Recording of Cordis Briefing held on 16th July 2020
July 2020
July's virtual briefing covered the Covid legacy, business rates and local authority finances, profiling the not for profit sector, and the Cordis Viewfinder for 2020.
Archive of July, 2020
- More demand.
- Ongoing under-funding.
- A continued lack of refuges and safe spaces.
- A tangled system with limited strategic and operational oversight between the critical parts of the system that must collaborate to be effective (e.g. health, social care, housing, education, criminal justice).
- And a continued shortage of perpetrator programmes with strong evidence of success.
- The need to ensure system leadership is informed by evidence: this involves very rapid strategic needs assessments and facilitating informed discussions among system leaders to make decisions.
- Rapid evaluation of innovative or un-trialled approaches: the aim is to provide emerging evidence of likely success so that more confident decisions can be made regarding investment and/or disinvestment in services.
- We can produce bespoke versions of this stress-test plotting your CCG’s performance against each indicator. This helps understand your relative strengths and weaknesses. We are able to do similar for a basket of CCGs, e.g. your statistical neighbours. There is a small charge for this analysis.
- We are experts at service reviews and evaluation. Relevant experience includes an evaluation of a children and young people’s Emotional Wellbeing and Mental Health Transformation Programme; evaluation of a Trauma Recovery Model approach within youth offending; a multi-site evaluation of the Living Well approach to improving mental health; and evaluation of an innovation project designed to safely prevent escalation to tier 4 CAMHS.
- We also offer needs assessments, helping you map local need and service provision and identifying gaps and areas for improvement. These can be population-wide, e.g. mental health services for all children and young people, or focused on particular cohorts, e.g. looked after children, or particular aspects, e.g. training needs assessments for those working with children and young people who may have emotional and mental health needs.
Domestic abuse and Covid-19
July 2020
This blog explores the crisis which the domestic abuse sector is facing. It draws on Cordis Bright’s experience of research, evaluation and consultancy in this sector over the last ten years to highlight the key tenets which would ideally underpin the local and national response.
Four months into lockdown. We are adjusting to the shock of Covid-19 and its devastating effect on the health and wellbeing of our society. People are now talking openly about a new way of living in the medium to long term which will involve more periods at home and ongoing social distancing.
Those who understand domestic abuse have been clear from the outset about the very significant risks which the lockdown creates. In April, Dame Vera Baird DBE QC, (Victims’ Commissioner for England and Wales), Nicole Jacobs (Domestic Abuse Commissioner for England and Wales) and Anne Longfield OBE (Children’s Commissioner for England and Wales) informed the Home Affairs Committee of the urgent changes which are required to ensure domestic abuse victim-survivors are supported and protected.
The government’s decision to focus on medical/hospital pressures meant that although those voices may have been heard, action from government was and continues to be minimal. We know that an additional £2m has been made available to domestic abuse charities, but it is clear that this is not enough . For instance, the reported data makes for harsh reading: Refuge report a 700% increase in helpline calls [1], Scottish Women’s Aid report that 84% of its groups operate waiting lists (this figure was reported before the lockdown had begun) [2] and the project Counting Dead Women reporting more than five suspected domestic abuse deaths per week during lockdown (a figure which is usually around 2) [3].
Now that the country is reconciling itself to a new normal, a very rapid review of domestic abuse and violence against women and girls (VAWG) strategies, with a particular focus on families and children must be an urgent priority.
Unfortunately, as the Marmot Review 10 Years On [4] reminds us, the fabric from which this new approach must be fashioned is not nearly robust enough. And more specifically, we know that mobilising a response to domestic abuse challenges is especially difficult due to under-funding, system-wide approaches still being developed (evidence suggests that a co-ordinated response which encompasses health, social care, housing, education and criminal justice is likely to be more effective) [5] and the lack of refuges and safe spaces.
In our view, this issue needs a two-fold approach: national government needs to review policy, legal requirements and practice guidance to ensure that ongoing social distancing requirements and other coronavirus pressures do not become an excuse for inaction. At the same time, local areas must rapidly understand changes in demand and examine ways of re-prioritising service delivery, support and enforcement in this space: local commissioners and providers must collaborate in the creation of an urgent, flexible strategy and delivery plan.
