Week in Public Services: 27th April 2023
This week: Raab fallout; a manifesto for adult social care reform; and the government hits its police target
General
The big news in Westminster this week is obviously the resignation of the deputy PM, who was caught like a Raab-it in the headlights of the Tolley report (I’m really sorry, this pun has been going through my head for days and needed an outlet). The discourse quickly spiralled into an argument about “activist civil servants” trying to block government decisions, and the need for civil service reform. This is all very much in the IfG’s wheelhouse and there is lots of content from colleagues to get into. First, last week’s podcast delves into the story in depth. Second, Hannah White argues that Sunak’s lukewarm acceptance of Raab’s resignation misses an opportunity to demonstrate his government’s commitment to “integrity, professionalism, and accountability”. Finally, Alex Thomas had a great thread defending the concept of civil service impartiality. That thread generated much debate on Twitter, including this claim from Steven Barrett that Alex’s tweets were “a major constitutional failure”. This immediately prompted much debate in IfG towers as to whether Alex Thomas is a major constitutional failure. We’ve got our constitution team on the question, and will report findings in due course.
While this is all very interesting, I do agree with Sam Freedman about the oddity of a story about ministerial bullying quickly turning into a debate about civil service reform. This is the third minister in recent years embroiled in a bullying scandal. How has there been no major reassessment of what is and is not acceptable ministerial behaviour? This story looks unlikely to stop, with news that Steve Barclay has also been accused of bullying by some in DHSC.
There is a public services angle here: Raab’s resignation means that we now have our tenth justice secretary in as many years. The latest iteration is Alex Chalk, a staunch Sunak ally, KC and definitely “not a career politician”, as his own website points out. Which raises the question of whether he’s just an amateur secretary of state? Or maybe just doing it as a hobby? Maybe he’s on a career break and finding himself on an 8 year-long (and counting) gap year in Westminster? Nick Davies provides a helpful thread briefing Alex on his in-tray.
Another contribution to the long-running debate about economic inactivity due to ill health, this time from the Health Foundation. The authors examine a number of potential explanations for the increase: long Covid, increasing waiting lists, and pre-pandemic trends and demographic shifts.
On long Covid, they show evidence that though there are 110,00 people reporting not working due to the condition, this is likely only having a minor effect on economic inactivity, with people instead signed off work for extended periods of time. Waiting lists: also not a large contributing factor, with long waits most likely affecting those already out of work. Changing demographics could explain about 13% of the uplift, the authors estimate, though this is also not that strong an effect. The end point, then, is more or less where we started; an observable increase, but no concrete explanation for the phenomenon. For what it’s worth, I think the cause is probably multi-faceted and extremely complex, not lending itself well to simple explanations. Regardless, one thing we can say, is that as long as the NHS is struggling to return to pre-pandemic levels of performance, the government will struggle to reverse the trend.
In Prospect Ben Zaranko argues that the UK is heading towards being a larger state, relying on ever larger tax receipts to fund more public spending. The causes are familiar by now: an ageing population, Baumol’s cost disease, and a desire for more defence spending. The key question that he poses to those who want a smaller state is: what services that the government currently provides would you be fine for it to no longer deliver? He then lays out some steps that the government could take to ease the transition to a higher tax steady state. I agree with all of Ben’s points, but one addition I would make is to challenge the idea of Britain as a high tax state, even when tax receipts are forecast to rise to 37.7% of GDP by 2026/27. As the OBR showed in their autumn statement analysis, the UK is currently in the lower third of OECD countries when it comes to tax burden and will only rise to roughly middle of the pack if taxes rise to 37.7% of GDP.
Health and care
Wes Streeting expanded on Labour’s vision for the NHS last Friday. Streeting identified general practice as being in need of expanded support and emphasised that it will take “a decade to get the NHS back to where it was under the last Labour government”. All good stuff. Where it’s less good is where he falls back on familiar politicking, with promises to recruit “7,500 more doctors and 10,000 more nurses every year”. Is there any basis for these numbers beyond the fact that they’re round and sound big? It’s impossible to tell. Meanwhile, Streeting ignores the potentially quicker — though politically less glamorous — wins that would come from focusing on retention. Elsewhere, much of what he announces is not that new. For example, he pledged to “boost the range of health professionals working alongside GPs to ease pressure on primary care” in a move that sounds remarkably similar to the Tories’ ARRS programme. Which doesn’t mean it’s a bad goal, just one that is already in progress, and comes replete with its own problems.
