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Can cash-strapped councils be trusted with public health nursing?

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Earlier this month, I received a phone call from a school nurse in Slough, who explained to me that she was concerned about the imminent transfer of her service’s contract to a private provider.

The running of the area’s 0-19 service will be transferred from Berkshire Healthcare NHS Foundation Trust later this year, following a decision by Slough Borough Council to award the contract to a firm called Solutions 4 Health (S4H).

“The firm involved in the takeover had no real experience in children’s care”

This is, of course, not the first time I have received a call about a service takeover. Nursing Times has run many stories over the years about community service contracts being moved from the NHS to the private sector or social enterprise schemes. It’s something that inevitably upsets staff and creates uncertainty.

But what made me realise that this case was unusual was when the nurse told me that the firm involved in the takeover had no real experience in children’s care, its previous expertise lying mostly in the areas of smoking cessation and weight loss management.

One of my team looked into the situation further and last Tuesday we exclusively revealed the concerns of the 60 to 70 school nurses and health visitors who are affected. They described themselves as being in “shock” and that the move risked “dismantling” all the service’s good work.

The story was subsequently picked up by BBC Radio Berkshire and I was interviewed on Thursday morning about it, including being asked why I thought the council had chosen the provider they had. 

This was a good question. Although the council won’t reveal the details of the contract, it is hard to get past thinking it was really just down to the money on offer.

As we know, local authorities are under the cosh financially – lest we forget they had £200m stripped from their public health budgets in the same year they were handed commissioning for much of the sector from the NHS.

Nursing Times has written numerous stories over the past two years about public health services being restructured or cut-back by cash-strapped councils trying to live within their meagre means.

At the same time, workforce figures have shown that the number of health visitors and school nurses in the NHS in England is falling dramatically – which is not only concerning but also a real shame given the former health visitor implementation plan to boost staff numbers by 4,200 over five years.

“Having watched the public health sector closely, all I feel is concern”

Being flippant, you could argue that, based on the firm’s experience, at least the children in Slough are less likely to be obese or take up smoking. But having watched the public health sector closely for the last five years, all I feel is concern.

Despite the council’s protestations that its contract was awarded after a “rigorous procurement process”, it’s unclear who else bid for the service and I’ve heard second hand that Berkshire Health didn’t think they could continue to run the service with the money on offer.

So, I am left thinking: is Slough the thin end of the wedge and setting a precedent for similar contracts being awarded to recipients that it could be argued lack sufficient pedigree?

Gone are the heady days of 2015 when councils and public health directors looked forward to the return of the sector to local authority control – its spiritual home, as I heard it described. We seem to have entered a period of the lowest bidder gets the prize, regardless of whether they are the best candidate.

The losers unfortunately in all of this are likely to be the children that rely on the specialist nursing services provided by health visitors and school nurses, who may find themselves less well supported and spread more thinly. 

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