Collaborative management in the face of government response to COVID-19? Evidence from care home staff and stakeholder experiences in West England.

Luke Bradbury

Picture credit: https://socialvalueportal.com/support-national-effort-covid-19/resources/news/social-value-in-action/support-national-effort-covid-19/

As a student on the MSc Public Management course at INLOGOV and having worked part-time in care for a number of years, I felt my final dissertation project was an opportunity to investigate the impact of COVID-19 on adult social care and the implications of government intervention. The works of organisations such as SCIE (Social Care Institute for Excellence) have already shown that inaccurate government guidance – combined with years of underfunding – resulted in the sector being ill-prepared for dealing with a pandemic and that care policy and practices had to rapidly adapt to unforeseen circumstances with limited support.

This case study aimed to explore this in the context of two care homes in West England during the early months of the pandemic. It was also interested in the role of collaborative management between care homes and their surrounding communities including local authorities, charities, businesses etc. ‘Collaboration’, in this context, took some influence from Helen Sullivan and Chris Skelcher’s conceptualisation of a collaborative agenda governing the (often mutually) beneficial cooperation between different public bodies and community agencies. One might consider how care homes may have banded together with their own local communities to ensure they still had the means to provide quality care in the face of COVID-19. Indeed, recent research by Fiona Marshall et al. has shown that, where government support was scarce, many care homes formed resource networks with external stakeholders such as local businesses, dentists, veterinaries, and domiciliary care agencies to source vital materials including personal protective equipment (PPE), electronics, toiletries, bedding and even food.

This study used semi-structured interviews and recruited five participants via a combination of snowball and non-probability purposive sampling. This included two deputy care home managers representing two different care homes in West England as well as a carer, a local parish councillor, and a co-owner of a local chemicals firm. The latter two participants were recruited as active members of the local community for one of the two participating care homes (or ‘external stakeholders’). Thematic analysis and grounded theory-based coding was then used to interpret the data.

The analysis firstly uncovered a strong dissatisfaction with the central government response to COVID-19 amongst all participants. Care staff spoke about how the implementation of the Coronavirus Act forced them to take on extra patients from hospital without an effective COVID-19 testing system in place and that inconsistencies between government guidance and company policy led to confusion amongst managers. Practices were forced to adapt; for example, adhering to stricter infection control measures and taking on extra care duties such as virtual GP consultations. External stakeholders also spoke about how these circumstances encouraged some level of collaboration within the community and a desire to assist local care organisations; for instance, a parish council was enabled to collaborate with the local chemicals firm and local school to source PPE such as goggles and hand sanitizer which could then be distributed to care providers.

Despite this opportunity to establish a resource network, collaboration between the two care homes and their surrounding communities was not evidenced as Marshall et al. had found previously. This was attributed to two main reasons. Firstly, resource dependency was less prevalent because effective internal management within both care homes meant they already had a sufficient supply of PPE. As one of the deputy managers recalled, the manager for her home made the decision to stock up on PPE and to lockdown early, therefore minimising the spread of the virus. The second reason was down to external circumstances that aided both care homes. Since both operate within rural areas of West England, they occupy less densely populated regions than care homes within inner city locations and therefore surrounding transmission rates remained relatively low. The implication is that locality largely eliminated the need to establish support networks with external stakeholders because they were not experiencing the same level of devastation seen in many other care homes. This was corroborated by staff who felt ‘fortunate’ compared to what they were seeing on the news.

These findings indicate the importance of effective management but also the extent to which contextual circumstances may or may not have necessitated collaborative networking between care homes and their surrounding communities during the early months of the pandemic. Whilst collaboration was less necessary here, the background coordination of parish council and local actors to produce a ‘safety net’ of resources did highlight the potential of localised collaboration and intervention in times of crisis. Perhaps, had such coordinated localised governance been enabled within the surrounding communities of less fortunate care homes, they may have been spared some of the devastations of the pandemic. Regardless, there is certainly a strong call for greater support towards the care sector for government and policymakers to consider – particularly in terms of clearer guidance, increased funding, and enabling localised governance to support care organisations.

Luke Bradbury graduated from the MSc Public Management in September 2021.

‘The Great Parliamentary Resistance’ – some of the outcomes

Chris Game

Back in early February, I wrote a blog dissecting one of two big and controversial Government Bills involved in what I slightly hyperbolically termed the “historic Monday evening of the Great Parliamentary Resistance” – Monday, 17th January, when the Elections Bill received its Third Commons Reading, while across the way the Lords were savaging the ‘flagship’ Police, Crime, Sentencing and Courts Bill by defeating the Government a Parliamentary record 14 times in the same sitting[1].

