That this House takes note of the Report from the Public Services Committee A critical juncture for public services: lessons from COVID-19 (1st Report, Session 2019–21, HL Paper 167).
My Lords, the report is the Public Services Committee’s first. The committee was established in February 2020 and is the first in this House to hold the Government to account on a range of issues that cut across public services and on policy areas that are the responsibility of multiple departments and so, too often, are the priority of none. It is a Standing Committee, so will continue to work for many years, I hope. I have the enormous privilege of being the first chair and am working with an outstanding group of Members from across the House, who have all worked with energy, commitment and challenge throughout. We have also been served by similarly outstanding officials, and I want to say thank you to all involved.
The establishment of the committee coincided with Covid-19 and it soon became clear that the pandemic was the most testing experience that our public service model had faced for several generations. It would reveal its strengths and weaknesses, and would be an opportunity, some might say a critical juncture, for reform. This became the focus of our first report.
We heard from 165 organisations and individuals, and I am enormously grateful to them. Unfortunately, no government Minister found it appropriate to come and talk to the committee. However, much of what we heard has informed our follow-up work on commissioning and data sharing, as well as our current inquiry on child vulnerability. How public services are organised, how they are funded and how effectively that funding is spent, how different services work together and, most importantly, how services are experienced by the people and communities that use and need them are the priorities for the committee.
Covid-19 has been a national tragedy for the United Kingdom. We have lost more than 130,000 people to the virus and Covid-related pressures have pushed many families to crisis point. After 18 months of tireless service, our front-line workers are exhausted and their well-being is at an all-time low.
However, the inquiry also gave us cause for hope. Amid all this despair were incredible innovation and civic action, often at local level, to support communities to stay resilient under unprecedented pressure. Decisions that before the pandemic took months or even years were made in minutes. National government worked with councils to accommodate 15,000 rough sleepers. Many of those had access to addiction and mental health services for the first time.
We were inspired by the surge in voluntary action: there are now more than 4,000 mutual aid groups across the UK. Innovative local authorities played a key role in co-ordinating volunteers to support hard-to-reach groups. For example, Agatha Anywio, 76 years old from London, relied on her local Age UK group to support her during the first lockdown. A few weeks ago the committee heard from her again. She told us that she was still getting support from the local voluntary sector to connect her to her local community. Age UK even organises two virtual exercise classes a week, which she participates in and loves.
My Lords, I remind the House that I am a vice-president of the Local Government Association. First, I congratulate the committee on its report and thank the noble Baroness, Lady Armstrong, for her introduction. She is absolutely right in calling for us to learn the lessons of how public services have been delivered—or, indeed, not delivered—during the pandemic. She also talked about the importance of resilience and of engagement with people and communities. I subscribe to everything that she said.
As the title of the report says, this is a critical juncture for public services. The committee was right to use those words. It is urgent that we learn the lessons of the Covid pandemic. It brings into stark relief the delay in this report reaching the Floor of the House for debate. It was published in November 2020. The Government replied three months later, but it has taken a further five months for this House to hold a debate. Can the Minister explain why there has been such a delay?
I want to make one crucial point this afternoon, and it is this: you cannot run England out of London. The Government’s replies to paragraphs 117, 139, 140 and 141 of the report, on the need for decentralisation and local integration of services, are, frankly, inadequate. I submit that it is not enough to promise a White Paper “in due course” based on directly elected combined authority mayors and regional partnerships such as the Midlands Engine and the Northern Powerhouse. This leaves out counties, public health structures and local government generally. It does not address the need for a single, unified health and social care service and for greater investment in prevention, which could in turn save public money, as the report makes clear.
Crucially, and as the report also makes clear, we cannot continue with a system of overcentralised delivery of public services, poor communication from the centre and a tendency for service providers to work in silos. This, my Lords, is a hub and spoke model, so beloved of bureaucracies, which promotes silo working rather than service integration. As the committee has pointed out, local authorities often receive divergent messages from different government departments. As worrying was the need for local areas to interpret public announcements by the Government without prior consultation.
My Lords, I begin with a tribute to the noble Baroness, Lady Armstrong, who chaired our committee with tact and skill. Her professional background in social work has been a real advantage, not just in putting witnesses at ease but in managing any neuroses from committee members. We were well-served by our clerk, Tristan Stubbs, our policy analyst, Mark Hudson, and our operations officer, Claire Coast-Smith, who navigated the virtual network between us and our witnesses.
