Week in Public Services 29th June 2021

This week: test,-trace-and-not-isolate?; reviews of police responses to rape and domestic violence; and a new health secretary

Health and care

Well then. Hancock is out and Sajid Javid is the new health secretary. He’s got quite the big in-tray as I noted in a long twitter thread here. Andy’s HSJ column is particularly good this week too.

Outside all of that excitement, the NAO published the second of their investigations into NHS Test and Trace (T&T), covering November 2020 to April 2021. They find that the time to trace contacts from an in-person PCR test has improved…but these make an ever-smaller share of tests conducted. NHS T&T is still using lots of consultants and there are big underspends (NHS T&T spent just over 60% of its original planned budget for 2020/21).

Perhaps the most damning criticism of the government in there, though, is the NAOs point that “NHST&T is responsible for driving up public compliance, but research suggests that only a minority of people who have COVID-19 symptoms come forward for testing […there is] no target for increasing this, the uptake of LFD testing or compliance with self-isolation”. You could argue that the levers to do drive up compliance do not sit with NHS Test and Trace — and clearly the Treasury would have to sign-off more isolation payments — but it doesn’t exactly scream competent, co-ordinated strategy, does it?

In better news, there is a chance to secure some benefits from the large investments T&T made in building laboratory infrastructure…but it has yet to draw up a “detailed benefits realisation strategy” to think about just how that would work. One for the to-do list, then.

In other news, the Department for Health and Social Care have published their draft data strategy — though there notably doesn’t seem to be many more proposals for improved adult social care data aside from the proposals already in the NHS white paper. The (so far voluntary) proposal to collect client-level data (rather than have local authorities submit activity data to national bodies) would definitely make it easier to link health and care records. Amazingly, NHS Digital estimate that 30% of care providers only use paper-based systems…and people say the NHS pager is out of date!

The latest NHS England and Improvement board papers are out. Also worth a flick through — the section on covid recovery (and not just elective surgeries) is well worth reading to understand what’s going on. Apparently, NHS England expect 44 community diagnostic hubs to be set up in this financial year.

A novel and interesting King’s Fund report looks at the impact of NHS administration on patient care based on in-depth qualitative research, and argues that it plays an under-rated role in people’s overall experience of care. They think that “embracing a user perspective, seeking and harnessing patient feedback, and working with patients and staff to co-design processes will be essential to developing truly high-quality admin in the NHS”. See also the accompanying BMJ blog. Other new pieces:

• Nuffield chart exactly just what proportion of the NHS workforce are staff from overseas
• HSJ on the potential benefits of dermatology screening clinics
• Good challenge about how to make sure integration works for patients, from Alex Fox
• Excellent Axel Heitmueller thread on the NHS and Care bill and how to really improve health and care
• Good article about social care pay reform, and why the government needs to be careful to avoid perverse consequences (lowering the quality of care provided) by Simon Bottery
• Isabel Hardman on Conservative backbenchers’ fears that the government’s health reform bill — in particular the provisions that involve Matt Hancock taking more power — will be a “Lansley part II” as they make their way through the Commons and the Lords. Have the government underestimated the political risks here?

Children and Young People

Good blog from Jack on the latest teacher recruitment and retention data, with the slightly odd finding that the leaving rate hardly improved among the under-25s. See also his analysis of the extra support that the government has funded for teachers that did their initial training during the 2020/21 school year, which was (obviously) heavily disrupted by the pandemic.

In school news, a new Onward/New Schools Network report looks at the geographic dispersion of good and outstanding schools across the country, finding that there are ‘educational deserts’ (no, not school puddings) — areas of the country where there are few good or outstanding schools. Some areas which were ranked lowest on lists (when comparing attainment and Ofsted scores) in the late 1990s were similarly at the bottom of their ranking in 2020.

What does this all mean, then? Onward argue that “deprivation and access to strong teaching and leadership” explain school underperformance. Their policy recommendations range from paying good teachers more to teach in low-performing areas (I see the logic of this), to getting high-performing multi-academy trusts to expand and takeover low-performing schools (I see the logic although worth noting that sponsored academies in New Labour also got hefty cash influxes too) and asking Ofsted “to take account of the results of FSM pupils in inspections so that it is harder to become outstanding without supporting disadvantaged pupils to improve and to remove incentives to ‘offroll’ or restrict FSM pupils from enrolling” (I struggle to see how Ofsted could inspect for this).

