HC 1048-III Health CommitteeFurther written evidence from the Royal College of Nursing (PH 128A)

Following the Government’s response to the NHS Future Forum Report, the Royal College of Nursing (RCN) has issued this further submission to the Health Select Committee.

Public Health England

The RCN was pleased to see that the NHS Future Forum had listened to concerns raised by the RCN in regard to the independence of Public Health England (PHE), as originally proposed in the Public Health White Paper and legislated for by the Health and Social Care Bill. The RCN sees the establishment of PHE as an executive agency and Non-Departmental Public Body, as a positive move. However, we await the full details and extent to which PHE will be independent. The RCN also awaits further detail on the structure, governance and funding arrangements of PHE.

85% of the public health workforce will transfer in to PHE on NHS terms and conditions with access to the NHS pension scheme. RCN members have been clear that they do not want to be involved in compulsory transfers to Local Authorities. The RCN is yet to see formal proposals in relation to the employment of PHE staff, but we would argue strongly that PHE should employ staff on NHS pay, terms and conditions and that all staff should continue to have access to the NHS pension scheme. To introduce any other pay, terms and conditions package would create a barrier to future staff retention and employment and could potentially lead to equal pay claims.

At this time of financial constraint across the public sector, the RCN is concerned that although public health funding has been ring fenced, responsibility for allocation of that budget has moved to the Local Authorities. Local Authorities’ budgets are facing a reduction by 25% over the next four years. There is a real risk of this budget being squeezed and services outside of the remit of public health being funded out of this budget. This must be guarded against with greater detail of how ring fencing this budget will happen in practice.

Transfer of Functions and Workforce to Local Authorities

As public health commissioning responsibility shifts from the NHS to Local Authorities, the RCN has concerns with how the transfer of staff between employers is managed.

There are ongoing discussions about the transfer of functions and staff from the NHS to Local Authorities, yet it has not been made clear which public health professionals will be involved. The RCN is clear that regardless of the scope or nature of the transfer, there should be parity across the profession and equality of treatment of the public health workforce. Developing a two-tier workforce or multi-tier transfer process would be detrimental to the success of these teams.

The success of public health is that the workforce is a multi-professional team of doctors, nurses and other professionals with public health qualifications. The move to Local Authority responsibility for public health should not undermine the success and effective working of these multi-professional teams.

RCN members working in public health are clear that they value more effective and closer working relationships with Local Authorities. However, they do have some serious concerns and reservations about the impact these changes will have on their employment status, pensions, pay, terms and conditions, career and professional development.

NHS pension, pay, terms and conditions and NHS employment are vital tools for the recruitment and retention of highly skilled and qualified professionals. Retaining NHS employment supports effective professional training, development and flexible movement of staff across the sector. Transferring staff to Local Authorities, and the loss of access to a national pay, terms and conditions package and the NHS pension scheme, will create a barrier to staff movement and career development and will have a detrimental impact on the future development and skills of the public health workforce.

The RCN believes that there are a range of employment models, which are currently being used to support integrated working within public health, and that these should be promoted as good practice. The RCN believes that these employment models offer Local Authorities, the NHS and public health staff the opportunity to work in an integrated way, while removing professional and career barriers for public health staff. The RCN would want to have the opportunity to explore and promote these models further with the NHS and Local Authorities.

Public Health Observatories

The RCN, in its original submission to the Health Select Committee inquiry on public health, stated its support for the vital role that Public Health Observatories (PHOs) carry out. PHOs are able to present national and local statistics which provide valuable information as the basis for public health policy and strategy. Without this sound information it would be more difficult to formulate effective policy and improve health outcomes. As such the RCN welcomed the recognition that the Government’s response to the NHS Future Forum gives to PHOs but would like to see more information as to how the merger of PHOs and the National Treatment Agency will work in practice.

July 2011

Prepared 28th November 2011