We are a collegiate committee with a broad range of relevant expertise, and our discussions have been non-partisan and good humoured. Thanks to Zoom, I am now familiar with my colleagues’ tastes in literature, paintings, casual dress and light refreshment. In our report, we mentioned what went well during the pandemic—often overlooked by the commentariat: the success of DWP in coping with a huge number of claimants for universal credit, and introducing the £20 supplement; the Treasury’s furlough scheme and wider support for business; and, of course, the stunning success of vaccine procurement and distribution. But we also identified a number of structural problems, some touched on by the noble Lord, Lord Shipley: over-centralisation, departmental silos, underinvestment in preventive measures and ill-preparedness for emergencies, themes that are recurring in our current inquiries.
I want to focus on the lessons to be learned from the three countries from which we took evidence: New Zealand, Taiwan and Germany. They are all different, but they are grappling with identical viruses with the same range of policy options and the same information about the disease.
I have three points to make about New Zealand. First, like Great Britain, it is an island—or, rather, two islands—but unlike us it challenged the early WHO advice that border restrictions were unnecessary, and in retrospect it was absolutely right.
My Lords, as a member of the committee I welcome this debate, partly because it gives me an opportunity to warmly thank both the noble Baroness for the way in which she has chaired the committee and the staff for the quite exceptional way in which they have supported us.
Some of us have spent many happy hours down the years talking to empty rooms about the need to reform government, not because we long for some bureaucratic nirvana but because we were convinced that without reform some of the most disadvantaged people in our society would continue to experience poor, difficult-to-access services, and we as a nation would continue to waste scarce public money. So I was pleased that for its first report the committee chose to look at what the pandemic could teach us about our public services, and I was not surprised that it concluded that there was now an overwhelming case for reform, notwithstanding the outstanding commitment of so many of our public servants. That view seems now to be shared by the Government themselves because in their own Declaration on GovernmentReform, published just a few weeks ago, they accepted that the pandemic
“has … exposed shortcomings in how government works.”
I hope the Government will now revisit the committee’s recommendations, particularly the eight principles of reform that the chair referred to earlier.
For today, I shall focus on four of those principles which, surprisingly, the declaration of reform barely mentions. The first, as has been said, is the need to prioritise prevention and early intervention. Our system of government is designed to respond to problems rather than prevent them, and the pandemic has demonstrated how short-sighted that can be. Covid hit hardest those with preventable disease, such as obesity and type 2 diabetes, living in poorer communities. It is not just in the field of health that we need to prioritise prevention. Our prisons are full of people who have been failed by the education system, whose mental health problems have never been addressed and whose addictions have been left untreated. We are now seeing the cost of responding too slowly to the impact of climate change, measured in terms of the human misery caused by flooding and pollution. Any credible vision for the future and the reform of government has to prioritise a shift from response to prevention.
I declare my interest as a Cumbria county councillor.
This report from our Public Services Committee, chaired by my noble friend Lady Armstrong, is one of the best things that I have ever read on the reform of public services. It sets out an ambitious agenda, drawing on the lessons of the Covid crisis and international experience. It shows what a cross-party consideration of these issues can achieve and how a remarkable degree of consensus on principles for reform can be established.
However, I am afraid my question is whether our politics is up to the challenge. We saw a very weak response from the Government to this report, both in their refusal to engage in the work of the committee and in their very weak response. The response popularised by the Government is the so-called levelling-up agenda, but we saw in the recent Prime Minister’s speech how empty that is. When you come out with a proposal for a £10 million plan for dealing with chewing gum on the streets, that shows that you do not really have sensible principles for reform in your head. It seems to be a splash of central government paint to cover up fundamental cracks in our society.
I agree with the noble Lord, Lord Shipley, in his condemnation of overcentralisation. Not only is that a very inefficient way of trying to tackle deprivation and complex problems of poverty at local level but it is, frankly, quasi-corrupt; it is getting near to pork-barrel politics, and that is not where we should be going.
We need fundamental reform in governance and funding. At present, the Government are levelling down, not levelling up: the proposal to withdraw the universal credit supplement will plunge many poor families further into poverty; the rejection of Sir Kevan Collins’s plan for educational catch-up was a very bad sign; and, despite all the talk, there is still no long-term funding solution for the NHS and social care.