It will be worth looking out for the government’s response to this letter from the Lords public services committee about what they are doing to work out what extra resources children’s services departments need to respond to the hidden harms which have (probably) built up during the pandemic.

In a timely report, the Social Market Foundation have looked at how to improve foster care in England and call for a “national strategy to increase effective foster care capacity” in response to the slower rate of growth of fostering placements when compared to growing numbers of children who could be placed in foster care.

Law and order

Difficult but important reading on how the criminal justice responds to rape victims. The government review of rape found that charges, prosecutions, and convictions in rape cases reported to the police fell after 2015/16. It has set out a series of actions which it hopes will increase the volume of cases going through the system, improve the quality of cases the police refer to the Crown Prosecution Service, and increase the number of early guilty pleas “so that victims do not have to wait as long for an outcome in their case and potentially avoid the challenges of going to court [decreasing] the trauma for victims in having to give evidence at trial”.

Another important review — this time by the Police Inspectorate — has looked at how the police handled domestic abuse during the pandemic. A lot in here — but some of key findings are that:

• In 2019/20 — before the pandemic — three out of four domestic abuse cases reported to the police resulted in the police closing the case without prosecuting — and this has risen over the last few years (p.35)
• There is not yet any data on charge and prosecution rates during the pandemic, but the Chief Inspector worries that long waits for court hearing may result in victims “becoming disengaged” and giving up on the criminal justice system: “many forces told us that delays in getting Crown Prosecution Service (CPS) advice for some domestic abuse cases meant victims were potentially exposed to further risk of harm. In some cases, victims withdrew their support for prosecution. While withdrawal of support is not new, it was exacerbated due to the delays”
• Forces received fewer referrals about domestic abuse than usual at the start of the pandemic — very similar to referrals to children’s social care — but referrals rapidly increased in May 2020, and reached pre-pandemic levels by June 2020

(This does not mean that domestic abuse fell. While there were fewer referrals to the police, “specialist domestic abuse services have seen very large increases in calls to their helplines and online platforms [such as Refuge’s and Welsh Women’s Aid helpline]” during the first lockdown)

• The number of arrests for domestic abuse rose sharply in the first two quarters of 2020/21 (coinciding with the start of the first lockdown) — there were 15% more arrests between April to June 2020 when compared to April to June 2019

Guardian write-up here.

Meanwhile, there are ongoing problems in Greater Manchester with the police response to crime. Following a Police Inspectorate report which found that Greater Manchester failed to record 80,000 crimes within a year last December, many officers blame a new computer system — the “Integrated Operational Policing System”, which they say did not allow officers to easily share intelligence and often gave inaccurate information. For more detail on the computer system problems, see this Inspectorate report. Full Newsnight report on Greater Manchester here — one anonymous senior officer told Newsnight that he “wouldn’t feel confident reporting a crime to my own police force”.

In other news, this Conversation article is a very interesting paper comparing crime rates in different cities during various covid lockdowns. The authors note that while some street crimes such as theft fell others, including murder, did not. The falls were bigger in cities with stricter restrictions. They conclude that “despite restrictions limiting interactions for many people, the findings suggest that lockdowns seemed to do little to change the behaviour of those involved in serious violence”.

Regardless of the short-term impacts, school closures during lockdowns may have increased recruiting opportunities for gangs, which paints a less sunny picture for the future of crime. A new Centre for Social Justice report warns of severe knock-on consequences. BBC write-up here.

A final aside: police satisfaction among victims of domestic abuse will apparently be one of the new national priorities (the Home Office is calling them “directional measures” — which are, erm, targets to get a trend rather than a particular number, in your author’s view) — which I had missed but appear to be online here.

Local government

Interesting blog discussing whether there should be an alternative to Section 114s in local government — effectively an(other) early warning sign for central government about local government funding pressures. Andrew Hardingham, the former Plymouth finance director, concludes that “current mechanisms in the system [need to] get the message out and heard”.

Elsewhere on the website, their discussion of the new Public Account Committee report about local government funding and oversight is also interesting.