The on-going pandemic poses many vital questions in terms of how key public services and the economy need to adapt to a changed world. Scotland has the opportunity of comparing varying political party approaches to such essential reforms at the May 6 Scottish Parliament elections.
The election date is less than nine weeks away, with manifestos due before that. However, so far there seems to be little rush amongst Scottish political parties toaddress the issues raised by the pandemic and set out appropriate policies. This is disappointing given the urgency with which these need to be addressed.
Areas of importance
There are a significant number of economic and public sector policy areas where planning a new route will be vital in coming years. Each area will need to address:
- how to catch up on lost activity;
- how to introduce greater resilience; and
- how to settle on a ‘new normal’.
The following discussion outlines five such key areas, looks at some of the difficult and complicated questions that need to be answered, and outlines some of the ways forward that have so far been proposed.
While many of the reformative proposals already published will be relevant across the UK, it remains disappointing that much of the analysis refers principally, or only, to England and that less analysis is available with respect to Scotland and Scottish conditions. In part, this reflects the lack of properly funded think tanks operating in Scotland, a long-standing issue that has restricted the emergence of new ideas and the evaluation of existing policy.
1) How to tackle the increase in NHS waiting lists? (URGENT)
A recent paper by the Reform (UK) think tank (‘What’s next for the NHS’)estimates that, for NHS England alone, there were 6 million fewer referrals in 2020 and that, by April 2021, there will be 375,000 individuals waiting for 52 weeks or more for non-urgent procedures (compared to 1,154 at the start of the pandemic). While comparable figures are not available for Scotland, it seems likely that a similar picture exists.
Clearly, as well as continuing to provide facilities to treat COVID victims, and ensuring that hospitals do not act as conduits for contamination, NHS Scotland will need to find a way to encourage missed referrals back as well as reduce the much expanded waiting lists.
Such challenging conditions set up a series of questions that need to be answered. For example:
- How to increase capacity in order to hasten and expand activity?
- Can some form of makeshift Nightingale hospital be used and do the staffnumbers exist for them to operate?
- What operations/activities should be prioritised?
- How to avoid the emergence of some form of postcode lottery in catch upmode?
- How to best incorporate the technological advances that have been madeduring lockdown into everyday practice?
- How to measure the backlog of mental health issues that will inevitablyhave arisen during lockdown?
There are no definitive answers to these questions, however, the Reform paper outlines what seem like some sensible starting points. For example:
- building ‘diagnostic hubs’ to help meet the backlog;
- providing training modules that present easily and quickly digestible information;
- creating an NHS ‘reserve list’ of healthcare professionals prepared to rejointhe NHS to respond to a crisis;
- undertake an inventory of key assets;
- undertake a review of bed capacity in the health and care system, focused onincreasing its long term resilience;
- mandate the publication of waiting list recovery plans by board, includinguse of any independent sector capacity.
Other areas that will need to be considered include:
- the current capacity for treating mental health issues and resources needed to upscale on a temporary or permanent basis;
- improving funding of preventative measures that would help reduceconditions which worsen the impact of viruses such as obesity.
The potential cost of some of the additional work needed has been estimated in an analysis by the Health Foundation, although much more work is needed in this area.
The discussion above suggests some form of long term (10-year?) plan (as NHS England has had for some time now) emerging from a comprehensive review of how the future NHS in Scotland is to work. Even more ambitious would be a 10-year NHSCS (National Health and Social Care Service) plan, which promoted the greater integration of the two linked services on a firm timetable. (See below for further discussion of potential Social Care reforms.)
2) How to tackle the loss of education time for schoolchildren? (URGENT)
As the extent that school students have been deprived of normal schooling has increased so too have the concerns over the educational, psychological andinequality impacts. On education alone, evidence from the Netherlands shows that test scores for primary school children were significantly lower than previous cohorts.
