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Cuts to public health will widen health inequalities, warn public heath directors

Survey indicates that many services likely to be cut or decommissioned

Caroline White

Friday, 05 February 2016

The nation’s health will worsen and health inequalities will widen, as a result of cuts in central government funding for public health, warns the Association of Directors of Public Health (ADPH), following a survey of its members, published earlier this week.

Some 78% of respondents think the cuts to English local authority public health grants will have a detrimental impact on health, while three out of four think that health inequalities will widen.

Following the 2015 Comprehensive Spending Review announcement of an annual 4.9% reduction in the public health grant from this April, on top of a £200 million overall cut, the ADPH surveyed all 132 directors of public health in England to find out what they thought the potential impact would be.

Some 87 validated responses were received, giving a response rate of 66%.

The results show that all services will take a hit by 2017, with non-statutory provision, such as weight management, mental health support, and smoking cessation services being decommissioned in some areas.

Many services will be reduced, and some decommissioned this financial year, and many more will be decommissioned in 2016-17 the responses show.

Many of the responders pointed out that reducing the cost of services does not necessarily mean poorer outcomes, and that re-contracting should be seen as a positive opportunity.

Similarly, decommissioning poorly planned or inadequately evidenced services is a good thing and should be viewed as an opportunity for innovative solutions, many said.

But the size of the cuts will curb the ability to introduce lower-profile but nevertheless important preventive measures, they suggested.

In response to questions about the position of reserves being held for public health and their trajectory over the coming two years, almost two thirds (63%) of directors said that by April 2017 they would have no reserves left, with a further 13% saying they would have less than £500,000.

There is also evidence that staff cuts will have to be made in some places, with 58% of respondents expecting a reduction in headcount this year and the same percentage next year. Comments indicated that in some places staff cuts would be particularly deep.

These cuts are particularly tough, given that they come amid wider local authority cuts and a squeeze on NHS budgets.

One director of public health commented: “This is a big ask, but it's the same ask that is being made of other senior local government officers. The difference for public health is that we are starting from a more difficult position where it is still a new role for local government and one which is not yet as part of the DNA as it needs to be.”

Another emphasised the knock-on effect for the NHS: “The impact on the NHS of council cuts is being ignored by the centre, but it is putting the whole joint commissioning/integration endeavour at risk.”

Furthermore, over half of the respondents (55%) are still very concerned about the government’s intention to remove the ring fence from the public health grant, with only one in five (21%) saying that it should be removed after 2018 as the government plans to do.

Concerns also centred around the context of massive cuts to other local authority services. And the government’s proposal to fund public health through business rate retention is viewed by 84% as a “worrying development.”

Cllr Izzi Seccombe, Local Government Association Community Wellbeing spokesperson, commented: “Given that much of councils’ public health budget goes to pay for NHS services like sexual health, public health nursing, drug and alcohol treatment and health checks, these are cuts to the NHS in all but name. And it will put further pressure on other NHS services.”

She added: “We need to move away from a focus on treating sickness to actively promoting health. Investing in prevention ultimately saves money for other parts of the public sector by reducing demand for hospital, health and social care services and ultimately improves the public’s health.”

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