Motion to Consider
That the Grand Committee do consider the Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) and Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) (Amendment) Regulations 2015.
Relevant document: 23rd Report from the Joint Committee on Statutory Instruments
My Lords, these regulations mandate the provision of five health and development assessments and reviews as set out in the healthy child programme. The healthy child programme for the early life stages focuses on a universal preventive service, providing families with a programme of screening, immunisation, health and development assessments and reviews, supplemented by advice around health, well-being and parenting. The assessments and reviews are to be offered to pregnant women and children from birth to age five.
These regulations also adjust the 12-month exemption period from the community right to challenge for health visiting, the Family Nurse Partnership and other child health services for reviewing the development and promoting the health and welfare of children under five years of age.
The Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) Regulations 2013 set out steps that local authorities are obliged to take in carrying out their health improvement functions and describe what they must do in the exercise of certain of the Secretary of State’s public health functions. This instrument amends those regulations by prescribing what local authorities must do to provide or secure the provision of universal health visitor reviews, thereby ensuring that certain elements of the healthy child programme are provided by all local authorities in England.
I am pleased to report that according to the most recent management information—from January 2015—published by NHS England, the number of health visitors has increased by 3,736, which is an increase of 46% since May 2010. We will know in due course exactly when the coalition’s commitment of 4,200 has been achieved, but I can say now that an enormous amount of effort, both locally and nationally, has gone into delivering the additional numbers, and those efforts continue as we speak.
It should also be noted that the latest indications show that the Government’s commitment to increase the number of Family Nurse Partnership places to 16,000 will be met. This is crucial, as family nurses deliver the five reviews these regulations aim to mandate to those families under the care of the FNP programme.
The policy document Healthy Lives, Healthy People: Update and Way Forward, published in 2011, sets out the Government’s intention to transfer responsibility and power to local government, allowing local public health services to be shaped to meet local needs. The document set out the progress made to date in developing that vision and identified those issues where further development was needed.
Subsequently, public health services for children and young people aged five to 19 and other mandated functions were transferred in April 2013. The transfer of public health services for children age nought to five was delayed until 2015 to provide NHS England with sufficient time to deliver the Government’s commitment to increase the number of health visitors and transform the service, allowing the transfer of a much improved public health service.
This Government are committed to improving the health outcomes of our children and young people so that those become among the best in the world. What happens in pregnancy and the early years of life impacts throughout the life-course. Therefore, a healthy start for all children is vital for individuals, families, local communities and, ultimately, the whole nation. Health visitors provide valuable advice and support to families and are trained to identify health and well-being concerns. We have supported the profession more than ever before to transform the service.
By introducing these regulations we intend to provide a degree of consistency within local government for the delivery of these services. I am confident that that sends a clear signal to health visitors, family nurses, local authorities and the public of the Government’s ongoing commitment to universal public health support for pregnant women, children and their families.
We have been clear that we need to avoid creating new unfunded burdens. I can confirm that the requirement on local government in this instance to make arrangements for the reviews will be no greater than at the point of transfer. The funding for local authorities will reflect that for services at the point of transfer. However, the regulations require local authorities to act with a view to continuous improvement in participation in the five mandated reviews.
Back in 2010, at the time of the publication of the White Paper Healthy Lives, Healthy People: Our Strategy for Public Health in England, the Government consulted on the funding and commissioning routes for public health services and proposed how the department might create a public health outcomes framework. Over 2,000 responses to the consultation were received from a wide spectrum of individuals and organisations.
Respondents were generally supportive of the proposal that local authorities should commission public health services for five to 19 year-olds. However, a number of respondents commented that having different commissioning routes for children’s public health services from pregnancy to the age of five, and five to 19, could lead to fragmentation. The transfer of commissioning to local authorities from 1 October 2015 and these regulations will address this, and will allow for joined-up commissioning from nought to 19 years, improving continuity for children and their families.
In the period since the formal consultation took place we have continued to work alongside our stakeholders to develop plans for the nought-to-five transfer and to draw up these regulations. We are grateful for their continued input and would like to express our gratitude in supporting us to get to where we are today.
The Government have committed to fund local authorities for their new commissioning responsibilities that will transfer to them. The exact costs of delivering the mandated reviews will vary across the country. However, the funds being transferred—£428 million for the half year from 1 October 2015—are more than sufficient to enable local authorities to deliver the mandated elements as set out in the impact analysis. However, the mandated elements are only part of the nought-to-five service transferring.
Subject to parliamentary approval, the amendments in these regulations provide that a review may be carried out of the performance of local authorities around the five mandated universal reviews. The provisions in the draft regulations confirm that these regulations will cease to have effect on 31 March 2017. However, if a future Government conclude, after considering the results of any review, that the new provisions in these regulations should continue to have effect, the regulations amended by these regulations may need to be further amended accordingly.
The second area covered by these regulations concerns the community right to challenge. The Localism Act 2011 makes provision for a community right to challenge, under which a local authority has a duty to consider expressions of interest made by voluntary and community bodies, and certain other persons, in providing or assisting in the provision of its services. In line with the original government intention to exempt health visiting and other similar child health services for children under five years for one year from the point of transfer, these regulations amend provisions in legislation for the exemption period from the community right to challenge so that it would begin from the revised date of transfer—namely, 1 October 2015—and end on 30 September 2016.
I commend these regulations to the Committee. I beg to move.
My Lords, I thank the noble Earl for his very detailed explanation of these regulations. I want to ask just a couple of questions.
