Week in Public Services: 20th January 2023
This week: more problems in the Met; social care business models; and local authority reserves make a baffling return
General
Three strikes and you’re… legislated against? We’ve been tardy with this story (don’t hate — cutting-edge research takes time) but the PM’s ‘anti-strike’ legislation is working through Parliament. To give the government its due, that’s not exactly what it is, and although we don’t know what the final bill (here currently) will look like, a few observations:
- Strikes have been called because, e.g. for nurses, people tasked with delivering care are facing below-inflation pay, burnout, and high workloads that arguably pose more of a threat to patients than strikes. Legislation curtailing this — even partially — smacks of a head-in-sand-ness that doesn’t lend itself to resolution. The FT’s Sarah O’Connor rightly argues you can’t legislate your way to better labour relations.
- It looks minimum work levels will need to be approved by parliament, effectively making MPs loudly complicit in any and all disruption caused by the strikes if they vote against minimum levels.
- The regulations apply to a lot of service coverage, e.g. health, education, transport… It’s puzzling that govt hasn’t made more efforts to specify the precise roles they refer to. Joshua Rozenberg argues govt itself doesn’t know how the bill will work given the ‘consequential provision’ powers it gives the secretary of state.
Implications for public services? Probably not many for a while. The bill faces parliament and likely a number of legal challenges. In the meantime, my colleague Matthew Fright has written this fantastic explainer on military aid to struck/stricken(??) services.
Health and care
The health committee have organised a speedy and timely hearing for next week. Adrian Boyle — president of the Royal College of Emergency Medicine — will give evidence for his organisation’s headline-making claim that the crisis in urgent and emergency care is causing 300–500 excess deaths per week. NHS England will also be appearing to contest Boyle’s argument. Should be some must-watch TV, as far as committee hearings go, that is.
Helen Buckingham argues that while there are many steps the government can take to improve NHS performance over the medium- to long-term, there aren’t many levers to pull to alleviate immediate pressures. She says that the priority should be on supporting current staff — an area I agree with her on — to try and resolve the retention crisis in the service.
Elective waiting list update: there was an unexpected decline in the number of incomplete pathways in November. This thread from me (shameless self-promotion) looks at why, and if it’s likely to be sustainable. The answers in short: a large increase in activity, and it will be difficult to maintain, given pressures in urgent and emergency care. Still, excellent news for now!
Labour have been pushing their reforms of primary care hard this week, which has generated some interesting discussion.
The first of their proposals is ending the GP partnership model. Streeting announced this recently, and Keir Starmer wrote in support over the weekend. Ed Turnham had an interesting thread on this, saying that the strongest argument in favour was that there was poor uptake of technology across a fractured primary care sector. Steve Black also argues that the partnership model fails to distribute GP capacity equitably across the country. On the downside, Ed argues that larger practices risk harming continuity of care, and absorption into an ICS would mean further de-prioritisation of primary care in favour of secondary care.
The next proposal is that patients should be able to self-refer to specialists, bypassing GPs altogether. My knee-jerk reaction was that this was not the best idea; how would a patient know where to refer themselves? And wouldn’t this burden secondary care with needless referrals? But another thread from Ed Turnham has brought me round to the idea somewhat. Ed argues that better triage would direct people to the specialist they need, thus saving GPs’ and specialists’ time. I can see the logic in this. At the same time, improving and standardising triage across primary care is a huge project. Ed sort of acknowledges that in this tweet, but downplays the political and organisational barriers to making it happen.
These are both fascinating policy debates, but you have to wonder why Labour wants to have them now, with plenty of political hay to be made from the crisis in secondary care.
Three articles highlighting problems among adult social care providers this week.
First, the FT reports that social care providers want the government to pay more for places. Providers argue higher fees will allow them to increase wages, improving recruitment and retention. The problem (for the taxpayer) is that some of those higher fees will likely flow to investors. A spokesperson for HC-One (a private equity-owned provider) says they’d “be prepared to discuss restricting its margins to a ‘reasonable rate of return’ […] between 6 and 10 percent”. This is well and good but fixed margins and rising revenues still mean more money in absolute terms flowing out to investors.
Next, the Guardian reports brokers are earning “millions” finding places in social care for local authorities and the NHS. Ideally, commissioners would be able to place people easily, but the social care market is so fractured that brokers play a role matching need with availability — something which will hopefully speed up discharge and clear the backlog of people awaiting assessment for care. Interestingly, the article also claims that authorities are using private companies to assess patients, due to a lack of social workers. The question is if the government could save money by employing more social workers and saving money on brokerage fees.
Finally, the Guardian (again) reports that the CEO of a care home chain was paid “at least £21m in five years”. At the same time, almost a third of the care homes in his company were rated as “requires improvement” (compared to only 17.5% of all care homes). Another damning statistic in this story: the company (Runwood Homes) received £12.3m in emergency Covid funding in 2020 and 2021, while they paid out £14.3m as salary to the director and dividends to investors in the same time period.
