Week in Public Services: 24th March 2023
This week: The Spring Budget, Ofsted inspections and the Casey Review
General
“Was that it?” the question on many public services lips after the Spring Budget last week. Departmental spending totals were left mostly unchanged — meaning only small budget increases over the next two years and tighter spending planned after the next election. As you may recall from the Autumn Statement based on current fiscal plans prisons and courts are not likely to make a meaningful reduction in backlogs or safely house the expected increase in prisoners (more on this below). For a quick overview of the Budget see the six things we learnt from the spring budget, this explainer, and this strong IfG panel featuring the OBR’s Richard Hughes, the FT’s Stephen Bush and from the IfG — Hannah White, Gemma Tetlow and Nick Davies.
Also missing was the much anticipated NHS workforce plan — with the Treasury reportedly pressuring the NHS to remove all staffing numbers. Let’s hope the Chancellor, Rt Hon Jeremy Hunt MP, doesn’t ever find himself in the same room as the former Chair of the Health and Social Care Committee, Rt Hon Jeremy Hunt MP, a strong advocate for public figures on the NHS workforce plan.
While one Parliamentary Committee grilled a former PM over the nature of truth (for more on the significance of the session see this great comment by Hannah) — another committee drew out attention, the Parliamentary joint committee on human rights which gave the government’s Minimum Service Levels bill the once over and found it to be somewhat lacking. For those in need of a quick memory jog, the government introduced this bill in response to the recent industrial action across a range of public services, with the intention of effectively curtailing employees’ right to strike. The committee raised a whether “the bill is compatible with the UK’s human rights obligations, most notably the European Convention on Human Rights (the ECHR), which is given effect in domestic law through the Human Rights Act 1998”. So in addition to the bill likely being unworkable and contributing to worsening retention, it is also likely to break human rights law. Another fantastic piece of legislation from the government, then.
But, in more positive news… strikes. Yes, you read that right. A new NHS pay deal has been struck with ambulance workers and nurses including a one-off “non-consolidated” 2% bonus and an NHS “backlog bonus” of an estimated extra 4%. This alongside a 5% consolidated pay increase in 2023/24. As m’colleague Stuart points out the six months of damage it has taken to get here is surely not a price worth paying. With the government adopting a more conciliatory tone, intensive pay talks have also seen education unions pause strikes. Though not all disputes are resolved with the BMA announcing a 96 hour strike and estimates that up to a million hospital appointments could be postponed as a result.
Health and care
The biggest news in health and social care this week has been the release of the NHS staff survey results for 2022. While we crunch the numbers, a quick rant about data accessibility: can we agree to never use tableau as the primary means of downloading data? Maybe there’s a better way of using it, but it took me ages to get even one question’s worth of data out of it.
The Royal College of Emergency Medicine (RCEM) published a piece looking at what is needed to end the crisis in emergency care. They argue for five measures: (1) eradicate overcrowding and corridor care for patients; (2) provide the emergency medicine the NHS needs to deliver; (3) help the NHS provide equitable care to emergency patients; (4) evidence-based interventions to tackle overcrowding; and, (5) better metrics to track performance. Some good stuff, but Steve Black counters that the focus on emergency staffing is misguided, pointing to some previous analysis on the subject.
I missed this in January, but the House of Commons Library published a briefing on NHS charges, including an overview of prescription charges. Very useful for anyone getting up to speed on the current situation.
If you ignore the clickbait-y headline (spoiler alert: “robots” are not going to solve the A&E crisis), the rest of this article (£) is a really thoughtful and interesting insight into the current state of acute secondary care. Particularly interesting was the CEO of Addenbrooke’s — the subject of the case study — saying that he aimed to downsize his hospital and treat more people in the community. If we’ve got hospital CEOs saying this, all we need now is the political will to make it happen.
A really nice bit of dataviz showing patient pathways through A&Es.
The final instalment of Nuffield Trust’s series of explainers comparing adult social care across the UK’s four nations. This one asks the question of what role the government (national and local) should play in adult social care and provides a nice summary of the different levels of accountability across England, Wales, Scotland, and Northern Ireland.
