covid-19

England’s over-centralisation isn’t just a governance issue now – it’s a public health emergency

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Jessica Studdert

The concentration of power at Westminster and Whitehall has long frustrated those of us who engage closely with the structures of governance and compare it to decentralised norms across much of Europe. Now, as with so many facets of the Covid-19 crisis, the pandemic has exposed national vulnerabilities and left us grappling with the consequences. The grip on initiative that rests in SW1 is one such weakness, which is impacting how our system is responding to the virus, in turn perpetuating the public health emergency we find ourselves in.

A degree of national direction is clearly needed in the midst of a serious pandemic. People look to the Government for leadership and reassurance. Those in positions of power certainly feel personal responsibility for leading the response. Measures to implement service strategy nationally, such as through the NHS, or to use national heft for international procurement buying power, are certainly necessary. But time after time during the unfolding crisis, the centralised instinct has clouded decision-making, with terrible results.

The structures for the top-down approach to the pandemic were set early on, when the Government chose not to deploy the existing Civil Contingencies Act which set out clear roles, responsibilities and resources for all local and national public bodies. They instead rushed the Coronavirus Act through Parliament, which gave the Executive a greater level of unchecked power and no defined local role. This has had ongoing consequences for the coordination of an effective response. Leaked findings from an internal Whitehall review found that local emergency planning teams believe their abilities have been compromised by a controlling and uncommunicative approach from the central government machine, which persistently withholds data and intelligence.

The centralised response isn’t just structural, at times it has felt deeply instinctive. There has been a repeated preference for big, bold flashy schemes over smaller, sustained but potentially more impactful measures. In the early weeks of the crisis much media attention focussed on the new Nightingale hospitals, yet we are now seeing tragically how that time and resource could have been better invested in the more targeted shielding of hundreds of care homes. When faced with the need to quickly implement testing for Covid-19, the Secretary of State for Health reached for a high-profile 100,000 target and set up new large processing sites. This triumph of tactics over strategy directed the systemic response to focus on numbers over priority need and overlooked existing networks of local lab capacity. Even as attempts are made to set up contact tracing at scale to support the easing of lockdown restrictions, the Government seems to have more confidence in a new mobile app than it does existing local public health teams. This is despite the latter’s expertise in tracing the contacts of people who have highly infectious diseases and clear evidence from countries who have successfully managed their lockdown transition.

The formal power exercised at the centre is in direct contrast to the informal role for local authorities, which is having devastating consequences for their very viability. Because councils’ response has no statutory footing in the context of an emergency, they are left exposed to the whims of a few individuals making decisions in Westminster. At the start of the crisis, the Secretary of State for Local Government told local authorities to spend “whatever it takes” to protect their residents. Councils had immediately set about providing relief to shielded groups, protecting wider vulnerable groups and implementing public safety measures, all while ensuring essential services continued as usual. Rather than support these efforts, Government then rescinded this early clear backing, querying councils’ honesty over their cost assessments and leaving many facing a financial black hole.

The double standards central government imposes on its local counterparts is nowhere more apparent than when it comes to local government finance. An emergency on the scale of a global pandemic has required state-led responses on a scale inconceivable only months ago, and with widespread public approval. Central government spending has snowballed to accommodate unprecedented employee furlough schemes, emergency business support measures, not to mention the enormous costs to the NHS. The Chancellor has the leeway to respond to this through a number of different measures – incurring public debt, raising taxes, freezing public sector wages and reducing public spending, a combination of which he is reportedly considering.

Local government has no such room for fiscal manoeuvre. Councils are legally required to balance annual budgets and have only narrow revenue-raising powers through council tax and business rates which are themselves subject to centrally imposed controls. With a shock to their budgets of this scale they are at the mercy of decisions made by a few in Westminster. These have so far resulted in a couple of ad hoc cash injections of £1.6bn each, and a bit extra cobbled together earmarked for social care and rough sleepers – so far massively short of the estimated £10-13 billon shortfall councils collectively face.

