A critical juncture for public services: lessons from COVID-19 Contents

Summary of conclusions and recommendations

Introduction

1.We suggest that the Government and other organisations prioritise the following principles for public service reform:

2.The Government’s decision not to give oral evidence to the Committee is disappointing. Our aim in this report is not to apportion blame for past failings but to make constructive suggestions for future reform. The Government has stressed the importance of reforming public services after the pandemic; we hope that this report will assist it in this task. (Paragraph 13)

Insufficient support for prevention and early intervention

3.Preventable long-term diseases disproportionately affect the UK’s poorest communities. People who are obese, who smoke, who are diabetic and who live in unhealthy social, economic and physical environments are at higher risk of dying from COVID-19. (Paragraph 36)

4.An approach to public health that focused on preventing health inequalities over the long term would pay dividends by increasing the resilience of communities and reducing pressures on the NHS when a crisis occurs. If such an approach had been adopted before the pandemic, it would have reduced the number of deaths resulting from COVID-19. (Paragraph 37)

5.The Government’s commitment in its 2019 general election manifesto to extend healthy life expectancy by five years by 2035—and to narrow the gap between the richest and poorest—is welcome. It should now publish its strategy to achieve this manifesto commitment and its response to the green paper Advancing our health: prevention in the 2020s. Both documents should set out how central Government will work in active partnership with individuals, communities, local government, the NHS, businesses and charities to design and deliver preventative services to improve the health of the poorest communities. (Paragraph 38)

6.The Government should confirm as soon as possible how preventative services will be delivered, either through the new National Institute for Health Protection or other agencies. It should also confirm how the National Institute for Health Protection’s relationship with and accountability to the Department for Health and Social Care will differ from that of its predecessor, Public Health England. (Paragraph 39)

7.We recommend that the Home Office and Ministry of Justice draw up joint guidance on how the police, the prison system and National Probation Service should work with homelessness, mental health and addiction services to support people whose complex needs may have deteriorated during the pandemic. It should also outline the level of resource that the police and justice system should invest in preventative services (Paragraph 44)

8.There is a serious risk that disadvantaged children will fall further behind as a result of school closures during the pandemic. The Government should set out how it will support early intervention in education services to close the attainment gap, reduce exclusions and ensure that disadvantaged children’s education will not suffer adverse long-term effects from the first lockdown. The Government should consult with Ofsted and the Children’s Commissioner on how to hold schools to account and measure progress made in supporting disadvantaged children to catch up. (Paragraph 50)

9.Successive governments have failed to invest sufficiently in a preventative approach to health, education, justice and other public services. Investing in future potential can be difficult for governments due to a political cycle that prioritises immediate returns over long-term benefits to future generations; cost over social value; and the measurement of increased outputs over improved outcomes. (Paragraph 51)

10.The Government should recognise that investing in prevention and early intervention can reduce the pressures placed on the NHS and the justice system, and that supporting children to avoid poor life outcomes brings financial savings and economic benefits. A future inquiry might investigate further a preventative approach to public services. (Paragraph 52)

Inequality of access to high-quality public services

11.Before COVID-19, vulnerable children were falling through the gaps between public service providers, “invisible” to social services, the NHS and the education system. Many more have become “invisible” during the pandemic since losing contact with public services. (Paragraph 61)

12.The Government should urgently develop a cross-agency strategy which would support vulnerable children in, or at risk of, crisis and ensure that public services do not lose touch with children during future crises such as the COVID-19 pandemic. As part of this strategy, the Troubled Families Programme and community services that facilitate multi-agency support for families such as children’s centres and family hubs should be extended. Schools should have Child and Adolescent Mental Health Services professionals, police liaison officers and youth workers who can collaborate to address vulnerable children’s needs. (Paragraph 66)

13.The Government should study New Zealand’s “joint ventures” to understand better how central Government can encourage cross-agency collaboration on complex social problems. (Paragraph 67)

14.COVID-19 should be a wake-up call for the Government that the designers and providers of public services have paid insufficient attention to the specific needs of minority groups. The Public Sector Equality Duty has had limited success; Black, Asian and Minority Ethnic and Gypsy, Roma and Traveller groups experience significant inequalities of access. These inequalities have worsened since the beginning of the pandemic. (Paragraph 75)

15.The Government should introduce a race equality strategy that would apply across public services and address inequalities of access for Black, Asian and Minority Ethnic and Gypsy, Roma and Traveller people. Such a strategy should include joint targets, shared by all relevant service providers and supported by voluntary sector organisations working directly with these groups, to tackle persistent inequalities in health and educational outcomes. The strategy should investigate the links between such inequalities. (Paragraph 76)

16.Service providers should respond to race equality targets by developing clear implementation plans to meet them. The Government should set out the role of regulators in holding public services accountable for these implementation plans and targets. (Paragraph 77)

