Lessons from literature for local government

Professor Catherine Staite LLB, MBA, FRSA

No man is an island entire of itself: every man is a piece of the continent, a part of the main;

If a clod be washed away by the sea, Europe is the less, as well as if a promontory were,

As well as any manner of thy friends or of thine own were.

Any man’s death diminishes me because I am involved in mankind,

And therefore, never send to know for whom the bell tolls;

It tolls for thee.

John Donne

When every week seems to bring news of yet another major failure of governance in a local authority, some members and officers in other councils will be fearful that the same fate will befall their own council before too long, while others will be confident that all will be well for them.

When we look at the notable governance failures that have occurred in recent years, we see a very complex picture. Causes of failure are many and varied, ranging from the absence of the most basic controls to ambitious but risky money-making schemes. Some patterns are visible in all the complexity, including, failure to listen to officer advice, engaging in commercial activities without the requisite skills and knowledge, weak financial controls and opaque decision-making processes.

Councils need both strong rules, about finance and behaviour and strong public service values. Constant vigilance and honest collective self-reflection are vital to ensure that decision makers are independent, transparent, accountable, behave with integrity, have a sense of shared purpose and focus on outcomes. Ask yourself – are our informal and formal governance arrangements fit-for-purpose? If not, where might the weaknesses lie? Look at your structures. Are your Constitution, Codes of Conduct and Standing Orders up-to-date? Is your organizational structure robust? Are your s151 officer and Monitoring Officer on the senior management team and do they report directly to the Chief Executive? Then look at your systems. Are decision making processes clear? Can projects be started without the right sign-off? Can officers exceed their authority without consequences? Last, but by no means least, take a long hard look at organizational behaviour. How do leading politicians and officers respond to being challenged? Is bad behaviour rife but undiscussable?

It’s important to avoid complacency. Most of the members and officers leading and managing councils that have failed to uphold the best standards of good governance either thought what they were doing was fine, or that they could get away with it. Sometimes those who are part of an organization are the last to notice how the patterns of weak governance and bad behaviour, which have become so familiar that they cease to be noticed, will eventually lead to their downfall. Even when officers can see that their council is not going to able to balance its books or manage its risks, it can be difficult to speak up if members do not want to listen and it can be career limiting when a bullying culture prevails. Although statutory officers have statutory powers and duties, they are will not be protected from retaliation if they are perceived to be raining on the parade of colleagues and members who, because of ambition or political expediency, have lost sight of what good governance looks like. The statutory protections that attach to senior roles are not proof against bullying or actions amounting to constructive dismissal. The power imbalance between members and officers remains significant because while members may lose positions of power, or even their seats, officers risk losing their livelihoods and even their careers.

Those members and officers who consider themselves safe from failure may take some guilty pleasure from the failure of another council, especially if its run by another party. Councils have been encouraged to compete with each other for funding and kudos, so perhaps it’s natural to feel that the standing of better run councils goes up when the reputations of failing councils go right down. That’s a big mistake, for two very strong reasons; failure of one local authority reduces public confidence in local government as whole and it gives central government convincing reasons for not delegating resources and power to a local level. For all that we refer to ‘sovereign’ councils, no council is ‘an island, entire of itself’ and the failure of one diminishes all. When we open the LGC or MJ, to see for ‘whom the bell tolls’ we should hear the message that ‘it tolls for thee’.

Picture credit: Maggie Meng https://www.flickr.com/photos/snowfish2014/

Catherine is a researcher, consultant and coach who specialises in strengthening leadership, improving governance and supporting senior politicians and managers.  She is an independent consultant with Darlingburn, a small consultancy practice and is working with Grant Thornton on local government audit, specializing in governance. She was the Director of the Institute of Local Government Studies (INLOGOV) at the University of Birmingham from 2011 to 2017.