It is no way to run a country. It never was, but in the context of the crisis the contradictions of our top-heavy system of governance are laid bare. The rumblings of discontent from Mayors in the north of England at their regions being side-lined, and from councils over plans to fully reopen schools in the absence of clear local test, track and trace infrastructure, suggest the popular tide is beginning to turn against blanket centrally-imposed measures. As local government is increasingly being seen as better placed to protect their residents, particularly in the context of a Government that is increasingly mis-stepping, there may now be an opportunity for a deeper discussion about how our country should be run in the interests of everyone.

Jessica Studdert is deputy director of the New Local Government Network (NLGN), a Londonbased think-tank. She leads NLGN’s thought leadership and research, and contributes strategic oversight of the organisation. Prior to joining NLGN, Jessica was political adviser to the Labour Group at the LGA. She led policy there, working closely on public service reform and devolution. Previously she worked in policy roles in the voluntary sector for a street homelessness and a childcare charity, and she began her career at the Fabian Society.

The disparities in housing and public health within the BAME community and the pandemic crisis

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Cllr. Ketan Sheth

Public Health is important: it prolongs life. A fundamental quality of Public Health is its preventative nature; prevention is far more effective and far less expensive than cure. Public Health is important because we are constantly striving to close the inequality gap between people and encourage equal opportunities for children, all ethnicities and genders. Health is a human right and we should be ensuring no one is disadvantaged, regardless of their background, their ethnicity or where they live. Becoming the voice for people who have no voice is our collective duty. Simply put, our influence on the improvement of someone’s health is a fundamental act of kindness.

Poor housing and living environments cause or contribute to many preventable diseases, such as respiratory, nervous system and cardiovascular diseases and cancer. An unsatisfactory home environment, with air and noise pollution, lack of green spaces, lack of personal space, poor ventilation and mobility options, all pose health risks, and in part have contributed to the spread of Covid-19. The disparities in housing and public health within the BAME community have persisted for decades cannot be doubted, and is underscored by a raft of research over the past six decades as well as highlighted by the recent analysis of the impact of Covid -19. The death rate among British black Africans and British Pakistanis from coronavirus in English hospitals is more than 2.5 times that of the white population.

What are the possible reasons? A third of all working-age Black Africans are employed in key worker roles, much more than the share of the White British population. Additionally Pakistani, Indian and Black African men are respectively 90%, 150% and 310% more likely to work in healthcare than white British men. While cultural practices and genetics have been mooted as possible explanations for the disparities, higher levels of social deprivation, particularly poor housing may be part of the cause, and that some ethnic groups look more likely than others to suffer economically from the lockdown.

Homelessness has grown in BAME communities, from 18% to 36% over the last two decades – double the presence of ethnic minorities in the population. BAME households are also far more likely to live in overcrowded, inadequate or fuel poor housing. What’s more, around a quarter of BAME households live in the oldest pre-1919 built homes. And their homes less often include safety features such as fire alarms, which is striking given the recent Grenfell Tower tragedy. Over-concentration of BAME households in the

neighbourhoods in London, linked to poor housing conditions and lower economic status all ensure negative impacts on health, all of which means lower life expectancy. The roll-out of Universal Credit is having greater effects on the living standards of BAME people since a larger percentage experience poverty, receive benefits and tax credits, and live in large families.
Larger household size also means that ethnic minorities are far more vulnerable to housing displacement because of the Bedroom Tax or subject to financial penalties if they do not move to a smaller home.
These stark facts, sharply bring to our attention the health, social and economic inequalities among our minority ethnic community, all of which are critical to understanding why some ethnic minority groups are bearing the brunt of Covid-19. In this time of reflection, it is not enough to observe; we must think about what more we can do, right now, to reduce the health, housing and economic vulnerabilities that our BAME communities are much more exposed to in these fragile times. Let’s act and prolong life together, as a flourishing community.