Yet the present moment is an ideal time for a Government to make difficult tax and spending choices. Everyone is aware of the cracks exposed in public services, but at the moment we are seeing the Government allowing a manifesto commitment that they made on taxes to trump the lessons of Covid—and of course that commitment came well before the Covid crisis. The point about manifesto commitments applies equally to my own party: some in my party want to elevate the 2019 manifesto to semi-sacred status, but really we should be looking at the lessons of the Covid crisis and developing policies for public services along the lines of the committee’s report.
My Lords, I draw the attention of the House to my relevant interests recorded in the register as a member of Kirklees council and as a vice-president of the Local Government Association. As a member of the Select Committee, I too wish to praise the leadership of the committee by the noble Baroness, Lady Armstrong.
My abiding memory from the witnesses who gave oral evidence to the committee was of the dedication of all those involved in providing public services. Service providers rose to the multiple challenges posed by the pandemic and overwhelmingly put first the needs of the people they served. As we know, some of them literally gave their all. I pay tribute to all those in public service for their heroic actions during this continuing pandemic.
As we have already heard, this is a wide-ranging report and I wish to focus my comments on the response of services provided by local government. What struck me most in listening to the witnesses was that staff were energised by the challenge of continuing to provide services in a different way. They were almost always motivated to continue providing the best services they could and determined to find ways round the barriers rather than be intimidated by them. The result, we heard, was that innovative practices were introduced. Some were the result of government initiatives and funding. As we have already heard from the noble Baroness, Lady Armstrong, 15,000 rough sleepers were rehoused in hotel accommodation very quickly thanks to a government grant and local government action. This was a significant success and one that had other benefits for homeless people.
Innovations were also sparked by practitioners from different services and organisations, such as NHS community services and local government social care working more closely together and with local and national charities and voluntary groups. They described how they felt empowered by the challenges of the pandemic to pay less heed to existing service guidance and just find a better way of doing their job.
The Deputy Speaker (Lord Brougham and Vaux) (Con)
I call the next speaker, the noble Lord, Lord Davies of Gower, and remind noble Lords that the time limit for speeches is six minutes.
It is a real pleasure to follow the noble Baroness, Lady Pinnock and to speak this afternoon as a member of the Public Services Committee on the first report of the committee. This was a very revealing inquiry prompted by the unfortunate and unexpected arrival of the Covid-19 pandemic.
I pay tribute to the chair, the noble Baroness, Lady Armstrong, and the committee staff who worked under extreme pressure, frequently producing documents and suchlike at very short notice. I also pay tribute to my fellow committee members whose depth of knowledge and diversity of life experience made this inquiry so interesting and worth while. This was the first inquiry that I had been party to since joining your Lordships’ House, and I found it quite thought-provoking.
I say that it was a revealing inquiry because it highlighted areas of government that hitherto had been accepted as perhaps good working practice or, at the very least, accepted as the norm, with no real incentive for change. The Covid pandemic certainly put many of these previously accepted practices to the test, and they were found wanting when the chips were down. The report identifies many of these, a recurring theme being that of data sharing and, as it says clearly and is very well evidenced, Covid-19 has highlighted the inadequate data sharing between national agencies and local services.
As can be seen, we identified a number of conclusions and recommendations. If I were to choose an area from the inquiry that really caught my attention, it would undoubtedly be the overcentralised delivery of public services. We heard compelling evidence from a large number of witnesses identifying a clear lack of involvement at local level. In many cases they had been left in the dark as to the support that they were entitled to but denied due to confusion and a deficiency of clarity caused by a very centralised approach.
My Lords, I declare my non-executive membership of the Cabinet Office. It is a pleasure to follow the noble Lord, Lord Davies of Gower, a colleague in the police service, the House of Lords and this Select Committee.
I add my own thanks to the noble Baroness, Lady Armstrong, for this debate and her determined and human leadership throughout the Select Committee—no easy task, given that the committee was new, the membership had not worked together and it had to be arranged virtually. I would also like to thank the clerks of the committee, who were flexible and very hard-working, for keeping the committee and the witnesses well briefed and cared for: a great achievement.
I fully endorse this report and our recommendations but wish to talk about only two issues, which were themes running through the evidence. The first is whether prevention is truly prioritised by the Government. The second is the ability of our public services to share data for the benefit of our citizens. Covid and the consequent lockdowns have brought both into sharp relief.
