Week in Public Services: 22nd November 2021

This week: pandemic preparedness; Tony Blair’s views on criminal justice; and social care shenanigans


The National Audit Office have analysed the UKs preparedness for the Covid-19 pandemic, and have found quite a few weaknesses. Much of this was already well-known — but the sections on what the government had not prepared for (shielding; employment support; financial support to local authorities; managing school disruption) make for interesting reading.

The annual Reform ‘State of the State’ report on citizen and expert perceptions of the state is out — and the section on the legacies of the pandemic is particularly interesting. Police leaders interviewed were particularly concerned about fraud.

Health and care

In a week in which care workers have had to be double vaccinated and there is likely to be a fall in the number of care workers, the biggest story was, surprisingly, not that but instead the story that the government making social care reforms less generous for people with modest assets. What? Let’s start from the beginning:

On Wednesday, the government published “further details” on how the new cap and means test would work, explaining that only costs paid by individuals would count towards the £86k cap (after which the state would cover all personal care costs). The expectation had previously been that costs paid by individuals and the state would count towards the £86k cap — the logic being that people with fewer assets should make a smaller contribution towards their care costs than those with more.

Andrew Dilnot, author of the 2011 cap proposal which formed the basis of the 2014 Care Act, was critical of the change in his evidence to the Treasury select committee. Sally Warren and Charles Tallack both have good threads explaining the change clearly. Politically, this seems like a massive hassle for not saving a huge amount of money, as Giles points out here. There is a nerdy governance point in here which I will not stop banging on about: publish an impact assessment of the social care reforms already!

Meanwhile, the deadline for care workers to be vaccinated has come, and the National Care Forum are worried about the potential 8% loss of care home staff as a result of the policy. That 8% figure comes from a survey though — and a closer look at care worker vaccination data from Nuffield Trust shows that, as of 26 October, 11% of care workers had not received two doses by 11 November. For context, this is at the high end of the percentage of workers that DHSC expected not to take up the vaccine (3%-13%). With a particularly tough winter coming up for health and care, this is very concerning. Hopefully the now-published Capacity Tracker data will gave DHSC the evidence needed to make a case for urgent changes if staffing pressures become too great.

In the health world, Nick Triggle has written in my view the single best summary of pressures on the NHS, pointing out just how much bed space is now occupied by non-covid patients.

The Financial Times also have an interesting piece about changing primary care in England and how GPs are trying different approaches to support people. A good read — and not just because it cites Performance Tracker graphs!

A big two weeks for new health and care research, as well:

  • The three big health think tanks have outlined the arguments for spending more on social care — good read, if for no other reason than it reframes social care as a cost to be met to an investment to be made
  • The Kings Fund have investigated how the UKs response to Covid affected mortality and life expectancy (and how that compares to other countries)
  • The Social Market Foundation published an interesting essay collection about general practice (I particularly liked Richard Disney’s essay about economic incentives)
  • The Health Foundation have analysed whether integrated care programmes reduce emergency hospital admissions (TL;DR — no, or at least not quickly — but this is not the only metric that matters)
  • The Nuffield Trust have been busy, as always — analysing whether the government is on track to meet staffing pledges (roughly — yes on nurses, no on GPs, reasons for concern in both cases), and what high UK health spending during the pandemic reveals
  • They also have a bigger report out about how to attract and retain a diverse NHS workforce, which is well worth a read

Two other pieces I found worth reading:

  • Nigel Edwards’ argument that targets and terror will not drive improvements in the NHS
  • An ace King’s Fund blog from Deborah Ward on visualising the size of the backlog — lots of good examples of how communicate the scale of big numbers

Children and Young People

One thing we looked into in this year’s Performance Tracker was the slightly concerning rise in pupil absence not directly attributable to Covid, which might have shown the pandemic causing some pupils to drop out of the school system entirely. Education DataLab have taken a closer look at primary school and secondary school pupil absence in Autumn 2021 and found that the increase in pupils missing a lot of school “looks like this is result of COVID directly causing increased sickness, rather than indirectly causing more unauthorised absence.” Reassuring!

In data news, Department for Education has released the latest children in need data last month, covering referrals, numbers of children in need, and children on child protection plans during the 2020/21 financial year — most of the pandemic. On skim, it backs up the picture we found in this year’s Performance Tracker: the new data also shows a 7% decrease, driven mainly by fewer referrals from schools. The trend is the same — although the scale of the decrease is slightly lower than the sample of local authorities providing data to the Vulnerable Children and Young People survey would have implied (around 11%). Do you know the why? If so, message me.

Another finding that stuck out to me was that the police actually referred more children to local authorities in 2020/21 than in 2019/20 (presumably some of these children would normally have been referred by schools).

In wonkier schools news, a new paper by Sam Sims analyses the Westminster government’s proposals to reform to initial teacher training in England, and argues that the reforms are worthwhile — but the government should announce additional funding in order to cover the additional costs involved in delivering the proposed reforms.

Law and order

The Health Foundation have published a detailed analysis of the impact of the pandemic in prisons. The most remarkable thing in there, I thought, was that even in April 2021 (a year after the first lockdown), prisoners still averaged 22.5hrs per day in isolation.

Jon Collins, chief executive of the Prisoners Education Trust, makes a compelling case for prisons investment in the Spending Review — given the Ministry of Justice received a relatively large increase in the Spending Review, the Prison Service will now need to make the case that it could use some of those increased budgets to enhance prison education!

An interesting Tony Blair Institute paper analyses how the government should respond to two problems in the criminal justice system: (1) that the police are taking longer to respond to incidents and (2) that fewer offenders are being charged and prosecuted. They argue that the government should set “minimum standards” (which sound a lot like targets) for response times and charge rates, joint prosecution targets for the police and the Crown Prosecution Service, and a national approach hiring fraud investigators. It’s an interesting report — even if it commits the serious crime of putting police-recorded crime between 2010 and 2019 in a time series without acknowledging improvements in the way the police recorded crime in 2014 — ARGH!



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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.