Week in Public Services: 30th April 2021
This week: Sir Simon Stevens steps down; the costs of lost learning; and how prisons fared during the second wave
General
Another double edition of public service news this week — and there’s a lot to cover, so I’ll keep this intro short with just a few interesting reports from the past fortnight.
First up, new research from NatCen shows that people who experienced large falls in income during the pandemic have seen the worst decline in their mental wellbeing. 42% of those who became dependent on universal credit or self-employment grants over the past year reported poor mental health in January. A regular reminder that another health crisis may be on the horizon.
IPPR have just published this fascinating report into women’s experiences of the pandemic in the North. They make the great point that building back fairer means taking an intersectional approach to policymaking, to tackle regional, racial and gender inequality — the latter of which UN Women warn has been set back by Covid. Highly recommend a read.
An interesting paper from the Tony Blair Institute for Global Change explores how to build real-time data infrastructure in public health, and what new initiatives were set up during the pandemic to improve the government’s response. On another note, the think tank are urging ministers to delay the final lifting of lockdown restrictions in June, to save 15,000 lives. The reasons for this are here.
Finally, IFS have released useful analysis of the SNP manifesto for all the Scottish policy wonks out there. And new Institute for Government analysis on devolved public services came out yesterday! Find out how much is spent on the NHS, social care and schools — and with what results — in the four nations here.
(On an editorial note: this week’s health section is by Graham)
Health and social care
Weekend surgeries, joint surgical hubs and more — The Guardian have covered how hospitals are working together to reduce waiting lists. One set of hospitals in Dorset are running a “health pop-up village” in the ground floor of a shopping centre to assess people who might need care faster, building on the systems used to roll out the vaccine.
In health news, a good Financial Time story covers how staff disillusionment in countries across the world may hinder any Covid recover — a factor that is surely in lots of recovery planning. A fascinating Nuffield Trust analysis of the NHS staff survey data found that staff who had worked with Covid patients were more likely to report illness as a result of work-related stress. See also this article from Shaun Lintern.
Jugdeep Dhesi and Lisa Plotkin have outlined options to improve waiting lists, including using waiting times to reduce high-risk patients’ likelihood of post-operation complications and planning across specialities to increase day surgery rates. Liza Morton considered how to improve waiting times for patients, here.
The big news is, of course, that Simon Stevens — probably the single most influential person in the NHS over the last twenty years — is retiring. Oddly enough, to go to the Lords — here’s hoping for some speeches on the government’s new legislative proposals. HSJ have the lowdown on who might replace him as the next head of NHS England here. Paul Waugh and Andy Cowper’s analyses are well worth reading too.
Big Nuffield Trust report about the social care provider market in England, focusing on what reforms — other than the obvious candidate of more money — might improve it. They rightly highlight the problems that lack of good data and communication channels created during the pandemic (an issue we covered last summer, here), and have a very sensible list of ideas for reform. Personally, I find the points about data and certainty of funding more convincing — and most in need of reform. Neither providers nor local authorities will be able to improve quality or put in place schemes to improve staff recruitment and retention if they are always responding to last minute funding announcements and have no certainty over their future budgets! This (okay, my) blog on this from 2018 sadly remains as relevant now as it was then.
I am not sure that more service user choice will improve outcomes (the evidence that it did in healthcare is limited) but I could be persuaded. There’s certainly good evidence that public transparency about performance was associated with improvements in schools and hospitals in the 2000s. Social care is in many ways a classic ‘distress purchase’ (all credit to Simon Bottery who I recall having this conversation with years ago) so it’s not obvious to me that people will read through lots of consumer information before selecting a care provider.
Children and young people
The Education Policy Institute have calculated the cost of education recovery this week: the government will need to spend an estimated £10–15bn to meet its catch-up commitments, rather than the £1.7bn allocated so far. This sum reflects the scale of the challenge at hand — by the first half of the autumn 2020 term, pupils in England had lost up to two months of reading progress, and up to three months of maths. Based on IFS analysis of the increases in lifetime income people earn per each additional year of school, these shortfalls could translate into lost lifetime earnings of up to 3.4%.
Worryingly, Ofsted’s spring inspections show that secondary school pupils who were already struggling to read have also not had enough help online throughout the third lockdown. There’s clearly a lot to think about as the government formulates a recovery settlement.
According to EPI, teacher quality is key to recovery. Good news then that the government is establishing a new Institute of Teaching to provide teachers with training, early career support and professional development courses throughout their careers. Schools Week have a great piece on everything you need to know about the Institute here.
In other positive teacher news, the latest teacher recruitment and retention data shows that 2020/21 was the first year that the overall recruitment target was hit in a decade! A pandemic silver lining, although it’s not going to be enough to fill the backlogs in shortage subjects such as maths and physics which have persistently under-recruited over the last few years. (While there are numerous ways to encourage recruitment, bringing forward the planned teacher starting salary rise to £30,000 would be a start, according to Sir Kevan Collins.)
Councils are set to lose a total of £125m from changes to pupil premium funding, according to analysis by Schools Week. This is because funds are now allocated based on October’s figures, rather than January — and 102,000 more children became eligible for free school meals during this period. For the breakdown by council, see here.
