Government details of how cuts to public health budgets are to be applied have created a “state of despair” among those working in prevention, with health visiting, school nursing and sexual health services all expected to be in the line of fire for savings.
Earlier this week, the Department of Health announced details of the £200m in-year cut to the public health grant it provides to local councils, which were first trailed in the summer, saying a reduction of 6.2% would be applied evenly to each authority.
“It’s going to be hard and in some places very hard”
This was despite the majority of local authorities backing alternative options in how to implement the savings.
Leading community nurse organisations warned councils in some areas had already decided to make the savings by reducing health visiting services, while others would now look to cut down on school nursing where commissioning responsibilities overlap.
Local authorities have only just become responsible for commissioning services for 0-5 years olds, taking over from NHS England at the start of October.
The chief executive of the organisation representing directors of public health at local councils told Nursing Times only a “handful” would be able to make the savings from reserves.
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Nicola Close said areas where councils were tied into big, long-term contracts that are not due for renewal would likely be forced cut their smaller nurse-led services, such as breastfeeding support, weight management and mental health.
Many councils wanted to deliver “innovative” health visiting services to show there is advantage of it sitting within the local council remits, said Ms Close, but noted this budget was not ringfenced and could be targeted.
She also warned of further cuts to public health budgets expected in the government spending review next month.
“We all regret this [£200m cut] is happening and it’s going to be hard and in some places very hard,” she said.
Dame Sarah Cowley, trustee of the Institute of Health Visiting, told Nursing Times said the “huge” and “quick” in-year cut – which will be applied in the last quarter of this financial year– could “sour” relationships between health visitors and local authority commissioners.
“We know that if we only had the five contacts it would be a very ineffective health visiting service”
“We have heard of places where health visiting services are going to be cut back,” she said. “It’s [the cut] put everyone in a state of despair really about how on earth you convince this government that it’s a silly idea to take nearly 6.5% out of the very preventative services that they are saying need to be increased for the NHS for the future.”
Local councils are now mandated to ensure every child receives at least five checks before the age of two and a half years old from a health visitor.
Dame Sarah said although this offered a degree of protection for the service, it was a “double edged sword”.
“There are places where it’s been suggested, ‘As long as we can get the five contacts we don’t need to worry about anything else’ when of course the five contacts are the absolute minimum,” she told Nursing Times.
“We know that if we only had the five contacts it would be a very ineffective health visiting service because the contacts are about identifying where the need is and then providing for that need,” she added.
Rosalind Godson, professional officer at Community Practitioners’ and Health Visitors’ Association, part of Unite, suggested local authorities would start to pull out nurses from non-statutory services and those where commissioning overlaps with NHS England.
“The work going on with the elderly and stroke clubs, exercise groups to keep the fit – all those things will be cut”
She pointed to the school immunisation programme which is commissioned by NHS England but delivered by school nurses who are employed in services commissioned by the local council.
“I could see the local authorities saying ‘not in our remit’,” she said. “Because if local authorities commission staff – ie school nurses – to be doing work paid for by NHS England they will surely want to be paid for that.”
Ms Godson also warned sexual health services could come under fire, as well as those nurse-led services for people outside of ages 0-19.
“For instance, the work going on with the elderly and stroke clubs, exercise groups to keep them fit – all those things will be cut,” she said, suggesting volunteers would be looked to as substitutes.
“I think the government is totally relying on the voluntary services doing all the work. They’ll do some in nice leafy areas where you’ve got lots of nice newly retired volunteers but you won’t get that in inner cities,” she added.
There has been widespread resistance to the cuts, including from directors of public health at local councils, NHS leaders and organisations representing community nurses, since it was annocuned in the summer.
In recent weeks, a joint letter signed by the NHS Confederation, the ADPH and others urged the Treasury to reverse the planned cuts, which it said would have a “direct impact on the NHS which will have to pick up the pieces by treating preventable ill health”.
“Applying these cuts in such a way leaves deprived areas facing a double burden and is simply going to add to the score of human misery and inequality”
Over the summer a separate letter penned by organisations including the Institute of Health Visiting, and the Community Practitioners’ and Health Visitors’ Association highlighted their “extreme” concerns, particularly around losing health visitors so soon after numbers had been boosted.
In response to the government announcement last week on how the cuts would be implemented, the Royal College of Nursing said nurses working in the most deprived and vulnerable areas would be “horrified” to hear they are being brought in.
“Applying these cuts in such a way leaves deprived areas facing a double burden and is simply going to add to the score of human misery and inequality,” said RCN chief executive and general secretary Janet Davies.
“Not only will people face preventable poor health because help and advice is not available, but families and communities are likely to be plunged into a spiral of health deprivation which becomes almost impossible to break,” she said.
Announcing the 6.2% cut, the DH said: “After considering the consultation responses, the department has decided to proceed with the savings by reducing each local authority’s grant by an equal percentage.”
“The decision on how much is spent on each public health service rests solely with individual local authorities in accordance with local population needs and priorities, and their statutory duties,” it said.
To find out how each council budget will be affected by the 2.6% cut, look at Appendix A, on page 21 of the DH grant allocations document