Nearly every public service claims that prevention of harm is its principal objective. This must be true logically; it is better that someone does not contract a disease or become a victim of crime if it can possibly be avoided. They will not suffer harm and the public service can either be allocated fewer resources in the future or—more likely—use the resources for other priorities. However, Covid showed that we did not prevent the spread of the disease and that we did not have a clear plan for how to prevent the spread of the disease.
It is also true that each public service struggles to articulate a detailed plan for how they will implement a preventive strategy. To take policing, all chief constables say they have a clear preventive strategy, but, when you ask for details of how they will do it, there is no detail. They cannot clearly indicate in their budget the resources allocated for this purpose. Yet we know that the design of products, for example cars, and places really helps reduce crime. People could not steal cars until recently because they were designed not to be stolen. Reasonable alcohol-control strategies, not allowing drug markets to get out of control, special measures to help and protect young people, and giving information to potential victims about how to avoid becoming a victim, will all have an impact. Health has a similar list.
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We also saw how digital technology was used more widely and more successfully than ever before. Changing Lives, a charity working with vulnerable adults, moved many of its addiction recovery services online during the pandemic. This gave service users greater flexibility and responsibility. They were not given daily scripts by the NHS, but weekly ones instead. This meant that they were more empowered. It was risky, but, actually, it resulted in increased engagement with services, a reduction in the relapse rate and, ultimately, fewer drug- related deaths.
However, while these innovations are impressive, unless government acts urgently to lock in such changes, this good work will be lost, and we heard evidence that this is already happening. Shay Flaherty is recovering from addiction and now volunteers in Birmingham with the charity Revolving Doors. At a follow-up evidence session last month, he warned us that much of the good work with rough sleepers during the early stages of the pandemic had already been undermined. He said that, once people had been moved out of temporary accommodation, their point of contact with mental health and addiction workers was often lost. Many have relapsed and returned to the streets.
Moreover, Covid-19 revealed how innovation and community resilience are too often undermined by fundamental weaknesses in the way we deliver public services in this country. Going into the crisis, the national Government too often did not take local expertise seriously. This played out with disastrous consequences. Jessica Studdert, who is the deputy chief executive of the New Local Government Network, told us that, during Covid’s early stages, too many local authorities did not get the information that they needed from the NHS about shielded groups, even though it was the local authorities’ responsibility to deliver food and essential supplies.
We found that our poorest communities went into the pandemic with incredibly low levels of resilience. Witnesses told us that the funding of preventive and early intervention services had not been a priority in the years preceding Covid-19. This had placed greater pressures on the NHS and increased costs to the state through poorer education, employment and justice outcomes for the most vulnerable.
Sir Michael Marmot reported to the committee that cuts to local authorities’ public health grants had fallen disproportionately on the most deprived areas. Since 2014, England as a whole has seen a cut in public health budgets of £13.20 per person: in the Midlands, it was £16.70 per person; in the north, it was £15.20; and the north-east has been worst affected, with cuts of £23.24 per person in the public health budget. Witnesses told us that the upshot of those cuts was that obesity and associated diseases such as diabetes were concentrated in our very poorest communities and among our most marginalised groups. That made them extra vulnerable.
Covid-19 mortality rates in the most deprived areas were almost twice as high as those in the least deprived. Diabetes was mentioned on 21% of death certificates where Covid was also mentioned. The proportion was 43% among Asian people and 45% among black people. It was higher in all BAME groups than in the white British population.
Pre-existing inequalities have only deepened during the last 18 months. Sir Kevan Collins, who resigned as a government adviser over school catch-up funding, recently told the committee that disadvantaged children had fallen even further behind their better-off peers as a result of lost school time. His resignation should be a wake-up call to the Government that such disparities cannot be left unaddressed.
The pandemic influenced innovative local areas to break down long-standing barriers between the NHS, local authorities and other services, but in much of the country we found that collaboration between agencies was wanting. Many did not share crucial data on people’s needs. During the crisis, the lack of integration and parity of esteem between health and care saw patients discharged from hospitals into care settings without testing, resulting—we believe—in thousands of unnecessary deaths. The proposals in the Future of Health and Care White Paper and the subsequent legislation to strengthen co-ordination between the two services are welcome and necessary. True integration will depend on delivering real parity of esteem between the NHS and social care. It is deeply disappointing that the legislation to put adult social care on a secure financial footing has been delayed yet again—until, we are now told, later this year. Can the Government confirm whether the forthcoming legislation will include proposals for the reform and integration of social care, alongside any new funding settlement, to increase the resilience of the sector?
