• Local authorities and NHS providers concerned over pay uplift funding
  • Warning that government’s promise of real growth in public health budgets at risk
  • Public health directors say they may have to cancel contracts over late allocations

Public health commissioners and providers are warning they may be tens of millions of pounds out of pocket, amid a fresh row over funding for a pay uplift. 

Council public health directors say they face no real growth in their funding in 2020-21 because of cost pressures — contrary to a government commitment in the autumn — and that they may have to cancel contracts because allocations for the next financial year are late.

It comes as health and social care secretary Matt Hancock claims “prevention” as a priority, with plans to follow up the government’s green paper on it.

Meanwhile, NHS trusts which provide public health services — mostly community and mental health trusts — are concerned they will not be funded for the Agenda for Change pay award, which is due to NHS public health staff next financial year and will cost them more than £50m in aggregate.

For 2019-20, NHSE ultimately agreed to fund the pay rise for these staff, following a row with the Department of Health and Social Care, and similar concerns from providers. However, NHSE’s planning guidance for 2020-21, published last week, said it must be paid by local authorities next year, as the “non-recurrent funding provided [by NHSE] in 2019-20… will not be repeated”. Funding for non-NHS providers of the services is also uncertain.

Cost pressures and ‘unacceptable delay’

Association of Directors of Public Health president, Jeanelle de Gruchy, told HSJ: “These, and other cost pressures, mean the promised real terms increase in public health funding is not looking so real on the ground.”

Ms de Gruchy, also director of public health for Tameside, said the “unacceptable delay” to allocations meant “contracts cannot be signed off for key services” and added: “The government has yet to confirm funding for the additional pressures councils are facing, including [AfC] uplifts and the routine commissioning of [HIV pre-exposure prophylaxis].”

She said it was “crucial that local authorities — and indeed private companies — who provide public health services are reimbursed for the full costs of [AfC] uplifts”.

Central London Community Healthcare Trust chief executive Andrew Ridley, who is chair of the Community Network, told HSJ: “Next year is the third year of the NHS Agenda for Change pay increase which the government promised to fund in full.

“Providers of NHS services now commissioned by local authorities therefore face significant increases in costs for NHS staff delivering NHS service such as sexual health clinics and children’s services such as health visiting.

“It’s essential that councils receive significant increases in the public health grant so they can pass these funds to providers and ensure the commitments to fully fund the national AfC pay deal are honoured.”

‘A real nervousness’

NHS Providers chief Chris Hopson said: “Among providers of the services there is a real nervousness this will not get funded for their staff.

“Local authorities may understandably not wish to open up contract values, one or two years into a multiyear contract. There are also other pressures on local authority services which people feel any uplift to the public health grant will absorb… 

“We cannot treat NHS staff as second class citizens simply because the services they work for are funded from a different budget line.”

A DHSC spokeswoman said: “We have already confirmed that the public health grant will increase in real terms in 2020-21 so local authorities can continue to invest in prevention and essential frontline health services — individual allocations will be confirmed shortly.”

The DHSC said it would clarify the treatment of AfC costs when it issues allocations, and said these did not have to wait until the overall government budget in early March.