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Doctors urge halt to public health spending squeeze

BMA says local authority cuts mean that prevention services are 'deteriorating'

Mark Gould

Thursday, 28 March 2019

A new British Medical Association (BMA) report warns that years of local authority cuts have led to a serious deterioration in prevention services leading to a rise in hospital admissions related to smoking, alcohol and obesity.

The report Prevention before cure: Prioritising population health, urges the health and social care secretary to address this key challenge. It calls for the government to deliver a much more comprehensive approach to improving public health in the green paper on preventive healthcare which is expected this year.


The NHS Confederation, which represents managers across the sector agrees, saying public health is key to the success of the NHS Long Term Plan.

The report is published as local authorities say that cuts leave them little choice but to raise council taxes by an average 4.5% from next month.

The report underlines that the grant for local authorities to provide public health services has been cut in real terms by over £550 million since 2015/16. Over the last three years, alcohol and obesity services have had budgets cut by over 10%, and stop smoking services by over 20%.

At the same time, it says hospital admissions related to obesity, smoking, and alcohol are rising. Hospital admissions where obesity is a factor have risen 10-fold since 2006/07. Admissions associated with alcohol have nearly doubled since 2006/07, and those where smoking was a factor have also increased.

The BMA recommends that in the green paper the government commits to increased and sustained funding to public health services, reversing the £550 million cuts.

It also wants a comprehensive cross-departmental approach to addressing the societal factors that influence health which recognises the importance of health in all policy-making.

And it calls for effective regulation to tackle the key lifestyle factors, such as excessive drinking, smoking and poor diet, such as through the introduction of Minimum Unit Pricing for alcohol across the UK.

Dr Peter English, the chair of the BMA Public Health Medicine committee, said: “We have seen a systematic pattern in the past decade of all parts of the public health sector being subjected to a funding squeeze that has left preventive health care in crisis. A lack of joined-up thinking and national standards has led to widening health inequalities.

“These cuts come at a time when inequalities in life expectancy are widening. In England males living in the most deprived areas are now expected to die 10 years earlier than those living in the least deprived, while for females the gap is seven and a half years.”

Nick Ville, director of policy at the NHS Confederation, said poor public health provision could undermine the aims of the NHS Long Term Plan: “It’s a false economy to cut funding on vital services such as smoking cessation and sexual health when we know they deliver real benefits to patients and taxpayers," he said.

“Emergency admissions related to obesity, smoking and alcohol are on the rise so it is essential that we make prevention a priority for the NHS and move to a population health approach. This will require effective partnerships between the NHS and other local public services. Without this, we will fail to narrow the widening health inequalities we are seeing.

“The NHS Long Term Plan prioritises health and wellbeing services and outlines a vision for the future that needs to be backed. But this will be undermined if the government fails to boost spending on public health services in this autumn’s spending review.”

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