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Review finds local authorities 'best placed' to lead public health

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Responsibility for commissioning key public health services such as health visiting will stay with local authorities, the government has confirmed after a review. 

However, the Department of Health and Social Care (DHSC) has told the NHS to work “much more closely” with councils on organising and delivering these services. 

“Local decision making has meant that new parents are now faced with a postcode lottery”

Cheryll Adams

Specifically, the department has suggested that the NHS looks to co-commission sexual and reproductive health services with local government.  

In January, the NHS Long Term Plan committed to revisiting the controversial decision to transfer the commissioning of public health from the NHS to local government in the wake of policy reforms in 2012. 

Councils have since struggled with systematic budget cuts from central government. 

Executive director of the Institute of Health Visiting, Dr Cheryll Adams, said the current commissioning model was “not working” for health visiting. 

She said: “Whilst in principle there is logic to public health and health visiting being commissioned by local authorities and we supported that, the past three years have demonstrated that this model hasn’t worked for health visiting.

“Local decision making has meant that new parents are now faced with a postcode lottery of the quality of health visiting services they can access, indeed even if there are still child health clinics or not as many have been closed,” she added.

Dr Adams also said: “Furthermore, there are increasing examples arising of some local authorities trying to down-band health visitors to help them cope with the public health spending reductions.”

As highly trained advanced specialist practice nurses, health visitors should always have the same terms and conditions as the NHS, as they are part of one integrated healthcare system, said Dr Adams.

Following the decision, Dr Adams has called for a set of national standards and rules to protect the profession from “further decommissioning and down-grading”. 

Cheryll Adams

Cheryll Adams

Cheryll Adams

“It is logical that a workforce, which is always revalidated to the same standards across the UK, should also be protected by government in this way,” she said.

“This would still allow for some local variation according to different population needs - differences should be based on that and not on local decision making and cuts to public health budgets as it has been,” she added.

Speaking at a lecture at the Royal Society of Medicine last week, health and social care secretary Matt Hancock said the departmental review found that local authorities took an “active and efficient approach” to commissioning services and should continue to lead on this. 

“This review recognises that local government are best placed to lead on commissioning local public health services”

Duncan Selbie

Mr Hancock said many local authorities had taken steps to improve and modernise the services they commissioned, including through digital delivery, such as online sexually transmitted infection testing. 

He also reiterated recommendations for shifting towards councils jointly working with the NHS to co-commission sexual health services.

Speaking at the Jephcott lecture, Mr Hancock said: “Day in, day out, local authorities continue to provide excellent public health services.

“Whether that’s local action to reduce HIV transmissions or experimenting with innovative ways to reach people for sexual health services – such as offering online access to testing for thousands of people,” he said.

“We are committed to supporting and encouraging joined-up commissioning of these services by local government and the NHS,” he added.

The DHSC will soon be seeking views in a forthcoming prevention green paper about how action can be taken forward.

Department of Health and Social Care

Matt Hancock

Matt Hancock

“Our prevention green paper, which we will publish soon, will give people an opportunity to let us know their views on how we achieve this and build on the excellent local practice happening across the country,” said Mr Hancock.

Chief executive of Public Health England, Duncan Selbie, said: “This review recognises that local government are best placed to lead on commissioning local public health services and the invaluable skill and expertise they bring to this.

“The best services are always those commissioned collaboratively with the NHS and this review emphasises the importance of this for every part of England, as does the NHS Long Term Plan, including making the best use of shared resources,” he said.

Public health services are currently commissioned and funded by councils after responsibility transferred from the NHS to local authorities, triggered by the Health and Social Care Act 2012.

Local authorities gained control over budgets for public health services, including school nursing for five to 19-year-olds, in April 2013. They then took over the responsibility from the NHS for commissioning for services for all 0 to 19-year-olds, including health visitors, in October 2015.

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