Both Bills, in being big and controversial, were fiercely contested throughout their Parliamentary progress and significantly amended – to the extent that my initial idea of highlighting and summarising such amendments in two linked blogs in, say, February and March, proved ludicrously unrealisable. Not least because neither received their Royal Assent until 28th April.

On the ball, as ever, Jason Lowther blogged immediately about the particular aspects of the now Elections Act with which he had been particularly concerned – the Government’s ‘solution’ to the undemonstrated ‘problem’ of ‘personation’, of having in future to show counter-signed photo ID at UK Parliamentary and English local and PCC elections.

This single blog, therefore, will attempt two ludicrously daunting tasks: (a) to at least mention some of the additional, less publicised, measures in or out of the Elections Act, and (b) similarly, but even more summarily, for the considerably more complex Police, Crime etc. Act.

There were two key and particularly controversial Elections Act proposals, that went down to the proverbial wire at the so-called Ping pong stage of the Parliamentary process (pp.79ff. of the H/Commons Library briefing noted by Jason).

First, obviously, the several proposed age-discriminatory and non-photographic forms of ID that had been in and out of the Bill throughout – mentioned again here frankly as a pretext for reminding anyone who needs it of just how long and how implacably opposed the PM himself has been to ID cards of any description, and accordingly what we can presumably look out for come Election Day.

election1

The other long-running dispute concerned the Act’s provision for the Government to set a “strategy and policy statement” for the constitutionally independent Electoral Commission.  Some suspicious Parliamentarians suggested this might go beyond scrutiny and accountability, and “potentially into providing guidance about how [the Commission carries out its] functions on a day-to-day basis”.

They wanted it “not bound by” the Government’s “statement”, but apparently they were guilty of a “mischaracterisation” of the Government’s intentions, and the relevant amendments were defeated.

The Government’s listing of the Act’s additional benefits appears, of course, on the relevant Gov.UK page – summarised under the comfort blanket of the several “greater protections” it provides for voters, and also for candidates and campaigners.

Protection from fraud through photo ID, of course, but also from intimidation at the ballot box – the latter by fines, up to 5-year bans, and even imprisonment for offenders convicted of attempting an extended definition of ‘undue influence’.

Voters with disabilities must in future be provided with specialist equipment, and may be accompanied by an adult.  And the 15-year limit on the voting rights of British ex-pats, retired or working abroad, will be removed. An estimated 3 million potential voters are currently affected by the limit, and – read into this what you will – it fulfils a pledge in three recent Conservative manifestos.

Finally – although it was actually the first bit of the legislation I blogged about, back last April – the Act will change the voting system for both Mayoral and Police & Crime Commissioner elections from the ‘transferable’/choice-extending Supplementary Vote to First Past The Post – on the basis of “no other plausible argument” than it might fractionally reduce the numbers of rejected ballots”.

I have views – as doubtless do Mayors Tracy Brabin (Lab – West Yorkshire), Ben Houchen (Cons – Tees Valley) and Andy Burnham (Lab – Greater Manchester), all recently elected after transfers – but not here.

And so to the Police, Crime, Sentencing and Courts Act – a real pantechnicon of a Bill/Act, highly technical in places, with even the ‘short’ and definitely the ‘long’ (150-word) titles signalling how impossible it is seriously to summarise.

It makes major changes across the criminal justice system, significantly extending police powers and the treatment of suspected, arrested, charged and convicted offenders. Again, there is a substantial (100+ pages) Commons Library summary of the whole legislative process; also a detailed House of Lords account – presented, slightly disconcertingly, in reverse chronological order – covering the fate of at least some of the Lords’ 17th Jan. amendments.

I was never keen on listing Wiki on student reading lists, but in this case I might well make an exception.  For this blog, though, I have borrowed (sounds so much better than plagiarised!) the content of the next few paragraphs from the BBC’s summary –mainly because it focuses, as many of those Lords motions did, on the implications for and threats to the right to protest.

Until now, it has generally been the police’s responsibility, if they want to restrict a protest, to show it may result in “serious public disorder, property damage, or disruption to the life of the community” (emphasis added). They can also change/restrict the routes of marches. For major events, like the COP26 protests, details are typically agreed with the organisers weeks in advance.

