The thoughts that count - the best of global thought leadership (May 2021)

What will the public services we use look like in the future? The Serco Institute’s new monthly digest – ๐—ง๐—ต๐—ฒ ๐—ง๐—ต๐—ผ๐˜‚๐—ด๐—ต๐˜๐˜€ ๐—ง๐—ต๐—ฎ๐˜ ๐—–๐—ผ๐˜‚๐—ป๐˜ – pulls together some of the best thinking on public services policy from across the world.

COVID-19, vaccines & lockdowns

Counting the Cost of Australia’s Delayed Vaccine Roll-out: Part Two – The McKell Institute (Australia)

This short report projects the likely delay in the Australian borders reopening and the economic costs of this delay as a result of the country’s ‘slow’ vaccine roll-out. It finds that the country is on track to end international border closures 81 days later than originally planned and will incur an economic cost estimated at AUD$16.4 billion as a result. It is the second in a series of reports quantifying the economic cost of Australia’s “delayed vaccine roll-out”, with the first report projecting the cost of lockdowns required as a result of these delays to exceed AUD$1.4billion.

Few Unvaccinated Adults Have Talked to Their Doctors about the COVID-19 Vaccines – Urban Institute (US)

Few unvaccinated US adults had received information about the vaccines from their providers as of April 2021, despite providers being the “most trusted sources of information” on Covid-19, this survey-based study finds. The researchers argue that there is an opportunity for providers to engage with vaccine-hesitant individuals to discuss their concerns and expand take-up.

Reopening Under Uncertainty: Stress-Testing California's COVID-19 Exit Strategy – RAND Corporation (US)

Using a statistical model created by the think tank itself, researchers at Rand Corporation test different options for the releasing of COVID-19 restrictions in California. They find that successful reopening plans often start with “high initial levels of caution, meaning that policymakers were quick to lockdown before the vaccine was widely distributed”. They note that “significant caution” is still necessary and that rigidly sticking to fixed thresholds, like case or vaccination rates, to define when to unlock may not always be the best strategy.

What happened to English NHS hospital activity during the COVID-19 pandemic? – Institute for Fiscal Studies (IFS) (UK)

In this brief note, based on UK Government data, the IFS outlines the complex response by the NHS to the pandemic driven by large drops in supply for non-COVID services and demand-side responses to the pandemic. Their findings also underline “the need to increase available resources to address care backlogs and to direct resources to the people, local areas and groups that have been most affected.”

Tackling Covid-19: A case for better financial support to self-isolate – Nuffield Trust & the Resolution Foundation (UK)

Asking people with Covid-19 to self-isolate is vital to keep the pandemic under control as UK lockdown measures ease, yet only 52% of people who have symptoms isolate, according to this research. The Nuffield Trust and the Resolution Foundation argue in this paper that “financial support through schemes similar to furlough should be expanded so that workers isolating can continue to receive their full wages.”

Reaching the Vaccine Hesitant – Public Policy Forum (Canada)

As the supply and availability of vaccines continues to increase across Canada, the only limiting factor on vaccination rates will soon be the willingness of otherwise-reluctant individuals to be vaccinated. Examining data from the Media Ecosystem Observatory, Dr. Peter Loewen provides a real-time view of the vaccine hesitant in Canada. Who are these people? Where do they live? How informed are they about COVID-19?

Social care

Funding High-Quality Aged Care Services – The Australia Institute

AUD$10billion will be needed in additional Commonwealth funding if the Royal Commission into Aged Care Quality and Safety’s 148 recommendations are to be implemented, the researchers behind this analysis estimate. This report examines various options for financing this increase spending, including a 1% Medicare-style flat-rate levy.

Social Care 360 – The King’s Fund (UK)

This is report uses the latest available data (2019/20) to describe the key trends in adult social care as the Covid-19 pandemic struck and to suggest what the long-term impact of the pandemic might be. It paints quite a bleak picture of adult social care in England, with many key indicators already going in the wrong direction before COVID-19 struck.

Integrated care systems explained: making sense of systems, places and neighbourhoods – The King’s Fund (UK)

Integrated care systems (ICSs) are partnerships that bring together providers and commissioners of NHS services across a geographical area with local authorities and other local partners to collectively plan health and care services to meet the needs of their population. This report analyses what they mean for each stakeholder, why they are important, and their role in the future of healthcare.

