Public institutions and governance

Pushing experts under a big red bus?

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Picture source: https://paulcairney.wordpress.com/2020/07/08/covid-19-policy-in-the-uk-did-the-uk-government-follow-the-science-reflections-on-sage-meetings/
Jason Lowther


Politicians have a complex relationship with experts and the evidence the latter provide.  Back in May 2020, I reflected in the Municipal Journal on how Michael Gove’s statement in the Brexit campaign that ‘people in this country have had enough of experts’ had turned 180-degrees.  With the arrival of Covid, the PM told his 9th March 2020 press conference ‘we are doing everything we can to combat this outbreak, based on the very latest scientific and medical advice’ and this line was consistently reiterated by other ministers.  Thirty months on, Rishi Sunak (Chancellor in 2020) railed against the government’s main Science Advisory Group for Emergencies expert group (SAGE) saying ‘If you empower all these independent people, you’re screwed’. 

Sunak’s argument, presented in an interview with the right-leaning Spectator magazine, seems to be that the SAGE experts failed to consider any non-health impacts of Covid control measures (particularly lockdowns) and refused to show politicians their workings.  In the article he’s quoted as saying ’I was like: “Summarise for me the key assumptions, on one page, with a bunch of sensitivities and rationale for each one”, in the first year I could never get this’.  This doesn’t seem to match with the published SAGE ‘consensus statement’ on school closures issued in February 2020, which very clearly sets out its assumptions and explicitly states:

As well as the large economic and educational costs of school closures, including increased levels of workforce absence in the health and care system and elsewhere, school closures could have adverse consequences: As infections appear to be more severe in older people, putting children in the care of their grandparents may result in a higher number of severe cases. Once schools are reopened, the number of cases may increase again, with the overall attack rate not being reduced.
(SPI-M-O: Consensus view on the impact of mass school closures on 2019 Novel Coronavirus, Feb 2020)

Later, when facing the December 2021 Omicron variant, Sunak is said to have used his own alumni and private sector analyses to challenge SAGE advice for further lockdowns with the PM and in cabinet.  He argues that the scientific evidence failed to provide a balanced analysis of lockdown decisions, saying ‘I would just have had a more grown-up conversation with the country’.  Sunak also claimed that dissenting voices in SAGE discussions were edited out of the minutes, an assertion he supported by describing a Treasury official sitting in on the discussions and reporting disagreements and uncertainties back to him. 

SAGE scientists see this differently.  Former SAGE member Prof Ian Boyd from the University of St Andrews commented: ‘It is nonsense to suggest that Sage was insensitive to the issue of the long-term effects of lockdowns – a whole subgroup dedicated itself to trying to understand what this might look like. Sage was discussing the topic of excess deaths in detail in April 2020.  Those who attended Sage meetings were acutely aware of the trade-offs associated with implementing specific actions, such as closing schools. To the extent that it was possible with the information available at the time, these deals were included within the uncertainty expressed in the advice provided to politicians. It is simply unacceptable to rewrite history, by blaming scientists, to save a political class that has systematically failed to respond to the messages that scientists have been providing to them for many, many years’.

There are valid reasons to criticise elements of the advice system the government put in place during the pandemic.  The limitations of ‘a model in which a specialist committee produces consensus statements that spare policy makers any requirement to make choices on matters in which they have no competence’ have been demonstrated in analysis by Lawrence Freedman of the intelligence failings relating to the UK entry to war with Iraq as well as the Covid pandemic.   His analysis recommends a model with more opportunities for policy makers to engage with the experts as both the advice and the policy is developed.   The editor of the Lancet, Richard Horton, argued that expertise around public health and intensive medical care should have been in the SAGE discussions.  I argued in the MJ piece that having practical knowledge from local councils and emergency planners could help avoid recommendations that prove impossible to implement effectively, since esteemed experts can still make recommendations which are impossible to implement in practice.  But it’s simply wrong to suggest that SAGE ignored key evidence on non-health effects of Covid control measures or sought to silence dissenting views.  If the trade-offs and assumptions were not considered by the Cabinet, the blame for that lies not with the scientists but with the politicians.

