Week in Public Services: 3rd September 2024
This week: managing expectations for the budget; GCSE results return to pre-pandemic trends; and a shift in crime trends
General
Summer is over and chatter is already starting about October’s budget. The Guardian reports that Reeves will stick with spending plans of a 1% real terms increase in RDEL — an amount that we’ve argued implies quite large cuts for departments such as the Home Office, the MoJ and MHCLG. Reeves is also rumoured to be planning increases in inheritance and capital gains tax as a way to raise some more revenue.
The line on spending seems to be hardening after the election, rather than softening, as some (including me) expected. Reeves reportedly warned that “public spending is not sustainable” and is asking DHSC and DfE to find £1.3bn and £1bn of savings respectively before the budget. That sets up an interesting battle between NHSE — who are warning that with current levels of funding they will likely have to ramp down their elective activity this year (more on that below) — and the Treasury who clearly think the health service has substantial slack in its budget.
Of course, we also had Starmer’s speech last week which warned that the country will have to “accept short-term pain for long-term good”. The whole thing sounded remarkably similar to some of Osborne and Cameron’s speeches in the early 2010s. It seems that the country has absorbed quite a lot of “short-term pain” in the intervening 14 years and hasn’t seen a lot of that “long-term good”.
Pat McFadden (that’s the new Chancellor of the Duchy of Lancaster) is reported to be setting up (£) the government’s “mission control” to monitor progress against the government’s missions. There will supposedly be a large open plan office space, with “access to real-time data to track key metrics”. All very Dominics Cummings. I always find the obsession with live data feeds so odd. If it shows that elective waiting times in NHS trust XYZ are abnormally long, what are the Cabinet Office civil servants going to do? Phone the trust CEO and tell them to discharge Bob Jones from bed 17 in the Marie Curie ward? Strange.
More interestingly from a public services perspective is that the “mission controller” for the health mission will be Clara Swinson, currently the Director General for public health in DHSC. As David Buck points out on Twitter, if that indicates that the health mission will have a greater focus on health inequalities, that would represent a genuine shift in focus and approach. But maybe that’s reading too much into one appointment. For the meantime though, the impact of missions on public service delivery is very unclear. That’s most true in criminal justice, where the mission (“Take back our streets”) is arguably the vaguest and the system is currently failing to cope with substantial levels of acute pressure.
Health and social care
It’s déjà vu all over again in the NHS, as NHS England warns the government it will have to “slow down” efforts to cut the elective waiting list without further funding, the HSJ reports (£). That comes in the context of mounting deficits in trusts (for yet another year). The question now is how a Labour government will deal with the annual financial wrangling with NHSE. The approach of the last few governments was to act tough over the summer and then capitulate when winter pressures generated too much press attention. Last year, the government shifted funding from the capital to day-to-day budgets to shore up some of the deficit. It would be pretty damning if this government followed the same approach.
Another familiar headline: adult social care needs more funding. This article from the Independent puts the number at £8.6bn per year, which is the same number that the Health and Social Care committee came up with in 2020, adjusted for inflation. I think more interesting is the point that the repurposing of funding initially intended for reforms — such as the cap on personal care costs — is being used by councils just to maintain existing levels of provision. This is something the government will have to wrestle with: providing funding for reforms doesn’t address underlying unmet need.
The HSJ has run some analysis looking at the performance of trusts that have used a “continuous flow” model in their A&Es. Under that model, hospitals admit patients to wards regardless of whether there are beds free or not, the idea being that the rest of the system will then flex to absorb the patients by, for example, speeding up discharge. The HSJ found that trusts that implemented the model had very mixed outcomes with some seeing improvements in metrics such as ambulance handover delays, 4- and 12-hour waits and others seeing declines.
The Health Foundation and Ipsos published their biannual survey on the public’s perception of health and social care. The public’s priorities for the NHS included a wide range of issues. I found it interesting that they identified retention as a key problem — something with which we agree — but also that the NHS needs to improve recruitment — an area where I think the NHS is doing perfectly. What should catch the government’s eye is the public’s view that access to general practice and improving pay and conditions for social care staff are key areas that need to improve. I completely agree with both those issues. But the government does not currently have a coherent vision for either.
Children and young people
The press last week was plastered with pictures of pupils jumping in the air and holding up pieces of paper, which can mean only one thing: GCSE results are out. There’s lots going on, but the main theme is a return to pre-pandemic trends. The complete end of grading protections has meant that the proportion of passes (grades 4 or higher) is down by 0.4% from 2023, leaving it only slightly higher than in 2019. While the proportion of top grades (7 and above) is higher than both 2023 and 2024 at 22.6%, they are considerably down on the pandemic peak, when teacher-graded assessments took that to roughly 30%.
Going beyond these two headlines reveals more interesting (and concerning) findings. 16-year-olds who don’t get grade 4 in English Language and Maths GCSEs must re-sit, but with the resit pass rates at 20.9% and 17.4% respectively, union leaders are worried that pupils are being “consigned to a remorseless treadmill of resits”. The head of the exams regulator Ofqual has since called for Labour to review the policy in their upcoming curriculum and assessment review.
Perhaps the most concerning figures from results day: the persistent geographic variation in results. Many headlines zeroed in on the north-south divide, which is wider than pre-pandemic. In London, for example, 72.5% of results were grade 4 or above; in the West Midlands, the pass rate was nearly 10% lower. This gap was 6.8% in 2019.
But boiling these inequalities down to a dichotomy disguises some of the most fundamental differences in attainment. As FFT Education Datalab argues, in 2023 the north-south divide explained only 8% of variation in results — most variation occurs within regions.