A Japanese view of Jeremy’s budget

Chris Game

I had an interesting Budget week. I was part-hosting a Japanese academic colleague – Prof Toshihiko Ishihara (Kwansei Gakuin University) and his wife, Midori – making their first overseas trip since Covid. They briefly visited Birmingham, where Toshi was an erstwhile INLOGOV Associate, but were based in London, where I’d agreed to organise a theatre visit.

I’d booked tickets for a well-reviewed modern-day play, Romeo and Julie, loosely based on one of Shakespeare’s. Single-sentence synopsis: Julie – a bright, Cambridge University-bound, aspiring astrophysicist – is emotionally torn between uni and her affection for young single dad, Romeo, effectively sole carer for his baby daughter afflicted with Poonami.  

No, the Poonami doesn’t feature in Shakespeare’s version, but, researcher that I am, I’d discovered it’s a real medical thing, meaning affected babies’ sudden, massive, uncontrollable bowel movements. Better still, that etymologically Poonami derives directly from the Japanese tsunami – a sudden, volcanic, unstoppable wave. My guests were delighted – and the play too was excellent.   

The following Wednesday, however, was Budget Day – followed by the Birmingham Post’s impassioned coverage of our region’s “Power grab”, the “seismic shift in devolution as West Midland leaders take more control from Whitehall”, etc. (pp.1,7) – guaranteeing some amused but tricky questions from someone who both lives with and studies serious mayoral governance.

It was the national news headlines, though, that I was obliged to address first, and the UK’s “unsustainable … biggest since the war … tax burden” – characterised by Chancellor Jeremy Hunt as something horrendous and to be avoided, certainly by a Conservative Government, at almost any costs.

We’re not Basil Fawltys, but my Japanese friends and I tend not to mention ‘the war’ that much. Anyway, the timescale wasn’t really the issue. It was that highest-level tax forecast of 37.7% of Gross Domestic Product (GDP) – and yes, we do make life harder by colluding in almost invariably labelling it a “tax burden”, rather than, say, the “quality-of-life price” that the tax helps pay for.

What Toshi and other Japanese students of these things invariably query is: why the excitement/horror over a tax-to-GDP ratio currently almost identical to theirs? Yes, ours is indeed a higher ‘burden’ than those of, say, the US or Switzerland. But, as shown in the Office for Budget Responsibility’s Chart A, both we – at roughly 34% of GDP – and Japan are currently in the bottom third of “advanced economies”, and even at a forecast 37.7% we’d still be mid-table and some way BELOW both most sizeable West European countries, plus bits of Eastern Europe too.

It’s interesting. Pollsters never ask us if we prefer NOT being an ‘advanced economy’ – you know, one with fully staffed and functioning health and social services, decently funded schools, reliable public transport, etc.?  And I’m not sure how collectively we’d answer. Clearly, these things do cost money, yet we obviously like visiting these higher-taxed places for our holidays.  Not Denmark perhaps – top, with its 47% tax ‘burden’ – but France, Austria, Italy, Scandinavia, Greece, Spain, Portugal, etc.

It’s presumably at least partly these countries’ ‘quality of life’ (QoL) that attracts us – which, unsurprisingly, correlates broadly with ‘tax burden’. There are several QoL indexes, one being Numbeo’s. It’s not the most methodologically sophisticated, but it does produce nice maps, collectively summarising its measures, which include purchasing power, safety, health care, cost of living, and pollution.

Netherlands, Denmark and Switzerland are currently top, scoring nearly 200 QoL points. Then the usual suspects – Finland, Iceland, Austria, Australia, New Zealand, Japan (13th) etc. – down to No.21 – UK 166.4, just ahead of Croatia. Disappointing, but could be worse – bottom at 84th is red Nigeria, not with ‘nul points’ exactly, but only 40.

The underlying, systemic problem, obviously not mentioned by Chancellor Hunt, is precisely his Department: His Majesty’s Treasury – first time I’ve typed that! – and its overbearing central funding control, currently exercised politically and communicated by him. And formerly by, among others, one George Osborne – which is where the irony starts. When Chancellor of the Exchequer, Osborne launched, and currently chairs, the Northern Powerhouse Partnership (NPP) – self-described as “the leading voice of business and civic leaders across the North”.