To address fundamental weaknesses in public services, strengthen the resilience of our communities to future crises and ensure that the innovations from the pandemic are not lost, the committee called for a national programme of reform. In carrying out this essential task, we asked that the Government should be guided by eight key principles. These included the Government and public service providers recognising the vital role of preventive services and early intervention.
In its response to the report, the Government said that they were committed to levelling up life expectancy. They have not yet set out how they will invest in preventive services in order to meet their 2019 general election manifesto commitment to extend healthy life expectancy by 2035, and to narrow the gap between the richest and the poorest. Health prevention and early intervention in education were not a focus of the March 2021 Budget. To date, levelling-up announcements have largely focused on physical infrastructure and skills. How will the Government address this in the forthcoming spending review? The role of charities, community groups, volunteers and the private sector as key public service providers must also be recognised. They must be given appropriate support and encouragement.
Witnesses told us that the procurement guidance, introduced by the Cabinet Office in response to the pandemic, granted local public service commissioners greater flexibility to award long-term funding and contracts based on social value, rather than just the lowest cost. We were disappointed that the Transforming Public Procurement Green Paper failed to embed those flexibilities. It did not differentiate between the commercial purchasing of goods from the private sector and the commissioning of services for people, whether delivered by the voluntary sector or by other organisations to meet the needs of the local community. In recent letters to the Government, we have urged them to work with the voluntary sector and with commissioning experts to ensure that the procurement Bill promotes social value and delivers long-term funding agreements for charities delivering services. Can the Minister update us on progress in engaging the voluntary sector on this issue?
Another principle is that public services require a fundamentally different, vastly more flexible approach to data sharing. The Information Commissioner wrote to us as part of our current inquiry on children’s vulnerability. In her letter, she acknowledged that the current threshold for sharing data on children was too high and that her office would be working with the Department for Education to update its data-sharing guidance. Can the Minister tell us how this important work is progressing?
We argue that integrating services to meet the diverse needs of individuals and communities is best achieved by public service providers working together at local level. This should be supported by joined-up working across government departments at national level. I welcome the establishment of a Cabinet committee. Will the Minister set out how this committee will co-ordinate government activity to improve data sharing and integration? Local services and front-line workers must be given the resources and autonomy to improve, and innovate in, the delivery of services. How will the Government use the forthcoming levelling-up and devolution White Papers to achieve this?
People themselves are best placed to understand how services should meet their needs, strengthen their resilience and support them to thrive. I am running out of time, so I cannot go into this in detail. It is critical that the government strategy for public service reform takes this as its core in the months and years ahead. If people and places are to be resilient in the face of future crises, services must have political and financial support, as well as autonomy, to be truly preventive and integrated around the needs of their local area and people. They must have the places and the people they serve at their heart. I beg to move.
I said earlier that you cannot run England out of London. We do not try to run Scotland like that, nor Wales, nor Northern Ireland, so why, for example, do we run Yorkshire like that? The argument the Government have used has been that decisions have had to be made quickly. Of course they have, but that is no excuse for national attempts at recruiting volunteers not being aligned with locally co-ordinated responses, nor for national public health executive agencies not using local public health resources effectively, nor for the expertise of local authority contact-tracing teams being unused in the design of test and trace. These are fundamental matters. It is vital that local areas are seen as partners with far greater decision-making powers.
Very wisely, the committee, on page 14, described the German public health system, which has local and regional governance structures with 375 local health offices empowered to make decisions. We could learn much from them, and I hope we will.
I want to raise a final issue, which relates to schools and which the noble Baroness, Lady Armstrong, mentioned. The Prime Minister appointed an adviser, Sir Kevan Collins, as education recovery commissioner. He produced a report, supported, it seems, by the Prime Minister, calling for substantial funding over three years to assist pupils who had lost school time, but the Treasury refused to fund it. Just £1.4 billion was allocated for one year—about a 10th of the money asked for, albeit over three years. The commissioner resigned. This is not joined-up government.
Covid has exposed serious flaws in our systems of government. I hope this is understood by the Minister and his colleagues, because they have the power to drive the change we need.