This article appeared in the Local Area Research Intelligence Association newsletter on 27 Sept 2022

Jason Lowther is Director of the Institute for Local Government Studies (INLOGOV), University of Birmingham

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Schools and local authorities – where next?

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Edwina Grant

Recently, politicians at Lancashire County Council have reflected on the national picture regarding the ambition of the Department for Education, contained in the White Paper on Education and the subsequent Schools Bill.  The Bill aims to move all schools to become academies and to allow councils to open a Local Authority-established Multi Academy Trust (MAT), although some would argue that this was technically possible before.

The government’s aim to ensure that by a notional target of 2030, 90% of pupils meet the expected standard in maths and reading at Key Stage 2, and that the national GCSE average grade in both English language and maths is increased from a 4.5 to 5.  It sets out its strategy of delivery: “ensuring excellent teachers, supporting teachers deliver high standards for all pupils, deploying targeted support for those who need it most, and ensuring a stronger school system”.

Key policies to achieve this include the ambition that there will be a fully Trust led system with a single regulatory approach, through growth of strong multi-academy trusts.  The Bill envisages the establishment of new multi-academy trusts (MATs), encouraging existing and new MATs to expand and allowing trusts to be established by local authorities.  The notional ambition is, that by 2030 all pupils will be taught in a strong MAT, or their school will be planning to join one.

The White Paper was released in March 2022 and subsequent Schools Bill was introduced to Parliament in May 2022.

At Lancashire County Council, we have a good relationship with our local authority-maintained schools, with single academy trusts (SATs) and with multi-academy trusts (MATs).  We have prioritised the core responsibilities for local authorities on promoting the children’s right to education in terms of admissions, challenging exclusions and supporting alternatives and working with our schools collaboratively on behalf of young people with special educational needs.  We became even closer as a result of the challenges of the Covid pandemic.  The Schools Bill, however, is a challenge for us, as at the time of writing, 560 of our 628 schools are local-authority maintained.

There are obviously options for us.  Firstly, to continue the status quo and to let the market take its course.  Secondly, to proactively manage the market by working closely with the new regional Department for Education teams to ensure that our local authority voice is heard as more schools are encouraged to join MATs and indeed, more MATs, as yet unknown to us, are encouraged to join our school landscape.  Thirdly, to express our ambition to establish a local authority maintained multi-academy trust.

After much deliberation, including briefings and discussions with all our councillors, and close consultation with the regional office for the Department for Education, we considered that options 2 and 3 should be explored further.  We are actively strengthening our existing relationships with MATs and trying to understand who the new players might be in our bordering geography of which, given the size of Lancashire, there will be many.  We have also submitted an expression of interest to establish a local authority established multi-academy trust specialising in special education.  We decided on the special education specialism as we have a high level of strength in that sector, and also an existing deep relationship on a pupil level with the children in those schools.

The outcome is yet to be decided but thinking about the next steps has brought us closer to key questions about our existing commercial activity with schools in our authority.  Will the new MATs who take on existing county schools still buy our services, and if they do, in what volume, given the financial pressures ahead?  How do we shape our local elected councillor involvement to ensure the democratic voice is heard, and how do we advise and support the multi-academy trusts so that they fully understand the community context of our local offer for the most vulnerable families and their children?

Time will tell, but this is potentially the most interesting change since the implementation of the 1988 Education Reform Act, which reduced the powers of local authorities over schools.  As I was an education officer in Lancashire at the time, I can attest that it took enormous amount of goodwill from both councillors and officers to realign our systems and our structures so that our schools could get the best of that significant change.  To think back on that time now, that schools previously did not have full control of their budgets, seems strange.  I hope that another 30 years on from now, we will be able to reflect as positively on the changes ahead of us.

References:

Edwina Grant OBE is Director of Education and Children’s Services for Lancashire County Council.

Voter ID gets Code Red

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Picture credit: https://www.electoral-reform.org.uk/why-the-governments-mandatory-voter-id-plans-are-a-terrible-idea/

Jason Lowther & Chris Game

‘Code Red’, for anyone even approaching the generation of this blog’s more senescent author, has to cue the memorable final Tom Cruise/Jack Nicholson courtroom scene in Aaron Sorkin’s film, A Few Good Men. Indeed, said author has actually adapted and used it previously in these very columns:

Lieut. Kaffee (Cruise): “Did you order the Code Red?”  Col. Jessup (Nicholson): “YOU’RE GODDAMNED RIGHT I DID!!!”

