The Week in Public Services: 22nd September 2020
By: Graham Atkins
Tags: Prison Reform, Testing, Track And Trace, Algorithms, Local Government

This week: government-by-announcement; the costs of sentencing reform; and what on earth is going on with testing!?

General

Turns out taking a two-week break has left me with…quite a lot to cover! Let’s get stuck in:

A great National Audit Office report summarises everything we know — and the lots we don’t — about how much the government has spent to respond to Covid-19. Here’s a mind-blowing stat for you: the anticipated cost of PPE to respond to the crisis has more than trebled from £4bn in March to £15bn now. Lots more useful stuff in there — if this interests you, look out for new IfG work about the costs of coronavirus from our excellent Whitehall Monitor numbers nerds soon…

In light of the news that cases (and hospitalisations) are rising again in the UK, it’s worth asking what the government could learn from its first response. It still needs to fix test-and-trace, provide more clarity on local lockdowns, and ensure schools are better able to offer remote teaching, my colleague Sarah argues. In other words: less government by announcement, please. Another great blog from Sarah covers the increasing gulf between coronavirus policy announcements and implementation: “it is in the government’s own interests to think through the basic details of its proposals and talk to those who will deliver them before the prime minister takes to the Downing Street podium”. It is indeed.

And given we’re all about to start obsessing about Covid-19 numbers again, it’s time to start thinking about how best to interpret the stats. Thankfully, this Tim Harford column covers just that: beware of just seeing what you want to see, try to be curious, and remember that the best insights come from combining stats and personal experience. Sage advice — though he leaves out one critical lesson: listen to More or Less! Speaking of curiosity — I found myself struggling to explain why some academics think that the current level of cases doesn’t justify imposing new restrictive measures. This BBC article summarises their position — essentially that the government should focus on disease prevalence as measured by hospitalisations and deaths rather than cases — well. Worth reading. One other pro-tip — beware dashboards — which encourage data obsession rather genuine insight. Maybe Dominic Cummings should take a read…

Pivoting to long-term lessons from the crisis, this interesting Local Trust and New Local Government Network report explores what a more resilient economy, government, and society (y’know — the subject of all those longreads over the last few months…) might actually mean. Definitely one to look at.

Health and Social Care

There has been a lot of news about how well (or not) the test-and-trace system is working at the minute. Is it a problem of insufficient testing capacity? Or demand for tests? Failure to get through to all of a person’s contacts? Or people failing to isolate once they’ve been contacted by test-and-trace?

The answer is, predictably, a bit of all of the above. Let’s take a step back and try to get a few things clear:

A lot of testing capacity is already reserved: around 100,000 tests of the headline testing capacity is reserved for social care (although that’s still probably not enough)

Demand for tests is rising: there has been a rapid rise in demand after schools in England reopened — since schools returned, demands for kits for children aged five to 15 nearly quadrupled, according to Sky

Private labs are losing staff: the ‘Lighthouse’ labs created at the start of the pandemic to process ‘Pillar 2’ tests have seen their staff — many university academics — return to universities as terms have restarted, reducing capacity to process tests

Taken together, rising demand and reduced capacity in Pillar 2 testing has meant that it’s got harder for people to book tests, and it’s taking longer for labs to process tests (hence all those stories about people being told to travel hundreds of miles for tests and the UK sending tests abroad for processing).

The time taken to process all kinds of Pillar 2 tests has been ticking up since mid-August (the rise started earlier in the case of home testing and satellite test centres — tests provided “at places like hospitals or care homes that have a particularly urgent or significant need”):

It’s important to note that the chart above is actually an understatement of the problem — because it doesn’t include people who have tried to get a test and given up out of frustration — a number we cannot know but is anecdotally reported to be large. (I owe this point to More or Less).