And currently a very shouty voice. For, within days of Hunt’s Budget pronouncements, along came Osborne with his NPP ‘wrecking ball’ – a clumsily titled but potentially headline-making report: Fiscal DevoNation – The Blueprint for How to Devolve Tax to the Regions of England. The Treasury, he and his Powerhouse chums now reckon – and as local government has complained for years – far from being the provider of solutions, is itself the problem. Its voice is the overwhelmingly dominant one in what Osborne nowadays sees as a damagingly over-centralised fiscal system. Just like when he was boss.

The NPP’s solutions involve, at least eventually, full-scale fiscal devolution. The “most unfair” council tax – with its outdated property values – stamp duty (paid on purchasing residential property), and business rates should all go, eliminating the Treasury’s all-powerful role altogether. The at least eventual replacement, following a comprehensive revaluation of all homes, would be a locally set land value tax, plus three new council tax ‘super bands’ for the most valuable properties, with revenue to be shared across the country.

Yep – that’s radical, but there’s more – like the localised hotel tax that numerous other countries already have, which NPP reckons could raise an annual £5.5 millions for the Lake District alone.

But I digress – from what my Japanese visitors really wanted to talk about: that Budget highlight of a “seismic shift” in devolution, to the West Midlands and Greater Manchester regions, and their elected Mayors, Andys Street and Burnham, who will get new multi-year devolution funding deals, and be allowed to retain business rates – to be followed by further such agreements across England.

At the time of writing, there hadn’t been a direct response from Northern Powerhouse as to how far down the ‘full-scale fiscal devolution’ road this might take us. As for a Japanese reaction, well, this blog is already overlong; but their response would probably start with the country’s written constitution, and the local government chapter guaranteeing its role and “the principle of local autonomy”. It’s an ultra-crude summary, but basically the national state does currency, diplomacy and defence, and pretty much everything else is left to the 47 prefectures and 1,700 or so municipalities. And heading those municipalities … directly elected mayors!

As the American phrase puts it: ‘Way to go’ – in both senses.  


This is an adapted version of an article that appeared in the March 23rd edition of the Birmingham Post.

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.

Mission Possible? 

Jason Lowther

With under 700 days to the next UK general election, political parties are busy developing their manifesto documents.  In February, Labour leader Keir Starmer made a major speech laying out his “five missions for a better Britain”.   How do these five missions relate to local government?  And is the turn to “mission driven” government likely to work?

The five missions vary in their level of specificity and challenge.  Securing “the highest sustained growth in the G7, with good jobs and productivity growth in every part of the country…” is a little vague but likely to be difficult, especially given we are currently ranked 6 out of 7 in terms of output per worker.  Mission #2, “make Britain a clean energy superpower”, accelerating the move to zero-carbon electricity from 2035 to 2030, is specific but very challenging.  Mission #3, reform of health and social care and reducing health inequalities, will require a re-focus from secondary (hospital) care to social care and addressing the social determinants of health.  Mission #4 is about community safety, and likely to involve more community policing.  Finally, mission #5 is to “break down the barriers to opportunity at every stage” through reform to the childcare and education systems.

Local government potentially has important roles in each of the five missions.  Local education, skills and economic development functions will be critical to improving productivity.  On energy, Net Zero requires at least a doubling of electricity generation by 2050, from decarbonised sources.  Decarbonisation strategies need to be place-based, taking account of the geography, building types, energy infrastructure, energy demand, resources and urban growth plans.   We’ve recently argued here for the key roles of councils in this area. 

Turning to health and care services, local government clearly has leading roles – including ensuring place-based planning to address the social and behavioural causes of health inequalities.  Analysis by the Liverpool and Lancaster Universities Collaboration for Public Health Research in 2021 concluded: “investment across the whole of local government is needed to level up health including investment in housing, children’s, leisure, cultural, environmental, and planning services”.  Similarly community safety, child care and education are areas where local government could be enabled to have much greater positive impact.

