The 2020 Public Services Trust Blog

There’s quite a storm brewing in certain circles over the government’s personal care at home bill.  I was at an event organised by the SMF’s James Lloyd this week, where a panel was convened to critically reflect on the bill, including perspectives from a local authority that will have to find the cash and capacity to provide the extra care, a measured (but damning) perspective from the Kings Fund, and a searing and direct critique from Lord Warner. 

Not many people stood up for the bill – and those who did argued in terms of awareness, of keeping social care at the top of the legislative agenda during an election campaign.  Their fear is that a new government would have other priorities, and a greater compulsion to make immediate cuts that would harm those in need of the greatest care. 

But it seems from my perspective that forcing through the bill would seriously undermine the pretty sophisticated debate that has evolved around last summer’s green paper.  The idea of fairly sharing responsibility for the implications demographic change is blown out of the water by the PCAH bill, which – according to the Kings Fund – would have a partially regressive impact, and undermines the idea of partnership between individuals, families and the state.  The question of how local authorities could swallow the extra costs of the proposals (which are currently mooted from efficiency savings) becomes a daunting one if new figures suggesting serious under-estimation are to be believed. 

Next week the 2020PST will be launching a series of working papers – one of which is a paper on social care.  I wrote it before the bill was announced, so it doesn’t offer a perspective on this mess, but as Im not sure how this short term legislation could be squared with the long term goals of the green paper, I’m quite glad I didn’t have to try…

Wakefield prison

I went to an interesting round-table discussion this morning at the smf. The smf has been working on the question of how you could model a system of payment by results to reduce recidivism rates.

The smf has done some good thinking on this, having already undertaken a number of consultations before the round-table, so they had some slides to explain what they thought were the five biggest issues that would need to be dealt with before PbR could be put in place. These were:

Measuring re-offending: How accurate are reconviction rates as a proxy for re-offending rates? Are they accurate enough to contract on?

• Capacity and geographical dispersal: Many short-term prisoners are held far from their communities, and are also moved around for various reasons, disrupting attempts at rehabilitation.
• Case mix: Will providers ‘park’ offenders that are considered ‘to difficult to rehabilitate’?
• Profit motive: Would the profit motive that drives providers create perverse incentives in probation’s role to provide sentencing assistance to the courts?
• No cost saving to the criminal justice system: Will cutting re-offending actually make savings, or will prison places simply be occupied by new offenders (‘backfill’)?

Participants flagged numerous problems with the smf’s proposed solutions to these challenges. On the measurement question, there was a suggestion that a binary measure (either they are reconvicted or they aren’t) was perhaps not the best, and that a measure of the number of reconvictions may be more appropriate. The idea was put forth of taking into account the severity of the crime, but this was quickly dismissed as too subjective.

On capacity and geographical dispersal, the smf proposed holding short-term prisoners in dedicated prisons. The was objected to, since more, smaller prisons will be more expensive, and also often it is necessary to have a mix of prisoners on remand, short-term and longer-term prisoners, for reasons of maintaining order.

Inmates at Doncaster Prison

On case mix, the smf seemed to think this was not an issue, since the short-term prison population would be mostly non-violent offenders. This assumption was put in doubt, and questions about prisoners with multiple and complex needs being ‘left’ were raised. The smf proposes an ‘escalator tariff’ which would increase depending on how difficult an offender was to rehabilitate, but there were questions about how one would set those tariffs.

On making savings, the smf’s argument was that there would be wider gains to society, but this is sounds rather weak in the current climate.

Unfortunately, in my opinion, the seminar focussed on a model for those offenders sentenced to less than 12 months in prison, which precluded any discussion of the best segment of offenders to target for a system of payment by results. I personally have my doubts about what the length of the sentence tells us about how prepared an offender might be to give up offending. Of course, we don’t want to work with offenders that will give up on their own very soon (this would be deadweight cost), but neither do we want to work with offenders that are extremely unlikely to change their behaviour. We need to find the appropriate target group between these extremes, which may be males aged 18 years old regardless of sentence length, or some other group.

