Public health should not be an easy target for cuts

Funding for public health has dropped by nearly a quarter since responsibility transferred to local authorities five years ago. We must make the case for investment in the future

Funding for public health has dropped by nearly a quarter since responsibility transferred to local authorities five years ago. We must make the case for investment in the future, says the chair of RCN’s public health forum

Picture: Alamy

Improving the health of the UK population has been a priority for public health nurses for many years. Public health includes many disciplines, such as sexual health, smoking cessation, travel health, immunisation and vaccination, school nursing, health visiting, occupational health, substance misuse and the prevention and treatment of tuberculosis.

Over the past decade, many successful initiatives have resulted in lower numbers of people who smoke, higher numbers of people testing for sexually transmitted infections, and the development of screening programmes.

These successes are down to the continued hard work and commitment of healthcare professionals and financial investment in public health services. Funding is vital to ensure we continue to build on these gains and not lose the progress made over the years.

No soft option

Sadly, in England, funding for public health services has been reducing year on year since it was transferred out of the NHS to local authorities in April 2013. An analysis by the Health Foundation shows that, by next year, spending in England will have fallen by 23.5% over five years.

This alarming decrease gives validation to what we are seeing and hearing about the reduction in funding, the closure of services and the loss of jobs. Public health is not a soft option and it is certainly not an area that deserves a short-sighted approach in relation to funding.  

From my perspective, public health funding is about two things: invest to save and return on investment. Fund public health initiatives now to prevent ill health, and the benefits will be seen in the future.

For example, the reduction in health visitors and school nurses could have an impact on child development, the physical and mental health of young people, and reduce access to support and services.  

Likewise, if smoking cessation services are reduced or stopped, what will be the long-term effects? An increase in smoking-related cancers and respiratory diseases, resulting in more hospital admissions. 

Experienced workforce

Nurses who work in services that are facing funding cuts have the challenge of supporting patients to ensure they can access the care, support and advice they need, alongside trying to find ways of working with a greatly reduced budget. 

Local charities and websites may be able to offer initial support to patients, but they cannot replace the skills, knowledge and experience of public health nursing experts. 

Funding cuts also have an impact on staff in relation to motivation and morale. Nurses may have less time available to undertake health promotion, and there are less roles available in preventive health services. 

The loss of jobs for health visitors, school nurses and public health nurses cannot be underestimated. We are facing a national shortage of nurses across the UK, and it takes time and experience to train and educate nurses in public health roles. There is no quick win to developing a skilled and knowledgeable public health workforce. 

Fighting funding cuts

Healthcare workers need to be challenging these cuts by raising concerns with their professional bodies and trade unions, as well as local patient representatives and councillors. The RCN is working hard to gather intelligence on funding changes and demonstrate the value of public health nursing.

New health and social care secretary Matt Hancock, who was appointed in July, needs to review what is happening to public health services in England. It would be interesting to know if members of the public realise that responsibility for public health in England sits with local authorities, not the NHS, and if they are aware that services are being cut.

The health of the nation is everyone’s responsibility. The government and local authorities must not forget that and must ensure that public health is fully funded, not seen as an easy target.

Jason Warriner is chair of the RCN public health forum and an independent healthcare consultant



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