This local response needs to work really creatively: the conditions in which it is operating are likely to include:
The new approach needs capacity to work quickly and respond to increased crises. It also needs to urgently prioritise pro-active family support services which have capacity to prevent situations escalating to crisis point and overwhelming the system. Finally, as there is a need to act on the basis of limited evidence, a nimble approach to testing-and-learning will have to become the new normal. In this environment, rapid evaluation, responsive feedback loops and practical implementation of the results will be key.
There is no doubt this is difficult. But perhaps recognised urgency provides an opportunity. The extent of the crisis could enable key partners to take stock, rapidly adopt proven ways of working, and innovate.
Lucy Asquith and Hannah Nickson are Senior Consultants at Cordis Bright. We have a strong track record of supporting the Home Office, Police and Crime Commissioners, police forces, and local authority areas with strategy and evaluation in the field of domestic abuse and VAWG. This includes previous experience of strategic needs assessments, reviews of specific interventions, and evaluations of whole system approaches, innovative whole-family support, and perpetrator programmes. The ideas in this blog have been drawn from those experiences. We are really interested to hear others’ views: sharing ideas and solutions seems more important than ever. Please get in touch with your thoughts so that we can create and share stronger resources and ideas for the sector at lucyasquith@cordisbright.co.uk and hannahnickson@cordisbright.co.uk.
And if you are looking for support with a revised strategy, evaluation or learning approach, we’d be really interested to discuss further. We have been talking to clients about a number of activities, including:
Sources:
[4] http://www.instituteofhealthequity.org/resources-reports/marmot-review-10-years-on
[5] https://www.cordisbright.co.uk/news/post.php?s=domestic-abuse-a-whole-system-approach
CAMHS stress-test 2020
July 2020
This document presents an analysis of trends in Child and Adolescent Mental Health Services (CAMHS) in England. It presents a national picture and then examines how these trends vary by local area. Clinical Commissioning Groups (CCGs) are often experiencing different pressures to the national average: we aggregate 19 indicators to identify those which we think are experiencing the most pressures.
The purpose of these stress-tests is to provide new insight by analysing existing publicly-available datasets in new and different ways. The CAMHS stress-test has proved particularly difficult to design because the data that is available is relatively limited, there is often a lack of consistent reporting periods, and indicators do not cover all aspects of provision that we would have liked. In places we have had to combine datasets in atypical ways to create proxy indicators which give a flavour of potential trends in the system. We have drawn any conclusions carefully and tried to be fully transparent in the slides and references in the calculations that have been undertaken. We hope that, despite these ‘health warnings’, the analysis is helpful for local planning purposes – both now and into the future when we expect Covid-19 to have significant impacts on the mental health and wellbeing of children and young people.
If this analysis raises questions for your local CCG or local authority then Cordis Bright can help in the following ways:
Our team draws upon the expertise of people who have previous experience within children and young people’s mental health as well as children’s services more generally. If you would like to discuss any of these options further then please contact Colin Horswell on colinhorswell@cordisbright.co.uk.
The Immigration Bill, Covid-19 & the social care workforce
July 2020
When the government announced its plans for a new points-based immigration system in February 2020, it was met with varying levels of concern and dismay from experts and employers across industries. On 30 June 2020 The Immigration and Social Security Co-ordination (EU Withdrawal) Bill comfortably passed its latest hurdle in the House of Commons by 342 votes to 248 and will now be sent to the House of Lords.
In the new system, prospective migrants will be assigned points based on skills, qualifications and job prospects, as well as other compulsory conditions such as a required level of English, a confirmed job offer and a job at an appropriate skills level. Despite advice from the Migration Advisory Committee that previous attempts to introduce a points-based immigration system in the UK had proved “ineffective and overly complex”[1], this move has been offered by the Home Secretary as a way of opening up the UK “to the brightest and best from around the world.”[2]
As the bill continues its passage through parliament, we’ve been considering how these new measures might impact the social care sector, including the supply of EU workers, how skilled the workforce is and what role the Covid-19 pandemic will play.