Cllr. Ketan Sheth is a Councillor for Tokyngton, Wembley in the London Borough of Brent. Ketan has been a councillor since 2010 and was appointed as Brent Council’s Chair of the Community and Wellbeing Scrutiny Committee in May 2016. Before his current appointment in 2016, he was the Chair of Planning, of Standards, and of the Licensing Committees. Ketan is a lawyer by profession and sits on a number of public bodies, including as the Lead Governor of Central and North West London NHS Foundation Trust.

Councils Can…

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Victoria Ashcroft

In this post a local government professional reflects on their experience of working in local government during the covid-19 crisis. 

Working in a partnership role in a District Council has its challenges at the best of times, but working in a partnership role, from home, with kids and studying, in the midst of a crisis makes it all the more challenging. The work/life balance that we strive for is now melded together for the foreseeable future.

Since the start of COVID-19 things have moved rapidly (unusual in this line of work). We’ve been told by the Government we need to set up a Community Hub, we’ve been asked by the County Council for support, we know we need to support the voluntary sector, we know the community have mobilised in ways not seen before. These truly are unprecedented times.

Technology has never been so important; it’s no mean feat setting up an entire organisation to work remotely. The behind the scenes effort is huge. So far we’ve set up helplines, email addresses, a communications plan and produced numerous press releases. We’ve placed rough sleepers in as many available accommodation spaces as we can, we’ve set up a food bank, we’ve set up a scheme with the local supermarket to order food for isolators, this food is being delivered by our Elected Members, Solicitors and Environmental Health Officers to name a few – it’s all hands to the deck. The list goes on. We’ve closed the crematoriums and burial grounds and then opened them again. We’ve supported businesses too.

The next task is to call thousands of residents we’ve identified to see how they’re doing, if they have support in place, and if they need help or assistance or just a friendly chat. Quite reassuringly in the main they have good support networks in place but there’s a handful who need further assistance, signposting or a referral onto support agencies. Everyone is really appreciative of the call and thankful to the team of volunteers (diverted in from all departments across the organisation). They are so pleased to have not been forgotten.

Everyone is working hard, and all are doing something new and learning new things.   Such a mammoth task has been undertaken and it feels like there has been little recognition for the very important work being done in this sector, not that we need or want recognition, we are just doing our job contributing to the national effort. We’re not just bins and council tax.

Unprecedented seems to be the word of the moment, and it sums it all up perfectly.

But what comes next…we know domestic abuse will rise, we anticipate a rise in crime and anti-social behaviour, there are worries for the economy, we might lose friends or loved ones, our children will have lived through a crisis we could never have imagined. What we do know is that local government will not be the same again but how we fare in the long term remains to be seen…..

 

Victoria Ashcroft is a local government professional with almost 20 years’ experience in the sector. Currently her role is supporting business planning for the authority and she responsibility for a number of statutory duties and responsibilities. She gained her undergraduate degree in Social Science and Politics through The Open University and is now a student on INLOGOV’s Masters in Public Administration programme.

A local councillor’s reflection on the coronavirus crisis

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Cllr. Ketan Sheth – Chair of Community and Wellbeing Scrutiny Committee, Brent Council

I want to share something very important with you: for me the coronavirus crisis has been the most difficult period I have experienced as an elected member. I have lost loved ones, felt the distress in local communities and experienced the dislocation in people’s lives as children no longer attend school, workplaces shut and voluntary organisations suspend many of their vital services. So, this is a personal view and reflection on the crisis to date.

Firstly, the situation has underlined the importance of strong communities and resilient third-sector organisations. As elected councillors, we are community leaders and a bridge between the local authority and our residents. During this crisis I, like many of you, have been supporting those individuals and organisations who have been the most affected by what has not only been a health emergency but for some has meant a struggle to get the daily necessities of medicines and food.

Many of you will have been involved in mutual support organisations. In my own borough in the north-west of London there was a groundswell of local residents’ organisations, faith groups and other organisations coming together to support and assist local people. For me, the crisis has also reaffirmed the importance of the voluntary sector. While many of our local third sector organisations had to suspend some of their services or deliver them online or by phone, many have kept offering excellent support to their clients. In Brent, we have many excellent voluntary organisations working with older people, those with disabilities and the homeless; I would also pay tribute to those of our local foodbanks who have worked so hard to meet a basic need for many people in the borough.

