Week in Public Services: 30th December 2022
This week: the condition of the schools’ estate; Thurrock finally issues a section 114 notice; and our thoughts on NHS ‘reform’
General
Twas the night before Christmas, and all through the nation, not a service was working, not even education… and for that reason we’re back with our last Week in Public Services of 2022 (*single tear*).
The news for the last week has been stuffed (my favourite festive tradition: terrible Christmas puns) full of stories about strikes across both the public and private sectors. The most eye-catching in public services was the strike by ambulance workers, who walked out on the 21st. Ministers warned the public to “use common sense” when it came to calling 999. Interestingly, the message seemed to get through, with the public having the presents of mind (ok that one was a stretch, I’ll stop) not to call the service.
Can we expect an end to the strike action anytime soon? It appears not, with the government maintaining its position of refusing to negotiate with the unions. It’s tough to work out what Sunak’s strategy is here but my (ill-informed) take is this is a pale imitation of Thatcher’s strategy from the 80s, i.e. trying to appear tough, while hoping that public opinion will turn against the strikers. Stephen Bush’s (much better informed) opinion is that, unlike Thatcher, Sunak is not taking a strategic, nuanced approach to the strikes, and is instead treating rail workers, nurses, border staff, and postal workers the same. He also points out that unlike with coal in the 1980s, it is impossible to stockpile healthcare and wait the nurses out.
As to the hope that public opinion is going to turn against the strikers, this YouGov poll shows that two-thirds of the public support the nurses. Two-thirds!!! Astonishing support for a country that can’t even agree about whether Yorkshire puddings belong on a Christmas dinner (the answer is that they obviously do not, by the way).
The government’s other tactic is to blame the pay review bodies (PRBs) for strikes. The logic here is a bit clearer — PRBs are ostensibly independent and the government can therefore say that it’s merely following a recommendation. But the backlash to this has been swift, with the GMB pulling out of the process, claiming that PRBs are not truly independent. This is dangerous for the government. As my colleague Gemma Tetlow points out in this piece, PRBs play an important role in setting public pay and the government should not use them as political cover for something that is ultimately their decision.
All of this does raise an interesting set of quite IfG-ish questions about the suitability of PRBs. One of their key selling points is their independence, but as Gemma argues and Chris Giles also says in this excellent article, their independence is constrained by the remit that ministers give them. For example, PRBs are asked to consider the size of departmental spending settlements when making pay recommendations — an amount that is in the government’s gift.
Another interesting point made by Gemma and Lucina Rolewicz in her thread about PRBs, is around the timeliness of recommendations. PRBs report to government once a year, often as much as 6 months after first accepting evidence. In times of economic stability, this is no great problem. But when there is a lot of uncertainty, recommendations can often be out of date by the time they are made. Take this year. PRBs reported in the summer and started taking evidence in January. A lot of the evidence would have therefore been submitted before Russia invaded Ukraine and sent energy prices spiralling upwards.
Health and care
Last week, we reported that Steve Barclay wants to bring senior NHSE leaders into DHSC to improve communication and therefore performance. Nick Timmins has some words of warning on that point. He argues that the NHS is best managed at arms-length, while more direct control over performance will also mean direct accusations of blame if things go wrong. As such, policy — not musical chairs — is what’s needed from Barclay to address problems such as delayed discharge, early retirement of consultants and GPs, and pay disputes.
*Deep breath, think calm thoughts*: Sajid Javid claims the NHS needs to be reformed and says that “I don’t think the model of the NHS as it was set up some 70 years ago is sustainable for the future”. At this point I think Week in Public Services should just have a stock response for every vague demand for NHS “reform”, so here we go:
· What do you mean by reform? You can’t just claim that reform will make the service better without outlining what the reform is and how it will improve outcomes. And by outcomes I don’t mean the government spending less, I mean how will it, for example, lower wait times for elective care, improve access to primary care, improve population health etc etc
· If you’re talking about funding reform (which they almost always are, though are too afraid to say it outright) you have to tell me why the decade of disruption that will accompany any change is justified by the outcome. There is little evidence that the source of funding for a health service correlates with better outcomes. In that case, why go through the administrative hell of creating a new funding system for scant benefit?
· Javid claims the NHS hasn’t been reformed for 70 years and you can’t suggest any reform without “someone jumping down your throat”. See also: “the NHS is a religion that you can’t discuss”. This is abject nonsense. The NHS has been reformed repeatedly since its inception, including recently (for example the statutory footing for ICSs and the introduction of PCNs). Even if it hadn’t been reformed multiple times since 2010, who is there to blame but the government, which happened to be Javid’s own party for that entire time! As to the point that you can’t talk about NHS reform; we have linked to about 5 or 6 articles from a number of national outlets in recent weeks making exactly this argument. “Reform of the NHS” is discussed constantly, rarely with any intelligent input, as this Javid intervention goes to show.
