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Transferring public health nursing services ‘may not boost prevention’

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Transferring the commissioning of key public health services, such as health visiting and school nursing, back to the NHS may not be the solution to ensuring better preventative care, according to a leading health commentator.

The warning comes after the government said it would look again at the commissioning arrangements for health visiting, school nursing and sexual health – currently the responsibility of local authorities.

Under the NHS Long Term Plan, the government has said it will consider giving the health service more say in commissioning clinical public health services given the direct impact they have on demand for NHS care.

The move also comes amid widespread concern about falling health visitor and school nurse numbers and unmanageable caseloads while sexual health services struggle to meet demand.

Nursing organisations have suggested moving services back into the NHS could prevent them being depleted further and lead to more joined-up care.

However, Richard Murray, chief executive of the influential King’s Fund, told MPs on the Commons’ health and social care select committee that “another structural change in commissioning” may not be the answer.

“Really what you really want is the two sides to be working more closely together and to do that I think there is a case for a national target on health inequalities,” he said.

In the first of two sessions to explore the NHS long-term plan, the committee of MPs heard public health services would be a key factor in making the blueprint work, given its focus on prevention.

However, funding for public health has been subject to swingeing cuts in recent years and there were “crucial questions” about the level of spending going forward, MPs were told.

Spending on public health from 2020-21 onwards is due to be announced by the government in the next spending review.

Ian Hudspeth, chair of the Local Government Association’s Community Wellbeing Board, said it was clear there was a need to increase the public health budget.

“If public health had stayed with the NHS and had the same increase with the NHS, there would be an additional £2.4bn in the system, which would be devoted to preventative medicine,” he said.

“The problem is not so much that local government has been given them, it is that budgets were cut”

Richard Murray

However, Mr Murray said the move to local government was not necessarily the reason services had suffered.

“I understand the frustration that these services were moved into local government and then promptly started to get cut,” he said. “I would say the problem is not so much that local government has been given them, it is that budgets were cut.”

Public health services are currently funding by the public health grant allocated to local authorities and set by central government.

Public health was often one of the first casualties when money was tight including when the NHS held the purse strings, explained Mr Murray.

“You have got to remember that the budgets were cut partly because the government quite rightly identified that whenever the NHS is short of money, it cuts public health,” he noted.

He said: “It has just turned out that moving it to local government didn’t turn out to be the answer and exactly the same thing happened all over again.”

Health and Social Care Committee

Health select committee

NHS long term plan: oral evidence session to Commons’ health committee on Tuesday 15 January. Niall Dickson, chief executive of the NHS Confederation, Dr Jennifer Dixon, chief executive of the Health Foundation, Richard Murray, chief executive of the King’s Fund, Nigel Edwards, chief executive of the Nuffield Trust

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