‘Co-production’ and user voice

17.The pandemic has shown that designing public services without consulting the people who use them embeds fundamental weaknesses such as inequalities of access. Users often have a better understanding of the outcomes that they would expect to see from public services, and involving user voice in service design increases the resilience of those services . (Paragraph 84)

18.Local authorities and central Government should set out how they will support homelessness, mental health and addiction service providers to involve people with ‘lived experience’—and the voluntary organisations that advocate on their behalf—in the design and delivery of services. (Paragraph 85)

19.‘Co-production’ can embed service delivery innovations of the kind that have developed since the pandemic began, and in a cost-effective manner. In its response to this report the Government should confirm how it will encourage ‘co-production’ in the commissioning of public services, and how it will measure the levels of involvement in service design by groups of service users such as disabled people and those from BAME backgrounds. (Paragraph 86)

The fragility of adult social care

20.The COVID-19 pandemic has accentuated the systemic frailties in the care sector, with the tragic consequence of a large number of deaths in care homes and domiciliary care settings. Reform is now more urgent than ever. (Paragraph 101)

21.In recent years much has been written about the lack of integration between health and social care and the need to provide adequate funding for social care. The problem of fragmentation of services is understood, but no priority has been given to creating coordinated services on the ground. (Paragraph 102)

22.Closer integration and equality between health and social care will require Government action in three key areas. The fragility the adult social care should be addressed by providing the sector with adequate funding; the Government should give social care equal visibility and priority to health care; and the two sectors should integrate data collection and share data more effectively. (Paragraph 103)

23.The Government should commit at the earliest opportunity to an interim sustainable funding settlement for adult social care. The Government has delayed the publication of its white paper on the long-term funding, integration and reform of the sector. This should be published as a matter of urgency. (Paragraph 104)

24.We are concerned that the Government’s own pandemic planning had identified that social care would need significant support during the outbreak of a disease like COVID-19, yet social care was the poor relation to the NHS when it came to funding. In reviewing its pandemic planning processes the Government should explain how it will ensure that the social care sector receives adequate funding, resources and support while COVID-19 continues, and in any future pandemic. (Paragraph 105)

Over-centralised delivery of public services

25.COVID-19 has demonstrated that certain key public service functions are best delivered locally. These include the pandemic response of public health systems, the recruitment of volunteers and contact-tracing. To increase the resilience of public services in any future health crises, the Government must give more decision-making responsibility to its partners at the local level. (Paragraph 117)

26.It is clear that the underfunding of local services in recent years left them ill-equipped to deal with the resource pressures of the COVID-19 pandemic. For too long Government has prioritised services delivered from the centre, when many of the services that people use every day are organised at local level. The pandemic offers an opportunity to rethink how central Government funds and supports local services. (Paragraph 127)

Empowering local public services and communities

27.The pandemic has demonstrated the need for local authorities, health care, social care and other service providers to operate as integrated components of local systems. Given the hurdles to public service delivery that COVID-19 has revealed, service providers should give careful consideration to which services are best coordinated at national level, and which services should be coordinated at local level. (Paragraph 139)

28.The Government should set out in the white papers on English devolution and social care how it will ensure that local areas have the means and autonomy to develop a placed-based approach to delivering public services. This should be the default approach to reform of public services, rather than the current tendency to drive change from the centre. (Paragraph 140)

29.The Government should set out in the white paper on English devolution how the tension between the NHS as a national service provider and the aims of the Government’s devolution agenda—which seeks to give more autonomy to local areas—may be reconciled. It should explain how the NHS will work with local authorities to ensure that the strategy for service integration laid out in the NHS Long-Term Plan aligns with place-based plans for integration in local areas. (Paragraph 141)

30.Community groups and volunteers have played an invaluable role during the COVID-19 pandemic in forming a bridge between public services and ‘hard-to-reach’ individuals. There are now over 4,000 COVID-19 mutual aid groups supporting vulnerable people across the country. When commissioning public services in future, commissioners should recognise the valuable experience of service delivery gained by the third sector during the pandemic. (Paragraph 146)

31.Areas where local authorities had built strong links with community organisations before the pandemic were able to harness the surge in civic action. Local charities and established voluntary and community organisations were better placed than centralised national bodies and charities to coordinate volunteers. (Paragraph 147)

32.The Government should set out in the white paper on English devolution how it will empower local NHS providers, councils, and other local public service providers to draw up agreed measurable outcomes for their area. It should delineate how regulators will work with local areas to agree such outcomes and hold individual service providers accountable for partnership working. The outcomes should reflect the specific needs and priorities of local areas. (Paragraph 153)