Social care: a guide to attracting and retaining a thriving workforce – The Work Foundation (UK)

This new paper is framed as a “guide to tackle workforce challenges in adult social care”. It says that around a third of UK jobseekers are considering a career in care and that perceptions of the sector are improving; however, significant barriers still remain. Particularly, the report notes there are challenges in attracting young people to work in the sector and the lack of an overall, long-term strategy for social care, which could include a professional development framework to address ongoing skills issues.

Healthcare

Stopping the death spiral: creating a future for private health – Grattan Institute (Australia)

In this dramatically named report, the researchers argue that Australia’s private health industry urgently needs a rescue plan. With over 40% of the population having some form of private health insurance and most procedures done in private hospitals, the Government and industry need to bring in changes to ensure the sector’s ongoing viability. Its recommendation includes exposing the prostheses market to competition, a quicker turn-around for patients in hospitals and cutting the cost of “expensive surgeons”.

The role of communities in improving health – King’s Fund (UK)

This report discusses how the role of communities in improving health is increasing, and now receiving long-overdue attention in health policy and practice – the need for this focus has been underlined by experiences during the Covid-19 pandemic. 

The Doctor Might See You Now: Healthcare Rationing in the NHS Before and After the COVID-19 Pandemic – Adam Smith Institute (UK)

This paper, by Dr Robert Sutton, a junior doctor in the UK and a recent graduate of the University of Oxford Medical School, argues that the NHS is failing to meet is central goal: healthcare free at the point of use, free at the point of need.

Reformer Thoughts: 'The Biggest Health Challenges of the 2020s' – Reform (UK)

This report brings together experts from the scientific research community and health and social care sector to offer their perspectives on the biggest health challenges of the 2020s and how we can put ourselves in the best position to face them.

Affordable Care Act (US)

Covering the uninsured in the United States’ multi-payer health system – American Enterprise Institute

Although multiple, competing insurances plans provides the market incentives which define US healthcare, it can also lead to “breaks in protection”. This paper examines three reforms to ensure that the US Government can consistently “meet its obligation as an advanced economy” to “provide medical care for their entire population”: firstly, the building of a nationwide automatic enrolment system for non-group insurance; secondly, giving employers options to increase take-up by more workers; and finally compromising on Medicaid as the nation’s safety-net insurance plan.

Recovery Legislation Should Build On Affordable Care Act Improvements in Coverage for Adults Over 55 – Center on Budget and Policy Priorities (US)

Older adults have benefited most from the Affordable Care Act (ACA) as well as from health coverage improvements in the recent American Rescue Plan. This paper argues that the recovery legislation that Congress has begun crafting should solidify and extend these gains — for older adults and adults of all ages.

Continuous Eligibility Keeps People Insured and Reduces Costs – Center on Budget and Policy Priorities (US)

The ACA cut the number of uninsured US citizens nearly in half from 16% to 9%, but 29 million people remain uninsured, including about 18 million who are already eligible for Medicaid or subsidized coverage in the health insurance marketplaces. This paper argues that more must be done to achieve universal coverage, and coverage also needs to be stable, continuous, and accessible. The paper outlines how “in addition to steps that policymakers can take in recovery legislation to reduce health care costs and improve access, they can implement continuous eligibility in Medicaid, which keeps people enrolled for 12 months regardless of fluctuations in their income and reduces the likelihood that they will lose coverage due to small changes in income or administrative challenges”.

Affordable Care Act Marketplace Premiums and Participation 2021 – Urban Institute (US)

ACA Marketplace premiums at the state and rating region level are explored in this detailed and technical paper. These premiums fell for the third year in a row when aggregated to a national level, whereas premiums increased in the employer-sponsored insurance market over the same period. The paper finds that increased insurer participation in an ACA Marketplace decreases premiums. It also notes the impact of state-level policy which may directly or indirectly impacts premiums.

