Week in Public Services — 28th August 2018
This week: more people get convinced that local government finance is interesting; GP numbers are still dropping; and some surprisingly wholesome findings about mobile phone use in prisons.
This is a non-comprehensive overview of what is going on in public services by the performance Tracker team at @instituteforgov. Did we miss something important? Let us know below.
It’s gloomy, the bank holiday weekend is in the past, summer is officially o v e r…and things are ramping up again in the public service policy world.
Health and social care
‘Privatisation’ in the NHS can mean lots of different things. There’s a lot of rhetoric, but we’re often lacking in substantial evidence about what the real scale and effects of contracting out health services are. A new FT investigation finds that NHS England’s spending on private providers has increased marginally since 2013/14, but as share of total spending it has declined. But comparing the performance of public and private providers does not show any clear pattern.
The latest GP numbers are out: and they are still dropping. This recent King’s Fund survey of trainees offers some insight into what sits beneath these recruitment and retention issues.
Neighbourhood services and local government
We know that the rise in social care spending is putting pressure on other services — such as trading standards, which has sustained heavy staff reductions (raising fears of a potentially unmanageable workload after Brexit. But high-profile financial failures are keeping the seemingly un-sexy issue of local government finances high on the political agenda.
Both Northamptonshire and East Sussex have said they will reduce their services to a “core offer” — but what does this actually mean? A Guardian investigation of planned cuts to East Sussex’s respite care budget found that they intend to no longer provide after-school and holiday clubs for SEND children, and that bed spaces in respite care are increasingly constrained. Some parents are worried that without this support, they may be forced to place their children in residential care.
New IFS work on the distributional impact of various options for local government funding. If the Fair Funding review makes councils who set low tax rates bear more of the costs of services themselves, then high-needs, low-tax councils lose central government funding. However, professional local-government watcher, LSE’s Tony Travers thinks county councils will receive a bigger share of central funding, as ministers have been “spooked” by Northamptonshire and East Sussex.
Clive Betts, chair of the HCLG select committee, argues that uncertainty over “local government’s financial infrastructure” — its ability to raise and spend taxes locally — is now as big a problem as the immediate shortage of money. “Fundamental reform” are required, he argues including council tax, business rates, and possible premiums for children’s and adult social care.
CIPFA have attempted to support the public debate by drafting a financial resiliance index, to clearly highlight which local authorities are struggling the most, and in greatest need of intervention. This proposal — still in its consultation phase — has not been uncontroversial, and SOLACE are the latest sector organisation to raise questions, arguing that it may be too crude to provide a balanced picture.
Children and young people
In more outsourcing news: the number of children’s residential homes are increasing, and an increasing share are run by the private sector. The total number of local authority homes has been in decline since 2015. Ofsted plan to investigate trends in private ownership, and will publish inspection profiles of the 10 largest private organisations later this year.
There’s a new EIF report on the impact of government-funded childcare for disadvantaged children. Did it reduce the early years attainment gap? Nationally, there’s not been much difference in the rate in which the attainment gap between children on (and not on) free school meals has been closing; tracking take-up locally shows greater positive effects. A mixed bag.
The Home Office has provided cash for pilot schemes to provide at-risk children with “trusted adults” — role models such as youth workers, police officers, and nurses — following an Early Intervention Foundation review which found that “a lack of trusted relationships was a consistently cited contributing factor in cases of child sexual abuse and exploitation”. It’s great that the Home Office are following the evidence and trailing this new scheme through pilots — but is it just replacing which would have been funded through the (now-defunct) early intervention grant?
The coalition government’s reforms to speed up adoption may have created problems in the way social workers assess and select adopters due to, amongst other factors, inadequate scrutiny and a tension between social workers acting as advocates and as assessors. 3.2% of adoptions broke down over a 12-year period, according to a government-commissioned review.
Law and order
The problems facing our prisons are serious and will take a wide range of interventions to successfully tackle. But having a minister take personal responsibility for ameliorating them — as prisons minister Rory Stewart appears to be doing — is a really important step. CapX are optimistic about his prospects.
Meanwhile, Russell Webster has a great summary of some very interesting HMPPS analysis of mobile phone use in prisons. It’s a much more complicated picture than you might expect.