Secondly, to deal with departmental silos, it has just set up interdepartmental boards, which they call joint ventures. We were told that
“all the interesting and difficult public policy issues are on the interface”,
by which was meant that they cross departmental boundaries. Here, NHS Health and local authority social care spring to mind. The joint ventures bid direct to the treasury for funds and a cabinet Minister is in charge, but instead of a permanent secretary, a board of the relevant permanent secretaries delivers the policy. My noble friend might like to ask the Cabinet Office to keep in touch with New Zealand on this, as it is often ahead of the game in the development of public policy
Thirdly, public confidence in the Government rose as the pandemic progressed, whereas the opposite has happened here. We did not press too hard for the reasons—again, the Government might want to pursue that further—but it was ascribed to firm leadership, a strong culture of co-operation and robust dealing with fake news.
Taiwan’s approach avoided lockdown entirely and last year it recorded record GDP growth, but its experience may not be entirely representative as it had the background of coping with SARS and a tradition of wearing masks, which was described to us as the equivalent of a vaccine.
Its equivalent of Eat Out to Help Out was more broadly based, focused on retail spending rather than just spending in restaurants, and those on low incomes were included, receiving vouchers worth about £80, whereas our scheme was much narrower and arguably regressive. Ninety-eight per cent of the population in Taiwan participated, and you got a bonus if the money was spent out of doors.
I turn finally to Germany, with its federal structure, where health and education is devolved to the Länder, which managed most of the Covid response. Perhaps the most remarkable contrast was on health spending, where there are no government-imposed cash limits, as insurance picks up the tab. I quote verbatim what we were told:
“There is no room for refusing somebody an operation that he needs or a pharmaceutical drug that she needs for financial reasons … There is no place in the German health system for refusing money because somebody is 90 years old and has a life expectancy of only seven more years. In that case … if it does not medically kill them and they can stand the operation—then go for it and the finance system has to follow that.”
That, of course, has wide ramifications for how we fund the NHS, but against the current background, I thought it worth mentioning.
I make one final point on Germany. The local authorities there all have equal powers. Our witness, John Kampfner, told us:
“It is one thing to advocate the devolution of powers within England to local authorities; it is quite another to be able to deliver that within the patchwork quilt of local government that we have at the moment, which in my view is really not fit for purpose to deal with a crisis like this, as distinct from what exists in Germany.”
Clearly, it is easier to manage devolution if the bodies you are devolving to have equal powers. At the end of the session on Germany, we asked for a key message. “Plan for the future and build in some slack”, was the reply.
I hope the Minister in response to our debate will recognise that the present system of running the country is capable of improvement—without wholly adopting the Cummings agenda of hard rain—and can tell us that the Government have an open mind on some of the radical implications of our report.
It also needs to tackle the issue of sharing data. The declaration of reform mentions data only as a way of enhancing the accountability of services. While that is important, the committee found countless—and I mean countless—examples of how the failure to share data between services has stood in the way of improving those services and providing essential services. We were told that schools are often not aware that a pupil is receiving support from social services, GPs are not told that a family is involved in a child protection process and criminal gangs are able to exploit teenagers in county lines because of the failure to share information between the police, children’s social care and health. We found some excellent examples of how, during the pandemic, services had found new ways of sharing data—usually at the local level—to benefit clients, but in a governance system that is now so fragmented we have to find better permanent ways to share information across bureaucratic boundaries if we are ever to reform government.
As the chair has said, the committee also saw many great examples of how charities, community groups, volunteers and the private sector had delivered essential services, often supported by their local councils. These non-statutory services, not for the first time, showed how they could respond quickly, how they could innovate and make services more accessible and how they were more trusted than traditional providers. To be fair, we saw many examples of how statutory services had helped them by introducing new flexibilities, not least in the way in which services were commissioned. Again, though, our concern was that these changes would not survive the return to normality. We felt strongly that the new normal should be about services for public good being provided by a coalition of providers, some statutory, some voluntary, with those in the voluntary sector being given real parity of esteem as professionals in their own right.
Lastly, the committee became persuaded that, in future, public services should be designed and delivered with a great deal more user involvement. We heard how the failure to do that in the past had resulted in services being provided in the wrong place, at the wrong time and in the wrong way. Civil servants and local officials need to find new ways to involve citizens and users, children included, not via ever more sophisticated consultations but by way of genuine co-design and co-production. That is especially important if the inequality of access experienced by minority groups is to be tackled.