Tower Hamlets will “abolish social care charges” from April 2024. This is really interesting, but I’m struggling to work out what exactly this means. It seems that the council funded home care before 2017/18, but then switched to charging for it due to funding pressures. Is this then a return to funded home care? Is it just for people eligible for local authority support? Or anyone who requests it? And how is the council paying for it? The press release says they are utilising the full 2% social care precept, but so are many other LAs who are not “abolishing social care charges”. Looking at the Medium Term Financial Strategy, the council plans to increase spending on “Health, adults, and the community” (which I take to include social care) by £13m in 2024/25 — just under a 10% increase. Which doesn’t seem like enough to abolish all charges. Strange. Anyone with further info, please DM me. 2018–2022
Children and young people
An intense debate over the role of Ofsted in the schools system opened following the tragic death by suicide of Ruth Perry the headteacher at Caversham primary school — a school due to be downgraded from “outstanding” to “inadequate”. Her death, linked to the stress of the Ofsted inspection, has released much pent up anger from the teaching profession about inspections — with campaigners submitting a 52k petition to the government calling for Ofsted to be replaced. The Chief Inspector, Amanda Spielman in response has rejected these calls and proposals to pause inspections, emphasising the importance of inspections for schools and parents. Unions remain critical of the decision to not pause inspections and continue to push for more than a single word summary of a school’s performance (a position not far from the ‘report card’ proposed by Labour — something which was barely a week ago referred to as a ‘logical evolution’ by Amanda Spielman).
In other schools news — both the BBC and Schoolsweek covered school absenteeism. As the Schoolsweek team note, absence for all pupils soared after Covid lockdowns and now almost 2 in 5 poorer pupils were persistently absence in the last year. In total there were more than 140,000 “severely absent” (i.e. missing at least 50% of classes). Terri White says, this can be for many reasons, anxiety, mental health and special educational needs, but drawing on her own experience growing up as a vulnerable child she emphasises the importance of schools as a safe space preventing harm against children.
Given the recent scandal about placing vulnerable asylum-seeking children in hotels — see my commentary here — the protection of underage children seeking asylum hit the news again linked to the new asylum bill. The government faced vocal opposition from the children’s sector for proposals which ‘profoundly undermine the Children Act’ and increase the risk of detention and deportation. For full details of the key provisions and voices in the sector see this report by Mithran Samual
A ban on the use of unregulated accommodation for children under the age of 16 will be extended to 16 and 17 years old from October 2023 onwards under a new government plan. While a welcome change, regulation may not be enough — as seen earlier last year, a lack of regulated accommodation had led some councils to place under 16s in unregulated accommodation (see earlier Weeks in Public Services) — its currently unclear whether a stretched system will have the capacity. The government also rolled out new mandatory quality and Ofsted oversight standards for unregulated accommodation in the announcement coming only days after criticism from Josh MacAlister.
The IFS published a really good explainer/budget primer on early years support and childcare. The overwhelming impression from their work is of the complexity of the policy area: there are 8 programmes designed to support parents with the cost of care, making it hard for parents to navigate. A prime example is the Tax-free Childcare programme. The IFS found that only 40% of parents had even heard of the programme, despite the fact that almost all working families can use it. The result is that the government spent £1.7bn less than expected across the first three years of the programme.
While we’re on the topic of childcare, Coram released their annual report on the state of the service. They find that just half of local authorities (LAs) have sufficient childcare for children under 2 — a 7 percentage point decline compared to 2022. The situation is worse if you have a disabled child, with only 18% of LAs reporting sufficient childcare, down from 21% in 2022.
Childcare is a bit outside our usual remit, but the IFS piece explains why it’s an important policy area: “research finds that ‘high-quality’ early education has raised attainment and reduced inequalities. Equally, there is evidence that flexible and affordable childcare can help parents to work, reducing the gender wage gap.” It also featured prominently in the Spring Budget. Listen to Nick Davies talk through the implications in this event held at the IfG discussing the implications of the Spring Budget for UK fiscal policy.
Law and order
The big news this week is the publication of Baroness Casey’s excoriating review into the Met, finding systemic problems in how the UK’s largest force is run, the integrity of its officers, and cultures of sexism, racism and homophobia. My colleague Matthew asks whether the Met is able to learn why it hasn’t removed toxic cultures 25 years on from the Macpherson report — surely a key question if this is actually going to spark changes. Others have asked whether trust between the Met and London/s black communities might be repaired with an Operation Trident-esque effort. On the Met’s lack of focus on violence against women and girls, Gavin Hales asks whether this might have something to do with its absence from the government’s Serious Violence Strategy. He also has a useful thread on the recommendations here. Similarly, an interesting take on future steps from Tim Newburn here.
The Guardian has this piece reporting that more than 1,500 officers have been accused of violence against women between October 2021 and April 2022, while fewer than 1% of them have been sacked. I haven’t had time to dig into the data, but it seems like a pretty emblematic example of the difficulties forces face in getting rid of undesirable officers. It also has this fantastic long read on Betsy Stanko, the adviser at the front of the push to improve forces’ response to rape and sexual assault — well worth a read.
This marks the final month of the original Police Uplift Programme’s target for increasing the police’s capacity by 20,000 officers. Ben Butcher has a good thread exploring officer increases, geographic disparities, demographic shifts, and pay issues affecting the police in the context of the uplift. Well worth a read as the Home Office looks increasingly likely to miss its target, as we predicted here.