The new Act enables particular measures to be designed for ‘static protests’, like those of Extinction Rebellion, whose modus operandi is to force governmental action on the “climate and ecological emergency” through non-violent civil disobedience, the occupation of roads and bridges, etc.  Start and finish times and noise limits will now be set, even for protests involving just one person, with fines up to £2,500.

Edward Colston, the C18th merchant/slave trader whose statue was pushed into Bristol docks gets his own clause, with damage to memorials earning up to 10 years’ imprisonment.

Shadow Home Secretary Yvette Cooper has described the “rushed” legislation as creating “incredibly widely drawn” powers …”, allowing the police to stop and search anyone in the vicinity of a protest, including passers-by, people on the way to work and peaceful protesters.”

The Government/Home Office/Police viewpoint is set out in a Home Office Policy Paper.

[1] It appeared on 4th February, at the start of what proved a particularly active blogging month, with the consequence that, to access it, you may need to key ‘Older Posts’ at the end of the February 2022 selection.

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Chris Game is an INLOGOV Associate, and Visiting Professor at Kwansei Gakuin University, Osaka, Japan.  He is joint-author (with Professor David Wilson) of the successive editions of Local Government in the United Kingdom, and a regular columnist for The Birmingham Post.

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After austerity, comes the reckoning

Jason Lowther

The publication last month of the Institute for Government’s report on the impact of cuts in local services during the decade of austerity has revealed to the public what has been obvious in the sector for years – austerity was hugely unfair and hit the poorest hardest. 

Neighbourhood services under strain is written in IfG’s usual forensic style, and its conclusion is all the more brutal because of it: the most deprived areas received the biggest grant cuts, resulting in bigger reductions in local services such as libraries and recycling.  Central government grants were cut more in deprived areas because of the way cuts to grant funding were distributed ignoring councils’ different degree of dependency on this income source.  Because of the central cuts and pressures such as the increasing demand for social services, councils have been forced to cut preventative and universal services like children’s centres and housing programmes to help vulnerable people to live independently.

The report’s detailed analysis of changes in spending reported to DHCLG concludes that most councils chose to protect similar services.  ‘Relatively protected’ services included environment and regulatory services, homelessness and public transport.  At the other extreme, most councils applied higher than average spending cuts in housing, cultural, and planning services (figure 1 below).  This mirrors earlier analysis by the National Audit Office (which also highlighted the protection of social care services).

Figure 1: Local authorities that disproportionately cut, relatively protected, or increased neighbourhood services spending between 2009/10 and 2019/20, by category

Source: Institute for Government analysis of DLUHC, Local authority revenue expenditure and financing in England: individual local authority data – revenue outturn 2009/10 and 2019/20.

The IfG report hints at the innovative ways different councils responded to these pressures, from contract renegotiation and the use of new technology, to service redesign and rationalisation.  For a more detailed exploration of this, I recommend Alison Gardner’s excellent thesis on how local councils responded to austerity – including strategic asset management, shared services, commercialisation, co-production and demand management.  Whatever methods were used, however, it’s clear that by the second half of the decade of austerity the cuts were no longer into ‘fat’ but into ‘flesh’.

These new findings add to a growing library of research on the effects of the UK government choice to pursue austerity policies, including a BMJ study in October 2021 which suggested that the constraints on health and social care spend during this period of ‘austerity’ have been associated with 57,550 more deaths than would have been expected had the growth in spend followed trends before 2010.  Considering cuts to local government funding specifically, a July 2021 study in The Lancet estimated that cuts in funding were associated with an increase in the gap in life expectancy between the most and least deprived quintiles by 3% for men and 4% for women between 2013 and 2017. Overall reductions in local government funding during this period were associated with an additional 9,600 deaths in people younger than 75 years in England. Well before the pandemic, the UK was seeing a rapid slowdown in life expectancy gains in the 2010s and, although a number of other high income countries also saw such slowdowns, of large populations only the USA experienced a more severe slowdown/reversal and the magnitude of the slowdown in the UK was more severe than other large European populations.

Perhaps the most damning finding of the IfG report is that central government lacks the information to know what the impact of its spending cuts are on local services.  This echoes the assessment of the Nuffield Trust and Health Foundation back in 2014 which warned government was making decisions with ‘no comprehensive way to quantify the impact that social care cuts are having on their health and wellbeing’ and were therefore effectively ‘flying blind’.  Having abolished the Audit Commission in 2010, the government was left with no comparable performance statistics for two-thirds of local services.  Some may believe that this was quite convenient, given what we are now learning about the effects of that government’s spending policies.