The pandemic exposed serious flaws—we need to be honest about that—but the innovative response from so many points us to how we should change by creating a system where public services are more devolved, co-designed with users, focused on prevention, delivered through diverse providers and better at working in partnership and sharing data. That should be our future.
It is not enough to simply say, “Let’s spend more money”; we also have to have a credible agenda for reform. On reform of the NHS, we have to recognise that, despite its achievements, the NHS has failed so far to provide an equal opportunity for people to live a healthy and full life, and the emphasis has got to shift to prevention. In education, we have got to recognise that there are many problems of deprivation leading to poor educational opportunities and schools where standards need to be raised.
We know that people in public services work very hard, but they often work in silos. We have to be prepared to use the charity and the voluntary sectors and even, at times, the private sector, which we must see not as an enemy but as a potential partner. We have got to avoid hidebound, bureaucratic approaches that lead to inadequate data sharing, as we have heard.
We need an ambitious agenda of public service reform. I hope that a Labour Government would be prepared to follow the principles of this committee report, which are so sensible and so wise. I thoroughly commend the committee on its work.
One of the examples in the report is of social care and the NHS in the Leicestershire area establishing what they call their “care home cell” to ensure co-ordination. That is an example of dependence on already very good working relationships across the organisations. The importance of effective personal relationships was repeated by other witnesses.
It was also vital in another strong theme that emerged: the importance of local, place-based services. Time and again we heard evidence about topdown control being less effective than local solutions. For instance, as someone in the Local Government Association described it:
“Guidance came out in dribs and drabs. One of my [local authority] colleagues said it was like trying to construct a piece of Ikea furniture with a piece missing and the instructions being posted daily in bits and pieces.”
Another example of topdown instruction not being as effective came from my own local authority. Early in the pandemic there was a significant outbreak in a meat processing factory in Kirklees. The central data provided was so poor that the council’s public health director asked the council’s digital service to provide the data in a more meaningful and accurate way. This was successfully achieved.
However, it was clear from the witnesses that local services of all kinds were in a fragile state following years of austerity. Age UK wrote that the pandemic had revealed the
“true extent of the impact that underfunding, structural issues and market instability have had on the system’s ability to respond”.
Local government was described as much less resilient as a result of very significant funding cuts.
One of the lessons was best described by users. They said that where providers have listened to them and then changed their practice as result, their needs were much more effectively met and there was a reduction in duplication. This co-production—codesign— was much the best way forward for users who gave evidence.
This is a valuable report; I have touched on just a small part of its deliberations and conclusions but to me the lessons are clear. First, we should reduce central control and have much more local, place-based definition of service provision. Secondly, we should enable coproductions to flourish. Thirdly, we should recognise the enormous contribution of people and personal relationships in innovating and overcoming adversity, and value those people. Finally, underfunding services on which our society relies cannot continue if care for the more vulnerable among us is important to society as a whole. The challenge for the Government is how these vital lessons are to be at the forefront of their thinking and funding decisions. I hope the Minister will explain how the Government intend to respond to these very significant challenges.
This was made abundantly clear by a number of witnesses. I too want to mention Agatha Anywio from Wandsworth, who told us of her experience in the early days of lockdown. She said that
“I had a letter from the Government telling me that I should officially shield, but nothing happened … It was about four weeks into lockdown before I was actually recognised, only because I persisted … If I had kept quiet and done nothing about it, I have a feeling that I might have been completely forgotten.”
Debra Baxter from Wigan, who is 55 years old and has cerebral palsy, told the committee that she was now a full-time wheelchair user. She said:
“My personal experience was that if it was not for the support of my daughter, who is here beside me, during lockdown I would not have been able to cope … I also felt that this pandemic, shall we say, took us all by surprise, and there were no actual structures with the social care setting to deal with emergencies like this. If it were not for my daughter and the friendly neighbours who live around me, I would struggle a great deal during lockdown.”
The impression left by front-line public service providers who gave evidence was that there was no co-ordinated communication strategy across government departments. Dr Jeanelle de Gruchy, president of the Association of Directors of Public Health, told us that her colleagues from central government
“often failed to draw on local resources because they were unaware of the role played by local authority public health teams”.