In the film, ‘Code Red’ is a term used for any extra-judicial punishment or action taken against US marines for the purposes of humiliation or worse. Its function is, essentially, to deal with issues that can’t be solved using the normal legal framework.

In substantial contrast, the UK Government’s Code Red, though hardly a regular feature of our media’s political reporting, is at the very core of our modern-day governmental system. It is a (arguably the) key instrument of the Infrastructure and Projects Authority (IPA), the Government’s centre of expertise for infrastructure and major projects, reporting to the Cabinet Office and HM Treasury.

Formed in 2016, the IPA’s intended function is to increase government efficiency and save public money by monitoring and ‘scoring’ the viability of its literally hundreds of infrastructure and major projects … and does so with an effectiveness that has some Ministers in the present Government viewing it as more of a PI(the)A.  

This already substantial introduction does have a local government-relevant point – promise!  And it is no blog’s function to deliver lecturettes, which in this instance are both available and well illustrated, from the Institute for Government and the IPA itself in its very recent 2022 Annual Report.

What follow, therefore, are a few shortish paragraphs outlining the IPA’s work, and two graphics from that 2022 Report worth, if not the proverbial thousand words, certainly a good many. We then focus on the issue of voter ID in England, reporting the government’s own assessment on the risks involved, and conclude that Government has still not yet shown how voter ID will operate in England without adversely affecting certain minority and disadvantaged groups.

The focus of the IPA’s work is the Government Major Projects Portfolio (GMPP), comprising this year 235 projects with a total Whole Life Cost of £678bn and estimated “monetised benefits” of £726bn, delivered by 18 departments and their arm’s-length bodies.

The projects are divided functionally into four categories, biggest-spending being Infrastructure & Construction (70 projects: £339 bill. whole life cost; £356 bill. “monetised benefits”) – high investment projects, including improving the UK’s energy, environment, transport, telecoms, sewage and water systems, and constructing new public buildings. Dominated financially, and in the IPA’s ‘unfeasible’ delivery confidence rankings, by the Dept for Transport’s HS2 (£72 – 98 billion) and Crossrail (£19 billion+) projects.

Transformation and service delivery covers projects changing ways of working to improve the relationship between government and the UK people, and harnessing new technology. Example: Vaccines Task Force.

Military Capability ispretty self-explanatory. Example: the Future Combat Air System – clever, mid-2030s stuff like uncrewed aircraft and advanced data systems.

ICT projects enable the “transition from old legacy systems to new digital solutions” to equip government departments for the future. Example: Emergency Services Mobile Communications.

Now to the interesting bit: the actual ‘confidence rankings’, or in the above cases of HS2 and Crossrail ‘no confidence rankings’. The official term is Delivery Confidence Assessments (DCAs): judgements of the likelihood of a project delivering its objectives to time and cost.

In essence, it’s a basic traffic light system. Green represents high likelihood of successful delivery of the project on time, budget and quality; amber: successful delivery feasible, but significant issues already exist, requiring management attention; and ‘Code Red’: unachievable, not a cat in hell’s chance; major issues everywhere, with project definition, schedule, budget, benefits – all at this stage apparently irresolvable.

Given the variables involved, it sounds more than a touch crude, and two additional ratings were added: amber/green – successful delivery probable, if given constant attention; and amber/red – successful delivery doubtful, major risks apparent in numerous key areas, urgent action needed.

Usefully added, it seemed, as unqualified amber regularly took between 40% and 50% of ratings (see Fig.7 below). But no, looked at another way, the “average project rating worsened from Amber/Green in 2013 to Amber in 2020” (p.16). It obviously couldn’t possibly be the quality of the proposed projects, so it had to be the assessment system, which accordingly for the 2022 assessments was changed.

But oops! The number of red assessments nearly quadrupled, almost equalling the previous four years’ red totals between them – but that’s OK, because the average project rating, we are assured, “has improved over the past two years”, though it’s not entirely transparent in the second flow chart.

