Comment

Rod Thomson: Government rhetoric on public health not matched by its actions

Plans to end the public health grant break a promise and cast doubt over the future of vital local services, says Professor Rod Thomson.
NHS Cuts

Plans to end the public health grant break a promise and cast doubt over the future of vital local services, says Professor Rod Thomson

The government has highlighted the need to address the growing demands on the NHS and social care services, stating the importance of preventing ill health and promoting mental and physical well-being.

However, its actions do not appear to match the rhetoric.

Public health departments in local authorities seen as a major focus for health promotion and illness prevention receive a grant from the Department of Health (DH) to commission a wide range of services, including health visiting, school nursing, smoking cessation, sexual health and substance misuse treatment.

Where the rhetoric and reality diverge is the governments decision to cut

...

Plans to end the public health grant break a promise and cast doubt over the future of vital local services, says Professor Rod Thomson


A promise not to cut NHS funding may be broken,
leaving vital services in doubt. Picture: iStock

The government has highlighted the need to address the growing demands on the NHS and social care services, stating the importance of preventing ill health and promoting mental and physical well-being.

However, its actions do not appear to match the rhetoric.

Public health departments in local authorities – seen as a major focus for health promotion and illness prevention – receive a grant from the Department of Health (DH) to commission a wide range of services, including health visiting, school nursing, smoking cessation, sexual health and substance misuse treatment. 

Where the rhetoric and reality diverge is the government’s decision to cut these public health grants by more than 2.2% a year over the past few years. These cuts are already having an adverse effect on hard-pressed local authorities, with several councils having to make greater cuts to programmes than the 2.2% required to deal with growing pressures from the cost of social care. 

Fair share

One local authority in the West Midlands has proposed cuts of almost 50% to its drug treatment services. Another has closed its smoking cessation service, leaving only pregnant women eligible for free support to quit. Other councils have started cutting investment in sexual health, health visiting and school nursing services.

Such cuts would be bad enough if all councils had a fair share of the grant, but as the DH’s own figures demonstrate, there are significant differences in the funding councils receive on a per head of population basis. 

Some of the most affluent areas of London receive £100 per resident more than other parts of the country. Rural areas in particular receive significantly less per resident than many urban areas.

A report from Public Health England and the Local Government Association on the well-being of rural communities shows that health inequalities in rural areas are not adequately recognised in the current indices used to calculate deprivation. 

Travel times

The DH has calculated that travel times between patients for a health visitor working in a rural county such as Herefordshire are up to five times greater than for those seeing similar patients in central London. Yet current resource allocations do not fully recognise the additional costs of providing accessible services to rural communities.

The government plans to end the grant in April 2019, bringing NHS funding of these health services to a close. In future, councils will be expected to fund services such as health visiting and school nursing from the business rates they collect.

This proposal has been criticised by local government and health agencies, partly because it breaks the government’s promise not to cut NHS funding, but also because of the threat it creates to the future of these important health services. 

Recent government figures clearly show that many councils will not be able to generate the business rates payments needed to fund these primary and secondary prevention programmes.  

Policy vacuum

While the government has indicated there may be some redistribution of funding from councils that can generate business rates in excess of what they need, no formula has yet been agreed. 

This policy vacuum means many local authorities are considering making severe cuts to the health services they are meant to commission. Priority will be given to services mandated by the government, leaving the remainder vulnerable to severe cuts. 

The longer-term employment prospects for nurses working in such programmes are worrying, with the possibility of redundancy looming. 

The government has indicated it may defer the change to business rates until 2020 due to the concerns raised. In the meantime, lobbying continues to protect key prevention services.


rodRod Thomson is director of public health for Shropshire

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