Week in Public Services: 18th May 2021

This week: ‘creative’ NHS accounting; the start of the new NHS bill debate in Parliament; and disputes over lost learning

Health and care

Let’s get stuck in quickly. The health and social care select committee have fired their opening salvo into the looming parliamentary debate about the government’s upcoming NHS bill. They think that the government should set out a fully costed and funded social care plan alongside the bill (to be fair — who doesn’t?), and call on the government to provide measures in the bill to mandate publication of transparent independent annual reports on workforce shortages and future staffing requirements over the next five, ten, and twenty years. They think the bill’s new proposed powers “do not give enough detail on how these new powers would be used, nor does it set out the necessary safeguards to ensure the NHS does not become politicised”. One suspects Jeremy Hunt enjoyed writing that recommendation. Full report here.

In more immediate news, a concerning HSJ story reveals that there will be a shortfall in anaesthetist recruitment this year, partly owing to limited Health Education England funding. What happened to building back better?

A truly mad story in HSJ. It looks like NHS England might spend less than expected to in 2020/21, and “some sources said local finance chiefs are now being encouraged to help mask the surplus using justifiable accounting treatments, for example by being “especially prudent” when estimating future costs.” Yes, you read that right. If true, this means that NHS England are encouraging chief financial officers to err on the side of pessimism to avoid reporting an underspend.

Only in the world of the UK government would this make any kind of sense. There’s a wider point here, I think. Whitehall’s (more specifically, the Treasury’s) obsession with ensuring departments stick to budgets (no more, no less, clawing back whatever they can from underspends) are creating wild incentives for some, erm, ‘creative’ accounting. I know, I know, someone somewhere is reading this quizzically asking ‘didn’t you write a report about causes of underspending in departments?’. Fair point — I did. But there has to be a better way of assessing financial performance to without obsessing about hitting a specific budgeted number, particularly in times of great uncertainty. There seems to be absolutely zero trust between the Treasury and NHS England at the minute, which just is not an effective way to run things.

One for the nerds: an interesting Office for Health Economics blog looks at how to measure efficiency in primary care, and what can be done about the problems measuring quality-adjusted output — how much of an effect activity has on people’s lives — not just how much is done. Their blog on the ‘digitalisation shock’ in primary care also clearly separates out how greater use of digital technology could make a difference, how, and what unintended consequences it might lead to. Worth a read alongside this Policy at Manchester analysis of primary care and digital inequalities.

Looking at the NHS workforce, Anita Charlesworth has blogged about what needs to happen to make NHS staff shortages “a thing of the past”. Her answer? Putting workforce planning on a “firmer footing”, by getting the government to “publish independently verified annual projections of the expected demand and supply of health and care workers looking 15 years ahead, both nationally and locally”. Elsewhere in workforce research, The Personal Social Services Research Unit have published a useful policy briefing on the (longstanding) challenge of care worker recruitment and retention, and what might be done about it.

In other new research:

  • A new IFS report analyses reductions in hospital activity during the pandemic and finds big reductions everywhere, but variations across the country depending on demand (increasing virus prevalence displacing elective surgeries) and supply-side (reductions in staff and bed availability) factors
  • A new joint Nuffield Trust and Resolution Foundation report about improving self-isolation, which argues that isolation support payments need to be expanded to improve compliance. They argue for modifications to the Job Retention and self-employment insurance schemes, which in their view would avoid unjustified variations in criteria that comes from discretionary payments. Op-ed in The Guardian here

Looking beyond acute care, I always like reading Greg Fell has to say — the director of public health at Sheffield. His latest evidence-based tirade (blog felt like an understatement) on public health is great and systematically refutes objections about lack of evidence and value-for-money.

I also enjoyed Barry Mulholland’s blog arguing that long waits for elective care cause problems in A&E and GPs (as patients show up there when they face incredibly long waits elsewhere). He looks particularly closely at Northern Ireland (which recent Institute for Government work confirms has incredibly lengthy waits for elective treatment in comparison to England, Wales, and Scotland) and argues that the government is currently too obsessed about reducing waiting times for treatment when it should be focussed on reducing waiting times for diagnosis — where the clinical risk to patients is unknown.

Children and Young People

A big Education Policy Institute report outlines a plan for £13.5bn to tackle lost learning because of the pandemic including extended school hours, additional Pupil Premium funding, summer wellbeing programmes and incentives for teachers to work in ‘challenging areas’.

Of course this all makes sense if pupils lost large amounts of learning over the last two years. Most commentators agree that lost learning is an important problem that governments need to prioritise as they recover from the pandemic. But is it? Primary school teacher Solomon Kingsnorth argues that the evidence underlying lost learning is flimsy (key point in seventh tweet). It certainly made me rethink how strong the evidence of a decline really is…

Elsewhere, a new Education DataLab blog on analyses attendance in primary schools before and after the last lockdown. They find that disadvantaged pupils missed 50% more sessions than other pupils (worth noting this is normally the case in non-pandemic times as well). Kathy Evans of Children England makes the case that children’s care is not, and should not, be a market:

Law and order

The elections earlier this month included police and crime commissioners (PCCs), where the Conservatives won 70% of all posts. Police experts think this means Priti Patel will face “little resistance” from PCCs when implementing her agenda. Over half of police forces have new PCCs, and there are now 12 female commissioners and the first black PCC.

There are also a lot of interesting debates happening in the criminal justice world at the minute. Recent crime figures provided to National Police Chiefs’ Council from forces in England and Wales show recorded crime rates are 12% lower than in the four weeks to 14 March 2020 — but chair Martin Hewitt warns that “the latest figures show smaller reductions than seen in recent months, suggesting a gradual return to pre-pandemic levels”. We’ll have a better idea of what’s happening when the full police-recorded and Crime Survey for England and Wales data are published.

In other crime news:

  • The Telegraph report that number of male victims of domestic abuse seeking legal protection from abusers has risen 50% during the pandemic
  • The Guardian report that the number of complex tech abuse cases requiring specialist support was 97% higher for the period April 2020 to May 2021 than the number in the three months before the pandemic began. “Complex tech abuse cases involve perpetrators using multiple accounts or devices to abuse, control and monitor their partners using a range of tech as well as sophisticated malicious software”. Calls to domestic abuse lines have soared globally throughout lockdowns — the dismaying pattern in England and Wales is not exceptional in this regard
  • The Metropolitan police report having seized over 400 knives and made 994 arrests as part of a national operation to reduce violent crime run between 26 April and 2 May. They say that “reducing violence” will be a top priority over the summer months. This is particularly interesting because the UK saw a big surge in knife crime after the first lockdown was lifted last summer. Let’s hope that pattern doesn’t replicate

In criminal justice research news:

  • Crest are conducting research with young people in West Yorkshire to understand the causes of serious youth violence and exploitation. Young people have given them fresh insight into local problems — and flagged up the lack of legitimate opportunities and need to make money other ways
  • A new paper from Strategic Review of Policing in England and Wales argues that the UK needs a crime and harm prevention system — which should include a national strategy, national agency, “duty to prevent crime” in the private sector, and expansion of Violence Reduction Units across all part of the country and all elements of local crime
  • In prisons, a really interesting report by Penal Reform International compares trends in prisons across the world — looks like the UK was not the only country where initial tight restrictions on Covid-19 led to deteriorations in prisoner mental health.
  • Last but not least, the Probation Inspectorate are warning that (re)insourcing probation services will be difficult in light of disruptions caused by the pandemic, warning about staffing levels in particular



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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.