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Public health cuts and fragmentation creating a ‘false economy’

Local authorities are struggling to deliver their new responsibility for public health services because of budget cuts and ‘fragmented’ leadership, the Health Select Committee has warned.

Local authorities were given responsibility for public health under the Health and Social Care Act 2012. However, public health funding for local authorities suffered a £200m in-year cut in 2015 and is due to be reduced by 3.8% in 2016-17, followed by 4.2% cuts in 2017-18 and 4.4% cuts in 2018-19. By 2021, the public health budget will have been cut from £3.47bn to just under £3bn.

In a major new report into public health changes since the Health and Social Care Act, the committee said: “Cuts to public health are a false economy. The government must commit to protecting funding for public health. Not to do so will have negative consequences for current and future generations and risks widening health inequalities.”

Earlier this year, a survey by the Association of Directors of Public Health found that 63% of council leaders will have to completely use up their reserves to meet cuts in areas such as public health.

The committee also found that efforts to reallocate public health budgets in order to reduce inequalities between the amount of money different local authorities have to spend had “only resulted in small reductions to variations”.

Furthermore, funding for public health will no longer be ring-fenced once full control of business rates is devolved to councils. Some council leaders warned the committee that the new system could lead to less money for poorer areas and deepen health inequalities.

The committee said that the government should set out how the planned changes to the funding system could be managed.

Cllr Izzi Seccombe, the LGA’s portfolio holder for community wellbeing, agreed with the report’s findings, saying: “Local authorities were eager to pick up the mantle of public health in 2013, however many now feel that they have been handed all of the responsibility but without the appropriate resources to do so.”

‘Fragmented’ public health services

The report also said that the changes have led to ongoing confusion about where responsibility for different public health functions lies.

For example, the High Court recently overturned a decision by NHS England to stop commissioning the HIV prevention medication PrEP on the grounds that it should be the responsibility of councils. NHS England is now seeking to appeal against the decision.

The report said that the issue needs “immediate resolution” and that NHS England and the Department of Health should clarify their positions on PrEP “without delay”.

Under the Health and Social Care Act, local authorities are required to create Health and Wellbeing Boards (HWBs), which bring together partners within the NHS, public health, adult social care and children’s services as well as elected members and representatives from Healthwatch.

The committee said that there is ongoing confusion about the role of HWBs and that they risk suffering from ‘mission creep’ as national policy places more and more responsibilities on them.

Dr Sarah Wollaston MP, chair of the committee, said that the government’s “disappointing” childhood obesity strategy was an example of “the gap in joined-up evidence-based policy to improve health and wellbeing”.

However, the report said that there is “cautious optimism” that HWBs are becoming more capable of holding the system together in the face of increasing “fragmentation”.

The committee recommended that local authority directors of public health are required in their statutory annual reports to publish clear and comparable information for the public on the actions they are taking to improve public health and what outcomes they expect to achieve, and to provide regular updates on progress.

It also said that the government should set out clear milestones of what it expects public health spending to achieve, with dates.

In addition, it recommended that local authorities are given the power to specifically consider the health of local communities in planning and licensing decisions.

Cllr Neil Clarke, chair of the District Councils’ Network (DCN), said the organisation welcomed the report, which showed the “crucial contributions" to public health district councils make in areas such as planning and licensing.

“The DCN is also in full agreement with the Committee’s view that prevention at community level represents the best chance we have as a nation to reduce major health inequalities,” he said.

“District councils make a major, but often under-recognised contribution to the health and wellbeing of their citizens and communities and as ‘sleeping giants’ of public health deliver disproportionately on prevention.

“As the move towards integrated place-based public services gathers pace, districts will be critical partners for the NHS and other tiers of local government in seeking to develop population health systems.”

A Department of Health spokesperson said:

"We are committed to protecting the public's health. Over the next five years we will invest more than £16 billion in local government public health services, in addition to what the NHS continues to spend on vaccinations, screening and the world's first national diabetes prevention programme.

 "We know local authorities are carrying out some excellent work in challenging circumstances and are pleased the committee has acknowledged their progress.”

(Image c. Mark Lennihan from AP/ Press Association Images)

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