Economy

Seize the Moment: an economic strategy to transform the UK economy – Confederation of British Industry (UK)

This report sets out the CBI’s vision and plan to “establish a competitive, dynamic and future-focused economy in the decade ahead”. It focuses on decarbonisation, technology and innovation and global trade links, as well as encouraging inclusivity and better health outcomes in wider society.

Australia Institute Budget Wrap 2021 – The Australia Institute

The Australia Institute has convened a range of experts to analyse the country’s recent Federal Budget. Its headline analysis is that although there is investment in aged care, childcare and mental health, the necessary tax reforms have failed to be prioritised.

Budget 2021-22: The Good & the Bad – The McKell Institute (Australia)

The McKell Institute offers up its summary and analysis of the Australian Federal Budget, saying that it included “welcome” spending commitments on aged care and ECEC. However, the Institute says, “the lack of ambition around wage growth and renewable energy, cuts to aid, and unclear assumptions around international borders and vaccine rollouts are cause for concern”.

The great COVID-19 divergence: managing a sustainable and equitable recovery in the European Union – Bruegel (Europe)

This report sets out the case for policymakers to act to prevent lasting divergence within the EU and mitigate scarring from the fallout from the pandemic. The first priority should be tackling the global health emergency. Secondly, the researchers warn against premature fiscal tightening and recommend instead additional short-term support from national budgets.

Transport & infrastructure

What’s heading down the tracks? The Future of Passenger Rail in Britain – Serco Institute

In a new discussion paper, ahead of the long-awaited UK Government review of passenger rail services, this paper calls for a revolution in the sector that re-focuses policy and practice on delivering what rail-users want. Alongside an examination of new contracting models and green initiatives, the paper argues for a new relationship between government, passengers and rail operators which would see rail-users help shape services and pick who operates them through a system resembling citizens assemblies.

Megabang for megabucks: driving a harder bargain on megaprojects – Grattan Institute (Australia)

About 25% of projects cost Australian taxpayers more than the Government expected. Governments in Australia “should stop worrying about the profitability of the industry and start delivering quality services at the lowest long-term cost to the community”, the report argues. Increased competition through allowing more international companies to bid for contracts, avoiding a rush to sign contracts before elections and a more transparent tender process are all recommended as ways to drive down costs.

Defence

US military options to enhance Arctic defense – Brookings Institute (US)

More attention should be payed to the Arctic by the US military, this paper argues. It outlines how the US, as an ‘Arctic state’, has a strategic interest in the region, which is being more hotly contested, in part due to climate change. The authors propose that the U.S. military should prioritize engagement in the region through international, defense-oriented bodies like the Arctic Security Forces Roundtable, redraw geographic combatant command borders to include the Arctic region under NORTHCOM, and continue improving operational relationships with allied and partner nations through joint exercises and training.

Defence Mobilisation Planning Comparative Study: An Examination of Overseas Planning – RAND Corporation (Australia)

Australia must adapt to face a changing range of threats beyond the conventional realm of defence, the authors of this paper claim. The concept of ‘total defence’, used in countries including Sweden and Finland, should be adopted, they argue. This would see Australia pursue a policy whereby the “entire civil community was ready and prepared to mobilise in collaboration with its armed forces, utilising economic, digital, and psychological means, just as much as military, to defend against contemporary threats.” 

Reserve Forces Review 2030: Locked Potential Awaiting a Key – RUSI (UK)

The UK Government’s Reserve Forces Review 2030 accurately captures the current utility and the broad potential the Reserves can offer, RUSI researchers argue in this paper. However, unlocking that potential requires a clearer demand for Reserves from the rest of defence and a funded programme for delivery.

Counterinsurgency Afloat: The Historical Importance and Future Potential of Maritime Counterinsurgency – RUSI (UK)

This short paper highlights the historical importance of “maritime assets within counterinsurgency campaigns,” and argues that “despite the renewed emphasis on the potential for great power conflict in contemporary times, maritime counterinsurgency assets, skills and knowledge must be maintained and honed, rather than cast off to the margins of naval debate.”

Integration and anti-racism in the British Army – Chatham House (UK)

Military sociologist Anthony King considers efforts made to improve diversity and inclusion in the British Army, “an institution which to this day struggles to recruit personnel from ethnic minority backgrounds”. In this interview King speaks to Chatham House about his findings and whether a truly anti-racist military can be realized.  

