24.08.15
Spending review will be government’s public health ‘litmus test’ – think tank
The upcoming Spending Review on 25 November will be a “litmus test” of whether the government is committed to investing in public health and prevention, a report by the King’s Fund has said.
Despite public health bulletins featuring “prominently” in the NHS Five Year Forward View – which outlines that a “radical upgrade” of prevention is needed to safeguard the sustainability of the NHS, the country’s economic prosperity and the population’s health – the government has done little in the way of it so far.
“To date, this narrative has been accompanied by little in the way of tangible policy initiatives, with the government’s only notable intervention being to rule out a tax on sugar when this was suggested by a junior health minister,” the report said.
It described George Osborne’s decision to cut public health budgets by £200m as a “worrying signal” that public health may face further cuts in November.
Earlier this month, councils spoke out against the cuts after a consultation on how they should be applied, saying they made “no economic sense”.
They argued that the savings could force several local authorities to save on money already allocated to long-term contractual health work in the NHS and other organisations – many of which require six-month notice of changes.
Many of the services threatened by public health cuts are also required by law, including tackling alcohol and drug misuse, smoking, obesity, and generally promoting a healthier lifestyle.
At the time, Cllr Lisa Mulherin, Leeds City Council executive member for health and wellbeing, said: “Just as we were starting to see the benefits of targeted public health work in Leeds, with a narrowing gap in health between the poorest and best-off parts of the city, we are losing the opportunity to build on this and reduce future burdens on GPs, hospitals and other health and care services.
“There is an old adage that prevention is better than cure, and that is true not just for individuals but for the public purse. Withdrawing funds from prevention will see both individuals and the services they use having to spend more to cope with the long-term impact of these cuts. That just makes no economic sense.”
Cllr Izzi Seccombe, chairman of the LGA’s community wellbeing board, added that councils can only “continue its important work such as reducing smoking or excessive drinking and tackling obesity” if they are “adequately resourced”.
However Duncan Selbie, chief executive of Public Health England, assured that local government had made “significant progress” in improving public health.
He said: “Though the government’s decision is a difficult ask of them, they are best-placed to manage and prioritise resources and I am confident they will with the least possible impact.”
The consultation, which suggests applying cuts either at a flat rate of 6.2% applied to all councils or varied percentages based on different circumstances, is due to close at the end of August.
Public health budgets, which already lie outside the NHS ring-fence, will also face increased pressure as services for children aged 0-5 are transferred to councils in October – thus facing the same cuts.
When the chancellor originally announced cuts to public health (referred to by the Treasury as ‘Department of Health non NHS’), he said the government was “getting on with what we promised”.
“Reducing the deficit – that is how you deliver lasting economic security for working people. For as everyone knows, when it comes to living within your means, the sooner you start the smoother the ride,” he said.
Further analyses by the King’s Fund show that proposed changes to the consultant contract as a result of seven-day services will require additional investment “at a time when most providers are already in deficit”.
Despite the principle of weeklong services garnering “widespread support”, the think tank warned that it will also trigger difficult negotiations with the British Medical Association.
Furthermore it begs addressing practical issues that need to be fixed before Jeremy Hunt’s ultimatum, announced on 16 July, can become a reality – such as ensuring sufficient staff are available in hospitals at weekends.
Despite the principle of weeklong services garnering “widespread support”, healthcare providers must look into the challenges of ensuring enough hospital consultants and other staff are available during the weekend.
Focusing on the practical impact of the seven-day contract is also essential to expand the GP workforce in primary care, the King’s Fund has said.