Patients at risk as cash-strapped councils outsource services in middle of pandemic, warn NHS bosses

Nurses and essential healthcare staff could be left redundant in the middle of the pandemic as local authorities look to make changes to healthcare contracts that would leave patients facing major disruption, NHS bosses have warned.

NHS Providers, which represents all NHS trusts, and NHS Confederation, which represents health and care organisations, said that the decision to put contracts for public health services out to tender as workers battle coronavirus in the community is “completely inappropriate” and a “damaging distraction”, creating uncertainty for those who have spent the past six months on the Covid-19 frontline.

Labour warned that the move by cash-strapped councils was “risky” and would undermine preparations for a potential second wave of coronavirus.

Many NHS trusts and foundation trusts across England deliver community health service contracts that are commissioned by local authorities. These include public health services, such as home visits and school nursing, and some mental health services.

Since the beginning of the pandemic, several have started the retendering process for their community health contracts, The Independent has been told, raising the prospect that these services could be placed into the hands of private providers.

The London boroughs of Waltham Forest, Enfield, Redbridge and Hackney are collectively seeking tenders for the provision of supported living services for people with a range of learning, physical and sensory disabilities. The contract, worth up to £170m, was first put up to tender on 12 August.

Cambridgeshire County Council is currently seeking suppliers for six community health-related contracts, varying from supported living services for disabled adults to home care. Three of these were put up to tender during the pandemic. The contracts are worth between £40m and £550m.

One trust in the southwest reported that its local authority has signalled they will retender all the trust’s community mental health services, while in London, another trust claims that two boroughs have indicated they will put its community health services out to tender.

Shadow health minister Jonathan Ashworth told The Independent: “This process is disruptive and wasteful at the best of times, but to be doing this mid-pandemic is risky, unnecessary and undermines the ability of frontline health workers to focus not only on preparations for a potential second wave, but a whole host of other health issues, such as Covid rehabilitation, community mental health services and children’s health, all of which are now urgent priorities.”

He said this was not a criticism of local councils, arguing that years of government cuts have left these authorities “under pressure” and short of viable cost-saving options.

In a joint statement, Chris Hopson and Niall Dickson, chief executives of NHS Providers and NHS Confederation, called for a pause on retendering NHS community services contracts until the end of 2021-22, to allow services and staff the time they need to recover from the pandemic.

“More and more community providers face the damaging distraction of local authorities retendering their services in the midst of a global pandemic,” they told The Independent.

“We understand that ministers’ attention has been elsewhere, but they must step in urgently to prevent yet more cuts to community and public health services, which would have damaging consequences for patients, the risk of redundancies for staff whose skills and commitment we need now more than ever, and would result in additional pressures on other parts of the NHS.”

”Of course we understand the pressure that local authorities are under to make savings and balance their books, but to do so at the expense of providing much-needed care in the community is simply dangerous.”

Budget cuts under the Conservatives have squeezed public health funding in recent years, forcing local authorities to strip back and downsize crucial services in order to balance their books.

The coronavirus pandemic has exacerbated this funding shortfall. According to analysis from the Local Government Association, councils are facing extra cost pressures worth £7.4bn.

Trust leaders are now worried that the trend of competitive retendering, which critics say often amounts to a cost-saving exercise and sacrifices the quality of service on offer, is likely to persist in the months to come and become more widespread.

“Now more than ever we need to keep people well outside of the walls of our hospitals,” Mr Hopson and Mr Dickson added.

“Community providers are planning for what looks likely to be a very difficult winter and the possibility of a second surge of Covid-19.

“Our incredible workforce only has finite resources of time and energy, which should be directed at tackling the pandemic and caring for patients rather than diverted into a lengthy competitive tender process.

“What’s more, this competitive retendering does not reflect the spirit of collaborative working during the pandemic.”

The Community Network, established by NHS Providers and NHS Confederation to support trusts and not-for-profit organisations providing NHS community health services, wrote to health secretary Matt Hancock on 29 June warning ministers of the consequences of retendering services during the pandemic. The group has yet to receive a response.

David Rowland, director of the Centre for Health and the Public Interest, said the “issue of retendering is a relevant issue”.

“It does cause disruption,” he told The Independent. “But throughout the pandemic, a lot of the procurement rules have been suspended, so you haven’t had to go through competitive tendering.

“You can award contracts or re-award contracts because we’re in emergency circumstances. That’s problematic from a transparency point of view, it’s problematic from a value for money point of view.”

A Government spokesperson said: “Councils are responsible for commissioning community health contracts and they will take into account a wide range of issues including the ongoing pandemic to ensure they best meet the needs of their local communities.”