Agenda item

From April 2013 there is a statutory transfer of public health functions to local authorities. A ring-fenced grant will be received to discharge the new responsibilities, and staff carrying out these functions will transfer into the local authorities from the PCTs.

The recommendations in the report attached as Appendix A were agreed by the Cabinet at its meeting on 15 October 2012.

Dr Melanie Smith presented the report in respect of the statutory transfer of public health functions to local authorities from April 2013.  The Cabinets of the three boroughs (Hammersmith & Fulham, Kensington & Chelsea and Westminster) had agreed the establishment  of a single tri-borough public health service, with the retention of individual borough sovereignty in relation to public health decision making and priorities, and with Westminster City Council as the lead authority.

Dr Smith stated that, during 2013/14, it was planned to focus on maximising the opportunities of an in-house public health function. Staff and contract liabilities would transfer into the local authorities from the PCTs. The transfer of staff from the PCT to Councils was a TUPE-like PCT owned process. The new organisational structure would be in place prior to transfer.

A register of all contract liabilities had been completed by the PCT. The three councils had procured an external forensic examination of the number and values of contracts to provide assurance as to which contracts and their values would transfer to the councils.

A ring-fenced grant would be received. However, on the basis of prudent financial planning assumptions at this point, it was believed that there would be a funding shortfall of £6.2 million, of which  £2.8 million had been  identified to Hammersmith & Fulham. There had been an unfavourable movement since the paper was written due to the identification of an additional cost of £300,000 to adult social care, and a decision to plan on the basis of no inflationary uplift.

Councillor Coleman queried the options to meet the funding gap. Dr Smith responded that the planned tri-borough structure achieved10 – 15% efficiencies and there was scope for savings in the contract portfolio. Displaced staff would be supported through the NHS redeployment pool, but it was possible that there might be  compulsory redundancies.

Councillor Craig queried the funding shortfall for a full year. Dr Smith responded that the allocation would be based on historic spend and, for the three boroughs, was above the national average. However, historic spend was over capitation for public health, and there was an issue in respect of whether the borough would continue to receive growth money. There were concerns in respect of sexual health funding as this was an open access services, and demand was increasing each year.

Prior to the forensic audit, contracts worth £53 million had been split approximately equally between NHS and external contracts. Most external contracts would have been negotiated locally and inflationary uplifts would be unusual. The key NHS contracts would be CLCH and genitourinary medicine with the larger trusts, and these would contain inflationary uplifts. The three councils would be responsible for any shortfall; the worse case scenario was £6.2 million.

Dr Smith stated that the biggest concern was in respect of the increase in activity generally.

Councillor Carlebach noted the indisputable value of the Community Champions.

Councillor Vaughan queried the accountability of the new structure and the portfolios of the Deputy Directors of Public Health. Dr Smith responded that the three boroughs would share responsibility for the service. Employees would work across the three borough, but would be based at Westminster City Council, with formal accountability up to the Chief Executive, Westminster City Council. The arrangements would mirror those in place for Adult Social Care and Children’s services, where there were regular formal meetings between Cabinet Members and officers before individual borough sign off.

Dr Smith stated that, whist the contracts within individual portfolios were of different values, there were significant areas for transition with different amounts of discretion, for example there was little flexibility in NHS contracts, whereas there was scope for innovation in external contracts. The three Deputy Directors of Public Health would lead teams with portfolios of:

·         Health intelligence and advice across the range of local authority functions;

·         Children and young people, healthy weight, mental health protection and promotion; and

·         Adults, sexual health, behaviour change and health protection.

The teams would provide support and advice to Clinical Commissioning Groups (CCG) . In addition, there would be a business support function, which would consider opportunities for savings in back office costs.

Councillor Vaughan queried the interaction with the Health & Wellbeing Board. Dr Smith responded that this would be included in the work with the CCG. There would be  a two way relationship between the local authorities and CCGs, which could hold each other to account for delivery of services.

Dr Smith responded to a query from the Chairman that staff would mostly be existing employees, and that an induction programme would address the range of training needs for both PCT and local authority employees, for example PCT staff were not experienced in working in a  political environment.

The Chairman queried the legal expertise in contracts. Dr Smith responded that Public Health would look to Adult Social Care and Family and Children’s services for support in negotiation and management of contracts, and invoice verification, rather than attempt to replicate these services.

In conclusion, Dr Smith stated that the intention was to ‘lift and shift; services and then add value. The transition was scheduled for completion by February, and thereafter or slightly before the focus of Public Health would move to adding value.

RECOMMENDED THAT:

1. The report be noted.

2. An update report be provided to the April meeting.