• NHS England lead hits out at “relentless retendering” of health services by local authorities
  • Claire Murdoch says issue can be “corrosive” to staff and quality
  • Public health services remain under local authority control after government decision in June

NHS England’s national director for mental health has reignited the debate over local government’s stewardship of public health services by claiming “relentless retendering” is damaging integration, quality and staff morale. 

The comment by Claire Murdoch came shortly after an acute trust failed in its legal challenge to prevent a council moving sexual health services from the NHS to a charity provider.

Writing on the social networking website Twitter, Ms Murdoch said: “The relentless retendering of vital health services by LAs [local authorities] can be corrosive to integration, staff morale and quality. Eg Addiction, Sexual Health, 0-19s, HVs [health visiting], school nursing. It commodities (sic) care.”

She later retweeted a post by Teeside Hospice chief executive David Smith, which said: “Repeated, unnecessary and badly managed procurements were one of the reasons I left mental health. It’s destroying the sector, pitching providers against each other, driving down quality to lowest possible standard. Only positive is job creation for procurement people/consultants.”

Ms Murdoch has not responded to HSJ’s requests to expand on her views. 

She made the comment in the wake of the Technology and Construction Court’s decision to allow Cornwall Council to award a sexual health services contract – held by Royal Cornwall Hospitals Trust for the past six years – to sexual health charity Brook.

In her tweet, Ms Murdoch stressed she had no view on the court’s decision as she was not familiar with the case.  

Responsibility for public health services transferred to local government in 2013. In January this year, the NHS long-term plan asked whether responsibility should be transferred back. As a result, the Department of Health and Social Care set up a review.

In June, the review concluded public health budgets should stay with local authorities. It found local authorities take an “active and efficient approach” to commissioning the services. The only change was giving the NHS and local authorities joint responsibility for commissioning sexual health services.

However, NHS England responded that the status quo was only “potentially workable” and required “an end to cuts… and a guaranteed continuation of the ring-fence around the public health grant”.

Ms Murdoch’s comment was supported by Steve Shrubb, chair of the Association of Mental Health Providers and former chief executive of West London Trust.

Replying to Ms Murdoch’s tweet, Mr Shrubb said: “I agree ‘relentless retendering’ is not helpful and often has negative impact for all involved. Voluntary sector providers face this all to often.” He said his organisation was working to establish if local authorities retender more frequently than NHS commissioners.

But Jeanelle de Gruchy, president of the Association of Directors of Public Health, said councils are “too often hindered in making long-term decisions by short-term funding settlements and £850m worth of cuts to the public health grant since 2014-15”.

“The recently announced delay to the spending review in favour of a one-year spending round will add further instability.”

She said councils have seen a “significant” 13 per cent increase in the numbers of attendances at sexual health services between 2013 and 2017. 

”The focus must now be on NHS England, CCGs and local authorities working in partnership to develop and deliver integrated pathways for the good of their communities,” she added. 

Ian Huspeth, chair of the Local Government Association’s community wellbeing board, told HSJ councils have “maintained or improved 80 per cent of the public health outcomes of the nation”, including reducing smoking rates, a reduction in sexually-transmitted infections diagnoses, and a 25 per cent fall in teenage pregnancy since 2013. 

”Councils work closely with their partners, including CCGs, in commissioning public health servicse and will only recommission these services if there are significant concerns and when absolutely necessary,” he said. 

Saffron Cordery, deputy chief executive of NHS Providers, said mental health and community trusts are “disproportionately affected by regular retendering”. 

“It takes time and money to prepare bids and doesn’t provide long term security over the delivery of these essential services,” she said. “This affects how trusts plan and staff their organisations so that uncertainty will have a negative impact on the workforce.

“Some services, including sexual health services, have different commissioning and provider relationships between local authorities, trusts, CCGs and national bodies. This make it challenging to manage services effectively.”

She said there was a long-term argument for revisiting how public health services are commissioned “as we move towards integrated health and care services”. But she added: “It’s worth weighing this up against the disruption of moving services back into the NHS at a time of huge local and national change.” 

NHSE did not want to comment. 

Story updated at 9.43am on 16 August to include comment from the Association of Directors Public Health and at 11.42am on 19 August to include Local Government Association’s statement.