Preparing Military Intelligence for Great Power Competition: Retooling the 2-Shop – RUSI (UK)

Military intelligence (MI) is critical to visions of future war. The analytical methodologies of the War on Terror have reshaped how MI teams are trained and deployed. MI personnel are increasingly specialised, with experience and judgement being replaced by rigid adherence to robust data-driven analytical methodologies. While these methods are likely to continue at higher echelons, the author of this paper argues that a large MI presence at the tactical edge will not be practical under the indirect fire threat on the future battlefield.

Leadership Challenges from the Deployment of Lethal Autonomous Weapon Systems: How Erosion of Human Supervision Over Lethal Engagement Will Impact How Commanders Exercise Leadership – RUSI (UK)

Lethal autonomous weapon systems (LAWS) – robotic weapons that have the ability to sense and act unilaterally depending on how they are programmed – will be capable of selecting targets and delivering lethality without any human interaction. This article considers the behavioural and leadership challenges that arise from the deployment of such weapons and how unsupervised engagements might “degrade the commander’s craft”.

Defence in a Competitive Age: Implications for Land – RUSI (UK)

The greatest alterations in direction announced in the UK Government’s Defence Command Paper are in the land domain, so claims this paper. The new types of brigades, their roles and capabilities are explored in this technical briefing.

EU Foreign, Security and Defence Policy Co-Operation with Neighbours: Mapping Diversity – Centre for European Reform

When the European Union speaks and acts on foreign, security and defence policy issues, the effectiveness and legitimacy of what it does is increased if other countries, particularly its neighbours, align themselves with the 27 member-states, according to this report. At least, that is the theory. This policy brief focuses on how EU co-operation works in practice, given that there is no single model for how the EU co-operates with its neighbours in foreign, security and defence policy, and the level of co-operation varies greatly.

Skills & work

Public Sector Apprenticeship: Improving Work for Governments and Residents – Urban Institute (US)

Public sector apprenticeships are a “powerful and underutilized tool for workforce and economic development”, researchers at the Urban Institute claim. This new fact-sheet from the think tank provides an overview of public sector apprenticeships in the US and highlights examples of three public sector programs which show the variety of available opportunities.

Online Career and Technical Education Programs during the Pandemic and After – Urban Institute (US)

Examining postsecondary career and technical education (CTE) in the US – training below baccalaureate degree level – researchers at the Urban Institute find that new ways of delivering training have become embedded as a result of the pandemic. They find that many programs that require in-person training are expected to move to a hybrid format – combining online and in person content delivery – after the COVID crisis. Challenges associated with online programming include technology access and the need for digital skills training and virtual work-based learning options, and opportunities include the ability to flexibly reach students in new ways.

New Working Arrangements – Public Policy Forum (Canada)

Tele-working has increased in Canada during the pandemic and it looks set to be a popular option for workers following the crisis. This report examines how some of the educational, economic, and technical inequalities that have been a barrier for some workers will allow homeworking to be an option for Canadians post-pandemic.

Technology

Algorithmic Transparency in the Public Sector – Reform (UK)

This event-write up brings together the ideas generated at Reform and Imperial College London’s The Forum, policy hackathon. It explores how confidence in the use of algorithm assisted decision making can be established – a concept which the authors argue “will be crucial in allaying fears about the dangers of so-called ‘government by algorithm’, the idea that algorithms are increasing displacing human decision making in harmful ways”.

Digital Public Services: What's Next? – Reform (UK)

“The challenges that arose with service delivery during COVID-19 – from lockdown and remote working to increased demand – further cemented the benefits of having the right digital infrastructure in place”. This report makes recommendations aimed at enhancing the UK Government’s digital capabilities.

Justice

Online Dispute Resolution: Perspectives to Support Successful Implementation and Outcomes in Court Proceedings – RAND Corporation (US)

In this summary of a collaboration between the US National Institute of Justice and the RAND Corporation, the use of online dispute resolution (ODR) as a forum for court matters to be resolved through a public-facing digital space as opposed to through in-person court proceedings is explored. The researchers find that ODR can be a tool for replicating in-person court processes and could remove access-to-justice barriers, but requires more consistent guidance relating to its use.

