Week in Public Services: 2nd June 2023
This week: The effect of GP practice closures; Rowley calls time on mental health; and house-building reforms
General
Welcome back — our blogging performance has been slightly off-track of late thanks to our work on the next Performance Tracker due in October. If you need a refresher on the cliff-hanger we left you last time, check out our spring update here.
Andy Haldane wrote a critique of fiscal rules in the FT. He argues our current set of fiscal rules discourage investment in assets that benefit us over the long-term — tangible things like roads, hospitals, and high-speed rail, but also intangible assets such as patents on new technology — because it raises debt to GDP ratios in the short-term. That lowers our economic resilience in the face of shocks, raises borrowing costs for the government, and undermines things such as population health, productivity, and our progress towards net zero. It’s a compelling argument, and encourages a greater focus on the asset side of the balance sheet when making spending decisions. The question I have is how to change the status quo? The Treasury seem so wedded to this way of thinking, and no politician is likely to come out in favour of current spending that will benefit a government in 30, 50, or 100 years’ time.
Have we witnessed the coining of a new buzz-phrase from Duncan Robinson? The thrust of this piece is that, in these straightened times, people have started believing that serious improvements to e.g. public services can be achieved on a shoestring. Out with the Magic Money Tree, in with the Reform Fairy (maybe Ritzy Reform Fairy would be better?). Not to denigrate efforts to go for easy savings/wins. This issue (as we’ve argued) is that there aren’t very many. Duncan argues that the promise of reform obscures the fact that a) to be done right, you need cashola, and b) long-term reform won’t solve severe short-term problems, which also require cashola. Realism about the cost of both and (I would argue) the need to suck up that cost will be crucial in the run-up to the election.
Health and care
James Hadlow and Chris Farmer argue in the New Statesman (£) that solving the workforce crisis among NHS doctors is not merely a matter of more undergraduate training places — which the government likes to announce — or improved retention, but also of better postgraduate training routes in the service. They point to the recent story of 350 anaesthetists being told that there were no spots available for them after they’d already completed 3 years of post-graduate training.
Joe Plewes at NHS Confederation brings us this analysis of the remaining 78-week waiters on the RTT waiting list. The NHS has made substantial progress in the last few months, bringing the numbers down from 54,822 in December to 10,737 at the end of March. This still won’t be enough though, and the NHS will still miss its target at the end of April. This analysis shows that 59% of those remaining haven’t been treated due to a lack of capacity, with the remaining 41% either choosing not to accept treatment or being too complex for quick treatment.
This write-up in Pulse Today about a study that looks into the effect of GP practice closure on spending per person is fascinating. It finds that as practices close, and patients move to another practice, the pressure on other practices increases. Among those practices that are most “exposed to closures”, funding per patient falls by 1.48% for each practice that closes. This problem is also distributional: more deprived practices are more exposed to practice closures.
Good article from the Guardian on the topic of one of the recurring stories in adult social care that I’m always most sceptical about: the use of technology to improve people’s care. The author lays out some of the benefits of care technology — one person uses a talking board as they are not able to speak for themselves, for example — but is also very clear-eyed about technology’s limitations in the sector. Not least is that additional work that technology adds to carers themselves, even when the tech is supposed to support them.
Children and young people
Industrial relations updates: several unions are re-balloting members NAHT and NASUWT are aiming for a strike mandate while NEU is hoping for a fresh mandate from July. If all three secure wins this could open the door to coordinated action in the autumn reports Amy Walker at schoolsweek. In a further headache for government, proposals for a 6.5% pay rise for 2023/24 by schools pay review body were leaked to the Sunday Times. In further reporting from Amy Walker — unions are now pushing for the proposals to made public and continue to push for final pay rise to be fully funded..
The EPI has this on trends in persistent school absence. In the 2022 autumn term, absence rates were 3.6%pts higher than the same period in 2019, with overall absence rates at the highest level since at least 2006. Illness is part of the story, as is a long-term increase in unauthorised absences (which have been increasing since 2006 in primary schools and 2015 in secondary schools). Persistent absence on the other hand (when pupils miss at least 10% of sessions) has grown since the start of the pandemic (although in secondary schools the pandemic only sped up a growing rate since 2018). Concerningly, when the authors looked at absence variation among local authorities, none of those with the highest absence levels were shortlisted for help from the DfE’s expanded attendance mentoring programme.
The Progress in International Reading Literacy (PIRLS) rankings were published recently, with the headline that the UK moved to 4th out of 43 countries, up from joint eighth. Though as Sam Freedman points out, this was largely due to the UK staying relatively stable during the pandemic, while the rest of the world fell back. I would have expected the UK to experience a similar decline, due to underinvestment in learning catchup. Both Sam and Rachel Wolf argue that this is the result of having both ministerial (Nick Gibb as schools minister) and policy stability for a prolonged period.
On the day judgement was passed in the tragic Finley Boden case the Today Show on 26 May reserved its 8.10 slot to discuss both the move for better reporting in family court cases and the need for an expert-led child protection system. Josh MacAlister outlined the recommendations in his review for expert practitioner co-working to get better sight of families and make swifter decisions.
