Week in Public Services: 22nd September 2022
This week: Coffey settles in; police recruits have their say; and rumblings in Thurrock
Health and care
Ignominious start as SoS for Coffey as her first communication with DHSC — which reportedly asked officials to avoid using Oxford commas and be positive about the state of the NHS — was dubbed “patronising” and was promptly leaked to the FT. This might seem trivial, but in the midst of an enormous crisis, those working in DHSC and the NHS want someone with a clear vision for how they will get through this winter, not pedantic exhortations about grammar.
The new government has floated scrapping measures encouraging healthy eating. Not in itself that surprising, but once again there is a clash between the government’s stated aim of reducing demand for the NHS through preventative measures and actual policy. It’s no surprise that officials at OHID were supposedly “aghast” at the proposals.
New report from the IFS about what drives different leaving rates across the NHS acute sector. Some of the variation between trusts is shocking: trusts with the worst retention rate saw and average of 4.5% of HCAs leave per month compared to 0.5% in the best trust. Other factors that influence leaving rates are: age, gender, nationality, regional unemployment rates, recent physical and mental health absences. On that last point, it is worth noting that absences for mental health reasons spiked during the pandemic and anecdotally are still high as staff work in stressful conditions — not a good lead indicator for improving retention.
Really interesting report from Nuffield Trust asking what can be learnt about professionalised care careers in other countries. The authors argue that professionalisation will improve recruitment and retention — partly through better pay — and improve outcomes for people using social care services. One problem I have with their argument that professionalisation will lead to higher pay, is that it isn’t a lack of professionalisation that stops us from paying care workers more, but rather a deficit of political will to properly invest in the service. Until that changes, no amount of professional qualifications are going to lead to carers being paid more.
Timely study in the BMJ finds that burnout among doctors leads to increased staff turnover and worse outcomes for patients. This should concern the NHS: the proportion of available FTE days in which staff were absent for mental health reasons rose from an average of 1.13% per month in 2019/20 to 1.26% in 2020/21, and again to 1.35% in 2021/22.
A real must-read from Dr Zara Aziz for anyone interested in what it’s like to be a GP at the moment. A few things that stood out:
· Rising staff numbers in Primary Care Networks (PCNs) means that GPs are increasingly seeing patients with more complex needs. On one hand this is a positive outcome — taking easy cases out of the hands of the most qualified staff makes sense — but on the other if GPs are forced to treat patients with more complex needs in the same amount of time, then there will inevitably be more work, more stress or both
· Aziz mentions “a national drive for reducing referrals”. This is something we’ve heard anecdotally and, arguably, one reason the NHS introduced Advice & Guidance, but also something that NHSE would strongly deny. It would make sense — managing the flow of people onto the elective waitlist is one way to keep numbers down, and is easier than increasing elective activity. The outcome, though, is increasing pressure on primary care.
· Finally, Aziz points out that the NHS also needs to invest in the primary care estate as well as recruitment and retention; it’s no good having more staff if there’s nowhere for them to work
From anecdata to actual data: the King’s Fund published this blog post (here’s the accompanying Guardian article) that summarises the findings of their annual survey of GP trainees. The headline is that 31% of trainee GPs intend to work full-time after qualifying which is, needless to say, not great, but is also not that surprising given that 77% of all qualified permanent GPs currently work part-time. The more worrying trend to me is the continuing decline of trainees intending to become a GP partner — 35%, down from 45% in 2016. It does raise the question of the sustainability of the GP partner model if there are limited GP partners in a few years’ time.
A couple of weeks ago we reported on the NHS’ winter plan which, it was announced, would include an expansion of virtual wards. Several authors in the Hospital Times, however, argue that much more can be done to ensure that the benefits of at-home monitoring (especially in relation to clinical time saving and patient outcomes) are fully exploited. The authors outline 6 broad ways of achieving this, including by using technology able to distil data to avoid clinicians being swamped with a load of unsieved waffle (those are official medical terms).
Children and Young People
This review from the IFS takes a comprehensive look at educational and skills levels in the UK. It includes some sobering figures. While the share of students achieving at least 5 good GCSE (or equivalent) results has increased dramatically in the last 20 years, English 16–24-year-olds rank 25th out of 32 OECD countries included by the IFS in terms of literacy and numeracy skills. Among OECD countries, the UK as a whole sees a very low uptake of advanced vocational qualifications. The study points out that academisation alone (by simplifying school governance) is unlikely to reliably boost educational attainment.
Education Datalab find that the KS2 attainment gap has widened further since the start of the pandemic — to its highest level since 2012. In the context of findings like these, the government’s £1bn Recovery Premium seems paltry, especially compared with Kevan Collins’ £15bn recommendation.
TES reports on a plan by the British Educational Suppliers Association (BESA) to bring legal action against the DfE over the establishment of Oak National Academy as an arm’s length body. Worth reading our recent case study on the rollout of Oak Academy and our argument for its establishment as a non-departmental public body.
Law and order
The Home Office has published this survey of new police uplift recruits, conducted between March-April 2021. The headline figures are encouraging, with 90% of new recruits reporting satisfaction with their new jobs, and 81% intending to stay in their job until retirement. So, what should we make of these results?
Elephant-memoried readers will remember this recent edition of Week in Public Services, in which we highlighted the stress, workload, leadership, and expectational factors that are reported to be driving PUP recruits out of the force. This may still have been a problem at the time this survey was conducted, with the sample consisting only of recruits with between 3–12 months experience (read: survivorship bias). However, it’s important to remember that this survey was conducted during the pandemic and by new recruits — hardly a representative snapshot.
Similarly, it’s tricky to square the circle between the findings in the PUP survey and the low levels of professional and personal morale among officers reported by the Police Federation. At the very least, it’s a mixed bag, and we can only hope that the Home Office will be slightly more prompt when it comes to releasing the 2022 uplift survey.
From more transparency, to building trust, to driving cultural change, this BBC article offers a candid assessment of some of the unenviable tasks facing Mark Rowley as he settles into his new job as Met commissioner. Having pledged, among other things, to send officers to every reported burglary, Rowley has also drawn attention to the difficulties he faces in dismissing underperforming or irresponsible officers. His promise to recruit more officers to the Met’s professional standards directorate is an indication that he — rightly — takes standards seriously, though it’s worth asking whether this is the best approach. In the past, concerns have been raised over the logic of police forces effectively policing themselves when it comes to most complaints. See, for example, page 26 of this Home Affairs Committee report from earlier this year.
Local government
In last week’s Week in Public Services, we provided you with a brief update on the financial difficulties faced by several local authorities. In the case of Thurrock, which has come under fire over its borrowing practices, DLUHC has appointed another council (Essex County Council) to act as a commissioner. Jack Shaw has this useful thread asking whether there is a tension between the need to ensure interventions of this kind utilise the advantages of ‘local knowledge’ (which DLUHC has said motivates this style of intervention) and the need to remain independent enough to be an effective commissioner.
It also provokes interesting questions with respect to the future makeup of interventions, and whether this could (as suggested in this LGC article) herald the start of an era of centralising in local government. This may prove to be a pertinent question in light of the establishment of the Office for Local Government, which may be able to give DLUHC a clearer insight into which councils require interventions, if this be its calling.