Helen Whately (minister for social care) delivered a statement to parliament on the government’s measures to support social care this winter. None of it is that different to other announcements: support for discharge, a new fall service etc. What’s frustrating is the framing of social care as important insofar as it supports the NHS, which is not new, but is definitely worsening in recent weeks as the NHS crisis worsens.
The other frustrating things is the regressive way that the government thinks about social care. Much of the funding and rhetoric is focused on expanding the number of “beds” available in social care. But is that the right thing to be doing? There are more than twice the number of people in community than nursing and residential care combined, and more people are waiting for home care than for a bed in nursing or residential care. As Simon Bottery points out, there is a risk that in our rush to free up hospital beds, we end up placing people in inappropriate care settings, meaning worse outcomes.
Children and young people
On Monday 90% of the NEU of voting members voted for strike action. Of its 300k members 53% participated — exceeding the minimum legal threshold of 50%. Despite unions meeting with the Education Secretary on Wednesday, no solution could be agreed. For a full breakdown of the dates affected see Vanessa Clarke’s report over at the BBC. For details on the DfE’s proposals to adopt covid-style measures to reduce the impacts of the strike head over to Samantha Booth and Tom Belger’s reporting at Schoolsweek.
How disruptive could the strike be? That depends on what happens to the other unions. Recently the NASUWT strike ballot failed to meet the minimum legal threshold for turnout. Frustrating no doubt for the union as the 90% of the votes cast supported a strike. Matilda Martin at TES notes that the NASUWT decision is being challenged as some ballots went to incorrect addresses and postal strike delayed others. The NAHT also failed to meet the threshold citing postal strike issues and is also seeking permission to rerun the ballot.
Analysis from Labour suggests almost a third of teachers that qualified in the last decade have left teaching reports Peter Walker. The party raised this through an opposition day motion seeking to establish a committee on taxation of schools and education. The vote failed after govt opposed it.
Media-grabbing Parliamentary chicanery aside, staffing matters for service delivery. Particularly for SEND pupils — as Amy Walker’s Schoolsweek investigation shows, schools are struggling to attract staff leading to the most vulnerable children reliant on unqualified teachers. She shows over double the rate of temporary staff use for special schools and cites the example of one school where 40% of posts are filled by agency staff or teaching assistants. A TES report found a 40% drop in the number of specialist support teachers for deaf children in Scotland.
As we commented in Performance Tracker 2022 — many subjects lack specialist teachers, resulting in a reliance on supply teachers. Tom Belger at Schoolsweek reports on the impact that an increase in cover costs is having on school finances.
In other education news — Richard Adams at the Guardian analyses the increasing authorised and unauthorised absence in schools which is partly put down to a cultural shift in attitudes towards health. Unauthorised absences rose by over 70% during recent strep A and scarlet fever outbreaks.
Finally, children and young people were missing from Sunak’s New Year’s Resolution speech. Emily Harle has the details with the PM facing criticism from the president of the Association of Directors of Children’s Services Steve Crocker for overlooking children’s services. The full details are reported here by Mithran Samuel, in which he discusses social worker wages, workforce pressures, agency workers and his hopes for the upcoming DfE reform plans. Also echoing many themes from the Crocker interview Cllr Mieke Smiles at Middlesborough Council writes on the Conservative Home website and the need for faster delivery of both the CMA’s and the Independent Review of Children’s Social Care proposals.
Law and order
The big news is that a now former Met officer has pleaded guilty to 49 offences (including false imprisonment and rape) committed over a 17 year period — a truly shocking story. The FT has a good summary here.
The explanation for why he remained undetected for so long are well-known to our readers, namely lack of proper vetting and poor follow up on repeated allegations. What I find staggering is that while there are very complicated issues to resolve around the culture, there are also simple changes that could make a huge difference but haven’t been bothered with.
For example, legal requirements that forces must check a permanent complaints history before promoting or accepting new officers aren’t hard to create. Ideas were mooted on the BBC (at 8.10), for example, about independent scrutiny of the recruitment process. Abolition of the Met, as happened with the RUC, has also been suggested.
Sky reports that the NPCC will request forces double check their officers against national police databases. I’ve got questions about what information these databases collect — especially as opposed to force-level databases — and how long that information remains there. I’ll keep an eye on this, but again, pretty incredible that this has to be requested of forces by one of the nation’s top policing bodies).
This takes on added relevance in light of the 1000 sexual and domestic abuse claims that are currently being investigated. Mark Rowley has an unenviable task ahead of him, and we’ll have to wait until the end of March to hear his take on progress under his leadership (that’ll be the 6 month mark), which we’ll be able to judge alongside Baroness Casey’s review. Before then, it’s worth reflecting on the questions this episode throws up about how to judge progress on these matters, which seems like a catch-22 for the Commissioner.