The HoL Public Services Committee published a report on the governments implementation strategy for reforms to children’s social care. It highlighted challenges with the pace and scope of change notably in relation to the voice of children and a need for greater coverage of workforce pressures. A survey of agency workers carried out by REC and reported on by Fiona Simpson suggests 40% of the 147 staff surveyed are unable to take on permanent posts, and 40% would exit the social work labour force entirely if the agency worker pay cap and other measures are brought in.
Dan Anderberg and Christina Olympiou published this paper looking at the effect of Sure Start centres on the rate of children entering social care. They find evidence of a higher entry rate into care for children aged 0–4 due to an ‘identification effect’: adults are better able to detect children who need to be taken into care. The other effect is an ‘investment effect’ for children aged 5–9, in which Sure Start centres reduce “dysfunctional family behaviour”, lowering the need for children to enter care. These effects are quite large.
Law and order
Bit dated, but this POSTnote looks at trends in police trust, examines the barriers to trust and how it can be increased. Confidence levels in England & Wales have declined in recent years, and those from White, Asian and Other ethnic groups have higher trust in the police than Black people. It finds trust in the police is more highly correlated with perceptions of police fairness than with perceptions of effectiveness in dealing with crime.
Mark Rowley will order his officers not (with some exception) to attend mental health callouts from September. He says Londoners are being failed by having officers pick up the slack from struggling health services and by having this time diverted from crime. The scheme (RCRP) was trialled in Humberside, and involves coordinating with health services to ensure police time is better spent/patients are seen by health professionals. Correct ambition, poor execution seems to be the assessment. Some have sounded the alarm over using Humberside as a model to emulate given the Met’s size (+ presumably the complexity of local services?), and while no-one doubts the current situation’s shortcomings, it has come about because of the capacity issues among health services. Health bosses have argued that artificial deadlines and unilateral moves aren’t helpful.
Nacro has this on offenders’ post-prison access to GP services, given prisoners’ high rates of health problems compared to the wider population. Limited access potentially increases their chance of reoffending (as do the employment, poverty, and accommodation issues many face). In the report’s experiment, 66% failed to register due to requiring a proof of address, and nearly half because of ID requirements (or both). Bad for rehabilitation? Tick. Bad for humanism? Tick. Bad for the economy? TICK — the report neatly demonstrates the obvious: limited care at earlier stages means a higher likelihood in engaging with the health system at the emergency stage, where things are more serious and costly.
The NAO published this on resettlement support for prison leavers. Of adults released in 2020/21, 40% reoffended in the following 12 months. This is concerning given the MoJ’s estimate (from 2016) that reoffending costs society £16.7bn (roughly £20.3bn in today’s prices) — this inc. losses to victims, justice system costs, supervision etc. Similarly concerning is the £550m allocation to the MoJ in 2021 to reduce reoffending (3.3% of the MoJ’s estimate –caveats about different time periods notwithstanding). Compounding this is a shocking vacancy rate among probation officers (29%!) with 92% of HMPPS’ probation sub-regions operating at or above operational capacity.
Following John Major’s speech to the Prison Reform Trust, Stephen Daisley weighed in with this sympathetic piece. It’s a good read, particularly on the need to balance evidence and ethics against public opinion. I was especially drawn to the distinction between reoffending rates for adults in general and those released after sentences of 12 months of fewer (the rate for the latter is 23%pts higher!). A pretty damning indictment on the ambition to use the justice system as a way to reduce reoffending.
Russell Webster has this on the latest HMPPS workforce figures,. An overall increase of 287 FTE staff since March 2022 is welcome, but the fact that there were 655 joiners over the last quarter points you pretty squarely to the big problem with the overall figures. In every quarter of 2022/23, between 14–16% of the workforce have left the service (read: less experience, greener workforce, poorer service quality).
Also in the release was the new prisoner population figure, standing at 85,193 — Danny Shaw points out this leaves only 957 spare places in the context of Fosse Way’s imminent opening (though no date set), other buildings behind schedule, and judges having been formally advised to consider alternatives to custody.
Local government
The DLUHC Committee has put out it’s report on Funding for Levelling Up, which finds that the funding method (including how funding is delivered and the extent to which different funds are compatible with the needs of communities) has created obstacles for the success of levelling up policies. (Can’t help but mention a line that could have come from the IfG itself: “The dearth of data available from the DLUHC is an area of serious concern. DLUHC has conceded that it does not have “sufficient data” in relation to Whitehall departmental expenditure on the full range of levelling up funds or on combined authority income or expenditure.”) Thomas Pope points out that the report echoes IfG recommendations.
Following the news that DLUHC is threatening to take over the planning departments of nine local authorities, Megan Kenyon brings us the insight (£, but short thread here) that only 1 in 10 planning departments are fully staffed, with a quarter reporting staff turnover of 20% or more in 2022. The piece points out that authorities are losing planning officers to the private sector and are finding a shortage of trained workers to replace them.
It’s a fun time with in the housing world, with Labour planning to instigate radical reforms to the way authorities buy and develop land. With falling rates of home ownership and consistently missed building targets, the plan will allow authorities to buy land under compulsory purchase orders without factoring in the ‘hope value’ — the value attached to land with existing (or likely) planning permission. Allowing that difference to be captured by authorities should — it’s hoped — act as an incentive to build more homes on the part of authorities. Based on the linked article, it looks like a proposal with broad cross-party support.
