The week in public services: 26th May 2020
This week: getting back to ‘normal’ in the NHS; the pandemic-proof class A drugs market; and where will the inspectors come from?
General
Right, everyone and their nan are talking about Dominic Cummings, so I am going to avoid the topic like the plague. Check Twitter for your memes about the branches of Specsavers open (or not) in Durham.
In other news, the National Audit Office have, with their usual forensic detail, summarised the government’s policy response to the pandemic. Which departments have done the most? Where has the government spent the most? What time were different decisions taken? My favourite fact? £82.2bn of the £124.3bn spent committed to responding to Covid 19 has been financial support for businesses. Really useful resource.
In other news, Prospect had an interesting interview with Wellcome Trust chief executive and epidemiologist, Jeremy Farrar, about decision-making under uncertainty, transparency. He thinks the critical turning point was the UKs slow reaction at the end of January and start of February.
And Nesta have published a long blog about the (many) possible consequences of coronavirus. I will confess, I normally find these kind of change-y wishlists quite grating, but I thought this one was interesting. The politics and economics sections are the ones most worth reading.
Health and Social Care
Following up on a story from a few weeks ago, where the Health Service Journal first reported that London hospitals were considering permanently increasing their numbers of intensive care beds, the FTs sources have confirmed that the plan is to double the number of ICU beds to 1650 over the next six months. The basic idea is to avoid the NHS having to cancel planned operations should there be a second or third surge later on. Pretty important, given that routine attendances are ticking up again — HSJ reports (£) that cardiac cases are already back to “normal” levels. Comes with quite a big caveat though: “the Treasury has yet to authorise the necessary capital expenditure”.
And of course, it should go without saying but just in case…you’ll also need some staff for those new beds, at least if you expect to treat any patients in them. Which makes that NHS workforce plan on filling existing vacancies and hiring new staff to meet rising demands even more important. A good chunk of that plan was about international recruitment — but given that international recruitment is now falling, the NHS is facing yet more problems. For a sense of how big the shortfall is, this updated Health Foundation analysis from Nihar Shembavnekar is great. The second and third-order consequences of coronavirus continue to cause huge headaches…
…and here’s a reality-check from the Health Foundation on getting back to ‘normal’. “The rate of funding growth, set out in the NHS Funding Bill in February 2020, will not be sufficient to cover the cost of meeting the 18-week standard by March 2024, even before any additional costs and demand arising from COVID-19”. To some extent, the only reasonable response to that is ‘duh’ — but it’s good to see the analysis, and the conclusions are stark and clear. To get back to the ’18-week standard’ (92% of patients waiting for routine elective treatments being treated within 18 weeks) would require hospitals “to increase the number of patients they admit by an amount equivalent to 12% of all the patients admitted for planned care in 2017/18”. That’s a big jump, even if hospitals didn’t have to put any measures in place to improve infection control. I’m getting a headache just thinking about it…
And in the ongoing debate about whether the decision to discharge hospital patients to care homes without testing at the start of the pandemic was the right one, this BMJ article from David Oliver is very good. Essentially — “things that were already essentially good and often mainstream practice before the pandemic are now presented as bad” — from trying to avoid keeping older people in hospital for longer than necessary, to discussing resuscitation wishes with patients and families, to making risk-based decisions on admissions to Intensive Care Units. The FT has a good summary (£) of the debate about who, if anyone, is to blame for the high death rate in care homes. NHS Providers have weighed in to tell Johnson and Starmer to pack in discussion about the specific rules, and instead discuss the (lack of) support available to care homes — which, in their view, was the real problem.
Good piece in The Guardian on what the UK could learn from Germany, South Korea, New Zealand and other countries that initiated test-and-trace regimes early. TL;DR? “Well-funded public services and an effective infrastructure, including widespread digital surveillance”. Having enough human tracers in place to contact people — Germany had to hire an additional 500 ‘containment scouts’, mostly medical students — and making any apps easy for people to use helps too.
Last-but-not-least, looks like testing shenanigans are still going on. This time, it seems that there was no data for yesterday because of problems collecting data from ‘Pillar 2 tests’ — the tests run in commercial labs. More or Less has been doing an excellent job of fact-checking the government’s testing claims each week, and if you want to know more, give Tim Harford and his merry bunch of stattos a listen.
