Joint commissioning could be the way forward for public health services including health visiting and school nursing, according to the secretary of state for health and social care.
Matt Hancock told MPs on the health and social care committee that joint commissioning of these key preventative services was “often the best way forward”.
“In many parts of the country there is now joint commissioning of those services”
His comments come after the recently-published long-term plan for the NHS in England pledged to look again at commissioning arrangements for sexual health, health visiting and school nursing – currently the responsibility of local councils.
The plan said the government would consider whether there was “a stronger role for the NHS” in commissioning these services.
The move follows concern about falling numbers of health visitor and school nurses and unmanageable caseloads.
Meanwhile, sexual health services have been struggling to cope with demand with some sexually transmitted infections on the rise.
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Mr Hancock said it was right to look again at commissioning arrangements and confirmed there were “potentially some structural changes around the boundary between public health and NHS-provided services”.
“I think it is right that the broad public health budget is held by local authorities because of the links to other local authority functions not least social care – both children’s and adult – and housing, which is very important,” he said.
However, Mr Hancock said services like sexual health and health visiting were “at the boundary” and were “actually much closer to the NHS”.
“In fact, most sexual health service money that goes through the department to local authorities then gets procured back into NHS services,” he said. “So, it does seem sensible to look at the commissioning of those services.”
However, he said this did not necessarily mean responsibility for health visiting, school nursing and sexual health returning to the NHS.
“In many parts of the country there is now joint commissioning of those services and often that’s the best way forward,” he told MPs on Monday afternoon, as part of the committee’s inquiry into the new NHS Long Term Plan.
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“Hence, instead of saying that we’d move that back inside the NHS boundary, we’re looking at the detail of how this is best commissioned,” said the health secretary.
He was asked about whether the commissioning of drug and alcohol services, which also come under local authorities’ public health remit, should be subject to the same scrutiny.
However, he said these were more closely linked to the day-to-day work of councils.
“Drug and alcohol services we think are more closely aligned with core local authority activity and so the benefits of their commissioning directly through local authorities are more clear. They are much more rarely commissioned straight back into the NHS,” he told the committee.
“This is a discussion we’re going to be having with government obviously”
During the session Mr Hancock was quizzed on the logic of cutting public health funding in 2019-20 – with a £85m in cuts announced at the end of last year – given the long-term plan’s emphasis on prevention.
He responded that funding levels had been set a while ago. “The public health budget was set in 2015 and so the changes from this year to next year are simply that playing out,” he stated.
When asked if cuts to public health funding in recent years had been a mistake, he said “it was the right the decision at the time”.
“Now the right decision is to increase focus on prevention right across the NHS budget,” he added.
Spending on public health going forward will be decided at the next spending review in the autumn and MPs were keen to know if funding levels would increase.
“This is a discussion we’re going to be having with government obviously as part of the spending review process,” said Simon Stevens, chief executive of NHS England.
“But what we have done in the long-term plan is both underline the importance of the contribution local authorities make to prevention more generally and show how the NHS will be stepping up and doing what only the NHS can do,” he said.