The government must clarify what will happen to the public health nursing workforce before it attempts to implement its reforms on the ground, the Royal College of Nursing has warned.
The Department of Health yesterday published details of the public health outcomes framework, the system under which the progress of local authorities will be judged after responsibility for public health is transferred to them from primary care trusts in April 2013.
The 66 indicators in the framework are grouped into four domains: improving the wider determinants of health; health improvement; health protection; and healthcare public health and preventing premature mortality.
But RCN chief executive and general secretary Peter Carter said that while the college welcomed the document it was also “acutely aware that changes have already been happening on the ground”.
He said: “There is certainly a great deal of work to be done in tackling major public health issues such as obesity, alcohol and sexual health and nurses have a key role to play in this.
“In order to achieve these goals the government needs to take its dedicated NHS staff with them, yet it appears to have completely disregarded the impact these changes will have on the workforce with many set to be transferred to local authorities without fair consultation.
“The RCN has consistently argued that trade unions should be fully engaged as stakeholders in this process and that staff retain NHS pay, terms and conditions, with access to an NHS pension,” Mr Carter warned.
“Anything less could lead to fragmentation and put people off public health as a career path. Information on the workforce strategy must be made available as soon as possible or the government risks damaging the very system it wants to improve,” he said.
Health secretary Andrew Lansley also announced on Monday that around £5.2bn would be allocated in total for public health in 2013-14.
The Department of Health confirmed to Nursing Times that around £2.2bn of the total would go to local authorities, £2.2bn to the NHS commissioning Board, £210m to Public Health England, and £620m to the Department of Health for campaigns.
Full responsibility for public health will pass from PCTs to councils from April 2013, though councils are set to receive “shadow” budget allocations for 2012-13 over coming weeks so they can start to work more closely with PCTs on planning public health services.
The £5.2bn represents the first time the government has set a figure for public health funding since a questionable £4bn estimate of current spending was first mentioned in the white paper in November 2010.
The government was strongly criticised by the Commons health committee for failing to explain how it had arrived at the £4bn estimate in October last year.
King’s Fund senior fellow on public health David Buck said the rise from the £4bn estimate to the £5.2bn figure did not mean the government was “being more generous”, rather that the new number was a “more tangible figure”.
He added that “£2.2bn divided by 150 [upper unitary councils] doesn’t look very much”.
In December 2010 the Department of Health published proposals on who would have primary responsibility for funding, commissioning and providing different public health services.
Most local public health services, including sexual health, school nursing and other services for children and young people aged five to 19, will be funded and commissioned by local authorities from their new public health budget allocation.
Other services will be commissioned by the NHS Commissioning Board. These include health visiting, the Family Nurse Partnership, immunisation, screening and public health for those in prison or custody.