Week in Public Services: 13th January 2022
This week: New year, new NHS guidance; maths to the age of 18; council taxes; and a shiny new IfG website
General
Near Year, new launch(es). After a Christmas break which saw public services commentary from everyone from King Charles to the Archbishop of Canterbury (see more below!), we all enter 2023 wary about the challenges ahead. Understandable then that both Rishi Sunak and Keir Starmer sought to fill this void, seize the political initiative and set the agenda in the run up to a likely election in 2024.
As the IfG’s very own Hannah White explains — Rishi Sunak opted for 5 pledges covering achievable objectives. The first three objectives (halve inflation, grow the economy, and reducing national debt) she argues depends on the measures and timescales that ministers choose. And as Hannah says for the other two (lower waiting lists and new legislation to target boat cross) — in Q&As the PM claimed some NHS times were reducing and there is a marked difference between new laws and fewer boats crossing the channel. While the speech spoke to issues voters care about (side note: the speech broadly matches to the December IPSOS index of the most important issues affecting UK voters) it missed proper discussion of strikes or other challenges affecting public services.
Keir Starmer set out a vision but the policy detail remained vague as the IfG’s very own Emma Norris explains. With talk of a ‘decade of renewal’ and painting himself as a candidate of change. As Emma outlines Starmer appropriated the Brexit campaign’s ‘take back control’ slogan to make the case for greater local decision making. He also outlined aspirations to work in partnership with the private sector, to exercise fiscal restraint and to undertake public service reform. But, the speech lacked policy detail.
While both speeches were big on ‘vision’, and both sought to make clear good government is a priority, practical solutions to pressing current problems like strikes were absent. We all watch this space for more details on how these visions will be achieved and the solutions to ongoing industrial relations challenges.
For the best place to watch developments go to our shiny new IfG website! Many congratulations to Melissa Itoo and the rest of the team for their great work. For all your public service needs now go to our slick new landing page here.
Health and care
NHS released its priorities and operational planning guidance for 2023/24 on the 23rd of December — a welcome Christmas present for health wonks. A few things that stood out to me:
· The stated priorities (improve ambulance response and A&E wait times, reduce long elective waits, cancer backlogs and diagnostic standard, improve access to primary care) are not a surprise. This echoes similar government rhetoric. It’s also notable for how wide it is, covering most of acute and primary care.
· The document recognises that poor NHS productivity needs to improve. And also says that retention is key to improving performance, which is something we argued for in last year’s Performance Tracker
· There is a tip of the hat to preventative services, but that seems hollow given problems in acute care and the cuts to public health budgets in recent years. As nice as it is to talk about prevention, it will realistically get very little attention or funding for as long as the crisis in the service continues
· The objectives for 2023/24 are a strange mix of easily achievable (recruit 26k more ARRS staff, something which it has been apparent for a while will happen) and depressingly unambitious yet potentially unachievable (76% of people seen within four hours in A&E by March 2024)
· Funding allocations will be flat in real terms between 2022/23 and 2024/25, though there is no mention of potentially higher wage costs as the result of industrial action, so while it might be “flat” in real terms, the money for increased staff costs will have to come from somewhere.
NHS Confederation provide their analysis here. They first of all welcomed the document’s brevity and also that it seems to place more decision-making power in the hands of ICSs. One interesting concern they raise is the use of paying unit prices for elective care, which they say introduces “an element of payment by results” and is “a retrograde step that risks undermining innovation, system working and value for money”.
The Royal College of Emergency Medicine (RCEM) claims that delays in emergency departments are causing 500 excess deaths per week. Unsurprisingly, NHS England disputes that, arguing that higher deaths is due to factors like “inclement weather and rising population numbers”. This is a flimsy argument, but to be fair to NHS England the estimate from RCEM is also a bit of a finger in the air. You can read their methodology for yourself. Charles Tallack brings some balance to the debate and raises questions about why there were fewer excess deaths earlier in 2022, despite long waits. For my part, it is almost certain that the current level of chaos in hospitals is leading to excess deaths, but determining the amount likely requires more work. In the meantime, the RCEM are right to draw attention to it, even if the total isn’t 100% accurate.
Really interesting list (£) from Shaun Lintern of 10 fast ways to improve the NHS (ignore the click-baity headline, the content is good!). Also a reminder that the Times’ coverage of the NHS falls into two categories: (1) insightful, thoughtful reporting from Shaun Lintern; (2) mindless “the NHS has too many managers” reporting from others
The big news over the weekend was that the government is going to block buy beds in care home to discharge patients into. As Simon Bottery points out, there are real risks with this: not everyone who is eligible for discharge needs residential or nursing care — in fact Nuffield Trust research shows that only 15% of patients do. Richard Humphries does not mince his words, calling the move “wrong-headed”. There are also reports that trusts in the South West are discharging patients into “care hotels” to free up bed space. Simon Bottery has another thread on this.
The government wants to cut the number of targets for the NHS and run it like the “localised” school system. The problem is, as Stephen Bush pointed out a few weeks ago, the school system isn’t that localised.