Which brings us back to Code Reds.  Unlock Democracy, the democratic reform campaign group – and also the Daily Mirror – reported last week that “the Government’s own rating system has given the Elections Bill implementation a code red, which is defined as successful delivery of the project appear[ing] to be unachievable.”  Followed by the Association of Electoral Administrators announcing that it “no longer believes it is possible to successfully introduce Voter ID in May 2023.”

The Government’s “Electoral Integrity Programme (EIP)” has been red rated in the IPA’s annual report (see page 58).  The report summarises the Programme as ‘implementing changes arising from the Elections Bill. The Elections Bill makes provision about the administration and conduct of elections, including provision to strengthen the integrity of the electoral process. Reforms will cover: overseas electors; voting and candidacy rights of EU citizens; the designation of a strategy and policy statement for the Electoral Commission; the membership of the Speaker’s Committee; the Electoral Commission’s functions in relation to criminal proceedings; financial information to be provided by a political party on applying for registration; preventing a person being registered as a political party and being a recognised non-party campaigner at the same time; regulation of expenditure for political purposes; disqualification of offenders for holding elective offices; information to be included in electronic campaigning material’.

DLUHC’s commentary on this result noted the deteriorating assessment and added: ‘The IPA Gate 0 Review of February 2022 concluded that the programme Delivery Confidence Assessment is rated Red and that the programme needs to address key risks related to the suitability of the structure, approach and governance given its complexity and delivery focus, suitability of its minimum viable and digital products, and its lack of contingency to deliver against immovable deadlines’.

Reassuringly, the department felt that ‘the programme is addressing these points’.   Meanwhile, the estimated ‘whole life costs’ of the programme jumped from just under £120m to over £145m.

Unlock Democracy’s Tom Brake has reportedly written to Levelling Up SoS Greg Clark saying ‘It would be highly risky to attempt the first roll out of photo voter ID for the largest election in the UK, without having tested it on lower turnout elections beforehand’.  This echoes Jason Lowther’s comment on this blog almost a year ago that ‘The Government has not yet shown how voter ID will operate in England without adversely affecting certain minority and disadvantaged groups.  Until issues such as costs and access are fully addressed, it needs to proceed with caution’.

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.

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

The Winding Stair: half a century of local government

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Sir Rodney Brooke

Image: https://talesoftimesforgotten.com/2019/12/18/no-medieval-staircases-werent-designed-to-give-right-handed-defenders-an-advantage/

My memoir, The Winding Stair, chronicles over half a century of my service in local government, a period which coincided with the decline in the importance and independence of local government as well as the biggest social changes since the industrial revolution. As a local authority chief executive, I experienced these changes at first hand.

Post-war local government attempted to tackle the problems of deprivation. Increasingly the emphasis shifted to the problems of affluence. The three post-war decades saw rising living standards, falling inequality, greater freedom and expanding welfare provision. The following decades saw the opposite. The belief that problems would be solved by spending more money evaporated.

Public expectations rose with the decline of faith in post-war remedies, such as urban motorways, multi-storey flats and town centre redevelopments. Communal services were privatised. Ministers introduced innovations before any assessment could be made about the effectiveness of their precursors. Rather than tackle a problem, governments changed the structure of the agency dealing with it. Responsibilities of the state were transferred to the private sector. An underclass of casual workers was created. My local government career placed me in the middle of these changes and my memoir chronicles them.

In my youth local authority chief executives were great men. Among them knighthoods were ten-a-penny. [Not one serving local government officer now has a knighthood]. The London train would be held for the county chief executives, who traced their authority to the Courts of Quarter Sessions for which they were responsible until 1972. They would expect the Permanent Secretary of the Ministry to call on them when they went to London.