80% of councils directly involved (again) in delivering housing

Chris Game

If you’re an academic – either a genuine intellectual, theorising one, or a more lecturing, popularising one like what I was – there’s a good chance that the week before Easter is Conference Week.

It’s easy to mock, and knock, academic conferences. Too many delegates reading, rather than ‘presenting’, their papers; no time for proper interrogation, discussion and debate; mediocre university campus food. And for overseas conferences, add in climate threatening CO₂ emissions.

However, I like them – conferences, that is.  Indeed, this recent Easter week I racked up a full half-century of attending, at least intermittently, PSA (Political Studies Association) conferences.

Like most such events nowadays, this one was ‘hybrid’ – with panels attended partly in person, partly digitally via Zoom. Which makes genuine discussion additionally problematic, and emphasises the importance of the written papers addressing subjects that ideally are appealing, topical and even newsworthy.

Happily, in the Local Politics Specialist Group this is almost the norm. And this year one paper especially – in addition, obviously, to that of the INLOGOV’s Director, Jason Lowther (from ‘Birminham’, according to p.25 of the evidently un-proof-checked programme!) – struck me as both sufficiently important and timely to bring it to the attention of a couple of slightly wider audiences⃰.

Timely because we’re fast approaching the May 5th local council elections, and, if these councils’ controlling parties choose to draw voters’ attention to it, many could boast something they might well not have been able to even four years ago when these same seats were last collectively contested.

Specifically, over four in every five should be able to claim that they are genuinely and actively involved in the business of delivering social housing.  And if that doesn’t grab you, or you’re thinking: “well, isn’t that one of the main things councils are supposed to do?” – or maybe, as a Birmingham resident, you’ve heard of the 4,000+ homes built by the Birmingham Municipal Housing Trust, the City Council’s housebuilding arm, and assume that it’s fairly typical, rather than really exceptional – then I politely suggest you’ve rather lost the plot in recent years.

When I used to lecture to particularly overseas students about housing in England or the UK, I would use a couple of very basic graphs, similar to those illustrated here. The first showed the changing relative importance of our main housing tenures since 1919 – private rented, owner occupied, local authority, and housing association.

Tenure1

At the end of the First World War, the ‘big picture’ was straightforward: roughly 90% of housing stock was privately rented, 10% owner occupied. Councils were empowered to build ‘corporation housing’, but few did.  But the War changed everything. PM Lloyd George promised not just houses, but “Homes Fit for Heroes’, and the 1919 Addison (Housing, Town Planning, &c.) Act facilitated it. Council housing committees sprung up, generous subsidies were provided, and council estates mushroomed.

By 1939 over 10% of the population lived in council homes, and the numbers increased steadily post-war, with the Labour Government’s Town and Country Planning and New Towns Acts. At their 1950s peak, under Conservative Governments, councils were building nearly 200,000 houses a year – one completion every three minutes, if you were wondering.

By the 1970s over a third of England’s housing stock was ‘council’. Private renting had plummeted to below 20%, with owner occupation over 50% and rising, and housing associations just beginning to take off.

The 1980s Thatcher Governments’ priorities, though, were very different: a “property-owning democracy”, with successive ‘Right to Buy’ policies – requiring, rather than allowing, councils to sell off their housing stock, if tenants, particularly of larger, better-quality properties, wished to purchase.

Coupled with Treasury restrictions on councils borrowing money for capital expenditure, there began the long-term shift from council housing to housing associations or ALMOs (Arm’s-Length Management Organisations): from 7% of all social housing in 1980 to over 60% today, including virtually all new social housing.

On my second graph, of ‘Housebuilding Completions’ – albeit scaled for dramatic effect – the local authority line by the mid-1990s was barely distinguishable from the horizontal x-axis. Council house building on any significant scale virtually stopped, new homes countable in the hundreds, rather than hundreds of thousands – until, if you peer extremely closely, you can just see the space between line and axis opening up in 2018.

Housebuilding

Sales meanwhile averaged well over 100,000 a year, re-boosted by increased discounts from the Coalition Government following the 2007/8 financial crisis. That same Coalition – or its Treasury – also imposed tightly restrictive ‘caps’ on councils’ ability to borrow against their own Housing Revenue Accounts in order to build affordable homes.

True, the 2011 Localism Act and other changes gradually empowered councils to work both like and with private sector companies. But it was really only when, several years later, Theresa May announced to her October 2018 Party Conference that she would ‘ditch the cap’ that councils’ widespread re-engagement with housing provision seriously took off.

