Mary E Black: Moving public health contracts out of the NHS and over to local authorities

maryeblack copyThe problem with us Brits is that when handed the impossible to deliver we actually go ahead and do it, methodically, honestly, and with many a sincere task and finish group. Which is probably why I am still staring at the list of my novated public health contracts, which came over just before 1 April in the lift and shift exercise of taking them out of the NHS and transferring them over to the local authority where public health sits and where I now work. Despite all good efforts at the last moment they got entirely mixed up en route.

Not that the transfer route has been either short or simple. It was a major endeavour to disentangle a myriad of interwoven primary care trust contracts, dissect out the relevant public health parts, find some kind of fair formula for allocating funds to each strand and send the lot into the new receiving organizations—which for public health includes local authorities, Public Health England, clinical commissioning groups and NHS England.  

I sat on the other side of this great “lift and shift” process up until the middle of March 2013, and marveled at the lateness of the guidance, templates, and entire process involved. I arrived in my local authority a few days before the dawn of brave new world on 1 April, which passed as eventfully as the famous millennium bug (i.e. nothing dramatic happened). It took a bit longer to realize that the lift and shift process was by no means over.

I think on the NHS side there has been a dire lack of understanding of local authority processes and procedures. Even with a direct instruction that receivers must receive there were still local governance processes to complete, and not enough time or thought was given to that. This is not to blame the individuals involved. I marveled at the Herculean efforts of the transition team—I was one of them for a while and I enjoyed our team efforts to white water raft through the rapids of bureaucracy. I also appreciated the efforts of the hastily convened NHS Legacy Team, who soldiered on picking up the pieces that they could but were then disbanded in June 2013.

So where are we now out in local authorities? Still picking up the odd wheel that has fallen off and gone missing or got lost, handling all these NHS style contracts, and planning how to convert them into councilese, trying not to feel either gleeful or resentful that most but not all of the public health functions have ended up in the same place as the attached budgets (and for some of them we will never know).

Life moves on. We are now in September 2013. I think I have only one more set of checks to go through with the local CCG and then all the various legal teams will be happy and we can close this off. This time next year, or perhaps somewhat longer, we will be looking at our nice tidy spreadsheets and properly monitored contracts and will be wondering, as one does after giving birth, what all the fuss was about. But next time anyone on high gets a grand idea and decides to throw the entire health system deck in the air leaving the diligent minions to sort out the discarded cards…

… please, please DON’T.

Mary E Black is a director of public health in London. Twitter:@DrMaryBlack

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