Recent analysis of English schools by the Education Policy Institute (EPI)has found that geographic differences in school attendance will have resulted in inequalities in face-to-face schooling. Attendance rates were generally lower indeprived areas and especially low for children with special educational needs or disabilities (SEND) – all of which suggests significant targeting of extra funds is needed. The EPI study also found that the level of extra financial support offeredby governments so far is modest, relative to the scale of the problem.
Initial ideas put forward in order to regain lost ground include:
- extending the school day or year;
- repetition of whole school years;
- introducing summer schools;
- greater use of one-to-one
Each of these ideas has significant resource implications, especially in staffing terms. Some short to medium term suggestions for rapidly expanding teacher numbers include:
- attracting back ex-teachers;
- short term courses for partially qualified;
- increased teacher training course places and bursaries;
- expansion of existing initiatives, like Teach
These initiatives could complement the existing National Tutoring Programme, targeted to reach disadvantaged pupils eligible for the pupil premium.
In Scotland, the Commission on School Reform (CSR) has recently published a paper outlining its suggestions for how best to catch up for educational losses in schools.
The CSR’s principal proposal is for additional staff to oversee late afternoon catch-up sessions over two to three years, with additional funds available for disadvantaged children.
To some extent the CSR proposals mirror those outlined in the EPI paper, although the EPI work emphasises the need for far greater funding than iscurrently being proposed in order to repair the damage to students’ lost learning.
Further work is needed with regards to how credible and effective each of these options is likely to be and on the degree to which such options should be universally available or targeted on those who have lost most time and are most at risk?
Such schooling issues, equally, spill over into Higher and Further Education. For example, to what extent should the (temporary?) higher examination pass marksresult in increased access to universities and should this extra capacity beretained?
Overall, the pandemic induced chaos with regards to learning, teaching and exams may be seen as an opportunity for the widespread overhaul of currentpractices.
3) How to tackle the backlog in court cases? (URGENT)
Even before lockdown there was a backlog of scheduled trials of 18,000 in Scotland. By last September this had risen to over 30,000 and no doubt it is iseven higher now.
Already some initiatives have been introduced, such as the use of cinemas as remote ‘jury centres’, although plans to replace some criminal trials by jury with a hearing in front of a judge were abandoned due to opposition in some quarters.
Post-lockdown, how can increased capacity be accessed, what are the keyconstraints in doing so and how might they be addressed? For example:
- can some trials be replaced by judges’ hearings and/or is a reduction in jurysize acceptable? What successful alternative systems apply in other countries?
- can retired judges and ancillary staff be used?
- can alternative court sites, like the Nightingale Courts being suggested forEngland, be found or built?
In some ways, including budgetary, the legal system, including courts and prisons, is the forgotten public service. It remains to be seen how long this relative negligence can continue before negative consequences ensue.
4) How to introduce greater pandemic-related resilience into essential public services?
There have been calls for greater resilience to be built into public service operations, in order for them to cope better if another pandemic, or similar ‘catastrophic’ event, should occur.
a) How to build up of spare NHS capacity for use in times of emergency?
This could incorporate a reservoir of ‘emergency’ workers who are trained in basic procedures, with occasional updates and refresher courses.
Spare physical capacity would also be needed, in terms of mothballed venues or quick to construct Nightingale hospitals.
Alternatively, a permanent expansion of physical capacity and staffing could be introduced. This would increase the quantity and quality of medical care in normal circumstances and be available to cater for ‘core’ activities as well as emergency activities in extreme circumstances.
b) How to build an education system that is resilient in times of emergency?
Such resilience could arise by, again, incorporating a reservoir of ‘emergency’ workers who are utilised when remote learning is needed.
Physical capacity here might involve: access to computers for each school age child in a household; adequate broadband access and speed; help to ensure a ‘spare room’ for work/ schooling purposes in every household.
As well as such practical changes the education system may need to develop a new examination system that is more robust in the face of the need for ‘remote’ learning and inability to conduct traditional centralised examinations. Indeed, this may be an area that is overdue for revision at both the school and higher education levels.
c) How to reform Care Homes to better deal with times of emergency?
