities are calling on the government to end the temporary rules which have allowed the police to interview suspects in stations with a defendant’s lawyer only present remotely (they would normally be present face-to-face). Likewise the bar councils of the UK -and the Scotland Faculty of Advocates — are arguing that virtual hearings are a “markedly inferior experience”.

Local government

In local government news, Jane Dudman wrote a good longread on “the human cost of centralisation” — the poor outcomes of some centralised decisions by the UK government during the pandemic, and there is another interesting longread on the effects of the pandemic and reorganisation on Northamptonshire County Council — the county council which issued a Section 114 notice prior to the pandemic in 2018 (and also my hometown!)

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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.