Anger as NHS England accused of public health 'land grab'

Jim McManus, vice president of the Association of Directors of Public Health, told LGC that reliable sources close to the process informed him that NHS England officials have been lobbying the Treasury for control of the public health grant paid to councils by questioning local government’s performance on prevention.

There has been widespread criticism from within local government of the long-term plan proposal, which said the government and the NHS will consider a “stronger role for the NHS” in commissioning public health services currently the responsibility of councils, such as sexual health, health visitors and school nurses.

Mr McManus said: “I have it from reliable sources that NHS England have said that public health in local government is not delivering, which is not true.

“This is a rather crude attempt at an NHS England land grab. It is trying to hoover up all the available cash possible; it is also a cultural thing, they do not understand services they do not run and commission.”

Mr McManus, who is director of public health at Hertfordshire County Council, insisted local government public health approaches compare favourably with those delivered by the health service.

He cited the example of the NHS national diabetes prevention programme, which he said cost more than localised council programmes and delivered less per average person who went through it, as well as problems with breast cancer screening and falling immunisation rates, which are the responsibility of the NHS.

“This is an organisation that seems to be incapable of delivering its own public health services despite not having cuts, and yet they want to take over other people’s services. It’s risible,” Mr McManus added.

ADPH is in the process of gathering evidence to show councils are performing well on public health, despite real terms cuts to the public health grant of £700m between 2014-15 and 2019-20. It will be worth £3.1bn next year. 

Public Health England chief executive Duncan Selbie insisted “the “rationale” for councils to lead on public health remains unchanged. He said the plan was referring to a joint review between local government and the NHS which would aim to achieve better joined-up working on public health.

Blackburn with Darwen Borough Council director of public health Dominic Harrison said the long-term plan’s emphasis on establishing integrated care systems across the country by 2021, while also proposing another shift in public health commissioning or provision, “seems like a clear tactical mistake”.

“We need all prevention services in places to be collaborating with a ‘one plan approach’ for the same population,” he added.

ADPH president Jeanelle de Gruchy, who is director of public health at Tameside Metropolitan Borough Council, said the “compelling case” for the transfer of public health services to councils is “stronger than ever”.

She called on any review of public health responsibilities to be “open and transparent” and directly involve directors of public health, who were not consulted on the long-term plan proposal.

“Ultimately this is a deeply disappointing distraction,” she said. “The focus should be on the significant additional financial resources needed for public health in local government and delivering the positive shift in the long-term plan towards prevention and health inequalities – rather than top-down reorganisations.”

Responding to Mr McManus comments in a statement provided to LGC, NHS England appeared to distance themselves from the wording of the long-term plan. 

A spokesperson said: “The long-term plan sets out concrete steps the NHS itself is taking to tackle big public health challenges like obesity, diabetes and smoking, which – as it spells out clearly and frankly – complement but are no substitute for properly resourced preventive services commissioned by councils, and their wider work on the determinants of health.”

Ruth Robertson, senior fellow, health policy at the King’s Fund, said there had been some surprise at the inclusion of the public health proposal in the plan, but added the biggest issue for public health services is funding “rather than where they sit and who commissions it”.

Responsibility for public health transferred to local government in 2013 under the Health and Social Care Act 2012. 

Ms Robertson said local government had innovated with sexual health services by, for example, creating ‘one-stop shops’ for the treatment of sexually transmitted infections and contraception.

But she added there remains fragmentation of treatment pathways in some areas due to a lack of collaboration between clinical commissioning groups, NHS trusts and councils which are responsible for commissioning different, but related, services.

“There is a feeling that the negative effects from reorganisation outweigh the benefits you might get from moving things into the NHS,” she added.

When challenged on the long-term plan’s pledge to focus on prevention at a time of ongoing reductions in the public health grant to councils during a Commons debate earlier this month, health secretary Matt Hancock insisted the grant was “being delivered well because it is being delivered by councils in concert and tied to other subjects”.

He later added: “Of course, the public health grant has to be settled as part of the spending review, but the idea that that is the whole of everything with regard to preventing ill-health is missing the point.”