Public health hardest hit by NHS cuts, despite going ‘under the radar’

Although national media attention tends to focus elsewhere, public health and community services have actually been hit the hardest by the slowdown in NHS funding since 2010-11, an influential think tank has found as part of a major investigation.

In its report, the King’s Fund revealed that contrary to popular opinion, acute and specialist services in the NHS have so far been relatively protected from funding cuts, and financial pressures have had “a much greater impact on some other services”.

“Factors that can combine to make some services particularly vulnerable include: a lack of data to monitor performance; block contract arrangements that have not adjusted to rising demand; services commissioned from the public health budget that has been cut in a way that NHS budgets have not; cuts having long-term implications that will not show up in outcome data for several years; and groups most affected by service changes not having a strong political voice,” the report explained.

The think tank argued these pressures are affecting patient care as a result, in ways that often go “under the radar” but will begin to spread and intensify in the future. Cuts to preventative services, for example, in which public health schemes form a big part, are “storing up problems for the future”.

“With acute services such as hip replacement and neonatal care relatively protected so far, while some community-based and public health services like genito-urinary medicine (GUM) and district nursing have been cut, the NHS appears to be moving further away from its goal of strengthening community-based services and focusing on prevention, rather than making progress towards it,” added the King’s Fund.

Ruth Robertson, a fellow in health policy at the think tank and the report’s lead author, argued that the findings prove longer waiting times for hospital treatments and restrictions to operations are “just one small part of the picture”.

“Our research shows that services like district nursing and sexual health, where we found evidence that access and quality are deteriorating for some patients, have been hardest hit by the financial pressures facing the NHS but that this is often going unseen,” she added.

One area of focus, for example, was in GUM services. The organisation’s research found clear evidence that pressures on these services has increased and really began to bite in 2015-16, when council spending on them fell by 3.5% compared to the year before due to public health budget cuts. As a result, and given that demand for GUM services is growing rapidly, patient care in some parts of the country has suffered.

Whilst the public health grant actually increased when it was transferred to councils – in “stark contrast” to other areas of local government spending – this trend was short-lived, explained the think tank: in 2015-16, public health budgets were slashed by £200m (almost 7%). Councils have been asked to find further savings equivalent to at least £600m by 2020-21, despite being legally required to balance their books each year.

STI testing and treatment accounts for a considerable share of council public health spend (12% on average), meaning it is largely targeted for potential savings – and this trend is set to continue. In 2016-17, planned national spend on STI testing is 7% less than in 2015-16.

Other areas not protected by a legal mandate have seen even deeper cuts, such as sexual health advice, promotion and prevention, which dropped by almost 15% between 2013-14 and this financial year.

During research interviews, the King’s Fund was told that the ringfence around the public health budget was “quite leaky”, with interviewees revealing that some councils are defining spending on other services, such as parks and non-health services, as falling within public health.

“Looking to the future, there were also worries about the removal of the ringfence in 2018-19. Commissioners and providers both told us that they were worried about public health money being channelled to other local authority services to compensate for cuts to council budgets,” the think tank said.

“Uncertainty about budgets beyond 2018 is making it difficult for some to plan services properly and to contract services for more than two or three years. The impact of the proposed shift to funding via retained business rates from 2018-19 is adding to the uncertainty.”


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