The week in public services: 18th June 2019
By: Freddie Wilkinson
Tags: Schools, Crowdfunding, Nhs, Mental Health, Prison

This week: not enough money for the NHS Long-Term Plan; rising knife crime; and crowdfunded councils!?

Some general things first. In a sneak preview of the next State of Transformation event, Robert Pollock and Jonathan Flowers argue that Whitehall’s interest in public service transformation has waned, and transformation has been “largely left to smoulder on the back burner”. One for leadership contenders to consider?

Amidst all the various promises about extra education spending in the Conservative leadership question, one under-looked aspect is a simple question. How much would they all cost? Luke Sibieta from the IFS has crunched the numbers. Johnson’s claim about a ‘postcode lottery’ of school funding seems odd in light of the fact “the government — which Mr Johnson was part of — effectively ended a long-standing postcode lottery in school funding in England”.

Health and Social Care

That extra money to deliver the NHS long-term plan? It won’t be enough to deliver this Government’s ambitions to improve care. Great, comprehensive, new Health Foundation briefing covering spending and demand on almost all aspects of healthcare — from training to public health to social care.

This comes alongside a new survey of NHS leaders from NHS Confederation, which finds that leaders are positive about the direction of travel outlined in the long-term plan, but are very concerned about staff vacancies, constrained capital investment, and social care funding.

A new Public Accounts Committee report reviews increasing waiting times for different treatments, and argues that NHS England are not holding NHS Trusts (hospitals) to account for ensuring patients’ rights to treatment within maximum waiting times. They are also concerned that NHS England have not clarified how they will develop a “fit-for-purpose workforce” to reduce demand in line with the ambitions in the NHS long-term plan.

Meanwhile, the European Court of Auditors has released a report on cross-border healthcare. Approximately 0.05% of EU citizens take advantage of the Cross-border Healthcare Directive — some 200,000 patients. They found that the Directive increased cooperation between member states but had limited impact for patients. Going forward, the European Court of Auditors recommends cross border exchanges of health data. Freedom of movement of data, anyone?

The New Economics Foundation has released a report on the sale of NHS land for housing — and that this is being used to build unaffordable homes. Arguing that surplus public land should be put to public and community use, their analysis shows that 80% of homes built on former NHS land would be unaffordable to a nurse on an average salary. Equally, as only 23 of the NHS sites declared ‘surplus’ in England in 2017/18 have the capacity for over 80 homes, this isn’t exactly on a scale that will fix a housing crisis…

As part of the commitment to making digital primary care available to everyone, NHS England launched Babylon GP at Hand. Patients and GPs who use GP At Hand like it, but the model won’t work for everyone. A recent independent evaluation showed it provides good quality care to registered patients, these tend to be the young, healthy and tech-savvy members of society who don’t require reading glasses to look at the screen, can fluently converse in memes and, most importantly, are unlikely to have complex health needs. As this is not representative of those who use GP most frequently (there are 14.2 million people with 2 or more long-term conditions, accounting for half of all GP visits), the question remains: how, if at all, can technology help patients with complex needs?

Children and Young People

We know from our work that spending on Sure Start children’s centres has been cut. We know from our friends at the Institute for Fiscal Studies that Sure Start children’s centres are associated with positive impacts on children’s health. But do we know whether more or less children are using children’s centres than in 2010?

New Action for Children research addresses that question through a survey of Freedom of Information requests of councils. They estimate that between 2014/15 and 2017/18, the number of children using centres fell by 20%, from 2.2mn to 1.8mn. As Graham said online — this is valuable work — but really something which the Government (read: the Treasury and the Department for Education) should have been onto already…

Interesting blog from Ofsted’s National Director for Social Care on what impact austerity has had on child protection. Her answer? Spending on preventative services has fallen, and social workers are dealing with more complex problems as poor housing, mental ill health, substance misuse and domestic abuse are now prominent in most referrals to children’s social care. Even Ofsted are now warning that “we are surely at a point where in many places, further money cannot be taken out of budgets safely or easily”.

New research funded by the Nuffield Foundation looks at fascinating questions:

· How much does the school a pupil attends affect academic attainment?

· Do human resource management (HRM) practices affect school performance?

· How much does school leadership matter for school performance?

· Does how school workers feel about their jobs matter for school performance?

The answers? In order: a little bit (it explains roughly 10% of variation in attainment); somewhat but not in the ways this normally works in other workplaces; more teachers in middle-leadership roles is associated with higher performance; and maybe — higher “organisational commitment” is associated with better school performance.

Earlier this week, Damian Hinds suggested that geography may play a role in educational outcomes. The verdict of the Education DataLab, however, is that demographic differences are the main explanation — and that any policy to improve outcomes needs to be designed nationally, rather targeted geographically.

Do children carry the weight of divorce? New research on parental separation and children’s weight suggests they do, with this new study claiming that the long term effects of parental separation can be seen through a significant deviation of the BMI of children with separated parents from those from intact families.

Meanwhile, the Government’s response to independent review of children-in-need is… well, in need. A few recycled announcements and no details on how the admissions process for vulnerable children will be sped up. Merely the promise of ‘further research’ on persistent absence.

Law and Order

The new prisons minister, Robert Buckland QC, has set out his priorities for prison reform: crime prevention, rehabilitation, and early intervention. Is the 10 prisons project continuing? “I am going to do things my way, but I remain passionately interested in the outcomes of this project” — which sounds like a no. The Ministry of Justice will, however, report on the results of the project by looking at quarterly assault rates and mandatory drug testing results. Laudable transparency which should be encouraged! We’ve been tracking their progress quarterly — with our latest update here.

The Guardian reports that knife and offensive weapon offences have risen to their highest level for almost a decade, with over 22,000 knife and offensive weapons offences in the year ending March — an increase of 34% since 2015 and the highest rate since 2010. 37% of these offences resulted in an immediate custodial sentence, compared to 22% in 2009, with the average sentence length increasing from 5.5 months to 8.1 months. Prison crisis? What prison crisis?

Neighbourhood services

Is food safety the canary in the coalmine for financial pressures on councils? A new National Audit Office report analyses how well the Food Standards Agency and councils are ensuring food safety and standards, and has found that councils have cut spending and staff who work in food control. English local authorities now have significantly fewer food controls staff than councils in Wales, Scotland, and Northern Ireland. An interesting case study of what is happening to services beyond social care in local councils.

In the same vein, Suffolk council’s planned reduction in the number of health visitors also illustrates the tough choices facing councils.

Could crowdfunding be the solution for cash-strapped councils? Mark Davis argues that crowdfunding — where a large number of people provide small capital contributions on the basis of receiving a financial return — could provide cheaper finance to councils than either commercial borrowing or public borrowing (from the Public Works Loan Board), and reconnect people with their local areas by giving them a stake in local projects. There’s some evidence this has worked well in Bristol and Leeds…