There were and still are significant hurdles: tenants’ right to buy, planning constraints, the need for more grant funding. But the climate has indisputably changed, and at least some of the circulating local election manifestos will surely contain the evidence.

The reason I’m confident of this is that one of the York conference sessions I attended was presented by Bartlett School of Planning’s Professor Janice Morphet, who, with her colleague Dr Ben Clifford, recently completed the third of their series of biennial surveys of councils’ engagement in the provision of affordable housing.

I was aware of this work, but frankly had no real idea of its scope, depth, rigour or even of the sheer quantity of data the surveys produced and made available, in both the respective main reports and the separate desk survey reports. Seriously impressive – and obviously impossible to do any kind of justice to here.

Hence the focus on what has been one of the surveys’ particularly key and consistent findings, summarised here in a couple of quotes: first from Morphet herself, then from the recent third survey’s Executive Summary:

“The third wave of research shows how local authorities are directly engaging in housing provision [and] that this has moved from a marginal to a mainstream issue.”

“From the desk survey, we found that in comparison with 2017 and 2019, the number of councils with [housing and/or property] companies … has increased from 58% in 2017, 78% in 2019 to 83% in 2021 … From the direct survey, we have found that 80% of local authorities now self-report that they are directly engaged in the provision of housing, a notable increase from the 69% … in our 2019 survey … and the 65% from the 2017 survey.”

Who said academic conferences are an indulgent waste of time?

________________________

⃰ A slightly abbreviated version of this blog – “Candidates will be homing in on a growing council priority” – appeared in the Birmingham Post on April 28th –  https://www.pressreader.com/uk/birmingham-post/20220428/281951726382871

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Chris Game is an INLOGOV Associate, and Visiting Professor at Kwansei Gakuin University, Osaka, Japan.  He is joint-author (with Professor David Wilson) of the successive editions of Local Government in the United Kingdom, and a regular columnist for The Birmingham Post.

What ID for Voter ID? 

Jason Lowther

Photo credit: Liz West, https://www.flickr.com/photos/calliope/

Last October, I wrote in this blog about the many positive aspects of the Elections Bill currently working its way through parliament.  It clarifies what “undue influence” on voters means, improves poll accessibility, reduces the risk of intimidation of candidates and requires all paid for digital political material to have an imprint.  The big problem, though, is the plan to require voters to present certain restricted types of identification in order to vote.  This month the House of Lords voted to mitigate this problem.

As part of the “Report Stage” of the bill, on 6th April the Lords agreed an amendment which radically expands the range of identification documentation which voters could use.  The new list is fairly extensive including an adoption certificate, bank or building society statement, P45 form, asylum seeker letter from the Home Office, and even a library card or National Railcard. 

In the debate, Cross-bencher Lord Woolley of Woodford claimed that the government had failed to make a convincing case on voter fraud – quoting one conviction from 47 million voters, which he likened to the chance of winning the national lottery jackpot.   He said that the cost of insisting on photographic ID could be to disenfranchise 2 million voters.

For the Greens, Baroness Jones of Moulsecoomb labelled the policy ‘a cynical ploy’. She went on to claim: “It is a clear attempt by the Government to make it harder for people to vote in elections. That is the only motive I can see when we have this sort of Bill in front of us. More cynically still, it will disproportionately stop BAME, working-class, Gypsy, Roma and Traveller people voting. These people find it hard enough to vote already. Anything you put in their way will stop them voting completely; that is preventing democracy’.

One of the amendment’s sponsors, Conservative former cabinet minister Lord Willetts, said that there was little concern with voter personation in the mainland and raised the concern that a future government elected with a small majority could face questions if significant numbers of voters had been unable to vote due to the new requirements.  He concluded that the amendment was ‘protecting our system from a major political and constitutional risk while remaining consistent with the manifesto on which the Conservative Party fought the last election’.

The vote on ‘Amendment 8’ in the Lords was 199 to 170, with three Conservative peers in favour and 155 against.  The House of Lords has its final sitting on the Report Stage on Monday (25th April), after which it will complete the Third Reading before the bill returns to the Commons for its consideration of the amendments.  The Government is known to be concerned at the inclusion of ID which does not have a photo, so the amendment is likely to be further challenged.

UPDATE (30/4/22): As anticipated, the Government rejected Amendment 8 in the Commons as the Government’s view was the types of ID listed were not sufficiently secure and might be prone to fraud. More detail is available in the excellent summary by Elise Uberoi and Neil Johnston for the House of Commons Library here.

Jason Lowther is Director of the Institute for Local Government Studies (writing in a personal capacity).