The Week in Public Services: 10th September 2020
By: Sukh Sodhi
Tags: Health, Pandemic, Covid 19, Coronavirus, Testing

This week: Moonshot and marshal law, NHS performance stats & criminal justice pressures

General

Moonshot: the kindest description of the government’s latest COVID testing ambitions. The prime minister in his press conference yesterday spoke of his ambition for a future mass-testing system where up to 10 million people would be tested each day. The BMJ says internal memos show it could cost over £100bn to deliver (this hasn’t been denied yet) and would rely heavily on the private sector. It’s hard to know where to begin with this but if you need a recap, the summary of the government’s previous testing pledges is here. Any upscale of testing needs tests more like pregnancy ones which would require ‘developing, validating, procuring, and operationalising testing technology that currently does not exist’, not to mention the accompanying infrastructure. Those who actually know about statistics have spent today pointing out that with testing on that scale the numbers of false positives would be huge with presumably even bigger knock-on behavioural consequences for those who’d think they’d already had COVID asymptomatically when they hadn’t had it at all. Perhaps more people in Whitehall (or just the guy at the top) need to read the IfG’s report on decision making in the pandemic which examines the 100k testing target in depth.

In the meantime it’d be nice if we could address problems with the current system first. The prime minister at PMQs was keen to stress increased demand as the reason why some have been unable to get COVID tests. Hmm… The Health Secretary has said people without symptoms shouldn’t get tested which is not quite what the message has been before this week. And the latest tracing statistics show another week where fewer than 70% of close contacts of COVID-positive people in England were reached (the target is 80%). It’s the lowest weekly % since the scheme was launched.

Marshal Law (sorry I couldn’t resist): Also in yesterday’s press conference was the announcement of ‘Covid-secure marshals’ for towns and city centres to ‘help remind people of the rules’ as it was described this morning. You can only imagine the thanks some pour soul in a high-viz jacket (and hopefully some adequate PPE) is likely to receive when telling a group of nine on the high street that they’re three too many. What powers they’ll have beyond that has not been spelt out yet — the government has said this will be a local government thing which appears to have taken the sector by surprise. Will there be extra funding for them? At 12pm today the answer was no. At 5pm the answer became yes.

Health and Social Care

The latest NHS performance data for July and August was published this morning and there’s some competition for the most jaw-dropping stat. Only 319 people started a first treatment for cancer in July 2020 (following a referral) which is more than 80% lower than the same month last year. As Ben Clover at HSJ points out, if you’re talking about £100bn you might want to urgently use some of it to save the lives of cancer patients missed by screening. The Nuffield Trust and Health Foundation’s Quality Watch has it all covered here. Also read this from Dr Elizabeth Fisher at the Nuffield Trust who takes an in-depth look at children and young people’s use of A&E during the pandemic. Analysis from The Times (thanks to FOI requests) shows that the number of people needing follow-up appointments is actually over 15 million because the official NHS waiting lists only show patients yet to have a hospital appointment following a GP referral.

Meanwhile even the simplest procedures and tasks in hospitals are taking longer because of distancing and stricter cleaning requirements. Hospitals are at risk of not meeting targets for restoring services because of factors such as their layout if it makes it harder to separate patients. In all this, are hospital managers helping or harming productivity? This insight from David Oliver cites a Warwick Business School study which showed a small increase in managers, from 2% to 3% of the workforce, led to a 5% improvement in hospital efficiency and a 15% fall in infection rates.

Worrying news from Northern Ireland where figures from June show nearly 10% of the entire population had been waiting for longer than a year to see a consultant for the first time. While longer waits have been common in many countries, Northern Ireland went into the pandemic with a huge backlog. The verdict from the Nuffield Trust on proposals put forward by Northern Ireland’s health minister is that it’s ‘not a detailed and comprehensive strategy for addressing the longer-term problems that the virus exacerbated.’ Countries elsewhere are also facing backlogs, with this study showing just how bad it could be for those in Ontario, Canada where the estimated backlog clearance time is 84 weeks.

The International Long-Term Care Policy Network has produced a masterful comparison of the effects of COVID-19 in long term care across the four nations of the UK. Its analysis shows that in Scotland, 47% of deaths attributed to COVID were in care homes compared to 28% in Wales. The proportion of care homes which reported COVID cases in Scotland was also nearly double the proportion of homes in Wales. Meanwhile the Scottish Government has announced an independent review to consider the idea of a ‘national care service’ there.

Looking forward, here’s a really interesting blog on the ‘Treasury view’ of social care from Age UK charity director Caroline Abrahams including a telling recount of her appearance before a Lords select committee before the pandemic: “Here is a former Treasury mandarin saying that the problem with creating a social care system worthy of the name is that informal carers, who are of often but by no means always women, might be tempted back into the labour market, whereas it makes more economic sense for the country for them to ‘stay at home’ and a ‘constrained’ social care system helps to enable this.” There’s already been some interesting change in the sector — of a technological nature — as this report from the Institute of Public Care commissioned by the LGA and ADASS outlines. It contains a wide array of examples of digital innovation in the sector, showing the potential for technology to help not just care and the maintenance of daily activities but also prevention and early intervention.

Children and Young People

With schools shut for so long there’s been a lot of talk about the ‘learning loss’ as a result, but this thoughtful piece from Daisy Christodoulou challenges that phrase and asks whether there’s actually been a loss of learning or a decaying of existing skills. In the case of the latter, there’s some hope that pupils might be able to make more rapid progress than normal to compensate. The Parliamentary Office of Science and Technology (POST) has an excellent summary of research on the gap between disadvantaged pupils and their peers. This one-stop shop is part of a collection of equally excellent COVID-19 work which is well worth checking out.

The Economist reports on those who have turned to teacher-training during the pandemic, helping to make up shortfalls and meet extra projected future demand. It should help a long running problem of shortages but only if they stick around: around a third of teachers leave the profession within five years of qualifying.

Research from The Guardian/Ipsos Mori shows that less than 30% of social workers in the UK feel their workload is manageable. Common suggestions from them to improve it include a reduction in workload and flexible working — something which may not be on the horizon as children returning to school are likely to mean an increase in urgent cases.

Law and Order

Lawyers have warned that the criminal justice system is facing a triple threat: a shortage of defence lawyers, the end of furlough and a mass postponement of trials. The growing backlog of cases means we could be in a paradoxical situation of job losses while there’s a mountain of uncompleted criminal casework. Trials are already being listed as far ahead as July 2022. The government said at the weekend it wants to increase the time those awaiting trial can be held in custody for — it’s already 182 days after a first court appearance before an application to a judge needs to be made.

Phil Bowden has written a great blogpost on criminal justice in the upcoming spending review with interesting reflections on how the process *actually* works: “I have personally had to write spending bids with 24 hours’ notice, on a policy area I only dimly understood, with pretty hazy cost data. In those circumstances, the difference between sticking my finger in the air and the superficially reasoned memo I sent was pretty negligible.” There’s also some sunny optimism about the politics of drugs legalisation in there which I’m not sure everyone would agree with.

Some very concerning news as NSPCC analysis has shown a sharp rise in child online sex abuse cases logged by police in the year before lockdown — a 16% on the previous year. It’s even more concerning as police warned of a rise in the grooming of children on the internet during lockdown.

Local Government

In a welcome relief from non-COVID news the LGA has a briefing note looking at how a local tourist levy could work in the UK. Several cities have floated one as an option, and the practicalities of introducing one are more interesting than you might initially think.