First, the original plan for transferring the commissioning of services to local government from the NHS was due to start on 1 April and has now been changed to 1 October. I may have missed it in the noble Earl’s introduction, but could he explain the reason for that delay?
I turn to what is an interesting relationship between the Government and local authorities. The EM makes clear that the full scope of the healthy child programme will not be covered by the five reviews that the noble Earl referred to. Instead, it is described in the EM as providing,
“a ‘gateway’ to identify additional needs that the HCP guidance also addresses”.
The EM goes on to say that,
“Mandating only some elements of the HCP allows LAs autonomy to determine delivery of the remainder”,
and that local authorities are,
“expected to take a reasonable approach to continuous improvement in participation in the 5 mandated reviews”.
That seems to me an eminently sensible approach. I certainly understand that, if you are transferring responsibility to local government, there is no point doing so unless you allow and respect local government autonomy.
The noble Earl also referred to the report and review that have to take place before 31 March 2017. I wonder how, in the 18-month period from the start of the new provisions two years from now, his department will monitor performance in between times. Does it have any intervention powers if it feels that a local authority is not really doing what is necessary to make sure that the programmes work effectively?
Could I also ask the noble Earl about the budget? He referred to a figure that is to be transferred. The EM states that the Government are committed to fund local authorities for these new commissioning responsibilities. What happens post 31 March 2017? At some point, a decision has to be made.
Secondly, is the money being transferred as a ring-fenced budget to local authorities, or is it going to go through the DCLG vote? I am interested to know. Behind that is the question of whether the department can guarantee that the estimate it has made of the cost to local authorities is actually going to be spent by local authorities and that they will not seek to use it for other purposes. I remind the noble Earl of the tragedy of Healthwatch. As he knows, calculations were made by his department on how much should go to local Healthwatch organisations, and local government took a very big on-cost. We know from the national Healthwatch’s work that they took about 25% in the first year. Clearly, one wants to avoid that.
On the impact assessment, I must congratulate the noble Earl’s colleague Dr Dan Poulter and officials on what is a quite remarkable piece of work. I have looked at both the summary impact assessment and policy options 1 and 2, and the only answers given in the many columns are either “No”, “Unknown” or “Nul points”. I wonder whether that stemmed from uncertainty about what local authorities are actually going to do with the money.
On the community right to challenge, can I just ask the noble Earl about the 12-month exemption period now commencing from 1 October 2015? The reason for the short exemption is clear. I just want to ask the noble Earl whether he thinks that a year is long enough for the transfer to bed down.
My Lords, I am grateful to the noble Lord for his questions and comments.
The noble Lord asked me why we decided to delay the coming into force of these regulations until October, when the original intention was that it should be in April. We decided, after discussion with partners, that stability would be best served by transferring in October rather than April—the point at which the target of 4,200 health visitors was only just due to be met. It was felt that a six-month period when local authorities could reasonably prepare was prudent.
As regards the services we are mandating, as I think the noble Lord recognises, we are mandating the five universal health visitor assessments, and we will review that after 12 months if we are re-elected. This mandation is designed to support a smooth transfer to require local authorities to provide vital services that give parents and their baby the best start in life. However, it is true that a balance had to be struck. When we consulted on this, responses ranged from suggestions that all services should be mandated in all areas to respondents suggesting that none should be. In between, almost the full range of health improvement and health protection services were proposed for mandation. A number of respondents agreed with the department’s intention for the list of mandatory functions to be as short as possible to give local authorities the maximum possible freedom. We hope that we have got the balance right.
The noble Lord, Lord Hunt, asked me about monitoring. We will work with Public Health England to monitor how delivery has progressed. However, it is worth noting that the new service model has been tested in early implementer sites, and case-study material has been published. Those sites saw increases in the number of children receiving the two to two and a half year review almost double. We have launched six priorities for demonstrating success and building sustainable services, including: transition to parenthood and the early weeks; maternal mental health; breast-feeding; healthy weight, including healthy nutrition; and other measures. So there are a number of measures by which we will be able to assess the extent to which the arrangements are gaining traction in the way that we would like.
On funding, the proposed allocations for local authorities in 2015-16 are, as I mentioned, £428 million for a half year. The department is investing £36 million in a full year to pay for additional health visitors and Family Nurse Partnership places we have created, and £2 million to ensure that £15,000 per half year is available to every local authority for commissioning costs.
As with other elements of the public health grant, local authorities will be asked to report on spend in 2015. Reporting on spend will be split into two categories: spend related to mandated functions, set out in the regulations, and non-mandated spend. Local authorities are required to report spend against the sub-categories on a quarterly basis to the DCLG, which Public Health England will review on behalf of the Department of Health. Those data will be used as a means of monitoring usage, and local authorities will be required to ensure that the figures are verified and in line with the purpose set out in the grant conditions. Local authority chief executives and the director of public health will be required to return a statement confirming that.
Local authority allocations have been determined on the basis of “lift and shift”, supported by funding adjustments, including a minimum floor. That is, we have identified the scope of NHS England’s existing obligations under service specification 27 of the Section 7A agreement between the department and NHS England, and funding relating to that will provide the main basis for local authority allocations.
The noble Lord asked me about the possibility of a ring-fence. Yes, that money will form part of the public health ring-fence which we committed to for 2015-16, but of course decisions beyond that are for the next Government to make.
I think that has answered most of the noble Lord’s questions. If I have failed to do so, I will be happy to write to him.