The government has released terms of reference for a review into officer dismissals. No doubt recent events pushed this up the agenda, but it’s likely been in the pipeline for a while, since it touches more directly on the difficulties faced by forces when dismissing errant officers.
Moving on, Rick Muir wrote this on policing challenges in 2023, including: retention/recruitment problems, conduct/culture issues, and the Online Safety and Victims Bills. On the first, we reported here that retention in the uplift programme has been poor. Further upstream, the latest data from September shows govt has recruited 15,343 officers through the programme (headcount, that is). Accordingly, from September the govt has had to recruit 23% of the 20,000 officers with 15% of the programme’s time remaining — a tall order for a scheme that has missed its target for at least the last 7 months.
Poor retention might have something to do with the problems identified in the pay and morale survey from the Police Federation. You’ll have to wait for our spring Performance Tracker for the full story, but a couple of headlines: the proportion of Fed members reporting low force and service morale has grown consistently for the last 3 years, while 94% believe they are not paid enough given the stresses and strains of the job. Intention to leave the service is also high, unsurprising given reports that some police are having to rely on food banks.
The BBC reports on the Met’s efforts to gather data on those posing the highest danger to women (of those convicted of domestic assault, rape, stalking, harassment etc). It looks like part of Sir Mark’s effort to bring his knowledge of counter-terror (which naturally includes fairly proactive monitoring) over to violence against women and girls. A drive for better data on stop-and-search will also play a part to minimise unnecessary stops.
A couple of articles flying around illustrating the risks of poor justice investment. This story got lots of attention last week, outlining how a custodial sentence wasn’t given because prisons are ‘full’. Given prison demand, we can expect similar reports in the coming months. Secondly, the Guardian has this on MoJ data revealing that 900,000 cases have been committed by people on bail since 2010. This includes 7,200 sexual offences, some committed against children.
The Telegraph has this report on the courts coalface, documenting the inefficiencies and poor quality of justice delivered in a context of barrister shortages.
The latest court stats are out, showing in Q3 2022 the backlog in the crown court rose yet again to just under 62,000 cases, the highest on record. This is the last time backlog figures will rise due to the barrister strikes last year, and twitter chat suggests the number declined in November. Nice to see Danny Shaw take Raab to school on the government’s pyrrhic victory over the backlog… managing to lower it slightly by increasing the number of days courts can sit, having limited them in the first place.
Local government
Local authority reserves are back, with DLUHC calling for more transparency over “baffling” reserves data (if I were a DLUHC minister, I maybe wouldn’t admit that I found data produced by my own department “baffling”, but that’s just me). This follows reserves remaining higher in 2021/22 than forecast, after the largest single year jump on record in 2020/21. LG Improve published this in October, arguing LA reserves might be overstated. They claim money from business rates relief are still on authorities’ balance sheets, as they are intended to cover shortfalls over a longer time period than those two years.
The DLUHC Committee held their annual report and accounts questions with top mandarins. For a concise summary of the discussion of financial health of the sector, the decision to park the Fair Funding and Business Rate reviews, and the inadequacy of local govt finance see Jack Shaw’s thread. Thurrock and several high profile Section 114 proceedings (details here) came up during an exchange on whether DLUHC is delivering sustainability and resilience in local govt (see Qs29–32).
On financial sustainability… Thurrock. As we discussed last week Slough was seeking permission to increase council tax beyond the referendum limit. Thurrock is now attempting the same. Gareth Davies argues that even if central government permits this, significant cost-cutting measures are being proposed to balance the books [for more on the Thurrock and the question about accountability for the mess, checkout this Week in Public Services]. See the council’s discussion of the Section 114 and its action plan here.
Crisis released a report on the first years of the Homelessness Reduction Act (HRA). There’s a lot in there, so worth a fuller read, but a few things stood out to me. First, the difficulty that many people have accessing the service. There were reports of local authorities putting a high burden of evidence on people applying for a prevention or relief duty, similar to how authorities ration adult social care. The report blames continued poor outcomes not on the HRA but rather on the lack of affordable social housing. That deficit hinders proper homelessness prevention, as people are often left to become homeless before the council takes action. The report recommends a “Housing First” approach, accommodating people before looking to address underlying issues.
Given that focus on housing, this news that councils may lack the resources to address social housing repairs makes for troubling reading. For more on why a new inspection regime may lead to better understanding of the state of housing stock see here.
Councils report concerns about rising energy prices despite the Energy Bills Discount Scheme — with energy-intensive services such as leisure services and swimming pools not as strongly protected against higher prices according to the LGA. The LGA believes they risk reducing or closing services. This echoes warnings from Swim England that more than 100 pools could close/reduce services due to energy costs. DCMS can’t say whether leisure facilities are sustainable and lacks a strategy on how to maintain them.
Finally, last week the DLUHC minister Lee Rowley teased some “meat on the bones” of Oflog in “the coming weeks”.