“Finally we have it: pilot-tested, fully costed, independently evaluated, cast iron evidence that investment in preventative social care services more than pays for itself in savings to the NHS.”

This is David Brindle in yesterday’s Guardian, citing newly published research on the Partnerships for Older People Projects (POPPS), which were set up in 2005 to explore preventative approaches to care through focusing on human needs – loneliness through isolation, poor general health and social disconnection.  The project explicitly aimed to reduce ‘hospital based crisis care’ for older people. 

Policy advocates for preventative approaches should be pleased at these results – overnight hospital stays reduced by as much as 47%, for example.  Jamie Bartlett wrote a good report at Demos about the value of thinking preventatively, and this is more evidence to support a pragmatic, sensible and long-term way of thinking about health and social care. 

As David Brindle points out, the real value of this approach will be found if we start to think about preventative spending across current departmental lines.  He also makes a good point about the potential tension between policies that would promote cooperation and resource pooling in this way, and those that encourage competition.  To get round some of these issues, we need to think more about need, place and scale; and less about institutions and service categories.  This is obviously difficult. 

What also made me chuckle is how difficult it is to turn something that sounds like common sense into a policy idea that could feasibly be rolled out.  “Pilot-tested, fully costed, independently evaluated, cast iron evidence”.  If only Newcastle United’s transfer policy had been so rigorous.

My brother Sean sent me a fantastic article by Tony Judt from the NY Review of Books. The article is adapted from a lecture, in which the author rattles through a history of the European social democratic model, a consideration of why social democratic institutions have been resisted in America, and some thoughts about ‘where next’ for a model under serious economic and moral strain today.  It rewards a good (but challenging) read, but some of argument is also a bit troubling:

“We…have lived through an era of stability, certainty, and the illusion of indefinite economic improvement. But all that is now behind us. For the foreseeable future we shall be as economically insecure as we are culturally uncertain. We are assuredly less confident of our collective purposes, our environmental well-being, or our personal safety than at any time since World War II. We have no idea what sort of world our children will inherit, but we can no longer delude ourselves into supposing that it must resemble our own in reassuring ways.

If social democracy has a future, it will be as a social democracy of fear. Rather than seeking to restore a language of optimistic progress, we should begin by reacquainting ourselves with the recent past. The first task of radical dissenters today is to remind their audience of the achievements of the twentieth century, along with the likely consequences of our heedless rush to dismantle them.”

Surely he is right about the insecurity we are currently living through – and right to suggest that our notions of what is ‘good’ or should provide a grand narrative for society are fragmented and contested.  But I don’t agree that a ‘social democracy of fear’ – based on the idea that we must do everything to preserve what we have in the face of those who would dismantle it – is the inevitable future.

Yes, recognise the collective benefits social democracy has fostered – especially the idea of collective, public goods and collective responsibility for participating (through citizenship) in a society that sustains and protects these goods.  But does questioning some of the organising principles of our social democratic system really constitute a ‘dismantling’ of this ethic?  And is hanging on for grim life the best way to think progressively from now onwards?  I’m not arguing for creative destruction, but I think that our social democratic model can cope with some serious internal reform (electoral reform, decentralisation, more plural funding models, greater citizen autonomy and agency) and still retain the ethic of social citizenship and shared identity that Judt is concerned with.

As we are in the middle of the coldest winter in the UK for 30 years and people across the country are battling treacherous conditions after sub-zero temperatures follow days of snow, the economic impact of the cold snap is beginning to pile up.

The Federation of Small Businesses has criticised head teachers for closing schools too readily in the snowy weather (over 10,000 schools closed across the UK), saying lost working days are affecting many companies. With millions unable to get into work, business leaders are ‘forecasting’ (excuse the pun) that the cost to the economy could top £14.5bn by the end of January and with the big freeze set to continue until March business leaders are urging workers to carry on regardless.

This doesn’t bode well for an economy still navigating its way through a recession, oh and wait there is still more snow to come… I guess the only big winner from the cold snap has been energy firms, whose profits are set to soar, well I’ve had my central heating on all morning haven’t you?