Michael Marmot responded to Streeting’s speech in this Guardian column and argues that as well as reforming the service — a step he acknowledges is needed — Labour should also focus on the wider social determinants of health.
It seems almost certain now that the NHS will miss the target to clear 78-week waiters off the elective waiting list by the end of this month. The HSJ reports that “system leaders” now want to push the target back to the end of either June or July. It’s worth noting that while the current debate is around 78-week waiters, there are still more than 1,000 104-week waiters — a group the NHS was supposed to cut to zero by the end of July last year. I’m not going to hold my breath for 78-week waits to be eliminated any time soon.
Steve Black has a great piece in the HSJ about the importance of eliminating 12-hour A&E wait times (and also a helpful potted history of A&E targets and performance). Using work that he and others have previously done on the dangers of long waits in A&E, he estimates that long waits in A&E “added perhaps 2,000 extra deaths in February alone”. He concludes by challenging the NHS’s interim target to reduce 4-hour A&E waits and instead argues that the NHS should focus on reducing 12-hour waits first.
More from the HSJ, this time on ICS budgets, which the author reports have not been balanced in a quarter of ICSs, despite being well into the new financial year. The NHS’s response is to impose a hiring freeze in those trusts until they provide balanced forecasts. There was potentially an overreaction from one director at least who is quoted as saying this might lead us towards “Mid Staffs territory”. Which, as Steve Black points out, is both a gross misreading of that episode and also ignores the fact that performance in the NHS has not improved in the last three years despite record numbers of new staff.
This is an odd piece in the Times. Ostensibly, it answers some important questions: how many doctors are moving abroad? And how many plan to come back to the UK? But when you dig a little deeper, the data it uses is from a survey run by the General Medical Council and Health Education England in early 2020. Call me a cynic, but I think the intervening three years — which included a morale-shattering global pandemic and salary-eroding bout of inflation — might have somewhat coloured doctors’ views on whether they intend to move abroad and if they plan to stay there.
ADASS have published a report — Guardian write-up here — laying out their own vision for adult social care reform. Their recommendations include (only a small sample, because there are so many):
· Pay parity for carers with NHS staff
· Workforce planning carried out at an ICS level to include both health and social care
· Improved support for unpaid carers
· Determine and properly fund a fair cost of care
The report is obviously ambitious, and I think does well at framing the issues and outlining a vision for the service. Some of the difficulties come — as Simon Bottery argues — in the development of specific policy objectives. Still, this is a great piece of work which I think serves to highlight the government’s failures on social care reform.
Children and young people
An investigation by the BBC found the government’s national tutoring programme (NTP) failed to spend almost £209m, equal to a third of its budget. The NTP is meant to help pupils catch up with lost learning after the pandemic but as of January 2023 only 66% of schools have participated this school year. Low uptake is reportedly linked to budget pressures on schools.
In a sign of the pressures on school budgets, research from the Sutton Trust shows large cuts to teaching assistants school trips and IT equipment this year. A poll of almost 1,430 teachers found 63% of senior leaders cut teaching assistants this year up 21% from 2022. It also showed teachers from more deprived areas were more likely to cut school strips and a quarter of school leaders are cutting the range of GCSE subject available up from 17% the year before.
Twitter debates continue over provisions in the illegal migration bill which would allow the government to detain and remove children attempting to claim asylum. The Children’s Commissioner has reiterated her opposition here and a twitter thread summarising a report from the Refugee Council can be seen here. The main argument is that unaccompanied children are frequently fleeing the Taliban or Sudan; both countries that the government often grants asylum to, which does raise the question of why not children.
The government asked the Law Commission to review laws relating to social care for disabled children reports Community Care. The DfE aims to address a patchwork of legislation covering the children, the relationship between this and broader children’s social care laws and to develop more modern language and definitions.
A troubling report about children in care being place from far their home is summarised in this piece. More than 20% of the care population are placed more than 20 miles from home, up from almost 16% a decade earlier. Shortages in social care places is a driver and leads to worse outcomes for children, including disrupted education and feelings of isolation.
