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Government and NHS England in row over public health pay

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A row has broken out between the government and NHS England over £50m funding for pay of public heath staff employed by the NHS. 



The money is due to be paid this year for the annual pay rise promised by the government to staff in NHS public health services, like sexual health, health visiting and school nursing, Health Service Journal reports.

But both the Department of Health and Social Care and NHS England are refusing to fund it, leaving the providers of these services – mostly NHS community and mental health trusts – facing large gaps in their income.

Several of the trusts have indicated it will mean them missing their financial targets and falling into deficit, a trend the NHS is meant to be reversing in this financial year.

Ministers committed last year that the government would fund the pay rise deal they agreed for Agenda for Change staff – covering more than one million NHS staff – including for those working on public health services which are commissioned by local authorities.

In 2018-19, the DHSC gave the money to all relevant providers. But, for 2019-20, money for the uplift of NHS services was put into tariff prices and NHS England’s annual funding pot.

In an argument behind closed doors, the DHSC is saying NHS England should also fund the pay rise for public health staff. But NHS England is arguing this is not its responsibility and the government does not fund it to do so. This is estimated to be worth £50m.

HSJ understands negotiations are expected to continue on the issue. The DHSC has missed a deadline to publish its mandate which formalises its requirements of and funding for NHS England.

It leaves a standoff, with trusts uncertain whether they will receive the money and having to forecast the possibility of tipping into deficit. NHS Providers said that analysis it was due to publish soon showed a disproportionate number of community health providers were now expecting to tip into deficit.

It also follows a row earlier this year over whether commissioning of some public health services should return to NHS control, when the NHS long-term plan said the government and the NHS would consider “a stronger role for the NHS”. Many local government and public health leaders vehemently opposed this.

Several social enterprises and private providers are also affected.

Trusts believed to be short of large sums include Central and North West London Foundation Trust, Central London Community Healthcare Trust and Derbyshire Community Health Services Trust.

NHS Providers chief executive Chris Hopson said ministers had promised the Commons in March and June 2018 they would fully fund the pay deal including for NHS community services staff delivering local authority public health contracts.

“That commitment was honoured last year but this is not the case for 2019-20,” he said. “Affected trusts tell us that, for many of them, this creates a significant financial risk and will often mean the difference between being in surplus or deficit.

“National NHS system leaders couldn’t have been clearer that the priority for 2019-20 is to reduce the provider sector deficit and maximise the number of providers in financial surplus. Yet failure to meet this commitment is forcing an important group of NHS providers into unnecessary financial deficit.

“This is particularly unfortunate given that we estimate the cost of solving the issue is between £45m and £55m, a tiny fraction of the overall NHS budget of £121bn.”

Matthew Winn, chief executive of Cambridgeshire Community Services Trust and chair of the Community Network, linked the issue to the annual reductions in funding for public health services in recent years. He added: “We must treat local authority commissioned health services exactly the same as NHS England funded health services.”

A DHSC spokesman said: “We are aware of the timing pressures, and hope to be able to communicate specific arrangements as soon as possible. The Agenda for Change deal included funding for eligible organisations who deliver public health services commissioned by local authorities, and this funding will be made available to the system.”

NHS England did not comment.

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