Illustration of the building blocks of health; health professional stacking objects

Understanding the dangerous ‘false economy’ of public health cuts

Public Health England (PHE) is soon to be no more. Back in August, Health Secretary Matt Hancock swung the proverbial parliamentary axe at the organisation and abolished it in favour of a new, seemingly more centralised organisation: the National Institute for Health Protection (NIHP). The new organisation would be solely responsible for taking over the health protection agenda, managing and improving the UK’s response to Covid-19 and wider external public health threats.

As for the rest of PHE’s functions, and there were quite a number of them, they would be divided and absorbed into the wider NHS and health sector.

It was a move widely criticised at the time. The British Medical Association (BMA) questioned whether, in the midst of a pandemic which the UK Government was struggling to contain, PHE was simply a scapegoat. Restructuring wasn’t necessarily the problem; but an option was being overlooked with the NIHP to instead create a more transparent, impartial arm’s length NHS body.

Regardless of sentiments at the time though, it’s a move which is happening. The UK Government faces plenty of challenges ahead and must now create a public health system and strategy to meet its needs, with the structures and resources in place to deliver the care and services required.

Never before has the need for good public health been raised to be of such priority as has been the case since the Covid-19 pandemic emerged.

Now, both to support an effective recovery from the virus and to seize upon a societal hunger for change currently present, the Government must prioritise creating the right conditions and resources to create lasting, meaningful change.

As a recent Health Foundation report – The future of the public health system in England – explains, the transition to a new public health system needs to be managed carefully to ensure the reorganisation does not disrupt the pandemic response or lead to a weaker system in future.

Achieving that, in their view, will require:

  • A cross-government commitment to levelling up health outcomes and enabling people to live longer in good health
  • An independent body to report to Parliament on the nation’s health
  • A national function supporting the public health system
  • Strengthened local and regional infrastructure
  • As a minimum, an estimated £1bn to restore public health funding to 2015 levels, and a further £2.5bn needed to level up public health across the country
  • A further commitment to ensuring that public health funding keeps pace with the NHS with funding increases in the future

And nobody is disillusioned to the fact that a £3.5bn bill in the midst of economic pressures is not going to be an easy pill to swallow, but in keeping with the Government’s current motto that we must “build back better” it makes little sense to defer such requirements and allow costs to mount up further. It’s ripping the plaster off now, rather than letting it slowly bleed us dry.

We opted to go down this path back in August when PHE was given its notice. Simply turning back isn’t an option, and so there is instead a responsibility to continue forward and do it right for both the current and future health of our society.

If we don’t, we’ll face the consequences in the not too distant future.

As Nick Ville, Director of Membership and Policy at NHS Confederation, said: “We are clear that cuts to public health funding are a false economy, with potentially severe repercussions down the line.

“The Public Health Grant saw a £700m real terms reduction between 2014/15 and 2019/20 and this has already had major ramifications for population health and the services that help all of us to live well, including those covering sexual health, obesity and drug and alcohol services.

“[While] the Spending Review included some welcome additional funding for the NHS, the investment needed for public health wasn’t there.

“If the Government’s prevention agenda is to be taken seriously, then this must be re-evaluated in future spending rounds, so that everyone has the opportunity to live a long and healthy life, irrespective of economic status or background.”

The next few months and years could be instrumental in the future of our nation’s health. Not just in overcoming the ravages of Covid-19, but far beyond. Whether a good or bad decision initially, the abolishing of PHE has forced us to think about and re-evaluate public health; and crucially the path we wish to take with it. At the crossroads where we now stand, we have options. The prerogative is ours.

Get these key decisions right now and we could forever change health in this country for the better. But they’re not going to be easy decision and we must ensure that we do openly, transparently and with the consideration and advice of experts in this field. Covid-19 has proven clearer than anything before that health affects everything in society and these decisions cannot be viewed purely politically.

We must incorporate health in the conversations and together we can build a future for public health in the UK which is measured, sustainable and effective. But it must be done together; and absolutely not on the cheap.

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