· For actually useful insights, please read the King’s Fund’s elective recovery report from last week and listen to Sally Warren’s appearance on the Prospect podcast a couple of weeks ago.
Ok, rant over. Apologies. This is the last time we will link to any ill-defined call for NHS reform. If someone makes an actually interesting proposal for reforming the NHS (which must include a theory of change and is honest about the trade-offs involved, at a minimum) then we will engage with it on its merits. Until then, the above is our view on NHS reform.
This article from John Burn-Murdoch is better than most at identifying problems in the NHS. He says that it is the number of beds and, more broadly, the lack of capital investment in the NHS which has led to lower activity. I would agree with both those points, though would add there have been improvements in treatment in recent years which lowers the requirement for beds (be that due to previously admitted procedures now being outpatient procedures, or decreasing length of stay). Underinvestment in the NHS estate and diagnostic equipment is arguably more impactful. In addition, he dismisses staffing issues, claiming that because the service has hired more people, that means the problem must be elsewhere. But hiring new people does not replace the experience of the staff who left the service, a variable which has been shown to contribute to better outcomes. The other point is that the NHS is still woefully undermanaged. No single answer for lower NHS productivity.
Nuffield Trust show the effect on real wages for a range of NHS staff groups. The main takeaway for me is that there is a large amount of variation between groups and that headline figures often obscure a lot of variation. Ambulance staff’s pay looks to have fallen the least in this time period, but this is because much of it is made up of overtime and antisocial shift work, both of which bump pay up.
The HSJ (£, but this thread from Dave West is a good summary) finds that length of stay has increased in 2022 by one day compared to 2021–8.4 days per stay, compared to 7.4 days. Could be part of the answer to the puzzle of below-trend NHS productivity.
Interesting thread from Sarah Scobie about the reasons for sharp decline in NHS 111 performance for the week ending the 11th of December. That week saw a huge rise in the number of received calls (+60.5% compared to week ending the 4th) and a commensurate increase in the proportion of abandoned calls (25.3% w/e 4th, vs 48.5% w/e 11th. For context, the NHS’s target is 3%). Sarah points to a large increase in calls for young children, likely linked to concerns about strep A. The worry is where those people who abandoned calls will go next; A&E? GPs? A worrying lead indicator of level of demand at the beginning of winter.
The beeb has reported on a study finding that, on average, care workers are paid about £8,000 less per year than NHS workers with equivalent skills/responsibilities in a context in which, according to Community Integrated Care, pay pressures facing social care workers are “untenable” and “immoral”.
Children and young people
The IFS have published their annual report on education spending showing that school spending per pupil in England fell by 9% between 2009/10 and 2019/20. The authors note this is the highest cut in over 40 years, but comes after a 60% increase in spending during the 2000s. The authors estimate a real terms growth in spending through to 2024 which will return spending to at least 2010 levels. The report finds while the additional £2.3bn announced in last month’s autumn statement is helpful, limited net growth in per pupil school spending since the 2009/10 is still a big squeeze on school resources.
Talking of the £2.3bn uplift, John Dickens at Schoolsweek reports the pupil premium — extra funding for all pupils who claim free school meals withing the past 6 years — will rise by 5% from April 2023. The DfE is reported to say this will raise overall funding by £180m to £2.9bn.
In other education spend news — John Dickens at schools week is on the money again, reporting about the conditions attached to the £400m SEND funding announced in last month’s Autumn Statement. Councils will now have to make an allocation that is equivalent to 3.4% of the estimated total grant funding of the school.
Sticking to schools funding, there has been widespread reporting of lines in the DfE’s Annual Report and Accounts relating to the condition of school buildings. The situation has deteriorated since we noted the £11.2bn maintenance backlog in schools in our Performance Tracker. Schoolsweek’s Tom Belger reports that schoolblock collapse is one of the six key risks facing the DfE today with the risk rising from “critical — likely” to “critical — very likely”. This follows after an increased number of serious structural issues have been identified. Troublingly this news came not long after reporting from Amy Walker that more than half of schools nominated for rebuilds due to blocks in such disrepair they are at “risk of imminent closure” missed out on funding under the School rebuilding programme — for more details read here.
Several reports from Mithran Samual at Community care cover the challenges facing the children’s social care sector. The first is on the increase of vacancies linked to rising stress and workloads. High workloads are concerning; as another article shows, high workloads are contributing to social workers lacking the time to build the relationships they need with families where children are at risk. So where to look for extra staff? Agencies? A third article shows this is becoming increasingly difficult, with a fivefold increase in the number of social workers hired through agency teams in the past year.
