– A new contract is needed from next year
By Graham Smith
Public health nursing in Cornwall – long seen as a cornerstone of preventing serious ill-health through timely intervention – could be about to undergo a radical shake-up.
More than 4,000 new mothers and their babies benefit from the service in Cornwall each year. Nearly 10,000 under 5s benefit from the school nursing service.
Officials at Cornwall Council, who currently commission public health nursing from the National Health Service, are now considering a new contract which could result in a multi-million pound deal for Richard Branson’s Virgin corporation.
Public health nursing was traditionally provided direct from the NHS until 2013, when the government transferred responsibility to County Hall. There was little Parliamentary scrutiny and the transfer of power from NHS to local government was carried out by ministerial use of a Statutory Instrument, inserted into the 2012 Health and Social Care Act by the then Conservative-Liberal Democrat coalition government.
Cornwall Council maintained the £10 million/year contract with the Cornwall Partnership NHS Foundation Trust, but recently imposed a £410,000 budget cut for next year – something which CPFT said would make the service unsafe. The Lib Dem-led council blamed central government for the cut.
Cornwall’s public health nursing contract has one year left to run. Councillors have been told they now have three options:
- To extend the current contract with CPFT
- To undertake a full competitive tendering exercise, opening the door to companies such as Virgin
- To combine public health nursing with the council’s own, soon-to-be-outsourced, children’s services department – effectively bringing the nursing function inside County Hall, albeit through an arm’s-length private company
A report to councillors outlines what the public health nursing service provides. It is “a unique service that offers universal health promotion, screening, guidance, information and development review for every child and to every mother. This offer is in fulfilment of the local authority obligations in the delivery of the Healthy Child Programme.
“Health visiting and school nursing services are based on four levels of intervention: Community, Universal services, Universal Plus (short-term early/additional help), Universal Partnership Plus (long-term multidisciplinary support, for example with social disadvantage, illness/disability, safeguarding).
“School nurses offer targeted interventions and safeguarding support to children and young people of school age in a number of settings including school, home, GP and clinic settings. They support the transition of children into and between schools, mitigating the effect of identified health needs and enabling children and young people to maximise their opportunity for access to education as well as fundamental support for emotional and mental health.
“School nurses also deliver the national childhood measurement programme which weighs and measures approximately 10,000 children in Reception and Year 6 every year.”
The report warns that ultimately there is a relationship between quality and cash, and that further budget cuts pose a risk to breastfeeding rates: “At the initial transfer of the contract from NHS England the health visitor workforce had been built up to 113 health visitors through initiatives to increase the qualified workforce.
“Due to flat cash offer at contract renewal for the last 2 years and now a reduction in the contract value, the significant gains in staffing are being lost with the provider carrying approximately 21 vacancies. This threatens the ability to meet mandated targets or support community initiatives. UNICEF accreditation for Breast Feeding friendly status which has seen the improvement of breast feeding rates may also be at risk.”
Officials fear that if the council simply extends its current CPFT contract, and despite some potential for budget savings, it risks exposure to legal challenge. Virgin has not hesitated to litigate against what the company sees as “unfair competition” and is aggressively seeking to expand its interests across a range of UK healthcare services.
Virgin already holds a similar contract with Devon County Council and according to Health Services Journal is preparing a massive £260 million bid for a further seven year deal. Virgin Care runs several similar services around the UK, apparently at a loss, but across the whole Virgin Group Holdings pays no tax in the UK.The officials add that a full procurement exercise allows for a fundamental contract renegotiation, but warns that “further innovation or service change beyond the initial specification can be difficult in long term contracts without additional costs. There is also significant cost of the re-procurement process.”
Bringing nursing “in-house” to the proposed arms’-length new company offers flexibility and sensible integration with other children’s services, say the officials, but also warns that the initial set-up costs could be high.
Councillors must now embark upon an options appraisal exercise in time for a new contract in only 12 months. There will be a series of scrutiny and cabinet meetings. But the fear of a legal challenge from companies such as Virgin is already front-of-mind at County Hall: “A robust decision making process is essential to mitigate the risk of legal challenge,” says the report. “ A properly structured options appraisal will support good governance and decision making. The Council is subject to the Public Contracts Regulations 2015 and will need to ensure that any decision in respect of the future of this service takes into account legal and procurement advice.”
The officials acknowledge that their choices are limited. “Recent soft market testing in the South West region has demonstrated that there are a range of potential providers of PHN from the Public, Private and Voluntary and Community Sectors,” they say. “However, the soft market test undertaken in Cornwall during the re-tendering of PHN in 2015 showed a very limited market in Cornwall with only the incumbent and one other provider.”
The council’s children’s and families services scrutiny committee is due to consider options for the first time at a meeting on Wednesday (14th March.)