On this, the Home Office released its survey of new uplift recruits. It tells a pretty stark story about the worsening opinion of new recruits on last years’ survey, with across-the-board declines in intension to stay, satisfaction with the role and with support, and dramatic increases in recruits agreeing they’ve had to ignore their personal life needs due to work strain.
Last month Inquest put out this report into race and deaths in police custody.
Centre for Public Data published a report about the lack of government data on the representation status of people appearing before magistrates’ courts. This sounds niche, but their particular worry is that people who represent themselves experience harsher outcomes and yet we have no data on the number or the demographic make-up of these self-defendants.
I missed this month-old (actually more than, soz) story that the MoJ is extending the use of some of its Nightingale courts to help tackle the backlog. Along with doubling the sentencing powers of magistrates, recruiting more judges, and more money, the government seems to be betting on good progress, although it might be a tad soft-touch without improving workforce shortages.
But won’t this put pressure on prisons? Slam on the breaks, because yes, basically. So much so that magistrates’ sentencing powers have been re-limited to 6 months because of said pressure.
On the topic of prison pressure, the Sun reports on the opening of 1,000 rapid-deployment cells to prevent criminals being temporarily housed in police cells, with prisons themselves running at 99% capacity. Charles Hymas has this piece on the options Raab has, with sources saying he’s refusing to contemplate early releases, while approving the use of police cells and halting all non-essential prison maintenance to keep cells operational (you do wonder whether non-essential now becomes essential later though?). Other options involve fast-tracking deportation deals to get rid of foreign criminals or increasing the number of prisoners per cell. With the latter predicted to lead to reduced safety among prisoners and staff, the article also suggests the expanded use of tags and curfews could support early releases. Definitely one to keep a wary IfG-eye on.
In prisons, the Mirror has this story on the scale of prisons officer hospitalisations, which fell shy of 1,000 in 2021 alone (during which year nearly 10,000 weapons were seized). This is terrible for officers, with poor prison conditions and an inexperienced workforce facing a prison population who have been increasingly deprived of purposive activity since the pandemic (and many of whom are still locked up for up to 20 hours a day). The MoJ’s assurance that attacks have fallen by 20% since 2019 are of little comfort when you consider a) that small thing called covid, and b) the fact that assaults on prisoners have been rising since 2020 while assaults on staff are stable at an historically high level.
Local government
The LGIU state of local government finance in 2023 report came out with sobering reading about the critical state of council finances. In their survey of senior council figures, only 14% of senior council are confident in the sustainability of their funds and more than 90% of respondents plan to increase council tax. As Patrick Butler at the Guardian puts it — most are also proposing to cut spending (52%), increase fees for services such as parking and waste (93%), spend their “rainy day” financial reserves (67%) and sell off assets such as land and buildings (see also this report from the County Councils Network on the £1bn of savings needed to balance their 2023/24 budgets).
Yet little substantive relief was forthcoming in the Spring Budget. For a great summary of the implications of the budget for local government see this blog from Richard Harbord the former chief executive of Boston, Richmond and Hammersmith & Fulham Councils. First the wider fiscal and economic pressures will continue to bite (higher than inflation cost increases to social care, unfunded pay rises and living standards are due to fall reducing tax receipts and increasing demands). Second several policy announcements affect local government — swimming pool financial support, increases to the landfill tax, business rates retention being extended to more areas in the next Parliament and a new pothole fund. But in sum, none of these policies substantially address the fiscal concerns voiced by the sector.
Gareth Davies published his interview with Mark Coxshall, the leader of Thurrock Council. It is, to say the least, quite bad. There is no sign of contrition from Coxshall, other than a vague pledge to own up to problems “internally”. He also manages to blame everyone except for himself and the Conservative group of councillors, including council officers and the Labour party. Putting aside everything else, there is something vaguely illuminating in what he said: “the [disastrous] investment strategy was a root cause of not putting [council tax] up. The council wanted to keep council tax low. The council chose to invest to make money so they didn’t have to put council tax up”. I actually do believe him here, but the interesting thing is the funding source he doesn’t mention: government grants, which fell by 15% (including retained business rates) for Thurrock between 2009/10 and 2019/20. Of course, that doesn’t excuse the poor investment decisions, but funding pressures certainly led to local authorities chasing yield through risky investments.
The levelling up minister, Lee Rowley, attended the LGA councillors’ forum last week, where he said that the government would “see what we can do to speed […] up [the release of the provisional local government finance settlement]”. You’d imagine that the settlement is almost entirely in DLUHC’s gift in years where there isn’t a new spending review, making me wonder if it is just habit that means the government releases the finance settlement so late.
