Services commentary - analysis of the trends

Last year’s Monitoring poverty and social exclusion was the first time an entire chapter was dedicated to services. The justification for this was the important role services play in wealth redistribution, complementing the work done by taxes and welfare in reducing poverty. Therefore our approach to services has been about provision, access and outcomes. The indicators in this chapter have been chosen to reflect that.

Introduction

As well as the specific functions of services with regard to education, health, care, transport and so on, it is possible to put a monetary value on them to assess their role in redistributing income. Households at the bottom of the income distribution receive more in ‘benefits in kind’ (the non-cash benefits derived from education, healthcare, etc.) than households on average or high incomes (see graph below). This has been the trend for most of the past 15 years. Benefits in kind fell considerably for people in the bottom quintile of the income distribution in 2009, then rose again in 2010, although by this point benefits in kind received at the median were at a similar level and actually rose above the bottom quintile in 2011. Since then benefits in kind have levelled out at the bottom quintile and fallen slightly at the median, rising again for the latter in 2014.

The value of benefits in kind

Public services are currently facing overlapping challenges around demand, budget cuts and reforms designed to improve efficiency. A growing population and other demographic shifts around migration and people living longer has meant that health, education, social care and other services are experiencing shifts and often increases in demand. By considering a range of factors such as outcomes, provision, reliance on and barriers to services, this chapter seeks to highlight both improvements and pressure points.

Choice of indicators

The first two indicators look at educational under-attainment at ages 11 and 16. Educational outcomes feature prominently in the Conservative government’s rebranding of poverty. Here we consider differences by gender, ethnicity, subject and free school meal status. The chapter concludes with a map showing under-attainment of pupils at age 16 eligible for free school meals by local authority.

The third indicator shows variation by region and local area deprivation in poor performance in secondary schools. This complements the previous two indicators, by illustrating how service-related inequalities can simultaneously be expressed in terms of quality as well as outcomes.

The next two indicators look at health outcomes. The first traces how life expectancy among men and women has changed over time, and analyses shifts in health inequalities by looking at life expectancy by area deprivation. The second considers mental health, which is occupying an increasingly prominent place in public policy debates about health. The two graphs examine risk of mental ill health by gender, over time, and across the income spectrum.

Accompanying public policy debates about the future of the National Health Service is the increasing notion that social care is in crisis. The next two indicators reflect this. The two graphs on child social care look at increasing demand for care and outcomes for looked-after children. The two graphs on adult social care focus on the provision and intensity of care.

The following indicator on legal aid also reflects on the shifting relationship between supply and demand. Cuts to legal aid inevitably decrease the supply of free legal services, but cannot alone explain the accompanying fall in demand.

The final pair of graphs consider digital inclusion, increasingly important for accessing other services and predominantly market-based. The first graph shows how access to the internet and mobile phones has changed across the income distribution, while the second analyses the reasons that prevent people from accessing the internet.

Commentary

The other chapters in this report have shown that poverty is about more than just income. In addition to social security, public services exist to support people in leading a healthy, rewarding life. They also help people in times of acute need, as a step towards recovery from, say, illness or a debt problem. Yet the picture for public service finances over the next five years appears bleak. As a recent IFS report remarks of the current government’s deficit reduction plans: ‘Two years of overall spending being cut by 1 per cent a year, followed by a year in which overall spending is frozen, quickly becomes a 5.4 per cent a year cut, for three years, for a swathe of public services’.[1]

This comes at a time when some services, such as social care and parts of the NHS, are already struggling to match demand. Improving life expectancy, especially among the poorest (Indicator 44), is welcome, but a population that is living longer poses significant economic and service delivery challenges, with health and care on the front line and their paths connected. With adult social care provision declining (Indicator 47) and threatened by further local authority cuts in the Spending Review, hospital beds are already increasingly full of older people waiting for community care. Meanwhile, rising Section 47 enquiries in cases of children suffering significant harm (Indicator 46A) is suggestive both of rising demand and the claim by the NSPCC that child social services are increasingly operating as an ‘emergency service’.[2]

But demand and supply aren’t simply pulling in opposite directions: reforms designed to save money can actually appear to reduce demand. The Justice Committee found that poor implementation of legal aid reforms combined with poor measures to ensure access for marginalised and vulnerable people in part accounts for the falling uptake in civil legal aid since April 2013 (Indicator 48) and the resultant underspend.[3] The fact that claims have to initially be made by telephone in three areas of law – debt, discrimination and education – has been criticised for granting poor access to legal aid for people with mental health issues or English as a second language. The Public Law Project adds that limited awareness among potential clients can explain suppressed demand, and suggests that the gateway has acted as a barrier to access to justice.[4]

Cuts and reforms to public services have received less attention than cuts and reforms to social security but should not be ignored – public services such as legal aid, the NHS and social care help level up the disadvantages of low income. With more cuts to come, it is hard to see where savings can be made on targeted, means-tested services alone. It may be that over the course of this government, NHS and care waiting times, cuts to mainstream services – filling in potholes, maintaining outdoor spaces, collecting bins – and dissatisfaction among key service workers will elicit more public debate on the future of public services and further clarify the effect of those on low incomes.

Next up on services

More on this report

Endnotes

[1] Emmerson, C. (2015) Public service spending: more cuts to come. Institute for Fiscal Studies

[2] Jutte, S., Bentley, H., Miller, P. and Jetha, N. (2014) How safe are our children? NSPCC

[3] House of Commons Justice Committee (2015) Impact of changes to civil legal aid under Part 1 of the Legal Aid, Sentencing and Punishment of Offenders Act 2012. HMSO

[4] Hickman, D, and Oldfield, A. (2015) Keys to the gateway: an independent review of the mandatory civil legal advice gateway, pp. 75-76. Public Law Project