£200m cuts to public health could threaten NHS contracts

The in-year cuts to public health budgets are going ahead as planned despite opposition from councils and practitioners, the government has confirmed, meaning that some contracts with the NHS could have to be re-examined.

A long-awaited consultation on how the savings should be applied was unveiled on Friday (31 July), asking councils to suggest how the cuts should be implemented. It suggests either a flat rate of 6.2% applied to all or varied percentages based on different circumstances that would still add up to £200m.

Core responsibility for public health shifted from the NHS and primary care trusts back to local government under the Health and Social Care Act, with Public Health England (PHE) meant to support councils in encouraging healthier lifestyles and reducing the large health inequalities across England, especially in life expectancy.

The in-year cuts announced on 4 June are part of a wider government action on deficit reduction and would apply to 2015-16 health grants to local authorities.

Yet they 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 the cuts are also required by law, including tackling alcohol and drug misuse, smoking and obesity, as well as generally promoting a healthier lifestyle.

Cllr Lisa Mulherin, Leeds City Council executive member for health and wellbeing, said the affected services are “vital to improving the long-term health of people in Leeds and every other community”.

She added: “Just as we were starting to see the benefits of targeted public health work in Leeds, with a narrowing gap between 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.”

The LGA also opposed the in-year savings already coming on top “of a year-on-year real terms reduction in public health budgets”.

Chair of the association’s community wellbeing board, Cllr Izzi Seccombe, said: “Giving councils the ability to make a real impact to the health of local people was a positive step, but local government can only continue its important work such as reducing smoking or excessive drinking and tackling obesity if we are adequately resourced to do so.

“With further reductions in public spending expected next year we need to move away from a focus of treating sickness to actively promoting health and wellbeing. Cutting public health budgets is not the solution.”

Duncan Selbie, chief executive of Public Health England, said in June that local government has made “significant progress” in improving the public’s health and added: “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.”

When he originally announced the public health cuts (referred to by the Treasury as ‘Department of Health non NHS’), the chancellor, George Osborne, said the government was “getting on with what we promised”. He said: “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.”

BMA public health medicine committee chair Iain Kennedy said when the cuts were announced: “Investment in public health is already under pressure as local authorities use funding intended for public health services to cover cuts to other budgets. Yet the government has announced it is to cut another 7.4% from the supposedly ‘ring-fenced’ public health grant, potentially leaving services and staffing levels gutted and unable to cope with rising need."

The £200m cut is equivalent to the total public health grant for the cities of Birmingham, Leeds, Liverpool and Manchester combined, he said, adding: “Further cuts will end up costing the NHS and the taxpayer more money in the long-term, and run counter to the government’s claim to support more investment in preventive health, as outlined in the Five Year Forward View. This is simply another example of crude cost-cutting at the expense of the public’s health.”


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