She said:
“There was a really poor understanding and recognition of the role of the director of public health, the local public health system and indeed local government as a key partner in managing this pandemic”.
The Government’s response has been to recognise the importance of public services working together, saying:
“We are evaluating how Government can be more joined up for local government. The recent Spending Review outlines Government’s ‘Focus on Outcomes’ … and as part of this HM Treasury has been driving a X-Whitehall approach on outcomes, and evidencing impact and public value.”
It cannot come soon enough.
In contrast, there was a very constructive aspect of the response of government to the pandemic. I refer to the way in which the homeless were taken off the streets and found accommodation.
“The Government’s March 2020 ‘Everyone in’ initiative requested that all local authorities provide accommodation for rough sleepers in their area, often in hotels or hostels … by May 2020 a total of 14,610 people in England who were sleeping rough, or who were at risk of sleeping rough, had found emergency accommodation.”
I am bound to say that that was quite some achievement.
We heard from Revolving Doors, a truly remarkable organisation which aims to help people with substance misuse, mental health problems, domestic or sexual violence, homelessness or who have had frequent contact with police and the criminal justice system. Shay Flaherty, who I have already mentioned, a volunteer with Revolving Doors who gave evidence to the committee, is nine years into recovery from alcohol addiction and helps support homeless people in Birmingham. He was keen to tell the committee that the help the homeless were getting
“in the premises they happen to be in, whether hotels or hostels, has given them a start in life and a chance to get access to addiction services and support workers.”
He said:
“I have been amazed at how the Government and councils have managed to get the entrenched homeless off the streets … This might be the first step to getting a roof over their heads permanently.”
The important point here is that, when push comes to shove, government can be innovative. As we point out in the report,
“the Government and public services must now act to ensure that the progress made is not lost.”
Shay Flaherty told us that some innovations were being abandoned:
“Slowly but surely, the guys are coming back out on to the streets … because the accommodation is being withdrawn.”
That is disappointing, to say the least. There is no doubt that the Government’s approach to rough sleeping during the pandemic has proved what can be done by working with local authorities.
I ask—I hope—that this report will galvanise the efforts of government departments to learn from the experience of Covid-19 and acknowledge the deficiencies of a centralised government approach, in order that those less fortunate members of society may benefit. This report is worthy of recognition and of being acted upon at all levels of government. I am delighted to have been involved in the inquiry.
The pandemic showed that we do not have clear and measurable preventive strategies and 10 to 20-year plans for either of these particular challenges. The UK was particularly affected by this pandemic because of obesity and diabetes making people more vulnerable to serious and sometimes fatal side-effects; both obesity and diabetes being preventable problems to some extent. So I urge the Government to take prevention seriously. It is not, as it is often portrayed, a soft, woolly subject; it is as hard-nosed a discipline as engineering, and susceptible to hard-nosed, effective measurement.
In terms of data sharing, we heard some excellent examples during the pandemic that local public service partners had found imaginative, effective and radical ways to overcome hurdles to sharing data. This was excellent news, but the question must be asked: why did they need to be so creative? Why did it take a world- wide pandemic to create the perfect circumstances for such a leap forward? The various regulators cannot understand why the public services say they cannot share data. Well, I am afraid, “They would, wouldn’t they?”
The reality is that legislation is designed generally to prevent the sharing of data: we have privacy legislation to protect our confidentiality and data protection legislation to stop the inappropriate sharing of private data held digitally. This is, of course, commendable. However, I do not think Parliament, when seeking to prevent the inappropriate sharing of private data, also intended to inhibit public services from sharing personal and mass data for the purpose of giving benefits to citizens in terms of health and security—as just two example. But this seems to have been the outcome.
At the very least, public service practitioners and leaders believe there is a problem, and there is clear evidence that poor data sharing is leading to poorer outcomes. The regulators say they will produce yet more guidance to reassure the practitioner. I believe that it is time consider legislative change to change the landscape. I propose that a statutory defence should be created for public services that share data. It is a simple “reasonableness” defence. If they share data believing it is to carry out their duties and help a citizen, they should have a full defence in law to any breach of privacy or data sharing breaches.
The pandemic has allowed public servants to take risks on our behalf in the sharing of data. However, they should not have to take those risks and, by providing a clear defence in law, the Government will reassure our public services and improve their efficiency for the collective good.