Perhaps as important as the specific “missions” is the approach to governing which the party is proposing.   Labour’s document characterises this as a move from top-down, target-led, short-term, siloed approaches, to government which is more “agile, empowering and catalytic”, working across the public and private sectors, and civil society.  This, it argues, requires organising government around a shared vision, focusing on real world outcomes, concentrating on ends with flexibility and innovation concerning means, devolving decision making from Westminster, increasing accountability including central and local data transparency, and adopting long-term preventative approaches including greater financial certainty for local areas. 

In some ways the idea of mission-driven government echoes the 1990s thinking of Ted Gaebler and David Osborne’s book “reinventing government”, which argued for a more entrepreneurial approach to the delivery of government.  Their work pointed to entrepreneurial companies setting overall missions and goals, and then leaving managers to figure out how best to deliver these – for example, by providing an overall budget for a service rather than detailed line-by-line budgets which disappear if not spent by year end.  The focus on managers rather than considering the perspective of politicians is one of the problems identified in subsequent evaluations of the reinventing government model, together with difficulties in sustaining the approach.

Mission-driven policies addressing ‘grand challenges’ of society are increasingly common, for example in the UN Sustainable Development Goals and various EU policies.  Mazzucato et al recently argued that addressing such challenges requires strategic thinking about: the desired direction of travel, the structure and capacity of public sector organisations, the way in which policy is assessed, and the incentive structure for the private, public (and I would add community) sectors. Labour’s paper makes a start (albeit at a very high level) on thinking through these areas. The litmus test, though, will be in developing the detail and how far this engages with local areas.   

Over the next few months, we will be contributing to the debate on the upcoming party manifestos with some research-informed thoughts on a variety of local government related policy areas.  If you would like to be involved in developing these, please get in touch

Jason Lowther is the Director of INLOGOV. His research focuses on public service reform and the use of “evidence” by public agencies.  Previously he worked with West Midlands Combined Authority, led Birmingham City Council’s corporate strategy function, worked for the Audit Commission as national value for money lead, for HSBC in credit and risk management, and for the Metropolitan Police as an internal management consultant. He tweets as @jasonlowther

Picture credit: BBC

In (Climate) Emergency Break The Mould 

Paul Joyce, Philip Whiteman and Jason Lowther

Cities must be at the heart of a successful response to the climate crisis. Hundreds of local authorities in the UK are acting responsibly by taking the climate crisis seriously, whether it is by setting net zero targets or proclaiming a climate emergency. But they will be hampered in their endeavours for a number of reasons, including the significant capacity constraints that contradict their aspirations, even though national government in the UK has also set a net zero target.  

Support for local government action could increase if government ministers listen to the recommendations of a report by the Rt Hon Chris Skidmore  Environmental Audit Committee (EAC) Chairman, who issued a report on  how the UK could better meet its net zero commitments.  It’s an impressive piece of work, reflecting over 1800 written submissions as part of the official Call for Evidence.  Central to its recommendations is the need for central government to empower regions, local government and communities to play a greater role.    

We should acknowledge that on some measures the UK is already performing relatively well on environmental issues, particularly in reducing greenhouse gas emissions.  The UK was placed joint second in Yale’s global Environmental Performance Index 2022, with Finland and behind Denmark.  It achieved the fastest improvement of the three countries (and third best globally) in the last decade. Between 1990 and 2020, the UK reduced emissions by almost 50%, driven in part by a reduction in the use of coal and toward natural gas and renewables.  Some of this success stems from historic decisions such as the 2008 Climate Change Act, which committed the UK to reaching 80% emissions reductions by 2050, and actions such as the introduction of a carbon price floor in 2013 and investments in solar and wind energy.   

