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Threat of public health nurse cuts now becoming a reality


Council cuts to budgets for health visiting and school nursing services that are putting jobs at risk threaten to “unravel” recent national efforts to boost the workforce, it has been warned.

Local authorities took over the responsibility from the NHS for commissioning for services for all 0 to 19 year-olds in October. But since then the government has announced a string of cuts to the public health funding it provides to local councils.

“For those who have put huge amounts of effort into achieving the health visitor implementation plan, it is hugely demoralising”

Dave Munday

Last summer, it announced £200m public health in-year cuts for 2015-16, which it later confirmed would be applied evenly as a 6.2% reduction for each council.

Earlier this year, the Department of Health announced it would decrease local council public health grants by £77m in 2016-17, with additional reductions expected the year after.

Nursing Times has now learnt of several regions where authorities are cutting or reviewing the budgets for health visiting and school nursing, which are paid for out of the public health grant.

Due to proposed workforce cuts and reconfigurations, it has been claimed these services could in the future be run at “dangerous” and “unsustainable” levels.

Barnsley Council in Yorkshire will reduce its budget for health visiting and school nursing services by 17% from £5.8m to £4.8m later this year.

The local authority plans to reduce this funding by a further £0.5m, after it decided not to renew its contract for the Family Nurse Partnership programme, which supports young mothers.

However, it said this money would be “reinvested from 2017 in services for prevention and support for teenage parents and other vulnerable groups”.

“We won’t accept a service delivery model that isn’t safe or that doesn’t provide value for money”

Julia Burrows

South West Yorkshire Partnership NHS Foundation Trust, which currently holds the contract for the 0-19-year-old service, said it could not provide it at the level of funding the council now wanted. As a result, the council has agreed to take the service in-house. The decision will be formally confirmed at a cabinet meeting in May.

“We are now working hard and focussing our efforts on developing a new service delivery model that will provide an improved and integrated 0-19 service,” said Julia Burrows, director of public health at Barnsley Council.

“We know that other areas are successfully providing 0-19 services for less than we are currently spending and we won’t accept a service delivery model that isn’t safe or that doesn’t provide value for money for the families that use the service,” she added.

Sara Tonkinson, a nurse and Unite’s lead union representative for the trust, said: “We really do want to keep this service, but the trust cannot provide it safely for that money. The whole team of nurses are actually quite proud of the trust for standing up and saying ‘no, it’s too cheap, it’s not safe”.

“Of course they’re still devastated they’ll now possibly be faced with being transferred over to a service that might not be safe,” she said. “There are going to be cuts and they’re worried about redundancies, about terms and conditions.

“But overall they are worried about the kids they look after that they will not be able to spend the time with that they need to,” she added.

Meanwhile, London boroughs of Lambeth, Southwark and Bromley are reviewing their children’s services.

Guy’s and St Thomas’ NHS Foundation Trust in central London will see its funding for school nursing and health visiting services reduced in July by both Lambeth Council and Southwark Council.

It was unable to confirm by how much the funding would be cut, but said it expected to reduce its number of posts in both health visiting and school nursing.

“We are committed to seeking to achieve this in ways that will avoid the risk of redundancy through freezing vacancies and redeploying staff where necessary,” the trust said in a statement.

“Nurses are actually quite proud of the trust for standing up and saying ‘no, it’s too cheap, it’s not safe”

Sara Tonkinson

It noted there had been a “significant” increase in health visitor numbers in both boroughs in the past two years due to the previous national initiative to boost the workforce.

The Health Visitor Implementation Plan, which ran from 2011 to May 2015, expanded the workforce nationally by almost an extra 4,200 people across England. Lambeth Council is running an ongoing consultation on the future of its public health services, including health visiting.

It wants to develop the role of child support workers working alongside health visitors to provide “greater follow up to families around sleep, toileting, behaviour issues and so, to ensure health visitors have time to address complex issues”.

The consultation documents imply the council is looking at commissioning a service that sees around 20 health visitor posts removed.

“Lambeth has increased its health visitor workforce by over 50 staff since 2013 so, even with this decrease of around 20 staff, we are well staffed compared to many other boroughs,” they state.

Bromley Council has also confirmed it is reviewing the “nature and provision” of all children’s health services it commissions, including school nursing, because it believes it can “achieve better value for money as well as improved services”.

A spokesman said that it had not proposed cutting the service entirely, despite suggestions by unions that this was the case.

Social enterprise Bromley Healthcare, which currently provides the school nursing service, said: “We have been advised by the London borough of Bromley that they no longer plan to commission the current service from 2017.

“Ahead of receiving formal notification we are working closely with our staff to ensure they are fully supported at this time,” it added.

School nursing services are also being reduced in Blackpool, where the local council is cutting annual funding from £900,000 a year to £600,000 a year in 2016-17.

“It is no secret that our public health budget has been drastically cut over the last few years”

Amy Cross

Blackpool Teaching Hospitals NHS Foundation Trust, which currently provides the service, said in the future it will be run using only nurses with specialist community public health qualifications and assistant school nurses.

As a result, around 11 whole-time equivalent band 5 school nurse posts – which do not fall into these two categories – are now at risk. The service will be left with around 14 WTE staff.

Amy Cross, cabinet member for reducing health inequalities at Blackpool Council, said: “It is no secret that our public health budget has been drastically cut over the last few years.

“We have written to schools to let them know what elements of the school nursing service that we are able to continue to fund, and that there will also be the option for schools to buy in additional services directly from the school nursing service, if they so wish,” she added.



Dave Munday

Dave Munday, professional office at union Unite, which includes the Community Practitioners and Health Visitors Association, said the changes to services highlighted the direct impact of central government cuts on local councils.

“For our members, who over the last five years have put huge amounts of effort into achieving the Health Visitor Implementation Plan, it is hugely demoralising to see how quickly the government cuts are undermining and unravelling the amazing work that was achieved,” he said.

“The messages we have been giving the government is that something needs to change. Because the current situation they have created is unsustainable and it is dangerous,” he added.


Readers' comments (2)

  • michael stone

    One of the recent BMJ articles is titled:

    'The NHS’s sustainability and transformation plans: doing so much with so little'

    It starts with the line:

    'There are no easy fixes for the gap in the NHS’s finances'

    Says it all, really.

    Unsuitable or offensive? Report this comment

  • Will we ever learn? In a few years the impact will become evident and the changes to the system will be reversed - unfortunately the effects are irreversible!

    Unsuitable or offensive? Report this comment

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