Children and Young People
Good long FT article (£) about how school closures are increasing educational inequalities. Not much is new, but it’s a helpful summary for those who haven’t followed the research in detail. To avoid the paywall, you could always read this similar summary from the National Foundation for Educational Research instead.
Meanwhile, more evidence from Holland reconfirms what most academics have expected: that the better-off parents feel better able to support their children and school closures are increasing inequality.
Without wanting to delve too deeply into the schools reopening questions, Sean Coughlan has laid out a set of practical questions which I’ve still not seen any convincing answers to. Meanwhile, the education wonks on twitter have been discussing whether better real-time online learning could be part of the solution. I am sceptical, but this is a useful discussion.
Law and order
Useful Crest long blog post about whether county lines (gang-led drug smuggling involving young people crossing different local areas) has really gone away during the pandemic. TL;DR — the picture is more complex and gangs are turning to local recruitment, and taxis rather than public transport for longer journeys. The class A drug market seems to be pandemic-proof, which I found surprising.
In more positive news, a very helpful House of Commons library briefing about coronavirus in prisons: the scale of the disease, how it spread, and measures the government put in place to contain the spread. Cases and deaths haven’t been as high as Public Health England initially feared — but there are increasing worries about prisoners’ lack of access to rehabilitative activity. Whisper it: a quiet success story? You can compare how the England and Wales did against what academics identified as best practice, here.
Local government
Short Reform report about how local government could make the best of the post-crisis recovery, featuring essays from some of the various great-and-good of local government policy (though not that many people actually from local government).
Lots of interesting stuff on the Local Government Chronicle this week. In no particular order…:
- What testing the contract-tracing app was actually like on the Isle of Wight
- Leaked data councils submitted to MHCLG suggests that Covid-19 costs continue to rise, and there is an aggregate shortfall of £1.3bn for this financial year
- Council chiefs are unimpressed with the £600m infection control fund for care homes. Isn’t £600m a lot? Well, according to one council chief finance officer, “[one] care home is losing about £10,000 a week, [and] this funding will provide them with about £50,000”…
- Reports that councils are writing their own public health plans for releasing the lockdown because the centre is providing no real guidance
- …and tirades from Sarah Calkin and Nick Golding about central government (mis)management
Jess Studdert from the New Local Government Network makes an interesting argument that the government’s choice to rush the Coronavirus act through Parliament reflected centralising tendencies — why not just use the 2004 Civil Contingencies Act? Not something I’d thought about much, but does strike me as odd. But this article from the Bennett Institute instead suggests that it would have been unusual to use the Civil Contingencies Act, because it has never been used before. Does anyone closer to these questions have a better idea?
In funding news, urban local authorities have criticised the distribution of the government’s emergency funding, while Rob Whiteman argues that the government shouldn’t allow a series of Section 114 notices because “there is [currently] nothing elected councillors can do to balance budgets within 21 days of a notice” and “it is unlikely that government would have the bandwidth to then intervene in every case where a Section 114 notice receives no corporate response”. In short: a systemic problem needs a systemic response, and a Section 114 notice is not that.
Elsewhere, Adrian Jenkins summarises the cost pressures facing local government, and argues that “the only thing standing between directors of finance issuing [bankruptcy] notices is an expectation that there will be more funding from central government”. I think he’s right. Not exactly a good basis for financial planning, is it?
And here’s a sentence I didn’t expect to write: Thurrock council has borrowed more than £1bn from other councils to invest in renewable energy schemes, including a solar farm. The Full Bureau of Investigative Journalism piece is fascinating. The Institute of Chartered Accountants want local authorities to publish more frequent data on their balance sheets to central government to improve monitoring and support.
Last but not least, Sarah O’Connor wrote a great piece (£) about the number of health and safety inspectors and what impact local authority cuts during austerity have had on their ability to ramp inspections back-up as the government starts to want to reopen the economy (cheers for the tip-off, Giles). Spoiler:
“So who exactly will perform Mr Johnson’s “spot checks”, especially in so-called lower-risk sectors, such as care homes that are clearly now high-risk? The HSE [Health and Safety Executive] has failed to send me an answer.”
If you like pictures rather than words, here is my tweet summary version of the article. And for all the smart-arses saying ‘well it’s all good saying this now, but who could have known at the time?’, here’s a letter from an environmental health officer in 2017 pointing out the precise problems — recruitment problems, the decline in proactive inspections, and knock-on consequences for other services — the government is now struggling with. Prescient.
That’s it for another week. Stay safe.
