MCA briefing: impact of Covid-19 on public services

Yesterday, I joined an online briefing session facilitated by the Management Consultancies Association (MCA) on the impact of Covid-19. I spoke about the impact on the health and local government sectors, and share an expanded overview of my thoughts here.

The good news is that there is some good news, so I will start with that. As a result of this crisis, we have already seen significant improvements to ways of working, particularly in the level of integration between health and social care. The rapid removal of organisational, professional and financial barriers to joint working means that change that had been blocked for years has been delivered in weeks.

Public services are in many cases now working together as one system to support the vulnerable, for example by sharing data across departments and agencies. This has enabled more holistic risk stratification to be undertaken than ever previously achieved, which is especially important while schools are closed, because children at risk are not being identified. Nearly all rough sleepers have been taken off the streets into safe accommodation, showing the scale of achievement possible when central government, councils, charities and businesses all work towards a common goal.

Another huge change is that the demand profile in public services has transformed, almost overnight:

• New demand has been created. Local government has had to respond to new demand quickly, and was able to move impressively quickly to shift their focus onto those most vulnerable and at risk.
• Other demand has been deferred. As reported last month, child protection referrals have plummeted by more than 50% in some areas of England. Referrals are usually made by teachers and health professionals, but with schools closed and children confined at home this has been interrupted.
• Demand in some areas has decreased. There has been a substantial reduction in the number of A&E visits, with over 600,000 fewer people attending A&E last month, a drop of 29% compared to the same time last year. While some of this demand may end up re-entering the system (as the chance to make early interventions has been lost), a reduction in the overreliance on A&E will hopefully continue.

Working across organisational boundaries has in many cases paid clear dividends in terms of our ability to protect many of our most vulnerable citizens. Where this has not happened – in the case of the tragic impacts of Covid-19 in care homes – it is a graphic illustration of the negative effects of siloed thinking about public services. Nonetheless I am hopeful that the government can embed the learning from integrated working when looking at future funding arrangements. Shared funding across health and social care will absolutely lead to better outcomes.

My colleagues and I have had lots of conversations with service leaders and Chief Executives about the opportunities provided by the pandemic to improve public services. One positive we have seen is the substantial increase in the volunteer workforce; their involvement must be embedded in recovery and continue as a lasting legacy. The pandemic has also forced improvements in the use of technology, including remote working capabilities and the introduction of virtual hubs for GP appointments. Harnessing such technology moving forwards will be essential to reforming services and managing demand.

Without a doubt, the financial repercussions of this crisis will be immense; councils’ revenue streams have taken huge hits, yet they are spending more than ever – a significant double impact. However, as system leaders start to frame the challenge as a once in a generation opportunity to ‘bounce forward’ rather than just ‘bounce back’, we must build on the lessons learnt from Covid-19 to create a stronger future for public services and our communities.