A review and overhaul of the Social Care system is overdue and should incorporate lessons learnt from the pandemic. Key questions for the review would include:
- how to further integrate the system with the NHS?
- who/how to pay for the reformed system?
- how to address the need for enhanced quality, wage and conditions of staff? Is there potential for wages and conditions to be associated with some social care workers being given ‘key worker’ status?
Aspects of existing Care Homes also need to be addressed, including:
- the need for appropriately updated reserves of PPE;
- the requirement for ‘secure’ visiting rooms regardless of circumstances.
5) How to introduce greater resilience into the economy?
The economy should be more geared towards resilience, and less to pure efficiency. In the event of another major event, improved resilience should result in far fewer widespread shutdowns of whole industries but how to achieve this and how to measure it?
The considerable flaws of using GDP as a measure of economic success are well known and yet its dominance remains. Other measures might include various forms of well-being indicators but, compared to GDP, such measures remain fairly vague in nature, difficult to interpret, less regular and often only available with a long time lag.
New ways of measuring economic output/value might be explored. For example, increasing the value of some under-funded public sector services like: preventative health measures; mental health services; literacy and numeracy in education. This might be done by linking them to positive externalities and known wider economic benefits.
While such a measure may prove difficult or expensive to produce in a timely way on a quarterly basis, it could be calculated as part of an ‘augmented GDP’ measure on an annual basis. Such a measure would lack international comparability but Scotland could become a world leader in introducing such an initiative, just as New Zealand introduced ‘wellbeing’ into its Budget exercise.
In the near term, when volatile GDP data is likely to be less informative and reliable, labour market data may be a more important measure of economic activity. This might involve needing to refine what best measures desirable economic involvement and activity. For example, enhanced interpretation of ‘underemployment’ (a measure popularised by David Bell and David Blanchflower in the UK) and the appropriate weighting given to students, olderworkers, parents with young children etc.
Beyond such traditional measures, the earlier discussion considers other ways we might be able to enhance the resilience of our economy. For example:
- hospital capacity, including increased emergency reserves;
- (regularly updated) emergency medical supplies;
- public health preventative provision and practices;
- mental health resources;
- reservists (teachers, nurses, police etc);
- more flexible working practices;
- more flexible/low pollution travel to work
In other fields of economic policy and support there are important questions to answer in relation to: (re)training; the future role of high streets; publictransport needs; how to improve the safety and resilience of working conditions in general; and protection/support for vulnerable industries (hospitality, recreation etc).
An area of particular interest, in terms of remaking the social contract in post-pandemic times, will be pay policy, especially with regards to key public and private sector workers (as we are seeing right now). An acceptance of on-going relatively poor pay and conditions for workers in the care sector, or even in essential retail, seems much less likely now. But the means by which this issue should be addressed remain vague as yet.
Further sources of economic change will be more for the UK Government to drive at this point in time, but a Scottish Government interest and engagement would be useful. For example:
- the appropriate fiscal & monetary policy needs (see, for example, the call for a New Fiscal Framework by Orszag, Rubin & Stiglitz;
- a heightened role for public R&D;
- arrangements to detect early warning signs for credible future threats, both health and
All of the above suggestions are a subset of policies that might usefully be implemented, and different Scottish political parties may be able to offer further examples and different views in terms of identifying and prioritising policies.
In terms of funding, rather than give precise funding figures when much remainsuncertain, it may be better to simply indicate the intended source of higher funding levels, or indeed what budgets would be cut, in order to allow for these high priority activities to be funded.
The main concern at this stage is to actively engage in the debate and to present the Scottish electorate with alternative roadmaps for necessary reform.
This is an abridged/edited version of a posting first published by Scottish Trends that has been agreed with the author
Image of Parliament House by Kim Traynor via Commons Wikimedia, CC BY-SA 3.0