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.

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.

Empowering English local government to lead on sustainable and resilient development of their localities

Paul Corrigan and Paul Joyce

We have just been having a conversation about English local government and the United Nations Sustainable Development Goals. One of us had begun by being idealistic about it. Too idealistic. But our exchange led to this blog in which we end up wondering what local government can do pragmatically to encourage sustainable and resilient localities.

Let’s start with the realism. As a result of developments over the last forty years, as compared to much of Europe, English local government is an anomaly. To put it bluntly, English local government has a very low level of autonomy compared to local governments in Europe (and elsewhere), even though its national system of public governance is quite capable. Taxes are a relatively low proportion of local government revenue in the UK, and this is so in the context of a very low level of local government expenditure as a percentage of GDP. Surely, to have more autonomy in a locality local government needs to be able to find much of its revenue from locally set taxes. It is generally believed that if local government must rely on grants determined by central government, and especially if the grants are earmarked by central government for purposes decided by it, then there is little potential for local autonomy.

Countries such as Sweden, Finland, and Norway have reputations for much greater local government autonomy than the UK. These three are all countries which are rated as having very effective governance, high standards of living, high standards of health and education, and, on average, very happy citizens. Plus, they have enviable records in terms of public confidence in government, as compared to the situation in the UK over many years. It seems that you can have both good national outcomes and local government empowered with a lot of local autonomy.

We can see the financial situation of UK local government using OECD data for the year 2019:

Local government revenue and taxes (2019)

We should not give the impression that the only issue is one of finances. It is probably very important that English local government is embedded in a national system of public governance that is both strategic in character and operating in a whole-of-government manner. Arguably, the implication of such a governance system is that strategic coordination between levels of government is not attempted in a purely top-down way by central government. Another less obvious implication is that that there is a high level of social capital that local government can tap into so it can powerfully deliver sustainable development goals.

Now for the idealism. Local government has a long-term responsibility to its citizens to ensure that local communities survive and thrive for future generations. Consistent with this is the view that local governments (and regional governments) should be at the forefront of delivering the United Nation’s sustainable development goals. At the very least we can argue that local government has a critical role to play in their delivery.

Ideally speaking still, we can use some of the ideas of the United Nations’ Committee of Experts on Public Administration to suggest questions we might pose to local government everywhere – in every country – about their work in delivering the sustainable development goals (United Nations Committee of Experts on Public Administration 2022). The suggested questions are:

  • Have they aligned their visions for the development of their communities, their associated strategic plans, and their budgets and service policies with long-term sustainable development goals? 
  • Are individual local governments able to act in a way consistent with a whole-of-government approach to the delivery of their visions and strategies?
  • Are they able to track and account for their expenditures against the 17 sustainable development goals?
  • Are they able to evaluate and report to the public and other stakeholders on their performance in delivering the sustainable development goals in their locality?
  • Are they carrying out data analysis to identify the occurrence and extent of poverty and inequality as a prelude to local policy making?
  • Are they acting in their local areas to reduce poverty and inequality and to create more human development and empowerment?
  • Are they acting in partnership with citizens and other stakeholders through strategies such as community-driven development and participatory budgeting?
  • Are they able to engage the public in initiating and designing local public services?
  • Are they acting in accordance with the principles of open local governance?
  • Are they able to interact with central government and a get a cooperative response to problem solving from it?
  • Have they got the necessary skills and sufficient scale of financial resources they need to play a decisive role in sustainable and resilient development of their communities?

Finally, we arrive at the moment of pragmatism in this blog.  After the last forty years, which include the austerity years since 2010, we must recognise that English local government is placed in very challenging circumstances. We would say that they do not have the right legal framework, they do not have sufficient organisational capacity, and that they need more public support and resources to do what would be implied in the 11 questions above. They are currently exceptionally constrained in what they can do.

But the English local authorities have gained great skill in forming and developing partnerships and so they could develop stronger partnerships for sustainability. They could, for example, begin by consulting the public on community priorities. These priorities could be an input into local conferences to discuss voluntary coordination and efforts involving all the sectors (public, private, and voluntary). Finally, individual local authorities could prepare for better targeting of their highly constrained resources by auditing their expenditures against the 17 sustainable development goals.

In effect, pragmatic and idealist arguments suggested here call for the community leadership role of local government to be focused on delivering sustainable development mainly through encouraging and coordinating others at the local level.

Paul Corrigan has been a social science academic, a local government officer and a special adviser on health policy to New Labour Secretaries of State for Health and the Prime Minister Tony Blair. He now chairs Care City an innovation community interest company in the East End of London.

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.

Getting under the skin of council budgets: what does good scrutiny look like?

Cllr Ketan Sheth

It’s a testing but all-too-familiar mix: funding cuts from central government, skyrocketing demand for local services, a growing population, tough choices and communities vulnerable as they recover from the social and economic shocks of the pandemic. As we approach budget setting, our situation in Brent – a NW London borough – mirrors the position of local authorities around the country.