It may become more difficult for the UK to keep performing well as new, more challenging actions are needed.  The EAC report is clear that local government is critical to developing and implementing the necessary actions, and that this requires a fundamental change in its relationship with central government.  We highlight four essential changes. 

First, simplify net zero funding arrangements.  The report is clear that “current central government funding arrangements are standing in the way of effective local action”.  The funding landscape is disjointed, unfair, and expensive for local authorities because of its complexity and reliance on short-deadline competitive bidding.  

Secondly, trust local government.  The report recognises that “to achieve a place-based, place-sensitive, locally-led transition to net zero, Government must place its trust in local leaders and communities to deliver”.   Analysis by UKRI found that a “place-specific” approach to decarbonisation costs 70% less and delivers 90% more benefits than one which is “place-agnostic”.  The report recommends a high-level framework and an agreement to close future partnership working between central and local government. 

Thirdly, allow local communities to determine their priorities and approach within the national framework.  The report recommends a new statutory duty on local authorities to take account of UK net zero targets.  Disappointingly, government is asked to back only “at least one” Trailblazer Net Zero city, local authority and community, with the aim for these places to reach net zero by 2030.   

Finally, align the planning system with net zero ambitions.  The current framework sometimes stands in the way of councils insisting on high standards.  And cumulative cuts to planning department budgets mean many councils lack the staff to deliver effective planning inputs quickly.  As the report says: “Reforming the relationship between central and local government on net zero will empower local authorities to deliver place-based, place sensitive action and unlock the high levels of local net zero ambition that we have across the UK. Unblocking the planning system and aligning it more closely with net zero will enable widespread pro-growth, net zero development” (p.189).  

In our discussions with local councils, we often find strong aspirations to address the environmental agenda.   To turn green aspirations into reality, we need city and town governments that are properly empowered and resourced to achieve this.  One of our concerns is that while the local authorities in the towns and cities are positive about cooperating with central government to promote sustainable development, their capacity is limited by comparison with European counterparts such as Sweden, Germany, The Netherlands, Norway, and Denmark.  In consequence, the centralised approach to public governance in the UK has produced little “depth” to sustainable development by public authorities.   Furthermore, we note that whilst may local authorities aspire to improve the environmental agenda, there is often a lack of specific or explicit connectivity to international targets, comparing less favourably to local authorities in other countries.

It is time to empower local government to become a powerful means of transformation of UK society, to give them much more fiscal autonomy, and to give them a strong mandate for sustainable development of cities and towns.  This needs to be effective not just for the biggest cities, but also for smaller cities and towns where the capacity is sometimes more limited.  Chris Skidmore’s report has recognised many of these issues, we now need to break the mould and give local government the mandate, capacity and collaborative approach it needs to succeed. 

Paul Joyce is an Inlogov associate.  Paul has a PhD from London School of Economics and Political Science. His latest book is Strategic Management and Governance: Strategy Execution Around the World (Routledge, 6 June 2022). He is a Visiting Professor in Public Management at Leeds Beckett University.

Philip Whiteman and Jason Lowther are Inlogov staff members.

Is Government Giving Value For Money?

Jason Lowther

When money is short, how we spend it becomes even more important. As central government reheats its arguments for austerity following the chaos of the last few weeks, I’ve been reflecting on the contents of the 2021 budget (just a year ago).  The 2021 budget set out not just spending plans, but also a souped up approach to measuring outcomes and cost-effectiveness of government spending. How are these playing out, and will they survive the No 10 merry-go-round?

