Funding cliff edge risks school nurse numbers being slashed and sexual health clinic closures

NHS leaders warn of a funding cliff edge over the continued uncertainty in how the salaries of staff providing vital community services will be funded

9 March 2023

NHS leaders are raising the alarm over the continued uncertainty in how the salaries of staff providing vital community services will be funded from April.

They warn that a funding cliff edge coupled with chronic staff shortages in critical community health services, including school nursing and sexual health clinics, will leave patients continuing to face longer waits and missing out on much needed treatment. 

In a letter to the Rt.Hon. Steve Barclay, secretary of state for health and social care, the NHS Confederation and NHS Providers call for clarity over the funding mechanism for ensuring any pay rises for NHS staff agreed to by government are passed on clearly and without delay to roles including district nurses, health visitors, podiatrists, community dentists and speech and language therapists.

It warns that if the costs of meeting any nationally agreed NHS pay rise are not met centrally, community providers will have no choice but to absorb the pay rise for these staff within their own already very stretched budgets.

Community health leaders say this will have an impact on the quality of services they can deliver, and that if they are left to foot the bill, they will be forced to scale back both on patient services and staffing roles to meet the increased costs at a time when public health services are playing a vital role in helping people stay well in the community and at home.

Community providers deliver a range of vital services in their communities, and a considerable proportion of community health services are commissioned via public health budgets managed by local authorities and delivered by staff employed under NHS Agenda for Change terms and conditions contracts.

The letter warns that the mechanism for ensuring that these public health contracts properly reflect any NHS pay awards approved by the government has proved problematic over a number of years and that funding to cover commitments made by government on the pay award fails to follow a clear funding route and jeopardises the pay uplift for vital community health care staff.

In previous years there have been protracted discussions between the Department of Health and Social Care (DHSC) and NHS England about whether the funding for these pay awards should come from the NHS budget, the DHSC’s budget or the Public Health Grant to local authorities.

During the most recent negotiations, NHSE confirmed it would fund the pay award for this group of NHS staff until the end of the financial year 2022/23. However funding to deliver the pay award for NHS staff delivering local authority public health contracts has not been confirmed for the next financial year 2023/24, or for any further years.

NHS leaders are calling for an urgent commitment, at a time of significant operational pressure and with the real risk that more staff will leave the sector, to central funding for the salaries of NHS staff delivering local authority public health contracts to be delivered as a “point of principle, and as part of a lasting solution” rather than be persistently dogged by the threat of unfunded pay uplifts.

Matthew Taylor, chief executive of the NHS Confederation, said:

“Community services are absolutely essential in keeping people well at home and in their community and preventing demand on other parts of the healthcare system, but leaders are having to do the impossible, planning services with no certainty on the funding they will have available to pay their staff for any salary increases come April.

“Without action we are condemning patients, including young children, to lengthy waits and storing up problems in GP practices, A&E departments and other urgent and emergency care services that could have been dealt with earlier in the community because of service and staff cut backs.”

Saffron Cordery, deputy chief executive, NHS Providers said:

 “The future of many vital public health and community services is at stake. Providers need an end to the uncertainty and concern about government funding for staff pay rises.

 “Overstretched services already under immense pressure due to squeezed budgets, severe staff shortages and care backlogs simply can’t afford unfunded pay rises without having to cut important services which are supporting people to stay well in the community - essential to the long-term sustainability of our whole health and care system.”

Siobhan Melia, chair of the Community Network, which is hosted by the NHS Confederation and NHS Providers, added:

“Like much of the NHS, vital community services face significant staffing capacity gaps and the size of the waiting list for community services should act as an alarm call.

“Leaders’ funding concerns must be taken very seriously; we simply cannot afford to lose more valuable community staff if we are to make inroads into tackling community waiting list backlogs.”