Parents and Prisons – Institute for Family Studies (US)

This summary of a forthcoming study claims that, contrary to received wisdom, parental incarceration actually reduces children's propensity to be incarcerated and improves their “adult neighborhood quality”, while having no significant effect on their academic performance. In fact, it finds that parental incarceration was linked to a 20% reduction in a child's likelihood of being charged, a 22% cut in chance of being convicted, and a 40% reduction in the chance of being incarcerated before age 25.

Immigration

Criminal Immigrants in Texas in 2019: Illegal Immigrant Conviction Rates and Arrest Rates for Homicide, Sex Crimes, Larceny, and Other Crimes – Cato Institute (US)

This technical ‘policy brief’ seeks to inform the debate around crime and immigration. Using publicly available data it finds in Texas in 2019, illegal immigrants were 37.1% less likely to be convicted of a crime than nativeโ€โ€‹born Americans and legal immigrants were about 57.2% less likely to be convicted of a crime than nativeโ€โ€‹born Americans.

Pandemic population change across metro America: Accelerated migration, less immigration, fewer births and more deaths – Brookings Institute (US)

How has Covid-19 impacted population changes across the US? Alongside examining domestic trends – which show people generally moved away from metropolitan areas to suburbs – this paper identifies a “marked downturn in immigration to the U.S. from abroad”. It argues that predicting post-pandemic populations shifts – including immigration – has become increasingly difficult.

‘New Plan for Immigration’ Consultation Response: Identifying and supporting victims of Modern Slavery and Human Trafficking – The Centre for Social Justice (UK)

On the 24 March 2021, the UK Government’s Home Office issued a consultation document New Plan for Immigration which aims to reform the asylum system in the UK. The Modern Slavery Policy Unit at the Centre for Social Justice submitted a response to the public consultation which seeks to answer the questions related to identifying and supporting modern slavery and human trafficking. The response broadly welcomed the Government’s commitment to Modern Slavery, but explained that further refinement is needed.

New Plan for Immigration: We need to talk about Albania – Social Market Foundation (UK)

This briefing argues that by failing to engage with either the public’s scepticism of asylum seekers, or the “problem” of what to do about failed asylum applicants, the refugee rights sector has “ceded the ground to the UK Government”, and that the New Plan for Immigration is largely the result. The briefing considers Albanian migration to the UK as a microcosm of the blurred lines and complexities the UK’s asylum system has to deal with.

Immigration and the Success of Canada’s Post-Pandemic Economy – Public Policy Forum (Canada)

Immigration is an important part of Canada’s economic growth - especially in terms of sustaining the labour market. However, immigrants have been disproportionately impacted by a “decimated hospitality and service sectors due to recurring pandemic lockdowns”, according to this analysis. As such, researchers at Canada’s Public Policy Forum say there are several steps the country needs to take to fix this problem, and doing so will benefit not just immigrants but the nation’s economy as well.

Government

Government Reimagined: A Handbook for Reform – Policy Exchange (UK)

This extensive and comprehensive report examines the structures of the UK Government and its relationship with devolved and local administrations. The product of a commission set-up by the think tank made up of senior political, civil service, diplomatic and military figures, the report covers a vast area of issues, including: skills in the civil service, frequency of ministerial reshuffles, the structure of central government and the use of data.   

Decision-Making in Uncertain Times – The King’s Fund (UK)

How do leaders approach decision-making when the challenges they face seem so intractable and the context so uncertain? Thinking clearly, acting wisely, and staying healthy must be goals for anyone leading anything at the moment, but complex and uncertain times can make these goals hugely challenging to realise. This article addresses this contact with reference to the problem-solving typology developed by Sholom Glouberman and Brenda Zimmerman, which emerged from their work on reform in the Canadian health care system.

Taking back control of subsidies: Replacing EU state aid rules in the UK – Institute for Government (UK)

As the government prepares to unveil legislation for a UK state aid (or subsidy control) regime – which will regulate around £8bn of subsidies from governments and public bodies to businesses each year – this report sets out how to design a more flexible system than the EU’s to help achieve the UK Government’s objectives like ‘levelling up’ and ‘net zero’.

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