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Public health cuts put Cornwall and Isles of Scilly STP savings at risk

Cornwall Council has warned that savings in the Cornwall and Isles of Scilly sustainability and transformation plan (STP) may not be achieved because of cuts to its public health budget.

Caroline Court, the interim director of public health at Cornwall Council, who represents the council on the STP project board, raised the concerns in a report published ahead of a meeting of the Health and Adult Social Care Overview and Scrutiny Committee tomorrow.

In 2015-16, £2m of Cornwall’s public health budget was reallocated to other services, such as prevention within adult social care. The council agreed not to reallocate any other funding until 2019-20, but it still faces a further £4m budget reduction because of cuts to the national government grant.

It has met the cuts so far by scaling down staff numbers in the core and health promotion teams; reducing the value of contracts for drug, alcohol and sexual health services; and cutting the budget for NHS health checks in primary care.

The report warns that the council will need to further prioritise services to meet the funding shortfall, and make savings from important NHS contracts including health visiting, school nursing, sexual health and drug and alcohol services.

The Cornwall and Isles of Scilly STP has not been published, but the report says that it will contain an “ambitious and well evidenced” prevention plan, with areas including a domestic violence referral plan, improving immunisation uptake, a whole-system strategy to tackle childhood obesity, measures to identify patients engaging in harmful smoking and drinking, and a self-management and self-care programme.

As part of the STP, Cornwall is also seeking to reduce rates of fuel poverty, including through new powers it is seeking as part of the Devolution Deal.

The report notes that £20m will be needed to deliver these plans, but warns: “Overall there is a risk of a cumulative impact of the cuts to prevention leading to greater demand for healthcare and social care and putting some of the STP savings at risk.”

Last week, the Chartered Institute of Public Finance and Accountancy (CIPFA) published a review of nine of the STPs which have been published so far. It warned that they lack credibility in explaining how they will achieve their savings and need to introduce more joint working with councils.

Cornwall and Isles of Scilly STP has already secured external funding for some aspects of its prevention plan, including the Headstart programme for emotional wellbeing in schools, diabetes prevention and fuel poverty.

The council said it would continue to seek external funding, and that more might be made available nationally as the STPs are introduced.

In addition, it recommended seeking to embed some aspects of the prevention programme as ‘business as usual’ in contracts with providers, such as advice on harmful lifestyle behaviours, domestic violence referral, and identification of long-term conditions.

The Health Select Committee has warned that councils are struggling to meet their new public health responsibilities under the Health and Social Care Act 2012 because of budget cuts, which MPs called “a false economy”.

(Image c. Chris Radburn from PA Wire)

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