Week in public services: 13th July 2021

This week: learning loss in the four nations; the reopening debate; and the government’s “less transparent and less accountable” health reforms


The big debate remains whether the government’s decision to lift restrictions on 19th July is the right one — as well as just what restrictions should be lifted. My colleague Tom’s blog from last week is still relevant. Here’s some other links I found useful:

  • Modelling of expected deaths and hospitalisations in next wave — could be 10k deaths and 12k weekly hospital admissions
  • James Ward on the case for opening up, but with more mitigations than the government’s proposals
  • Oliver Johnson on hospital beds occupied by Covid patients
  • Adam Kucharski is sceptical about how much the government can really control the timing and size of infection waves

The less newsy — but just as important! — big report was the Office for Budget Responsibility’s Fiscal risks report. It comes out once every two years, it’s massive, and it’s truly a nerd’s paradise. I haven’t read the whole thing, but it is full of fascinating analysis of medium and long-term spending pressures, including health and social care — as well as the impact of the pandemic. Well worth a read — at the very least you should skim the twitter summary thread.

Health and social care

Aside from the rapidly rising covid cases and hospital admissions (more on that in a second), the government introduced the health and care bill to Parliament last Thursday, on the 8th July. In my mind, the one essential thing to read is Nick Timmins’ reaction blog about bill. Nick argues that it would be “madness” for the secretary of state to intervene in service reconfigurations because it will open the health secretary up to endless lobbying from MPs whose constituents might object to closing services — even where there would clinical or other benefits in rationalising provision. The choice quote that stuck out to me? “Guidance is promised on precisely how all this is meant to work. It is almost impossible to believe that it will work well.”

If that whet your appetite, this Hugh Alderwick thread is comprehensive and clearly argued. For other think tank reactions, check out the Nuffield Trust and Kings Fund. Expect this to kick off a massive parliamentary battle once MPs start to think through the implications of more ministerial control…

Before we get to the big health story, this is a cracking blog Andy Cowper about the race to become the next chief executive of NHS England, and what they should do to avoid getting fired. His argument: publicly set out what the health service needs to reduce the backlog. A move out of the Simon Stevens playbook if I ever saw one…

Right, the big health story: is it the right time to open up? There’s a lot going on in this debate, so here’s my brief attempt to set out the key issues:

  • What level of covid deaths (and deaths overall) are acceptable?
  • What to do about clinically vulnerable people for whom the vaccination offers less protection? Or those who can’t take the vaccine? Does the shielding advice still apply? (See Tom’s thread and Sharon Brennan’s coverage)
  • What about the consequences of long covid?
  • What about the risks of vaccine escape and a more resistant variant?
  • If the goal is to get to herd immunity via a mix of vaccination and infection, when is the best time to open society up to having more infections?
  • What is “unsustainable pressure” on the NHS? Is it just capacity to treat covid patients or is it also elective capacity to undertake electives and reduce the backlog?

The last question highlights a key tension. Those are very different things — one of the strategies to preserve the NHS’ capacity to treat covid patients was to reduce routine activity in the first, second, and third waves. Putting hospitals in a place where they were to do so again, when many patients have already waited for a long time for care, would cause considerable harm.

In terms of the NHS, the last question is probably the most pertinent point. The Scottish NHS is already under pressure as several hospitals suspend non-urgent treatment. Deborah Ward analysed the latest NHS activity data here. Alistair McLellan puts out context on how quickly hospitalisations are rising here.

I’ll confess, I haven’t had the time to think this through as much as I would like (who has? etc. etc.) but I would note that:

  • The mistake the UK government has generally made has been to lift restrictions too quickly, and err on the side of over-optimism
  • No other country in western Europe is considering all restrictions in the same way the UK is (before you say ‘but the UK has vaccinated so many more people’…we’re only about 10 percentage points higher than Italy, Germany and France in terms of the proportion of the population with a second dose). See also — the huge uptick in cases after the Netherlands lifted restrictions on June 26th

Both of those points should give the advocates of a rapid opening up pause for thought (which, in fairness, the government has at least away from in rhetoric)

In other research news:

  • Lucina Rolewicz highlights the increase in the number of people wanting to study nursing in all four nations of the UK. The number of district nursing applications increased dramatically between 2020 and 2021 — although in England’s case only back to 2016 levels (before the nursing bursary was cut)
  • Chris Ham on the “shared responsibility for health”
  • The Health Foundation’s covid impact inquiry
  • The 2021 GP patient survey is out! The data is here, and Jessie Morris’ summary thread is a great place to start
  • The 2020/21 social care workforce data is also out! Simon Bottery analysed the latest data to show that social care jobs increased between 2019/20 and 2020/21 — but almost entirely in non-residential care
  • A nice final note: Ed Humpherson sees reason for optimism when it comes to improving adult social care statistics

Children and Young People

An interesting LSE study has compared pupils’ learning losses in England, Wales, Scotland, and Northern Ireland. It has the striking findings that pupils in England experienced smaller learning losses than pupils in the other nations, and that the poorest pupils in England experienced lower learning loss than the most affluent pupils in the rest of the UK during the spring 2021 lockdowns.

Hold your horses before you declare school policies in Scotland, Wales, and Northern Ireland failures, though. The researchers’ measure of learning loss is a comparison of how many hours pupils learned for when compared with a 6-hour school day for 5 days a week. The main reason that England looks good is that more pupils attended school in person during the spring 2021 lockdown — rather than England having had more effective remote schooling policies.

Children’s minister Vicky Ford gave a speech at the ADCS conference, in which her major announcement was a £24m fund “aimed at levelling up outcomes for vulnerable children” which will be allocated through three regional programmes. It’s not totally clear how much of that money will be ringfenced for specific priorities, but Ford emphasised the importance of all local authorities help to accommodate unaccompanied asylum-seeking children. I imagine there will be some conditions attached to the funding on that front. The Department will also provide capital funding for local authorities to build new children’s homes…I’m pretty sure that counts as a tacit admission that the children’s homes market is not working!

Local government

The Local Government Association make the case for local government to be more involved in the pandemic recovery.



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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.