Finally, as exam term begins, there have been updates on grading. An Ofqual draft report revealed concern about using teacher-allocated grades this year, after research found that teachers are generally biased against socio-economically disadvantaged students and those with special educational needs.
Subsequently, the exams regulator announced changes to the quality assurance process, by which grades are moderated. Centres will be asked to provide work samples, once grades have been submitted, within 48 hours of the request being made. After backlash from teachers, Ofqual’s chief regulator confirmed this process “should not take too long”.
Meanwhile, EDSK have published a report recommending that a three-year baccalaureate programme should replace the current system of A-levels, BTECs, T-levels and apprenticeships to provide more flexible education from 15 to 18. The Department for Education are expected to publish revisions to post-16 qualification options later this year — something to keep an eye on.
Law and order
HM Inspectorate of Constabulary revealed last week that police in parts of Britain have “increased the number of crimes they decided not to investigate” during the pandemic — and the proportion of recorded crimes charged is now at a record low of 7%. Some forces have stopped checking on registered sex offenders in person due, in part, to social distancing guidelines, and more suspects are being released on bail.
Police across the country are taking concerted action on knife crime this week though, launching increased weapons sweeps, patrols and knife amnesty bins as restrictions ease. The Met in particular are keen to maintain reductions in violent crime, which fell by 26% in the capital last year.
In other police news, the former chief constable of the Merseyside police claimed that cutting poverty and inequality is the best way to reduce crime, in an interview last week. Acknowledging that people get into crime “because the opportunities to make money elsewhere aren’t there for them”, Andy Cooke called for increased apprenticeship opportunities to offer young people another alternative. This advice is noteworthy as crime rates are already rising in areas experiencing increasing inequality as a result of the pandemic.
And the Police Foundation consider how police forces can meet new targets, expected to be set by the government, in a new blog. The key will be making an evidenced-based, locally informed, realistic plan — and then tracking performance against that plan, rather than crime data. “If it’s a good plan, you don’t need to continually check if its working — just make sure its being properly implemented”.
Over in the courts, a group of 8 judges have called for a parliamentary inquiry into “discrimination, bullying and leadership structures within the judiciary”, as they believe it has led to ethnic minority judges missing out on jobs. Ethnic minority judges are under-represented at the top levels of the justice system: last year, they made up just 3% of Court of Appeal judges, 4% of high court judges, 4% of circuit judges, and 8% of all court judges — compared to the 14% of the population that identify as ethnic minority.
The Bar Council also wants the government to extend legal aid to all domestic abuse cases. This recommendation comes amidst concerns over rising domestic abuse levels during the pandemic.
Lastly — lots of prisons news this week. Important analysis presented to SAGE on Covid-19 transmission in prisons found that the number and size of outbreaks, hospitalisations, and deaths in prisons increased markedly in the second wave when compared to the first. Importantly, the gap between death rates in prisons and the community also widened during the second wave.
Research conducted by UCL last month found that people in prison have a risk of death from Covid-19 that’s 3 times higher than people of the same age and sex in the community — but Justice Secretary Robert Buckland QC still disputes the evidence. The MoJ’s position may be detrimental to the wellbeing of inmates, because SAGE notes that “universal vaccination of prisoners would have a similar impact to the current highly intensive control measures”, so could potentially lead to easing some restrictions which have caused disruption and damage across the estate.
We’ve said it before but damage has been particularly evident in the women’s estate — and new research from the Prison Reform Trust indicates that rising levels of self-harm in women’s prisons are “worryingly high”. The study also finds that the government has failed to meet almost half of the pledges laid out in 2018 Female Offender Strategy — and the announcement of 500 extra prison cells being built in women’s jails reverses one of the strategy’s fundamental aims to reduce the female prison population. In better news, following this analysis, the Justice Committee are launching an inquiry into women in prison.
This interesting piece in Prospect details troubling discrimination against Muslims in prison. From having prayer mats desecrated to being labelled as ‘terrorist’, “the Chief Inspector of Prisons annual report consistently shows that Muslim people in prison disproportionately experience more negative outcomes than non-Muslims”. Read more research on discrimination in prison from Maslaha here.
More positively, a RAND evaluation of Liason and Diversion schemes — projects which “identify and support people in the criminal justice system who have vulnerabilities such as mental and physical health issues and learning disabilities” — found that these services increase diversion from custodial sentences, and consequently contribute to savings of £13.1m to £41.5m in the criminal justice system.
Local government
Research released this week shows (again) that local government’s finances are in a precarious situation. New analysis from Cardiff University indicates that Welsh local authorities will face a £178m funding gap next year — due to increased demand for services like social care and post-pandemic pressures. This shortfall will exist even with 4.5% annual increases in council tax bills in Wales between 2022 and 2026.
While funding allocation is a tricky topic, Adrian Jenkins puts forward an interesting argument about the way the government distributes local government funding in this article. As there is no ‘right’ answer, he argues that the focus should instead be on ‘damping’ transitions so that every local authority knows that their funding will not hugely fall or increase in any given year.
