Public health nurses face being denied NHS pay rises

A funding shortfall could result in health visitors, school nurses adn others leaving because they do not receive pay rises agreed in the NHS deal

A funding shortfall could result in health visitors, school nurses and others leaving because they do not receive pay rises agreed in the NHS deal

Picture: iStock

Nurses, health visitors, midwives and other nursing staff employed by the NHS on national terms and conditions suffered from years of pay awards that were below the inflation rate.

Now NHS nursing staff in England, Scotland and Wales are receiving pay rises and changes to incremental progression as part of a three-year deal. But what about health visitors, school nurses and other nursing staff providing public health services funded beyond the NHS?

Nursing staff make a recognised and valuable contribution to public health. Improving the public’s health and prevention of ill health remain a key focus for the government agenda. Changes to the way public health services are funded, commissioned and delivered pose real challenges now, and for the future workforce.

Transfer of responsibility

In 2013, responsibility for public health, including school nursing, transferred from the NHS to local authorities in England, making it different from the other UK countries.

The final responsibility for all children’s public health services, including health visiting, transferred in October 2015. Since then, local authorities have been able to decide whether to deliver these services themselves or contract out services.

In some areas the contracts are delivered by NHS trusts, in other areas it may be the local authority or an independent organisation employing its own staff.

Staff employed by NHS trusts should be on national NHS terms and conditions, including pay rates. This includes health visitors, school nurses and other public health nurses employed by NHS trusts.

Terms and conditions

Nursing staff employed by local authorities or other independent organisations may have protected terms and conditions – and pay – due to a transfer of employment under protection of employment regulations that came into force in 2006, known as the TUPE (transfer of undertakings) regulations.

Usually protection is frozen at the point of transfer and does not include future pay awards or improvements. If staff are not on TUPE-protected conditions, their pay will be determined by their own employer, either the local authority or the independent company.

If local authorities or independent companies value their staff they will need to keep pace with NHS pay, terms and conditions. But is it as simple as that?

Where is the funding?

Where do these organisations get the funding to pay the staff delivering these services? Questions are now being raised about how NHS trusts will be able to afford the increases for NHS staff delivering public health services commissioned by local authorities.

For 2018-19, the first year of the NHS pay deal, NHS trusts received additional government funding to support the implementation of the deal. Some other organisations that were fully matching the NHS Agenda for Change also received funding for implementing the NHS pay deal.

Increases in the NHS tariff (contract rates for delivering NHS services) are due to cover the increases for years two and three. These NHS tariffs are not available to local authorities. There is no additional funding to cover local authorities’ public health responsibility.

Local authority contracts

The Local Government Association says funding for public health has fallen by £531 million in cash terms in the same period. As a result, local authority contracts for delivering public health, health visiting and school nursing will see little if any increase.

The association says overall local authority funding from central government has fallen by 77% between 2015-16 and 2019-20.

What hope have nursing staff in these organisations of receiving pay rises? By the normal terms of business and market forces, the answer would be little or none. However, the employing organisations know that their staff are the ones who deliver the service. They also know that they need to keep these highly skilled staff. But who is going to pay for them?

Fair funding = fair pay

Sufficient additional funding must be made available to reverse the cuts to local authority budgets overall. Specifically, there must be improvements to public health funding to allow for appropriate delivery of public health services.

Fair improvements in funding would mean there could be fair pay for the public health nursing workforce, whether they are employed by the NHS or not.

If this does not happen, local authorities and other organisations employing the highly skilled public health nursing workforce will inevitably face the prospect of staff leaving.

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Helen Donovan is RCN professional lead for public health; and Brian Morton is RCN national officer

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