Week in Public Services 8th June 2021

This week: reflecting on Test-and-Trace; care home-hospital discharge debate; and Kevan Collins finds mainstream tsar-dom

General

We’ll get to the schools catch-up debate in a bit, but This Guardian article is interesting on the ‘catch-up’ pressures in other services from criminal courts, featuring lots of very human stories on top of the numbers. How much money services will need to catch-up — and whether they will have the staff and resources to spend it — will be a focus of this year’s Performance Tracker, so keep an eye out in the autumn!

As I (and others) told Toby Helm, these are largely a consequence of the Treasury’s very tight public spending plans for day-to-day spending — where there is not much unallocated spending left to fund any ‘catch-up’ funds.

Unless the government allocates more money for day-to-day spending, expect more public debates akin to the schools row around the Spending Review. My prediction, for what its worth, is that the Treasury will use a mix of improved forecasts and extra borrowing to spend more without breaking its manifesto promises not to raise income tax, national insurance, or VAT. We’ll see how well that prediction holds up in the Autumn…

Health and care

The big news this week is the health select committee’s report on workforce burnout, which concludes that “chronic excessive workload” is the key driver of burnout. They (quite rightly) call for something similar to the NHS staff survey to be extended to social care workers so the government can better understand trends in social care staff burnout and make a series of sensible recommendations for other tweaks too.

In other research news:

• A sensible BMJ article investigates the Public Health England research behind the government’s claim that there were few cases of the virus seeded into care homes from hospitals.

The principal problem is that the research looked only at confirmed cases (residents discharged from hospital who tested positive at a time which implied they caught covid in hospital) but we know that testing was limited at the start of the pandemic so — by the nature of the research design — they cannot identify people discharged who probably had covid but weren’t given a test before discharge. The analysis also did not include people who weren’t care home residents prior to their admission.

• A useful blog from Health Foundation analyses the strengths and weaknesses of NHS Test & Trace, a year after the programme was begun. Predictably they find that the biggest failure has been lack of financial support for self-isolation, meaning that NHS T&T has found it harder to reach contacts in the most deprived areas.
• A Nuffield Trust piece looked at how to address waiting times in Northern Ireland — where the waiting list for planned admission to hospital or first outpatient appointment is nearly 450,000 — nearly a quarter of the population. In England, the waiting list is equivalent to 9% of the population. Their solutions include making greater use of the private sector in the short term, accelerating plans for “elective care centres” and developing a ten-year strategy for long term change.
• This Work Foundation and TotalJobs report about what the government and care providers can do to encourage more people to consider care work. Their analysis of job applications of Totaljobs (an online job application site which lists vacancies) found that the number of people applying for social care roles increased by 39% between 2019 and 2021. If care jobs posted on Totaljobs reflect the labour market in England (a big if), that suggests there is likely to be a short-term boost in care worker recruitment — as Skills for Care monthly data also shows.

Meanwhile, Dido Harding is apparently now in the running for the NHS England chief executive gig, though she revealed yesterday that she had yet to apply for the job. Andy Cowper put a useful (rough) transcript of Dido Harding’s R4 interview online here.

Children and Young People

This is a pretty damning summary of the government’s 2021 exam proposals (teacher assessed grades, where teachers have to provide evidence on how they made their judgements to Ofqual, the regulator). According to Billy Husband-Thomas, it’s “the worst of both worlds, keeping the pressures associated with high-stakes accountability without the benefits to reliability and validity”. A fair assessment.

The big news over the last week was, of course, Kevan Collins’ resignation over the size of the education catch-up package (£1.4bn for the school year starting September 2021 with promises of more to come in the Spending Review compared to this request £15bn over the next three school years). There is a lot to dig in to here — here are your key points:

• Kevan Collins on why he resigned (£)
• Education economist Simon Burgess on why the government’s proposals aren’t enough — and will lead to higher long-term costs because they will reduce the lifetime earnings of pupils who missed out on face-to-face teaching
• Natalie Perera of the Education Policy Institute making much the same argument, quantifying the scale of lost learning

(Simon helpfully points out that EEF have been collecting all the latest evidence on Covid-19’s effects on the attainment gap in England, here).