Rishi Sunak, then eight months into the job as Chancellor, noted that government borrowing was relatively high after the pandemic, warned of the public finances’ exposure to rises in interest rates, and outlined how spending was being linked to the delivery of outcomes alongside across the board ‘efficiency savings’:

The fiscal impact of a one percentage point rise in interest rates in the next year would be six times greater than it was just before the financial crisis, and almost twice what it was before the pandemic…

Decisions have been based on how spending will contribute to the delivery of each department’s priority outcomes, underpinned by high-quality evidence. The government has also taken further action to drive out inefficiency; SR21 confirms savings of 5% against day-to-day central departmental budgets in 2024-25. (page 2)

The “priority outcomes” are the latest in a long line of attempts to prod government spending into delivering effectively on political priorities, rather than blindly increasing/decreasing by x % compared to last year.  A 2019 report from the Institute for Government helpfully outlines many of these earlier initiatives (summary from the House of Commons Library) including:

  • “Scrutiny programmes” and the Financial Management Initiative (FMI), introduced under Thatcher.
  • The Cabinet Office and Treasury set up the Financial Management Unit (FMU) in 1982 to help with creating plans under the FMI.
  • The “Next Steps” report, published in 1988, which recommended the establishment of executive agencies to carry out the executive functions of government.
  • Tony Blair’s administration developed a greater focus on performance targets and Public Service Agreements (PSAs) which put these targets on a formal basis.
  • In 2001, Blair’s government also set up the Prime Minister’s Delivery Unit (PMDU), which was intended to coordinate PSAs and bring them under more central control.
  • Under the coalition government in 2010-15, PSAs were abolished and replaced with Departmental Business Plans (DBPs). These shifted the focus from targets to actions – in other words, they listed what each department would do and by when, rather than what they sought to achieve.
  • Under the Conservative government in 2016, DBPs were renamed to Single Departmental Plans (SDPs), which were themselves renamed to Outcome Delivery Plans (ODPs) in 2021. According to the NAO, SDPs (and by extension, ODPs) are supposed to be “comprehensive, costed business plans”.

As well as having to write down what outcomes they want to achieve, and how they will know whether that is happening, under the SDP system departments were also required “to assess progress in delivering their priority outcomes [and] … share regular performance reports with HM Treasury and the Cabinet Office”. 

In the 2021 spending review, the departmental outcomes were spruced up to reflect the (now last-but-one) PM’s five priorities of levelling up; net zero; education, jobs and skills; recovering the NHS; and reducing the volume and harm of crime.  

This blog’s audience may be interested in “Where does local government fit in this compendium of key priorities?”  The answer is a little depressing: on the last line of the last page (page 30 of 33), just before the devolved government departments. The relevant outcome is inspiring enough: “A sustainable and resilient local government sector that delivers priority services and helps build more empowered and integrated communities”, albeit with the reassuringly non-SMART measure that “the department will provide narrative reporting on progress for this outcome”.  Of course I exaggerate, because local government has critical inputs to very many of the earlier outcomes too, but it’s hard not to conclude that local services and communities were not yet at the top of the ministerial attention list.

Will the “priority outcomes” survive the whirlwind of ministerial movements and unforced economic missteps?  After the last seven weeks, I’m not going to make predictions – but we should know in the next month, and alongside the financial figures they could be our best hint yet on where a Sunak government is heading.

Picture credit: https://www.youtube.com/watch?v=Du_6mRV8Hm8

Jason Lowther is the Director of INLOGOV. His research focuses on public service reform and the use of “evidence” by public agencies.  Previously he worked with West Midlands Combined Authority, led Birmingham City Council’s corporate strategy function, worked for the Audit Commission as national value for money lead, for HSBC in credit and risk management, and for the Metropolitan Police as an internal management consultant. He tweets as @jasonlowther

Can drama “Help” social care?

Jason Lowther

Photo credit: https://www.youtube.com/watch?v=5Z2ufAl2lko

Fresh from winning the Grand Jury Prize at the Banff Rockie Awards on Monday, Channel Four’s drama Help was yesterday nominated for Best Drama in the Edinburgh TV awards, with its lead actor Jodie Cromer also nominated for Best Actor.  The drama was one of the most watched on the channel, bringing to millions of viewers the plight of care homes and their residents during the pandemic.  Whilst the Help storyline is fictional, it is based on hard and devastating facts.

