In Opinion

Follow this topic

Bookmark

Record learning outcomes

Public health commissioning is becoming a farce, with all the professional expertise out there in danger of being replaced... by an app, says an exasperated Andrew McCoig, chief executive officer of Merton, Sutton & Wandsworth and Croydon LPCs.

Back in 2015, George Osborne (the then Chancellor of the Exchequer) announced that while he was protecting the €NHS spend€ on health, he would not extend that protection to the public health budgets of local authorities. Consequently, he determined that £200m would be removed from those budget allocations across England and Wales. This equates to an average sum of £1.15m per local authority.

Faced with such a draconian and peremptory financial blow, public health departments have had to drastically rethink how they spend their shrinking pots of money.

The first reaction that directly affected commissioning, and by default the relationship with providers of commissioned services, was to lay off staff and invite voluntary redundancies.

My experience in South West London is that the primary care workforce and traditional providers of public health commissioned services have not been involved in any discussions about how to meet this challenge. We have become the erstwhile subjects, some may say victims, of the decisions made by accountants and others behind closed doors. The policy appears to be simple: if it is expensive €“ cut it.

These unknown people appear to have decided that they can address all the access problems and meet public health needs by designing user-friendly websites that will spread the messages about weight, diet, smoking and exercise.

Hard-to-reach populations and the vulnerable, their reasoning goes, can be persuaded to use their iPads, laptops and smart phones to access messages about their lifestyle choices. Better still, some really snappy downloadable apps will increase their exposure to all the stuff they need to hear and act upon.

As for the primary care professionals, with all that training and accreditation, who have been doing the job for decades: far too expensive €“ class dismissed.

At the last health and wellbeing board meeting I attended, I managed to start a fight back against this thinking. Luckily, the majority there saw this policy as the emperor's new clothes and were not convinced by the paper-thin evidence to support the direction of travel under the financial constraints.

None had any objection to a website but nobody was convinced that it should replace those face-to-face encounters in GP surgeries, community pharmacies and other health settings.

As a result, there has been a stepping back from the brink and we are now entering discussions that should have taken place last year, just after Mr Osborne made his announcement.

How is that dynamic?

In tandem with all this turmoil in commissioning, Croydon Council decided last year to introduce a new procurement system for primary care contracting with the snappy name of a 'dynamic purchasing system'. Believe me, there's nothing dynamic about it whatsoever.

Your training, qualifications and experience in providing all the commissioned services to-date could count for nought. There was a tortuous online portal to get to grips with in order to fill out and submit a lengthy questionnaire to determine your suitability to continue.

The system was designed to see how well you could complete a lengthy tender exercise, not how well you could deliver a service or for how long you had delivered that service.

Contractors were wrestling for days on end with the software system provided without proper support or help from the council. This part of the exercise had been subcontracted out to an IT company who resolutely remained distant from any kind of telephone helpline style of support. All in all, it appeared to be a clumsy way of 'culling' some experienced providers across the borough.

After some major protestations and pleas for common sense, it appears that some rational thought may be in progress and discussions are now opening on this issue as well.

All current contracts have been extended to March 2017 pending the outcome of what will hopefully be some agreed sensible way forward.

The lesson from all this? When you have a problem, open out the discussions with all those who have an interest immediately. It is called a stakeholder meeting. It is not new and it is one of the best ways to tackle a problem involving many interested parties. Let us hope that councils learn this quickly if they are to remain the custodians of public health.

It now appears that some rational thought may be going on