You should read Adam Briggs’ weekly masterful analysis of the test-and-trace stats for the latest detail. The good news is that contact tracers are actually now reaching a higher percentage of people with confirmed cases. And they are going on from there to reach a higher percentage of their contacts and telling them to self-isolate. But — you knew there was a but coming — they are still only reaching about 50% of all case contacts, which is far below the 80% of all case contacts that SAGE scientists thought was necessary for an effective test and trace system. Presumably this assumes that all of those people contacted by Test-and-Trace and told to isolate actually self-isolate. I don’t know of any data on whether that’s true or not — but I’d be surprised if there was complete compliance.

In response, the government has doubled down on its rhetoric complaining about people seeking tests when they do not need to. They have also announced more support and bigger fines for those caught breaking the rules. I’m sceptical that this will be enough to allow the testing system to cope and improve compliance with isolation requests— Torsten Bell has a good explainer on why the extra money isn’t enough and will miss some people who need it — but if the test-and-trace system is not able to test, trace, and isolate covid-case contacts effectively, then the only policy tools left in the box are much blunter. Hence all the talk of a ‘second lockdown’ this week. Boris Johnson is due to make his (heavily-trailed) speech today outlining what the government will do. Everyone will be watching to hear the new rules — but it’s worth noting that any changes will be based on the government’s view of how well its own test-and-trace system is working. If it thinks it’s fixable, expect some small-ish changes. If they don’t think it will cope, expect something more draconian.

The government separately announced that it is aiming for a ‘moonshot’ testing project. I’ll save you the bother of reading lots of detailed analyses: it’s “unprecedented around the world”, it’s incredibly expensive, it’s not clear there are enough people for this to administer and process testing technology, and if all these constraints could be overcome, the current rate of testing accuracy would almost certainly create a massive false positives problem i.e. that lots of people would receive a result telling them they had Covid-19 when they didn’t, requiring huge numbers of people to isolate and more confirmatory tests. Take this announcement with a bucket of salt. See also this excellent summary from Billy Palmer.

Looking longer-term, a good Financial Times longread analyses how the NHS mythology affected the government’s crisis response, and how the crisis affected public views about the NHS. In short, don’t expect the public’s affection to last forever when waiting lists continue to grow — or for that to translate into a willingness to pay higher taxes.

There’s quite a lot of change happening in acute hospitals both as a result of the pandemic, and to prepare for a second wave. NHS England will designate some hospitals as Covid-free zones in a second wave to ensure that it can continue to treat routine conditions. Patients in some parts of the country will be encouraged to book ahead for A&E via NHS 111 where they can, through a campaign called ‘Help us to help you’. NHS England have started a consultation on new A&E targets. Last but not least, new government guidance about NHS finances has kicked off a proper row between NHS managers — some of whom think that this a great innovation, others who think that anything apart from a payment-by-activity system won’t create the right incentives. A debate worth following.

In other news:

Helen Salisbury has written a good piece about the legacy of austerity — explaining with earwax — yes, earwax — why the declining capacity of public services left them in a worse position than they would have been in 2010 when this crisis hit

The excellent Billy Palmer took the PPE data I tweeted about a few weeks ago, and created a fascinating visualisation on how distribution of particular PPE items increased between 2019 and 2020. 25 times more face masks!

Jon Holmes has set out the Kings Fund’s asks for the (supposedly) upcoming Spending Review — long-term budgets for capital (buildings and equipment), workforce planning (recruitment and retention — particularly important given that NHS England is reportedly considering a 41% increase international recruitment after the pandemic…), and social care

A busy week in social care too, where the big story was the (very late) publication of the adult social care coronavirus winter plan. There will be more cash for the Infection Control Fund (money care providers can use to pay staff to self-isolate, and to ensure staff are paid enough such that they don’t have to rotate between care homes); free PPE until the end of March 2021; and making the data from the capacity tracker available to local authorities (good!). Is it enough? King’s Fund expert Sally Warren’s verdict is that the “content feels very weak — yes, a slug of cash but then it’s only really the dashboard for this winter”. This blog from Vic Rayner — who reckons the most important bit is allowing the Care Quality Commission to designate homes that are safe to receive COVID-19 positive patients — is also a useful overview. Anoosh Chakelian’s overview is also very helpful.