The Councils they ran were fundamental in the life of their residents. During my service I was central to some of the most newsworthy issues of the day. I

  • prosecuted for riot;
  • was the last person ever to be responsible for reading the Riot Act;
  • was responsible for the construction of the last municipal reservoir before water supply was stripped from local government in 1974;
  • warned Bradford City football club of the danger before 56 fans burnt to death in front of the TV cameras;
  • enabled the inquest into the notorious death of Helen Smith in Jeddah;
  • challenged the police belief in Wearside Jack’s claim to be the Yorkshire Ripper;
  • refused Willie Whitelaw’s secret request to sack the West Yorkshire Chief Constable over his failure to catch the Yorkshire Ripper;
  • as emergency controller for Yorkshire in the event of nuclear war, was to shelter in an underground bunker in the Pennines before emerging when Geiger counters showed that it was safe;
  • discovered that three Westminster cemeteries had been sold for 15p;
  • found the press camped on the lawn of our house when I resigned before Dame Shirley Porter began her Homes for Votes gerrymandering – which resulted in her being surcharged £42.5m.
  • acquired a knighthood, a CBE and decorations from France, Germany and three other countries.

Sir Rodney Brooke worked for Morley Council (1955-62); Rochdale Council (1962-63); Stockport Council 1963-73; West Yorkshire County Council 1973-1984 (Chief Executive 1980-84); Chief Executive of Westminster City Council (1984-89); Secretary of the London Boroughs’ Association 1984-90; and Secretary of the Association of Metropolitan Authorities (1990-1997). He remains involved with local government on a non-executive basis.

The Winding Stair is available online or from booksellers at £13.99. ISBN 9781838489977

The role of scrutiny in navigating our new health and care economy

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Picture credit: https://www.gponline.com/deadline-extended-gp-access-cover-england-brought-forward/article/1456385

Cllr Ketan Sheth

Mortality rates during the pandemic laid bare the health inequalities that exist across the country. Behind these figures lie human stories and grieving families that should remind us of the urgency and importance of understanding and addressing these inequalities.

In Brent, an ethnically diverse North West London borough, we recently set out to do just that.

Systems thinking

We know that Brent residents, who are from ethnic minority communities, disabled, or who are in poverty, experience significant health inequalities; but what does that look like in practice? How are our healthcare systems contributing to and/or compounding inequality? And what can be done to resolve this challenge?

Usually, GPs are the first point of call when someone is not feeling quite right. They ought to help everyone to access timely and safe healthcare. Therefore, reviewing access to GP services is critical and we decided to focus a dedicated scrutiny task group for eight months to report.

By giving ourselves time to understand this complex area in detail, we developed a deep comprehension of the landscape we were going to scrutinise. Patient voices are at the heart of our work, and we worked closely with Brent Healthwatch to ensure those from communities that have been under-represented in these conversations in the past, as well as those experiencing the worst health outcomes, were able to articulate and share their experiences.

Also, the task group held a number of evidence sessions over the course of six months, which were attended by stakeholders across Brent’s health economy. This included council officers, local commissioners and service providers.

All of this enabled the team to make a number of practical recommendations to  Brent Council and NHS partners.

Our work focused on three pivotal areas: Demand, Access and Barriers

With the dynamics of our healthcare and well-being landscape changing locally as well as nationally, it is more vital than ever to ensure all our residents have equality of access and consumption of healthcare services.

We found repeatedly that some groups of patients experience significant, and unnecessary, barriers, specifically:

• Patients of low-income

• Patients with a disability

• Older patients

• Patients whose first language is not English

• Children and young people

• Refugees and asylum seekers

• Patients who cannot access digital technology

Knowing this, GP services must seek to reduce and resolve the barriers experienced by patients, with a focus on deprivation, ethnicity, disability, and other protected characteristics as described in the Equalities Act 2010, if we are to execute our duties under the Act.

We recognise that rising demand, changing patient expectations and workforce retention issues continue to place pressures on primary care. Therefore, it is essential that the NHS continues to plan for this and uses the expertise of healthcare professionals across the system.

The digital transformation to healthcare, brought about by the pandemic, although helpful to some, introduced additional barriers for other people and communities.

In acknowledging the varying levels of ease in which patients access GP service, we strongly believe an access and treatment standard ought to be developed. This will ensure that Brent residents experience consistent and high levels of service: whether their requests are routine or urgent, focused on physical or mental wellness; or made via the telephone, online or in-person.

Our work has been conducted in the spirit of cooperation and partnership, and particularly, we look forward to continuing our dialogue and work with our partners across Brent’s health economy to evolve our shared vision of GP access across Brent.

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

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

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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.