Speaking of reform, Rachel Sylvester had a bombshell interview with Wes Streeting where he had big ideas about changing primary care. Part of those changes would be abolishing the partnership model and removing GPs’ “gatekeeper” role by allowing patients to self-refer to secondary care specialists. Steve Black responds thoughtfully in this thread.
As an interesting counterpoint to the idea of a more decentralised NHS, Patricia Hewitt told the HSJ that some ICSs will need “an awful lot of control” from the centre. This is *maybe* an unfair lead on this article; elsewhere she says that ICSs need more local accountability and that ICSs are at very different stages of development. Other insights into what she might say in her draft report (due to be released on the 31st of January) include that there are too many non-clinical support staff in the NHS, but not too many managers. Interesting nuance to a favourite debate of mine.
40% of junior doctors plan to leave the NHS “as soon as possible”, according to a survey conducted by the BMA. Guardian write up here. A couple of things about this. First, retention is clearly a huge problem in the NHS. But this is a snapshot poll and the BMA does not provide any comparison for other years. I am sometimes a little sceptical of these polls — talk is cheap, and angrily saying to a pollster that you are thinking of leaving must be a momentarily satisfying release if you’re a frustrated medic. Having said all that, the NHS badly needs to improve morale in the service.
A few other things in health news this week:
· Interesting datapoint which shows that, in this instant at least, many more people receive a face-to-face appointment than actually request one
· I missed this back in September, but this is the Health Foundation’s survey of public perceptions of the NHS and social care
· Deeply worrying piece about what it’s like to be a doctor in the NHS at the moment
This report from Community Integrated Care shows social care workers are underpaid by approximately £8k relatively to equivalent bands in the NHS. For more on this see this summary from Gemma Lloyd at Home Care Insight.
A new report out from the County Council Network highlights adult social care innovation. It has some great case studies from better data integration across healthcare settings in North Yorkshire to a £1,000 retention payment in Derbyshire Council which aims to fill 200 vacancies. What particularly drew our eye was use of ‘Cobots’ by Hampshire County Councils, using an exoskeleton to support a carer’s lower back the report claims can in complex care settings and reduce the number of staff needed from one person to two. You can see them in action here.
The Guardian reports on findings that care workers are known to take as little as 3 minutes to help vulnerable people during home visits, with councils commissioning care calls scheduled to last for just 15 minutes. Nor is this a new problem. This older column from Sarah O’Connor lays bare the harrowing consequences of ‘call cramming’, and is a useful reminder of the mismatch between the evolution of care work and the training + conditions that can undermine its success.
Children and young people
An announcement out of the blue, this one: Sunak apparently wants everyone to study maths to 18. The thinking is well-trodden at this point — Sunak claims that every job uses “data and statistics” and therefore British school leavers need to be more number-savvy. There are a couple of pretty glaring problems with this proposal though. The first is that maths is a subject with one of the largest shortfalls in teachers, a point supported by this timely TES article which claims that nearly half of secondary schools use a non-specialist for maths lessons. I suppose we could always train more teachers, but as Stephen Bush points out in this tweet, that costs money and Sunak’s whole thing is that the government doesn’t have any money. As Freddie Hayward also points out, this policy also directly contradicts Sunak’s Mais lecture (made in the distant past of 11 months ago) that claimed that the government should focus on adult skills, not secondary education.
Education Datalab have an interesting piece out this week looking at outcomes for the pupils they term “long-term disadvantaged”, i.e. pupils who spend more than 80% of their schooling on free school meals. They found that those pupils were more likely to have worse outcomes later in life, which is interesting, but not altogether surprising. The more interesting finding — to me at least — was the regional variation, with pupils from London performing substantially better than peers from, for example, the North East.
Continuing on the theme of improving technical qualifications — DFE chose to take out the trash on 20 December by sneaking out an Accounting Officer Assessment on T-Levels. Cutting through the jargon — this is where the Perm Sec, in this case Susan Acland-Hood, thinks a government major project won’t secure Value for Money. The AOA suggests the withdrawal of a linked technical qualification may affect it and also questions whether grading is properly calibrated.
Interesting to note last month the Education Select Committee launched an inquiry into childcare affordability and early years education. This is a pressing topic (as we pointed out in our last WiPS) and gaining increasing political attention among senior conservatives. All eyes will looking to see how the inquiry progresses.
Research from the BBC News team shows an almost 40% increase in spending on agency staff linked to a lack of children’s social workers. Data was collected across the UK from 125 out of 212 councils. This is to be expected given the staffing challenges facing the sector (again discussed in our last WiPS). Other concerning news from sector reports Emily Harle who summarises the Home for Christmas report by Become — they show on average 79 children per day were being moved between care placements during the festive period.
Law and order
The police inspectorate have published this report on the police’s handling of digital forensics. It’s of course the most worn-out garden variety cliché to say that digital tech has changed society, and this is no less true of investigations of crime. Despite this, the report concludes that some forces do not have a clear understanding even of what digital forensics are, leading to delays in the examination of digital evidence. Whatever the benefits of our decentralised system of policing, uniformity in the field of forensics (digital or biological) is an uncontroversial must have, yet the report identifies what is essentially a postcode lottery in digital forensics. To contextualise this, consider this recent case, in which false rape charges were brought against a teenager — subsequently held on remand for 10 weeks — on the basis of evidence whose veracity was judgeable by carrying out the digital equivalent of a handwriting check.