The ‘social care sector Covid-19 taskforce’ also published its final report recently, which made a series of recommendations for the government, local authorities, and providers to manage Covid-19 over the winter. There is some useful data on how many care homes actually feel able to undertake key elements of the government’s strategy — including safely isolating residents, and paying staff full wages while they isolate. Only 68% of care home respondents said they would be able to pay staff full wages if they had to isolate following a positive test result — at least as of 10th August. It’s a bit of a laundry list of tasks for the government to do, but most of the recommendations seem sensible. I am entirely in favour of their recommendation to “make both analysis and raw (or appropriately aggregated) data available to everyone”. Are you listening, DHSC!?

Elsewhere:

The Commons Library have summarised the government’s adult social care funding announcements to date

David Rowland argues in the BMJ that the longer-term cause of excess deaths in care homes is over thirty years of outsourcing (hmm — we found a mixed picture about quality of publicly and privately-delivered social care) and a focus on cost reductions (more likely)

Ewan King blogged for NHS Confederation on what the government needs to do to ‘reset’ the debate on adult social care

The Local Government and social care Ombudsman published its annual report about complaints in adult social care, and worried that “people who fund their own care are still under-represented in the complaints we see, and the number has plateaued for the past couple of years”

Nuffield Trust analysed the impact of new technology in adult social care, but found that they were unable to say much due to the patchy data and poor data infrastructure in social care (and they’re right to keep banging the drum about this too)

Children and Young People

What’s happening in the world of schools? The Education DataLab have analysed the 2020 school results and Phil Nye has shown that, based on a sample of 1,216 secondary schools who gave Education DataLab predicted pupil-level grades, attainment gaps appear do not appear to have increased. In fact, their 2020 data shows a gap of 22 percentage points between disadvantaged and non-disadvantaged pupils, compared to an attainment gap of 26 percentage points in 2019.

Also in good-ish news, the Economist have looked into the rising numbers of initial teacher training applications — and reckon that there is cause for optimism if the increase in applications has been driven by a rise in the status of teachers during the lockdown (rather than the increased demand for secure jobs in the public sector which recessions almost always generate).

Looking internationally, the US education academic Robert Slavin has written a great summary of how much, if any, impact various education reforms could have in addressing the loss of time in school during the pandemic. The most effective policy based on the existing research? Tutoring. Lots of tutoring.

In less good news, the Institute for Fiscal Studies have looked at what’s happened to the (part public, part private) childcare market during the pandemic. TL;DR — “many providers lost income during lockdown […] a longer-lasting fall in demand for childcare or an increase in costs related to social distancing could seriously hamper financial sustainability”. Another fascinating example of the complexities of a part publicly-funded, part privately-funded market — many of the pre-existing problems and market fragility were similar to the English care home market before the pandemic.

The Education DataLab have also been doing some fascinating work looking at teachers mental health during the pandemic. They found that: work-related anxiety rose for headteachers and private school teachers during lockdown but — intriguingly — lockdown was not generally associated with higher work-related anxiety for state school classroom teachers. When looking at wider measures of mental health, they found that over two-thirds of teachers agreed that the impact of Covid-19 had been negative on their psychological health, however. Sadly — but perhaps unsurprisingly — work-related anxiety was highest among female teachers with children. The pandemic have long-term implications too — one-in-five heads felt that the experience of lockdown has made it more likely that they will seek to leave the profession.

In children’s social care, the Children’s Commissioner published a good briefing about the use of unregulated accommodation. It’s not new — but it is a helpful reminder of this often scandalously poor-quality provision.