In my view, Help could be criticised for its farfetched ending and sometimes unsympathetic rendering of the care home manager, however its characterisation of care home staff and residents is both caring and revealing.  Clearly emotionally affected researching the programme, writer Jack Thorn said: “hearing the stories of those at the frontline, having people break down in tears on zoom in front of us has been incredibly moving and galling”.   

My two favourite parts of the programme (no spoilers) are the endless recorded message of a hopelessly over-run “NHS 111” call centre in the background for several minutes, and Jodie Cromer’s wrenching speech to camera (1:34 on the video) demanding “…underlying health conditions, eh?  When did all lives stop being worth the same?”  The programme ends highlighting some stunning research findings: 40% of Covid deaths in the early pandemic (from March to June 2020) were in care homes; the average wage of a care home worker is £8.50 per hour; whilst government provided 80% of PPE needs for the NHS, it only met 10% of adult social care’s needs. 

This last claim is based on the National Audit Office analysis published in November 2020, which found that the adult social care sector received approximately 331 million items of PPE from central government between March and July (10% of their estimated need) whereas NHS trusts received 1,900 million items sent to NHS trusts (80% of estimated need).  Whilst both fell significantly short of what was required, there is an apparent imbalance here.  Data collected by the Care Quality Commission (CQC) showed that, throughout April and May 2020, more than a fifth of domiciliary care providers had no more than a week’s supply of PPE. 

This situation was well known to the Secretary of State, not least because the LGA and the Association of Directors of Adult Social Services wrote stating “we continue to receive daily reports from colleagues that essential supplies are not getting through to the social care front-line. Furthermore, national reporting that equipment has been delivered to providers on the CQC-registered list does not tally with colleagues’ experience on the ground”.  Nevertheless, in a scene included in Help, during a Downing Street press conference on 15 May, 2020, Mr Hancock said: “right from the start, it’s been clear that this horrible virus affects older people most. So right from the start, we’ve tried to throw a protective ring around our care homes”, repeating in the House of Commons on 18 May that “we absolutely did throw a protective ring around social care”. 

Understanding the human costs of these central government failures is difficult, with the effects on staff, residents and their family impossible to measure objectively.  Help does a good job in illustrating some of the pressures on care staff and the pain of relatives unable to visit dying residents, made all the more poignant now that we know some of the behaviour during the pandemic of senior central government actors such as Hancock’s affair and Johnson’s multiple parties forensically examined in Sue Gray’s recent report

Perhaps the most basic measure is in human lives.  Last year researchers used the national death registry of all adult (aged ≥18 years) deaths in England and Wales between January 1, 2014, and June 30, 2020 to compare daily deaths during the COVID-19 pandemic against the expected daily deaths.  They estimated that during the early pandemic, about 26,000 excess deaths (almost half of the total excess deaths) occurred in care homes and hospices.  This is likely to be an underestimate since early in the pandemic, testing of suspected cases was available only in the hospital, whereas routine testing of staff and residents in care homes was not implemented until May 2020.

The latest ONS statistics, issued in February 2022, suggest that since the beginning of the coronavirus (COVID-19) pandemic, there have been over 274,000 deaths of care home residents (wherever the death occurred) registered in England and Wales; of these, 45,632 involved COVID-19 accounting for 17% of all deaths of care home residents. 

Intriguingly, The Lancet reported in March that “COVID-19 has had a disproportionate impact on the mortality of care home residents in England compared to older residents of private homes, but only in the first wave. This may be explained by a degree of acquired immunity, improved protective measures or changes in the underlying frailty of the populations.” Meanwhile, last month the Care Quality Commission finally published data on deaths in each care home during the first year of the pandemic (April 2020 to March 2021).

Whatever the precise figures, it’s clear that adult social care residents and staff were badly let down by central government, far from the Secretary of State’s “protective ring” narrative. This despite the best efforts of care managers, local commissioners and councils discussed in Luke Bradbury’s blog here last week.  Help does a fantastic job of showing the impact of these critical central failures – and recognising the incredible work care staff did in such difficult circumstances with so little financial reward.