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Cuts to public health budgets represent ‘short-termist thinking’, warns RCN

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Nursing leaders have warned that decades of progress in public health are under threat, after a new analysis revealed spending by local authorities is set to drop by £85m this year.

The analysis of council spending plans by the King’s Fund shows total public health expenditure will drop to £3.41bn in 2017-18, a reduction of 2.4% or £85m since 2016-17 – the first time public health spending has gone down in cash terms.

“To cut spending on sexual health services is the falsest of false economies”

David Buck

Once funding for 0-5 children’s health services is removed from the equation, the impact of cuts on other vital public health service is even more stark, reveals the think-tank’s analysis of data from the Department for Communities and Local Government.

Planned spending drops to £2.52bn for 2017-18, which is on a par in cash terms with the £2.51bn spent in 2013-14.

However, King’s Fund analysts said that, once inflation is factored in, then this year’s budget is worth around 5% less in real terms than it was in 2013-14.

The figures show sexual health, smoking cessation and substance misuse services will bear the brunt of the cuts, which professional bodies have described as a “false economy” that will simply pile pressure on other parts of the health service.

The data shows councils are planning to spend more on some services, including those that promote physical activity among children and adults, and some children’s services – but most face cuts.

“Decades of progress are under threat due to this short-termist thinking”

Wendy Preston

While the lion’s share of funding will continue to go to mandatory 0-5 children’s services, including health visiting, this will reduce slightly in 2017-18, as will funding for public health programmes for children aged 5-19.

According to the King’s Fund, spending on sexual health services will drop by £30m, a 5% cut, while funding for services to cut drug misuse in adults will go down by more than £22m, a 5.5% cut. Meanwhile, stop smoking services will lose almost £16m, a 15% reduction.

One of the biggest losers in percentage terms will be sexual health promotion and prevention activities, which face cuts of more than 30%.

David Buck, senior fellow in public health and inequalities at the King’s Fund, said councils were being forced to “make difficult choices about which services they fund” due to cuts in funding from central government.

“Reducing spending on public health is short-sighted at the best of times,” he said. “But at a time when the rate of syphilis is at its highest level for 70 years, to cut spending on sexual health services is the falsest of false economies and is storing up problems for the future.”

King's Fund

Public health funding cuts ‘short-termist thinking’, warns RCN

David Buck

The Royal College of Nursing said patients were already struggling to access sexual health services that were struggling to recruit and retain staff, and funding cuts “will do nothing” to address the problem.

“Decades of progress are under threat due to this short-termist thinking,” said RCN head of nursing Wendy Preston.

“Clinics led by nurses are extremely successful at promoting sexual health, helping people to give up smoking or overcome drink and drug abuse – cutting them back is a false economy,” she noted.

“The evidence shows that investment in prevention and intervention services works for patients and gives better value to taxpayers – the removal of them piles pressure onto expensive acute and community services,” she added.

The NHS Confederation, which represents health service organisations, said cutting back public health spending stood in the way of efforts to transform care.

“The government’s whole approach to reforming health care has been based on the promise of a radical upgrade in prevention and public health, yet all we have seen is cut after cut in this budget,” said its chief executive Niall Dickson.

“Our members report direct cuts to frontline services, including the treatment of substance misuse, smoking cessation and sexual health,” he said. “Further gaps in out-of-hospital and social care funding intensifies the pressures on health services.”

Councillor Izzy Seccombe, chair of the Local Government Association’s community wellbeing board, said ministers needed to look at “prevention not cure” to deliver long-term savings and better services.

Izzi Seccombe

Izzi Seccombe

Izzi Seccombe

“Interventions to tackle teenage pregnancy, child obesity, physical inactivity, sexually transmitted infections and substance misuse cannot be seen as an added extra for health budgets,” she said.

“Local authorities were eager to pick up the mantle of public health four years ago, but many will now feel that they have been handed all of the responsibility, but without the appropriate resources to do so,” she warned.

A Department of Health spokesperson maintained the government had “strong track record” on public health.

“Cancer survival and dementia diagnosis are at a record high whilst smoking rates and teen pregnancies are at an all-time low,” he said. “Over the current spending period, we will invest more than £16bn in local government public health services.

“Moreover, we have shown that we are willing to take tough action to protect the public’s health – introducing standardised packaging of cigarettes, a Soft Drinks Industry Levy and a world leading childhood obesity plan,” he added.

The way councils are funded is set to change but the government has said it will continue to ring-fence public health funding into 2018-19 to give councils the “clarity” they need to plan and deliver services and make the transition to the new business rates-based system.

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