A London Councils Member briefing March 2015

Transfer of 0-5 Children’s Public Health

Commissioning to Local Authorities
The duty to commission health visiting and, in some boroughs, Family Nurse
Partnership (FNP) will transfer from NHS England to local government on 1 October
2015. Member briefing No. 331 (October 2014) set out the background to the
transfer. This briefing updates members on final agreement on the financial scope
of the transfer to support the commissioning responsibility and the statutory
framework within which boroughs will be required to commission services.

Overview
Financial allocations
Under the guiding policy of ‘lift and shift’, the object of financial planning is to identify
funding within the scope of the transfer and ensure that this is sent to local government as
part of the transition.

To assist with the efficient ‘lift and shift’ of health visiting and FNP finances, in September
2014 local authorities were invited to review and sign-off a financial and workforce audit
which had been prepared by NHS England (London). This audit identified the financial and
workforce scope of the transfer, and established a strong foundation for understanding the
financial ‘nuts and bolts’ of the services due to be received by local government. The purpose
of this exercise was, in part, to gain a measure of local authority confidence in those aspects
of the transfer.

The data captured by this audit was used by the Department of Health to build draft 2015/16
baseline budgets for each local authority. Draft budgets were published by the Department of
Health in December 2014 and can be viewed here.

Local authorities were invited to respond to the Department of Health by 16 January with any
questions or comments in relation to their proposed allocation. Subsequently, the Department
of Health has responded to each borough and, where necessary, has asked for more local work
to be undertaken on issues which cannot be resolved by the Department directly.

On 13 February, the Department of Health published final local authority allocations, details
of which may be viewed here. A total of 13 local authority allocations were not finalised within
the published allocations and remain subject to ongoing work to agree final amounts. Twelve
of those local authorities were London boroughs. London Councils is supporting activity to
reach consensus on the final financial allocation. “
The Department
of Health
The overall value of the London allocation is in the region of £150 million annually, with agreed to
investment of around £20 million in Call to Action Health visitors. All allocations are half-year look at the
in 2015/16. Any adjustments to allocations for 2016/17 will need to be seen in the context evidence of
of the work which is being undertaken by ACRA, details of which are given elsewhere in this funding equity
member briefing. for the 0–5
population and,
on reflection of
Floor funding that evidence,
In preparation for the publication of draft local authority budget baselines in December, agreed that it
London Councils worked closely with the Department of Health to assess in more detail the would apply
relative funding position of health visiting in London. Analysis by London Councils suggested a minimum
that London as a whole was financially disadvantaged in comparison to its need and that within funding floor
London the share of funding across the capital created large inequities where investment in of £160 per
0–5 services had not kept pace with the changing relative need of areas. head of under
5s to all 0–5
“
The Department of Health agreed to look at the evidence of funding equity for the 0–5 allocations
population and, on reflection of that evidence, agreed that it would apply a minimum
funding floor of £160 per head of under 5s to all 0–5 allocations. This new funding floor
benefited local authorities in London and outside of London. Specifically, the following
London boroughs benefited from a financial uplift to meet the new funding floor:

• Barnet
• Bromley
• Ealing
• Enfield
• Harrow
• Havering
• Hounslow
• Merton
• Redbridge
• Richmond
• Sutton.

The application of a funding floor provided new investment to London’s 0–5 population of
around £5.4 million per annum.

Mandation
In the context of the transfer of health visiting and FNP, mandation means a public health step
prescribed in regulations as one that all councils must take. The regulations are made under
section 6C of the NHS Act 2006. Regulations were laid before Parliament in January and may
be viewed here.

The Department of Health is clear that underpinning the transfer is the belief that councils
are well placed to identify health needs and commission services for local people to improve
health. However, the Department also believes that some services need to be provided in
the context of a national, standard format, to ensure universal coverage, and hence that the
nation’s health and wellbeing overall is improved and protected - this includes some of the
Health Child Programme.
Subject to parliamentary approval, the government intends to mandate certain universal
“
Subject to
elements of the 0-5 Healthy Child Programme, namely: parliamentary
approval, the
• antenatal health promoting visits government
• new baby review intends to
• 6-8 week assessment
mandate
certain
• 1 year assessment universal
• 2-2½ review. elements
of the 0-5
Regulations contain an 18 month sunset clause, which would see the mandation demise unless a Healthy Child
future Minister decides to issue new regulations. The mandation would therefore cease in March
2017. The regulations also set out plans for a post-transfer review of progress, most likely at no
Programme “
sooner than one year but far enough in advance of the sunset clause to allow a decision to be
made and implemented in respect of any extension to the mandation.