Finally, childcare costs are a barrier to entering the workforce for those on Universal Credit concluded the Work and Pensions Committee on 20 December. The Committee noted that childcare is expensive for all, but that pressures are most acute for low-income families. A timely publication as later that day, a Westminster Hall debate brought by Tanmanjeet Singh Dhesi MP discussed the affordability and availability of childcare. Unsurprisingly there was common consensus on the importance of childcare in early years and the impact on later education attainment, the high costs facing parents, the impact on the labour market and the struggle to access places. This briefing from the LGA provides a helpful summary, including on areas such as availability of SEND childcare.
Law and order
The Law Society released this piece outlining 5 ways to reduce the crown court backlog. Their point about investing in the estate is interesting, and one that’s easy to miss in courts discussions, with 64% of Law Society members apparently experiencing delays in the last 12 months due to leaks, broken heating etc, and 30% regarding the physical condition of the court estate as ‘not at all’ fit for purpose.
Over half of the 1736 respondents to this National Police Chiefs’ Council survey claim to have experienced race-related incidents in the last 12 months. Unsurprisingly, a large proportion (64%) of those do not feel a strong sense of belonging. The finding gels with a survey of uplift recruits, which found that satisfaction with their new roles was six percentage points lower for black, Asian, mixed or other ethnicities than for white recruits.
The government released this year 1 report on the progress of Operation Soteria Bluestone. Findings include lack of specialist knowledge about sexual offending among investigators and other staff, including first responders. Disconcertingly, the report also found that a disproportionate amount of police time is spent testing the credibility of a victim’s account, often at the expense of checking a suspect’s criminal record.
With lots of chatter about the prison system at max capacity (see here), plans have been approved for a new prison expansion at HMP Fosse Way, allowing the government to make some more progress against its pledge to create 20,000 new places (the prison will provide 1,700).
Mark Rowley (*claxon for 100 days in post*) has said that public sector strikes leave the police picking up the pieces of other services, citing concerns over an increased volume of mental health work with ambulances on strike (I’d missed this, but apparently officers were also asked to fill in as ambulance drivers). While it’s likely the strikes will increase pressure on the police, it’s worth noting that this isn’t new: police are often considered a service-of-last-resort, with mental health callouts a particular long-standing concern.
The Telegraph has this write up of this Transform Justice report — slightly weirdly, since the report was published in June — on the effect of harsher pandemic-era criminal sanctions on assaults on emergency workers. The main finding is that tougher sentences don’t deter assaults, maybe not too surprising. A particularly intriguing take is the argument that tougher sentences — which in turn give defendants the right to request to have their case tried by a jury — are contributing to the crown court backlog (particularly the number of jury trials).
I found this old piece by Jane Croft in the FT, which provides a useful reminder of the dangers of low legal aid funding: including lower numbers of duty solicitors and heavy reductions in the number of criminal legal aid firms. Important in this context is the demographic profile of duty solicitors, a quarter of whom are over 50, and only 4% of whom are under 35 (a diminishing pool!).
Local government
The IFS estimates that local authorities’ core spending power will increase by 5.4% in real terms in 2023/24, with a large uplift coming from central government compensation for freezing the business rates multiplier. Worth having a read of my (shameless plug alert) comment piece for the IfG which looks at how the government is distributing the recently announced uplift between councils.
Thurrock council finally issued a section 114 notice this week, surprising exactly no one. The headline is that they have a £469m deficit in 2022/23 (reduced to £452m, following £17m worth of recent savings), after four investments lost the authority a total of £275m. The pain for Thurrock doesn’t stop in the new financial year; they face a further deficit of £184m in 2023/24 — an amount higher than its overall budget. We linked to it previously, but the Bureau of Investigative Journalism’s report on this is the best source on the full extent of the mismanagement in the council.
So in the face of such extraordinary mismanagement, the council is showing contrition and a willingness to learn from mistakes, right? Wrong. As Gareth Davies points out in this furious thread, Thurrock’s response so far has been laughable, with the council’s press release refusing to admit any wrongdoing, instead claiming that this is the first “step to financial recovery” and attempting to shift blame from councillors onto council officers.
The question of accountability is an interesting one. The council officers clearly deserve some of the blame — the chief exec resigned last week — but where does responsibility ultimately lie for these bad investments? The answer is probably a mix of councillors, local authority officers, a lax auditing regime, and poor regulation by central government.
What are the next steps for the embattled council? First, they are borrowing £836m from the Public Works Loan Board (PWLB), most of which will pay back loans from other local authorities. The government has also asked Essex County Council (ECC) to become “commissioner and best value inspector”. That latter intervention is…questionable. There are close links between Thurrock and ECC: 25 ECC councillors also serve as district councillors in authorities that have lent Thurrock money and a few share service provision with Thurrock. Are they really best placed to take objective decisions for the authority? In the longer term, there is the possibility of Thurrock being abolished entirely and subsumed into a larger Essex unitary authority, following the example of Northamptonshire.