​Against this challenging backdrop, I believe the role of effective Scrutiny is more important than ever, and so too is learning from one another.

This year, I co-chaired Brent Council’s Budget Scrutiny Task Group. It was our job to get under the skin of budget proposals, to grasp their real-world effects, to understand any mitigations, and to make recommendations where we felt the decisions of our Cabinet, and Full Council, could be strengthened.

To bring forward a balanced budget, this year we were called to scrutinise a package of savings totalling £2.7million, alongside Council Tax increases.

A deeper approach to scrutiny

Given the stark financial picture across the country, from the outset, we wanted to make sure that scrutiny was grounded in the complex reality of the difficult decisions that the Cabinet needed to take. We were determined that the scrutiny process must add value.

As a group, we worked with officers to develop a much broader approach than simply reviewing proposed savings. Instead of solely relying on the community consultation undertaken by the Cabinet, we went into detail on the impacts and sought out testimony from people on the ground. We felt we needed to get a deeper understanding of the experience of those who use Brent’s services and the complexity of their situations.

The idea was to test underlying assumptions made in the proposals, in order to give Cabinet and Full Council information and evidence to base their decisions on. We identified a number of areas to probe:

1. Impacts of Covid-19 on income from business rates, Council Tax and rents;

2. The impacts on health inequalities work when grant funding ends;

3. Implications of Covid-19 on the adult social care budget, especially mental health;

4. Pressures within the Dedicated School Grant; and

5. How the council’s £17m Covid-19 recovery package is being spent

The task group agreed a mix of less conventional scrutiny methods to build this holistic view, including focus groups and detailed evidence sessions with people on the ground. From local head teachers to voluntary and community sector partners, teams from our well-being  services, and Brent Hubs staff (Brent Hubs are spaces in the community bringing lots of services together under one roof to improve access for residents with more complex needs).

By taking this approach, we were able to assess the wider financial and service context, identify possible future budget pressures and the likely emerging needs of our communities.

It allowed us to make a number of nuanced, practical recommendations when reporting back. Most focused not on the savings themselves, but on how the Cabinet  might work differently to overcome and address some of those pressures. Helpfully, the group also identified areas where we felt the Council could effectively lobby for more support nationally and regionally. We’ve also put in place mechanisms for pulling insights from these testimonies as well as learnings from this deeper process through to future budget scrutiny cycles. Ultimately, we are all trying to deliver a better outcome for local people, and so I’m a big believer in the power of scrutiny to support good decision-making. I think that this is best realised by being a “critical friend”. The deeper, more contextual approach we took in Brent this year achieved just that, and I look forward to seeing these efforts bear fruit when the budget is taken to Full Council later this month.

Cllr Ketan Sheth is Brent Council’s Chair of Community and Wellbeing Scrutiny Committee and co-chaired its Budget Scrutiny Task Group

As the children return to school in September, the change in Pupil Premium funding will see many schools lose out

Cllr Ketan Sheth

Cllr Sheth on a recent visit to a school

Pupil Premium funding for our most disadvantaged children, based on the number of children eligible for free school meals (FSM) data collated every January, provides critical funding to schools for essential resources, which in turn benefits all children. Each FSM successfully registered increases the funding to schools, a substantial amount of which does not reach schools because not all parents who are eligible apply for FSM for their child.

New Government conditions have seen a change in how it is calculated. By shifting from a January date, for calculation, to the previous October date, a stretched borough, such as Brent, now, will have 900 fewer secondary school pupils eligible, amounting to a loss of £860K in their budget. 

Pupils at primary schools fare a little better in Brent; but the picture elsewhere in the country is less kind – 62,000 fewer eligible pupils in primary schools in England, according to FFT Education Datalab analysis of the Department of Education recent figures.

The need for FSM and eligibility is rising, as are casual admissions all year round, due to changes in family incomes. This change results in £90M missing from budgets when schools have already been under intense pressure with lockdown and are attempting to build-up again as we recover following Covid-19.

The result means that the Government has introduced a detrimental lag in funding, which will introduce a current year saving; but will impact on the much needed essential support for children who have had the greatest challenges of home-learning throughout the pandemic and now beyond.

We are often reminded of the mantra: “every child matters”; if we are serious about levelling-up everywhere then we must rethink this decision and how we best support our children, so no child is disadvantage. The time between September, the start of the school year, and January allows for an accurate reflection of school children in need of FSM; and therefore, schools requirement for Pupil Premium. The timing is essential to promote and ensure effective communication with parents/carers, enabling them to register for FSM.

There is some speculation amongst head teachers that the Government may overhaul or perhaps completely remove the funding – this will be catastrophic and a retrograde step for the levelling-up agenda.

Cllr Ketan Sheth is Chair of the Community and Wellbeing Scrutiny Committee of Brent Council