The regulations also set out in more detail the professional qualifications and training required
by any part of the workforce which delivers a mandated check. Data showing local service
performance against the mandated checks is available from local providers and NHSE (London).

Formula for 0-5 children’s public health

The independent Advisory Committee on Resource Allocation (ACRA) has been commissioned
by the Secretary of State to make recommendations on the formula for 2016/17 local authority
public health grants, which will include a component for 0-5 children’s public health services.

ACRA is an independent advisory group consisting of GPs, public health experts, NHS
managers, local government officers and academics. ACRA makes recommendations on the
preferred, relative distribution of health resources to the Secretary of State for Health and
to NHS England, on public health and healthcare (including Clinical Commissioning Group)
allocations respectively.

There are a number of steps in setting the public health grants to local authorities for 2016/17
including:

• establishing the baseline for each local authority

• setting the preferred relative distribution of resources
• setting the total resources available
• deciding how quickly to move local authorities from their baseline position towards the
level of resources implied by the preferred distribution (pace of change policy).

All local authorities have been written to on ACRA’s behalf to seek views on initial proposals
on the methodology for the 0-5 component. As the 0–5 component is a new area of the public
health grant, ACRA is keen to receive early feedback on its emerging thinking to help the
further development of the formula during the year.

ACRA makes independent recommendations on the preferred, relative distribution of

resources, which is also referred to as the target formula or fair shares formula. This is an
assessment of relative need between different parts of the country, and takes account of
relative unavoidable differences in costs. ACRA is not responsible for pace of change policy,
which is a matter for government ministers, nor the total resources available, which will be set
following the outcome of the 2015 Spending Review.

Responses to ACRA’s initial proposals for the methodology for the 0-5 children’s component
should have been submitted by 27 March.
Commentary
To date, a significant amount of transfer planning has related to more mechanistic matters
such as the financial value of services and mandation regulations. These are undoubtedly
points of central importance to local authorities in terms of the ability to begin developing
local commissioning intentions. In that respect, the Department of Health’s recognition of
the funding inequities in the system is welcome, not least as it will bring vital new investment
to services for children in London.

However, while the application of a funding floor was an important step in recognising the
relative disadvantaged position of the London system, it remains important for London to look
to the ACRA process to secure a fairer share for children in the capital. Engagement with ACRA
now and post-election is important, but in terms of what gains can be achieved through ACRA,
so is the 2015 Spending Review which will be shaped greatly by the outcomes of elections in May.

The power to transform children’s lives at the earliest stage is obviously an essential driver for
maximising the opportunities presented by the transfer of health visiting and FNP. The member
briefing published in October 2014 described some of those early intervention opportunities
and the system benefits of getting it right early. The coming 6 months, to the point of transfer,
are an important stage for local authority commissioners to begin the process of local planning,
but the realisation of those benefits are unlikely to emerge until a number of years down the
line when borough strategies are embedded. While there remains a debate to be had to secure
a better deal for London, individual boroughs will need to start from a position of how best to
plan in the current financial climate for the long-term needs of their communities and to make
investment decisions in a way which will buttress local strategies.

Transition planning is now moving into consideration of the transformation opportunities.

Between May and October, London Councils will be working with Public Health England and
NHSE London to convene a series of workshops for local authority commissioners in order
that a forum is established which can set the foundations to realise the transformational
opportunities. These workshops will cover a wide range of issues from an exploration of the
Healthy Child Programme, to performance and outcome measures and the health and care
commissioning inter-dependencies across the 0–19 years pathway. Dates will be circulated to
local authority Public Health and Children’s Services leads in the near future.

Author: Clive Grimshaw, Programme Manager: 0-5 Commissioning Transfer (T: 020 7934 9793)
Click here to send a comment or query to the author

Links:
Transfer of 0-5 children’s public health commissioning to local authorities baseline
agreement exercise
Transfer of 0-5 children’s public health commissioning to local authorities allocations
for 2015/16
NHS Act 2006 Draft regulations

This member briefing has been circulated to:

Portfolio holders and those members who requested policy briefings in the following
categories: Children and Young People, Health

London Councils, 591/2 Southwark Street, London SE1 0AL www.londoncouncils.gov.uk