Secondly, I would say that crisis has probably been the greatest test faced by the local authority and our local NHS. As the chair of an overview and scrutiny committee, which includes the NHS in its remit, I have built up a close relationship with our local NHS acute trust and commissioners. They have kept me informed about the challenging situation they are facing and how they have worked so tirelessly to respond to patients’ needs and increase capacity. It is clear how hard local authority officers have been working to respond to need in the community and redirect services, particularly for vulnerable adults and children. For all our residents, the council has strived to keep essential services such as rubbish collection going, and while ensuring there is appropriate social distancing in place, the borough’s parks have been invaluable spaces for people to exercise. While we have always been committed to local government and our local NHS working together to improve health, nothing has better illustrated this than people’s use of the parks.

Finally, there is no doubt this crisis has resulted in a seismic change in how local government works. The regulations in the Coronavirus Act allowing for changes in how members and the public can participate in committee meetings have come into effect. And, in an era of videoconferencing, I suspect that what are emergency measures will permanently influence how we work as members in local authority, especially in my own area of overview and scrutiny. These changes, which perhaps could have evolved in local government over years, have dramatically been brought into effect in a few weeks.

This has been a terribly difficult period. I hope that these reflections, and others many elected members will have had, will help us to rebuild for the better when this health emergency ends.

Cllr. Ketan Sheth is a Councillor for Tokyngton, Wembley in the London Borough of Brent. Ketan has been a councillor since 2010 and was appointed as Brent Council’s Chair of the Community and Wellbeing Scrutiny Committee in May 2016. Before his current appointment in 2016, he was the Chair of Planning, of Standards, and of the Licensing Committees. Ketan is a lawyer by profession and sits on a number of public bodies, including as the Lead Governor of Central and North West London NHS Foundation Trust.

INLOGOV and Coronavirus (updated)

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Jason Lowther – Director of INLOGOV

In the light of the Covid-19 situation, INLOGOV has adopted on-line teaching, support and supervision approaches for all our courses for the time being.

The INLOGOV offices are closed until at least the 1st June and staff are now working remotely. Staff are contactable individually by email, phone, Twitter, Skype, Zoom and so on. If you do not receive a timely response, please get in touch with me, Jason Lowther, INLOGOV Director at [email protected].

The ‘Clap for Carers’ confusion (plus the badge) said it all

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Chris Game

I admit it: I cheat. For years I’ve chatted and written about UK local government, for predominantly local government audiences and readerships, and I’m selective in the illustrative material I deploy. If there are numbers and examples that could present local government in a more or less favourable light, I’ll go first for the more favourable. I might mention that other researched statistics are available, but I’m not, say, a Government minister and, yes, I play to the crowd.

Which means regularly citing the now triannual random sample surveys the LGA commissions Populus Data Solutions to conduct on GB residents’ satisfaction with their local councils. Whether it’s money most productively spent is not, happily, my concern. I’m just grateful, and carry on plundering their graphs and tables.

Graphs like this one, from the most recent report, plotting the changes in residents’ reported satisfaction with various services.

Road maintenance has struggled a bit recently, but, contextualised by some of the headline figures in the Institute for Fiscal Studies’ recent report on English Local Government Funding, most services’ satisfaction ratings have held up perhaps surprisingly well, including the jointly ringed social services, of which more shortly.

The IFS calculated that central government funding cuts since 2009-10 have led to a 17% fall in councils’ spending on local services – equal, taking account of population change, to 23% or nearly £300 per person. In 2009-10 just over a third of councils’ revenues for services other than education came from council tax and business rates; today it’s 80%. You’d have to be a seriously unobservant resident not to have clocked something of the consequences.

The IFS also reported recently on UK Health Spending, noting that, while “the government’s recent approach to NHS capital spending has left a great deal to be desired”, current funding of health has at least been increasing annually, as opposed to the decreases faced by councils’ social services departments (my emphasis again).