Over at the What Works Centre for children’s social care, the Centre analysed four machine learning models for predicting children at risk based. Testing four models to see how well they would have worked in previous years, they found that the models failed both because they were not finding all the children who had been deemed at risk (false negatives), while also identifying at lot children who as at risk who were not (false positives). Not a great record — they conclude that “none of the models tested could accurately predict whether risks to children and young people would escalate”. Interestingly, they found that “the models performed equally poorly for most of the subgroups examined” — so little evidence of bias in decision-making. Quite surprising!

Taking a more reflective view, Michael Sanders and Ella Whelan from the What Works Centre for Children’s Social Care explore what lessons the pandemic has for the ‘What Works’ evidence centres. TL;DR — they’ve had to embrace a lot of research methods that stray pretty far from randomised controlled trials. But hey — there haven’t been any randomised controlled trials of the effectiveness of parachutes. Needs must.

Reading this led me to this interesting report from Jonathan Shepherd (whose work inspired the What Works centres). In it, he argues that the ‘evidence ecosystem’ — the networks, structures, and relationships that disseminate evidence from academics to practitioners — needs reform to better help professionals access the latest evidence, and to avoid duplication between the different What Works centres.

Law and Order

You wait ages for new criminal justice research and analysis, and then everyone publishes at once, all in a week or so. Arghhhh. Here we go:

The Ministry of Justice announced that it will extend a scheme that allows the police to hold people arrested for serious crimes in custody for longer periods than normal, due to the ongoing delays to jury trials. The Fair Trials campaign is not impressed — and neither are some judges, by the sound of it. In one case in Woolwich, Judge Keith Rayner refused to extend custody for one defendant by simply arguing that “lack of money provided by parliament to provide sufficient space for trials to be conducted does not amount to a good nor a sufficient cause to extend the custody time limit”. There will also be a bit more cash for criminal legal aid, and the little-used prisoner early release scheme has been paused.

The news that should have been bigger last week was the government’s impact assessment of its sentencing reforms — which concluded that they will come at a net societal cost of £542.6m over the next ten years.

Still following me? Any idea why that number matters? Welcome to the wacky world of impact assessments: the cost-benefit analyses that are produced for most government decisions. The analysts at MoJ get to this figure by totting up all the costs of the sentencing reforms (the building and running costs of new prisons to house the expected increases in prisoners; more money for probation services who’ll be supervising more people), and the benefits…of which there are vanishingly few that can be quantified.

Now, to be fair, the government’s goals with these sentencing reforms was not to save money. They were, as the impact assessment says, to provide “greater public protection” and “increase confidence in the criminal justice system for the public, victims, and the judiciary”. But is this really the best way to spend about £54m a year in an already-pressed criminal justice system?

A regular reminder: prisons did not enter this pandemic in a good state of affairs and won’t leave it in one either. A new report from the Public Accounts Committee sets out the extent of the problems, which Richard Vize covers polemically here. In (marginally) more positive news, Charlie Taylor — the to-be-confirmed incoming head of the Chief Inspector of Prisons — thinks that “the pandemic has seen prisons emerging changed — and ready for more change”. An interesting interview worth reading in full.

There have been lots of new think tank reports too:

Clinks have published a report about how to tackle institutionalised racism in the criminal justice system…

…and community empowerment

The Centre for Justice Innovation have published a report about how to increase use of community sentences

Local Government

In local government world, the economists at Economic Observatory have produced a great summary of everything we know about the impact of coronavirus so far. Nothing new, but a great succinct explanation.

The big debate over the last few weeks has been about local government reorganisation. There’s lots you could read, but two pieces I really liked were from the New Local Government Network and Centre for Cities, which give a good overview of the debate. Nothing more than “starve and carve” — that’s Adam Lent’s short and succinct case against reform in the middle of a pandemic. Centre for Cities are a bit more generous and think that there is a case for some reorganisation and simplification — and more importantly, that all new authorities should have “the same powers as the Mayor of London”.

I’m of the view that major reform probably isn’t worth doing in the middle of a pandemic, but I can see the case for some changes to local government — particularly if they cover local autonomy and revenue-raising, and not just abolishing various bits of local government…

Another week down. Keep staying safe.