Since results day, schools and colleges have been trying to plan for the future, something it seems the government was not expecting. While it has paused the previous government’s plans to scrap more than 200 vocational qualifications, its own plans are not due to be announced until December. This is making open days pretty difficult given that schools aren’t sure which courses they can offer prospective students.
In the realm of Children’s Social Care, Ofsted’s social care chief Yvette Stanley has warned that a “worrying” number of children are being wrongly placed in supported accommodation. Supported accommodation equips older children with skills needed to live a relatively independent adult life. But young people with significant care needs are ending up in these settings, ultimately leaving their needs unmet.
Criminal justice
I’m sure you’re all rather bored of us rattling on about the prison capacity crisis and the response to the riots. But things just keep happening! Last week the government triggered ‘Operation Early Dawn’, an emergency measure to delay court hearings for defendants likely to be sent to prison. Instead, they will either be kept in police cells or released on bail (to avoid falling afoul of time limits on police custody).
This measure was previously activated by the last government in May, and may be repeatedly turned on and off between now and 20 September, when the new early release scheme starts. With under a hundred spaces left in men’s prisons on Tuesday, the government didn’t really have a choice about pulling this particular lever — but it will further ramp up backlogs in the courts and delay justice for victims and defendants. Everyone is holding their breath and crossing their fingers it will be enough to make it to 10 September.
Finally, a new headline! The latest crime statistics (for the 12 months ending March 2024) came out in July and showed some interesting trends. First, some context: headline crime levels have been falling pretty much continuously since the mid-1990s (a common pattern around the world). This is based on survey data, which is the most reliable source for high-volume crimes such as theft, fraud and low-level violent offences. Police recorded crime, however, which measures crime reported to the police, has been rising sharply since 2013/14, though more slowly in recent years. Total police recorded crime was 65% higher in 2023/24 than 2013/14. Given declining levels of crime, this is due to changes in reporting and recording of crime — and probably more on the recording side than reporting.
So what do the most recent figures show? Well, a reversal of both those trends. Police recorded crime is down slightly and headline survey-estimated crime is up slightly — though this one isn’t statistically significant. We shouldn’t read too much into this: they are small differences relative to the longer-term changes. But it does suggest that long-established trends may be shifting.
There have also been some much larger changes when it comes to specific offence types, particularly shoplifting (up 30% year-on-year) and theft from the person (up 40%), driven by a massive 153% rise in snatch theft. Most other theft offences are down, however, including burglary, bike theft and theft from/of a vehicle, so overall theft is broadly flat. This is all getting a bit into the weeds, but it’s important context for some of the commentary we often see in the media around theft, especially shoplifting and snatch theft: they really are up, but a fair bit of this rise is probably people switching from other kinds of theft, rather than stealing lots more than they used to. And even these increases are outweighed by longer-term declines: overall theft offences are still down 19% since 2019/20.
To finish off with something rather different, everyone with an interest in policing (so, all of you!) should have a look at this excellent but harrowing report from Dame Vera Baird on experiences of police custody in Greater Manchester. Baird was commissioned by Andy Burnham to carry out an independent inquiry into the treatment of women and girls arrested and placed in police custody, following reports of ill-treatment. The report does an excellent job of personalising the experience of police custody and highlights some very serious failings. Interested readers should also check out this Transform Justice report on police custody from a few years ago.
Local government
New Local and the International Public Policy Observatory (IPPO) are conducting some work looking at how local authorities are responding to financial and demand pressures. I’m excited to read the report when it’s published and this blog post gives some insights into early findings on some innovations in authorities. They include insourcing more services (e.g. buying and operating children’s homes to avoid having to enter the disastrous children’s residential care market), greater integration of services in “hyperlocal” hubs, and using insights about local populations and needs to better design services.
A tourist tax is often touted as one option for improving local government finances, and giving authorities more control over how much cash they can raise. So it’s interesting to see one council — North Somerset district council, to be precise — argue that it doesn’t make sense for Weston-super-Mare. They say that it would likely deter visitors from coming to the area.
Speaking of North Somerset, the local authority has warned that it may have to issue a section 114 notice due to SEND pressures. This adds to the list of authorities who have cautioned that SEND might tip them into ‘bankruptcy’. It’s still unclear if this government will bail out local authorities with ‘exceptional financial support’ rather than face the damaging headlines from a s114, like the last government did.
The Audit Reform Lab (ARL, a group of academics) has written a report claiming that Birmingham Council was forced to issue its section 114 notice predominantly due to the botched implementation of the Oracle IT system, austerity-era cuts, and service pressures rather than its large equal pay liability. The report also raises questions about the extent of the cuts being undertaken and claims that they will likely “lead to a breach of the Council’s statutory duties”.
Some of this I agree with — the press and the government have largely ignored the effects of austerity on Birmingham’s financial resilience, and future spending cuts will be really damaging. But it’s odd to claim that the implementation of the Oracle IT system was ignored. It was widely discussed at the time (I even wrote about it in a blog post at the time, and I hardly have deep insider knowledge). Where I think the report has a better point is that the enormous backlog in local government audit is not merely a technical quirk, but rather hides a lot of financial risk that likely sits on the books of a range of local authorities.
This paper from a range of academics provides evidence that reducing child poverty reduces demand for a wide range of services, including taking children into care and hospital admissions. They identify abandoning the two-child benefit cap as a policy step to achieving substantial reduction in child poverty. This is exactly the sort of evidence I would have loved to cite in our report on prevention, which made similar arguments.