Set against that fiscal and financial background, other stats from those same 2020/21 Populus local government surveys don’t seem that shameful either. Very/fairly satisfied with the way my local council runs things: 63%. Trust my local council a great deal or fair amount: 59%. Politicians most trusted to make local decisions: local councillors 71%, MPs 12%, Government Ministers 7%.

My point in raising this is that for numerous reasons relatively few people will have seen this latest LGA/Populus report since its recent publication, actually on April 1st. What the public wanted, this April especially, was something with NHS in the title and about how much we value (or undervalue) the great work it does.

Nuffield (health care) Trust and the King’s Fund (health policy think tank) can’t have anticipated this when preparing their annual round-up of health and social care findings from the British Social Attitudes (BSA) Survey. But, publishing two days later on April 3rd, they struck lucky, getting plenty of coverage, not least in the local government media.

Let me be clear: the BSA is, as Nuffield/King’s Fund rightly note, a ‘gold standard’ survey, and I don’t blame the two distinguished health care institutions wanting to sponsor in recent years a handful of additional questions to a sub-sample of respondents into social care, as well as the range of NHS, services.

My reservation has been that, almost inevitably, these questions must appear to at least some respondents, as when reported in the illustrated table, slightly jarring add-ons, not least because they require a separate introduction explaining the switch from the NHS to “social care provided by local authorities for people who cannot look after themselves because of illness, disability or old age.”

It seems, in short, that the purpose is to compare the range of NHS services, funded largely from general taxation, with not a range of local authority services, but presumably a combination of adult and children’s care – funded by a mix of council tax revenues, steadily reducing general-purpose central government grants, and means-tested. Not exactly like with like; or, in boxing parlance, a catchweight contest.

The Nuffield/King’s Fund studies recognise this, invariably including in their reports warnings about how “public understanding of social care is relatively limited compared to people’s understanding of NHS services”, that proportions of ‘don’t know’ and ‘neither satisfied nor dissatisfied’ responses are much higher than for NHS services, and that “caution should therefore be applied when interpreting the data”. But still they ask the questions, and include responses in the same tables – in a kind of inversion of the Government’s daily reporting of Covid-19 deaths.

It always jars, but never more so than this year, when the report was published right in the middle of the unfortunate confusion about who exactly we should have in mind each week as we “Clap for our Carers”.

Actually, for Clap No.1 on March 26th there was no confusion. Check out virtually any pre- or post-Clap media report – from the BBC’s own ‘Newsround’ explanation to the appended badged circular – and “our Carers” were ‘frontline’ NHS staff.

Clap No.2 on April 2nd, when explained, was for “those working through the crisis … all key workers who are keeping things running … teachers, cleaners, supermarket workers, delivery drivers … as well as the NHS staff who are working round the clock”.

Social and residential care workers were doubtless in there somewhere, but you had to search hard for a direct reference – and the issues of the classification, counting and announcing of Covid-19 deaths in care homes were yet really to take off. Still, they did get a collective ‘thank-you for going the extra mile’ letter from Matt Hancock, who by then had presumably remembered that he was the one recent Health Secretary to have had ‘and Social Care’ included in his title from the outset.

Unfortunately, he is also the one apparently least able to resist both prevaricating and also digging himself great holes to jump into. And in the April 15th daily Covid-19 briefing he excelled himself. First, he attempted to claim, contrary to all evidence and almost everyone’s recollection, that the first Clap “was not for the NHS, but for all our carers”

He then proceeded further to patronise the latter by both wearing and attempting to launch on the public a green and white enamel, NHS-mimicking, CARE badge – “as a badge of honour in a very real sense”. Which verges on the tacky and tactless … even if it hadn’t actually been designed and launched 10 months earlier, precisely because he, Matt Hancock, was constantly seen wearing only the blue NHS lapel badge.

Almost needless to add, this latest gimmick was less than elatedly received by carers themselves. Oh yes, and the interminable wait for the Government’s review of the funding of social policy goes on.

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.