• The Institute for Fiscal Studies lay out the Treasury perspective (and why they still believe it to be incorrect with regards to schools catch-up). For the sake of balance, this is probably the single best thing I read on the topic last week.

Paul Johnson’s Times article is also particularly good: “why is the Treasury such a bunch of b*stards?” I wouldn’t put it quite like that, but, erm, yes that is one question a lot of people have after last week. The pertinent point, though, is his question about whether Treasury spending teams have the necessary expertise to make these decisions. To quote in full: “whether they [Treasury spending teams] always have the expertise and experience to wield that power properly is itself questionable. Their expertise in any area of government spending is necessarily limited. Collins and the education department know a lot more about education than does the Treasury. We are still paying for misjudgments in the funding of prisons and social care over the past decade. Treasury officials also find it institutionally extremely hard to account for the dynamic benefits of spending decisions, focused as they are on the immediate consequences for the public finances.”

Short on time? Here is my twitter thread summary of the catch-up debate.

In a similar kind of issue, Labour have accused the government of outsourcing the national tutoring programme to international HR company “with little tutoring experience”. Randstad was awarded the £25m contract earlier this week, after putting in a lower bid than rival National Tutoring Foundation which was established by the nerds at the Education Endowment Foundation. Lots of education wonks think this was also a short-termist, cost-saving decision (albeit one where the Department for Education made the decision rather than the Treasury).

In a neat bit of timing, the second part of the Education Policy Institute’s research on how much learning pupils lost, comparing reading and maths tests scores of pupils who took tests in the second half of the autumn term to the progress they would have been expected to make (and neatly linking them to the National Pupil Database to look at a range of different background variables), was published last Friday.

Unlike some other analysis which compares 2020 scores to the 2019 scores from pupils in the year above, EPI instead use a regression model to estimate how much progress the 2020 cohort would have made. This essentially estimates “what a pupil would have achieved in 2020/21 had they followed the same pattern of progress — based on their prior attainment and characteristics — as similar pupils in 2019/20”.

Right, methodology out of the way — key points are that:

• At the start of the autumn term, “the average learning loss in reading for primary aged pupils was around 1.8 months, for secondary aged pupils it was around 1.7 months. Learning losses in primary mathematics were greater at around 3.7 months”
• “Pupils from disadvantaged backgrounds (eligible for free school meals at any point in the last six years) lost, on average, approximately 2.2 months in reading amongst both primary and secondary aged pupils, and around 4.5 months in mathematics for primary aged pupils”
• In better news, “primary aged pupils had lost around 1.2 months of learning in reading by the second half of the autumn term, implying that primary aged pupils were able to catch-up around half a month of learning lost in one half-term” — though there was no statistically detectable catch-up in secondary schools

(I confess I haven’t read in detail yet — but it certainly looks like the most thorough and methodologically-sound evidence of learning loss to date).

In other news:

• A survey of parents of primary school-aged children in England found that school closures had a significant detrimental effect on mothers’ mental health, but made no difference for fathers
• The latest wave of the Department for Education’s vulnerable children and young people survey is out, and finds councils reporting greater prevalence of mental health problems among parents and children — although councils are split on whether reopening schools will lead to a rise in referrals. Write up here.
• A new National Foundation for Education Research review of free schools’ effects on pupil attainment, popularity, and teachers. They find that pupils in free schools scored higher than similar pupils at non-free schools at KS4, but lower at KS2.

Law and order

The chairman of the Police Federation has warned of a “pressure cooker” situation as violence rises across the country, with lockdown restrictions coinciding with hot weather. He believes that “gang members using the freedoms to settle scores” is only part of the problem — and that England has become more violent overall. England has become more violent and more people pull out knives in fights. London has had nine violent attacks and two murders in four days.

The Royal College of psychiatrists have also published a really interesting report on mental health in prisons, where they find that up to 8,000 people in prison in England and Wales “could have been sentenced more safely under a community order with a Mental Health Treatment Requirement (MHTR)” — if there were the resources to deliver them. The College are calling for calling for £12m for mental health services so that they can offer that option to offenders. They estimate the savings of keeping those eligible for MHTR out of prison could be £56m — so there’s clearly an ‘invest-to-save’ case here…