A new approach to data-sharing

33.COVID-19 has shown that the Government and other service providers need to rethink their approach to data-sharing. There has been too much reluctance from the centre to share data with organisations at the local level which are responsible for public services, hindering the efficient delivery of quality, person-centred services. (Paragraph 158)

34.We recommend that the Government and national public services review their systems for sharing data with local services. Unless they have access to the information that they need, public services will be unable to meet the challenges posed by winter 2020/21 and the second England-wide lockdown. (Paragraph 159)

35.Local areas should have the means and autonomy to maintain the data-sharing innovations developed during the COVID-19 pandemic. The Government should set out in the white paper on English devolution how it will support local areas and city regions to adopt new data standards, and how it will invest in common approaches and tools for information governance. (Paragraph 165)

36.We are concerned that agencies do not share the data that they need to support vulnerable children and to determine which children need their help. The Government should issue new guidance on data-sharing powers and duties to protect vulnerable children, and, if necessary, introduce legislation to ensure that such data is shared. (Paragraph 168)

37.While some local areas were able to innovate and share data in new ways during the pandemic, many public service leaders lack the confidence and understanding of existing data protection legislation to share information about individual service users with system partners. Such reluctance can limit the ability of public services to keep people safe, particularly during national crises. (Paragraph 173)

38.The Government, while recognising the need to protect personal data, should work with the Information Commissioner to build on the innovation in data-sharing seen in some local areas and to better understand the structural, legal and cultural impediments to data-sharing during the pandemic. Once the forthcoming statutory code on data-sharing is published, the Government and Information Commissioner should release updated guidance on how any such impediments should be addressed. (Paragraph 174)

39.The use of data was a critical factor in determining citizens’ experience of public services during the pandemic, and particularly for vulnerable people. The role of data in the delivery of public services will grow in prominence in the months and years ahead, as new digital technologies and Artificial Intelligence (AI) become more readily available to public service providers. A future inquiry may investigate data-sharing in public services more closely. (Paragraph 175)

Commissioning reform—unlocking the potential of charities and the private sector

40.The Cabinet Office showed admirable flexibility during the pandemic in issuing new guidance to commissioners which put greater emphasis on the social value that commissioning can create and gave greater autonomy to frontline service providers. (Paragraph 186)

41.The Cabinet Office should now update The outsourcing playbook to reflect the new ways in which businesses and charities delivered services during the pandemic, and provide commissioners with best-practice guidance to encourage joint working with the private and third sector. Any new guidance for commissioners must retain the existing focus on social value, partnership working and sustainable grant funding. (Paragraph 187)

42.Once updated, The outsourcing playbook should be incorporated into the forthcoming green paper on procurement. Its guidance should apply across the public sector to ensure that public service commissioners prioritise social value when contracting services from charities and businesses. (Paragraph 188)

Digital technology and innovation in frontline public services

43.There is a clear requirement for central Government and local services to evaluate the performance of services that moved online during the first lockdown, ensuring that public services maintain face-to-face services wherever they are needed. They should work closely with service users in conducting this evaluation, because users are best placed to advise on which services should be delivered online, by telephone, or in person. (Paragraph 200)

44.Central Government and local services should build on the advances made during the pandemic by prioritising funding for public sector digital services. The Government should put a particular focus on improving the digital skills of the public service workforce, and improving digital access and skills for those parts of the population that are at risk of digital exclusion. (Paragraph 201)

“From lockdown to lock-in”—how do public services learn?

45.In recent months, the Prime Minister and the Chancellor of the Duchy of Lancaster and Minister for the Cabinet Office have argued that the pandemic offers a chance for fundamental public service reform. Furthermore, the Prime Minister has promised an independent inquiry to learn lessons from COVID-19. (Paragraph 210)

46.Because the Government did not give oral evidence to the inquiry, and its offer to send written evidence arrived too late, we were unable to discuss how it intends to learn lessons from the pandemic in the forthcoming public inquiry and the approach that it will take to public service reform. We therefore call on the Government to carry out:

(1) a rapid evaluation of what worked well and what worked badly in public service delivery during the initial stages of the COVID-19 pandemic, to ensure that services quickly learn lessons. The Government should carry out this evaluation within the next six months;

(2) an assessment of the changes seen in public service delivery during the first lockdown, to embed the innovations that worked well. To ensure that positive changes are not lost, the Government should publish its findings within a year;

(3) a long-term evaluation of the fundamental weaknesses in public services that have been revealed by the pandemic, to inform a major project of public service transformation. (Paragraph 211)

47.We suggest that this report offers a starting point for any evaluation of how public services adapted to the pandemic, and the implications of COVID-19 for the future transformation of public service delivery. In order to lock in the remarkable innovations adopted by service providers since the beginning of the pandemic, we have set out eight key principles for public service reform. These principles should now underpin the Government’s approach to redesigning the UK’s public services for the twenty-first century. (Paragraph 212)



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