Week in public services — 28th November 2018
This week: No NHS reform plan yet, lots on mental health, and your author grudgingly accepts that running might be good.
This is a weekly round-up of research and happenings from the team at the Institute for Government that put together Performance Tracker — a data-driven analysis of the performance of public services.
Health and Social Care
The NHS Reform plan is coming out…soon? Matt Hancock and Simon Stevens were in front of the Health and Social Care select committee — mostly talking about Brexit — and gave contradictory answers, but the latest reports suggest that it will be published mid-December. Some are reporting that this delay is due to Brexit. Or it might be that Simon got his homework (NHS reform plan) done before Matt (adult social care reform plan), but Matt wants them to both hand them in at the same time, so he doesn’t look so bad.
In a teaser for the plan, Matt Hancock announced last week that £3.5bn of the additional NHS funding announced in the summer would go towards primary and community care, including money for rapid-response GP teams and dedicated support for care home residents.
But of course, the next ten years start with next year. Does the NHS have the right plans and expectations in place to deliver what it needs to in 2019/10? Chris Hopson from NHS Providers has made an interesting call for short-term realism.
The Health Secretary got himself in trouble last week, when he described an apparent rise in GP numbers as ‘terrific’. Unfortunately, a change in the way junior doctors are counted means that the numbers were artificially inflated. Boo to data breaks. Meanwhile, the number of other staff providing patient care (health care assistants, phlebotomists, pharmacists etc.) continues to rise rapidly.
DHSC announced a deal with the Association of the British Pharmaceutical Industry designed to save the NHS money and get patients quicker access to innovative drugs. The deal (still being finalised) proposed a new voluntary scheme for Branded Medicines Pricing and Access, which would open the dialogue between pharmaceutical companies and the NHS earlier in a bid to speed up the appraisals process carried out by NICE. It also cements spending growth on branded medicines to be capped at 2% over the next five years, which will reportedly save the NHS £930m; if spending rises above the 2% cap, pharmaceutical companies will repay the NHS.
David Buck at The King’s Fund has written a very useful blog showing the breakdown of local government spending on public health. Prescribed services for children 0–5 took the highest share (£759m of the overall £3.36bn local government spend), while health at work and wider tobacco control were at the bottom of the list. The King’s Fund has produced a new report on the wider determinants of health — which we haven’t read yet, but is bound to be good .Also worth a read is John Appleby’s dig into the inconsistent data on public health spending since Wanless.
Lots of mental health stuff this week. Last month’s announcement to introduce a new mental health practitioner role into schools has… not gone down well with nurses. Various nursing organisations have commented that, while the measure demonstrates a welcome focus on mental health support for young people, it would make more sense to build on the existing expertise of mental health and school nurses.
On to social care. Once we get the ‘how to pay for it’ question out of the way, this report claims that the answers to how we should transform services are already there. Co-production, innovation and cross-organisational co-ordination are the key says the Social Care Institute for Excellence. In a similar vein, the LGA have put together some new case studies showing that place-based, whole-person, person-centred, joined-up, integrated care really can be done.
Here’s one idea: replace carers with robots? Nope, says David Oliver in the BMJ.
Exciting for people who like social care data — but bad news for anyone who cares about the state of the service — the social care ombudsman has published a longer time series of their complaints data. This pretty clearly indicates a fall in the quality of provision: the proportion of complaints being upheld has risen from 43% in 2010/11 to 62% last year.
Finally, lots of interesting stuff in the new IPPR report on the social care workforce. Their analysis of ONS labour force survey data found that between 2010 and 2018 that proportion of employees in the sector aged over 50 increased from 32.8% to 39.5%. They also note that Skills for Care, the main body for social care workforce planning, had a budget of £27m in 2017. Health Education England, the main body for NHS workforce planning, had a budget of £5bn in 2016/17…
Children and young people
Really good EPI blog on who’s going to benefit from the DfE grants to schools to cover teacher pay rises. The allocation formula for the grant means that schools with small numbers of pupils and more teachers on the main pay scale (who are set to receive a larger pay rise) are less likely to receive enough grant money to cover the costs of their salary increases, and these kinds of schools typically have more disadvantaged pupils.
DfE are very keen that the Teachers Salary Review Board have a remit make sure future teacher pay proposals are “affordable”: early signs they are expecting a tight Spending Review settlement?
This is important: last week we saw the first data on children’s mental health disorders since 2004, and a new study from the Children’s Commissioner on quality and access to children’s mental health services. The new NHS Digital data is here; but if you want the key takeaways, Haroon Chowdry from the Children’s Commissioner and Franziska Marcheselli from NatCen have you covered. One in eight 5 to 19 year old’s had at least one mental disorder when assessed in 2017; rates are highest among girls aged 17–19; and areas that spend more on children’s mental health have higher rates of access.
Neighbourhood services and local government
Which council is best? Okay, fair, that’s an impossible question. But which council is most productive? Interesting analysis from imPower looking at “outcome value per pound spent”. They look at child protection plans lasting over a year, proportion of people with disabilities who don’t have a job, and unplanned hospital visits for people with conditions that could have been treated in their own home.
Local Government twitter is not happy that Melanie Dawes (Permanent Secretary at MHCLG) told the Public Accounts Committee this week that a ‘sustainable’ local authority is defined as one with the capacity to deliver its statutory duties (and not necessarily anything else). Not great for a supposedly democratically-led tier of government…
Law and order
Police and mental health was a big story this week. The Police Inspectorate has recommended agreeing a national definition of mental ill-health, and forces carry out a ‘snapshot’ exercise to assess mental health related demand as Welsh police forces did in October 2017 and April 2018. We heartily agree — lack of data on this issue is a real barrier to effectively tackling it.
Interesting Howard League report on why women continue to receive short prisons sentences, despite evidence suggesting community sentences are more effective: poor probation performance; and ‘knowledge gaps’ where magistrates don’t “fully appreciate” lack of services for women in prisons; and the impact prison could have on children where they are the sole carer:
Someone in team PT likes running. Like, a lot. I’m more of a fan of ‘sitting’, but this story of parkrun + youth justice warmed my cardio-deprived heart.