Max Hill (Director of Public Prosecutions since 2018) has sounded the alarm over our overloaded criminal justice system, citing difficulties in getting hold of barristers and age-long wait times that push victims out of the system. If this feels like well-worn territory for die-hard readers, it is, though no less important for being so. I recently came across a worrying stat in the most recent tranche of quarterly court data, showing that the share of ‘ineffective’ cases in the crown court (that is, cases that don’t happen on the day, so other cases can’t be held in its place — basically a waste of everyone’s time) is at 18% — the highest share since at least 2009 (full details in our forthcoming spring edition of Performance Tracker — don’t say we don’t spoil you).
Despite lifting the cap on court sitting days, using video hearings, and increasing magistrates’ sentencing powers, it’s also worth reflecting on the fact that the success of the defence barristers’ strike might be causing another blockage in the courts, as it leaves prosecution barristorial(?) work relatively less profitable.
I came across this fascinating (older but related) piece studying ‘victim attrition’. The summary: in recent years the proportion of cases closed with no suspect identified is down, while we’ve seen an increase in cases closed because victim’s don’t support further action. In other words, the police are identifying a greater proportion of suspects, but victims are becoming more reticent to pursue legal action to its end. We might chalk this up to waiting times (as suggested), but the average instance of victim attrition is recorded just 14 days after the offence was recorded. It’s a puzzling one, but I’d suggest anticipated waiting times + a general perception that the criminal justice system won’t do what it says on the tin are still contributing factors.
Looks like the government is looking at changes to civil legal aid provision and *IfG glee klaxon* further data publications on legal aid’s access/delivery. Due in 2024, we’ve got at least 12 months until we can dive into the detail, but fingers crossed that this signifies a more generous coming approach to legal aid — and that the justice system doesn’t break before then.
This story outlines the finding that 1,837 of the 15,000 officers recruited through the police uplift programme have already quit (that’s almost double the attrition rate of all officers in England and Wales). This doesn’t mean that only 13,163 recruits remain, but that the number of officers could be 12% higher if the government/forces were better at retaining officers. So what’s driving this? Thankfully, Sarah Charman (crim prof at Portsmouth) is doing the work for us: reasons include pressures of training alongside other jobs/studies, the attitude of tutors, and mismatched expectations. This matches figures from early last year that showed a 9% attrition rate among new recruits. We know from other sectors that the first couple of years in the job are crucial for retention — it’s just a shame the government hasn’t done a better job of it as we approach the end of the programme (in March!).
Chris Philp (yes, of rising pound fame) gave a statement on police funding for the coming financial year last month, which will include additional PCC funding of £523 million. *Caveat klaxon*: Part of this will come from an increase in direct central grants, and part by allowing PCCs to increase your council tax bill — if you’re living in a Band D property — by a fiver, on top of the extra tenner they were allowed to demand after the 2021 spending review. As we reported last year, however, PCCs might be reticent to tackle rising costs with tax increases on the increasingly hard-hit constituents.
Finally, after trawling Home Office updates we came across Operation Kraken — the Home Office’s new promotional campaign to report suspicious behaviour on the coast — reader, insert your favourite fish-based puns here.
Local government
Further aftershocks from the Thurrock S114 notice in the news. The council has scrapped plans for a £26m affordable homes scheme according to the BBC, and further details are out about their finances — Thurrock is owed over £690m by Toucan Energy holdings, making them by far the company’s biggest creditor. For more on this check out our deep dive into the Thurrock situation in our previous WiPS.
Council tax is also in the news. Analysis from the Times shows that Council Taxes are 20% higher in the north than in London. Also, many councils are planning to use the new powers granted in the autumn statement to increase tax rates: the City of York, Southend and Nottingham City Council are among some of those reported to be increasing tax rates. Though as Jonathan Knott writes in the Local Government Chronicle, 1 in 3 do not plan to increase council tax to the new limit. Interesting then to note Slough — a council which issues a Section 114 notice last year — has asked central government to raise council tax by more than the legal limit without a referendum.
As a reminder, there has only ever been one referendum on a council tax rise: the Bedfordshire police and crime commissioner proposed to raise council tax by 15.8% in 2015. He lost decisively, with 69.5% voting against the proposal. Surrey County Council thought about holding one in 2017 but never went through with it. Slough has clearly worked out that a referendum is not going to work and is instead going straight to the government to grant them dispensation.
Over Christmas, the government announced a new devolution deal for the North East covering Northumberland, North Tyneside, Gateshead, South Tyneside, Sunderland and County Durham. Mark Sandford (House of Commons library) has a thread looking at the funding, net zero and health commitments. The Local government Chronicle has political commentary from local leaders saying the financial package “in no way replaces” cuts to local government funding in the region.
Finally, a new NAO interactive visualisation allows you to see local authority auditor reports covering all bodies from NHS commission groups and the police through to local councils. A really helpful way to identify where auditors flag up VFM concerns or other concerns about the financial statements.