Social care’s dependence on immigration
The social care sector has been very reliant on a migrant workforce. A recent analysis of the social care workforce by Skills for Care reported that 8% of the social care workforce, or 115,000 jobs, are EU nationals (with a further 9% of workers coming from outside the EU).
At the same time, the care sector has experienced an increase in demand for labour, with an estimated 122,000 unfilled vacancies in adult social care (7.8% of total positions).[3]
Nowhere is this reliance on health and social care workers illustrated more strongly than the current coronavirus crisis; the Home Secretary recently announced that free visa extensions will be granted to “crucial overseas health and care workers” to continue to wage the fight against the virus over the coming months.[4]
So, how might The Immigration and Social Security Co-ordination (EU Withdrawal) Bill affect the social care workforce?
One consequence might be the levels of skills in the care workforce. One of the bill’s stated aims includes driving up the level of skill among the workforce. However, the impact of the bill may be counterproductive to this aim.
A 2015 study by Independent Age showed that migrant care workers are significantly more likely to be high skilled (having a qualification equivalent to level 4 or above), compared to their UK-born counterparts. Given that 69% of current EU migrants working in health and social work would have been ineligible to migrate under the new proposed system[5], a statistic that has been acknowledged by the government[6], will this supposed effort to upskill the sector actually result in the opposite effect – pushing a cohort that are more likely to be skilled out of the workforce?
Reactions from the sector to the proposed new system have been overwhelmingly negative, with experts across adult social care calling the move an “absolute disaster,”[7] one that “looks set to make our social care crisis even worse,”[8] and an immigration policy that will lead to a “vacancy black hole”.[9] Threaded through these responses is a clear message that the sector needs fewer barriers to recruitment, not more, and that “arbitrary salary thresholds” will do little to enable the social care sector to retain the number of staff needed to meet its needs.[10] The proposed changes to the immigration system will only serve to worsen these “deep-rooted problems within the care sector”.[11]
The future of social care
So what is next for the social care sector in the face of this challenge? As the bill travels through the Lords, it could be subject to a number of changes, including suggestions such as a separate migration stream for the recruitment of social care workers[12], or the designation of these positions as “shortage occupations”[13].
However, it is likely that the bill will be substantively the same when it returns to the House of Commons, so providers of adult social care will need to think about what they can do for themselves. In Independent Age’s report they identify the importance of making social work an attractive option for UK workers, through better working conditions and more appropriate levels of pay.
As Covid-19 continues to wreak havoc with the economy, social care will not face such stiff competition from the retail and leisure sector, which are already cutting jobs. Care workers have also perhaps never been held in such high esteem, given their heroic efforts during this crisis. It seems that this immigration bill will mean it is necessary for care providers to take advantage of these conditions to recruit more home-grown workers. The question is whether this will be enough to fill the gap left by the outstanding contribution of EU-workers that will no longer be able to seek work in the UK?
Sources
[1] Migration Advisory Committee, January 2020, ‘A Points-Based System and Salary Thresholds for Immigration’.
[2] House of Commons, February 2020, ‘Points-based Immigration System’.
[3] Skills for Care, October 2019, ‘The state of the adult social care sector and workforce in England’.
[4] Home Office, April 2020, ‘Home Secretary announces visa extensions for frontline health and care workers’.
[5] IPPR, February 2020, ‘Immigration plans analysis: Two thirds of current EU migrants in health and care sector would have been found ineligible’.
[6] Home Office, February 2020, ‘Home Secretary announces new UK points-based immigration system’.
[7] UNISON, February 2020, ‘Immigration plans ‘spell disaster for care sector’, says UNISON’.
[8] The Health Foundation, February 2020, ‘New points-based immigration system looks set to make our social care crisis even worse’.
[9] GMB Union, March 2020, .Care system risks 460,000 vacancy black hole thanks to immigration policy’.
[10] Social Care Today, February 2020, ‘New immigration system ‘won’t meet population’s health and care needs’’.
[11] NHS Providers, February 2020, ‘New immigration system will be difficult pill to swallow for social care’.
[12] Macmillan Cancer Support, February 2020, ‘Macmillan responds to government plans to move to a points-based immigration system’.
[13] Nursing Times, February 2020, ‘New social care warnings as government confirms immigration plans’.