The new ADCS president John Pearce has been doing the interview rounds amplifying the concerns he raised in his recent inaugural address including: morale, inspections and regional care cooperatives; children’s mental health services being overwhelmed; declining school attendance; and SEND reforms, a lack of childcare placements, and workforce recruitment and retention. In sum, a challenging and difficult time for the children’s social care sector.
Law and order
Was that it? This week the government reported that it met its manifesto commitment to recruit an extra 20k new police officers by March 2023, so where was all the fanfare? A couple of reasons might account for this paucity of coverage. First, as colleagues outline in their comment piece, a target to increase police officer numbers won’t address the wider issues in the police and justice sector.
Second, statistics rules prevented the final figure from being announced until 9.30am in effect stopping sexy press releases from dominating the news agenda because the government can’t brief the press the evening before.
Third, the numbers are controversial. This statement from the Police Federation critiques the outcome, arguing that these new officers still do not make up for the total number of police staff lost since 2010, an outcome which means higher workloads for those that remain. There are also fewer officers per capita than in 2010. Rick Muir highlights that cutting a workforce and then replacing posts means less inexperienced officers and therefore higher pressure. For a fuller drill down into the details of the data release check out this great thread by Gil, and check out this fantastic thread from Gavin Hales showing that while most forces have increased the number of police officers since 2010 (by headcount), about 2/3 of forces’ overall workforces have declined over the same period. Similarly great work here from Mark Brown.
Matt Ashby brings us this analysis that contradicts the recent narrative — in the media and from both political parties — that crime and anti-social behaviour is out of control across the UK. Matt uses data from the crime survey in England and Wales to show that rates of many common crimes — including burglary, theft, and violence against a person — have all dropped in the last year, with many falling substantially since 2010. More interestingly to me though is the 44% fall since 2010 in the number of people who feel there is a high level of anti-social behaviour (ASB) in their area. This is despite a lot of media attention and think tank thinking which claims that ASB is particularly pernicious at the moment. The one obvious omission from the analysis is fraud, which we know has risen enormously since 2010, though this is because, as Matt points out, the time series for that data only starts in 2017.
Local government
The University of Manchester released a report about how to improve recycling (brief aside: the project team is called “One bin to rule them all” and I for one would like to congratulate them on raising the standard for waste policy puniness to previously unknown heights). The report argues that the byzantine set of recycling regimes, which sees large variation between neighbouring local authorities, leaves residents confused and reduces the effectiveness of recycling. That makes the government proposal to standardise recycling across the country — that we wrote about a few weeks ago — seem that much more sensible. More interestingly (to me, at least) is that another bottleneck is both the variation in capacity and capabilities of recycling plants across the country. It made me wonder whether this is the result of local authorities negotiating hundreds of separate recycling contracts, each with different specifications and varying levels of investment? If one authority doesn’t have the resources or inclination to invest, then residents have little choice about how to recycle. Looking forward to more output from this project.
The LGC has some great analysis of local authority reserves, following an updated release of local authority revenue outturns. They argue that looking at raw reserves levels is not a good metric of local authority financial health and point out that Croydon had one of the largest increase in reserves in the same year that they filed their third section 114 notice in two years.
Speaking of those new outturn releases, it looks like DLUHC is taking its own steps to try and clarify the position of local authority reserves, with the addition of a new “Estimated other earmarked financial reserves (adjusted)” column in the revenue outturn. That adjustment strips out reserves which local authorities have identified as being related to Covid spending, leaving an “underlying” reserves amount. The result is a level of reserves that is substantially lower than the top-line figures that the government has been complaining to local authorities about.
On the topic of finances, Croydon’s interim audit is out. The auditors Grant Thornton found significant weaknesses in the accounts from 2019/20, 2020/21 and 2021/22. They also expect an adverse opinion for 2019/20. Cutting through the jargon, this means that Grant Thornton expect there to be substantial errors which doesn’t accurately reflect the financial state of the organisation. Room151 report that these financial inaccuracies have left Croydon unable to withstand other, wider shocks.
The New Statesman polled councillors on their views about levelling up. 63% of councillors called the project “a failure”, with only 15% of Tory councillors agreeing with that statement. Funnily though, despite so many Tory councillors thinking levelling up had been a success, 69% said that their area had not seen any benefits from the project. That implies that the majority of Tory councillors think it’s been a success, just not in their area, which does make me wonder how they judge it so positively.
