Funding cuts could kill local authorities’ enthusiasm for improving public health, experts say

BMJ 2016; 352 doi: (Published 02 March 2016) Cite this as: BMJ 2016;352:i1282
  1. Adrian O’Dowd
  1. London

Cuts to public health funding could undermine efforts to lessen health inequalities made by local authorities, MPs have been told.

Public health experts warned, during an evidence session held on 1 March of the parliamentary health committee, that cuts were dampening local authorities’ enthusiasm and damaging this area of work, which could significantly reduce demand on the NHS.

Responsibility for public health passed from the NHS to local government in 2013. During the committee’s session for its inquiry into how the transition has worked, MPs asked whether health inequalities—across the country and socioeconomic backgrounds—were levelling out.

Michael Marmot, professor of epidemiology in public health and director of the Institute of Health Equity, University College London, giving evidence said, “We are not making much progress in some of the key indicators.

“Set against that, there is a level of optimism and commitment that I encounter in local government that is thrilling. The excitement for me is that with all the difficulties that have been going on—austerity and cuts—local authorities have risen to the challenge.”

Marmot said that he and others were concerned about the cuts to the public health budget and to local authorities’ budgets. “There is no room for give and take, and the concern is that public health will lose out,” he told MPs.

Shirley Cramer, chief executive of the Royal Society for Public Health, also giving evidence said, “The £200m (€258m; $281m) in year cut [to public heath funding] was shocking because it came so quickly, and the 4% cut over the next few years is very disheartening for local authorities.

“Our concern is that the innovation, the progress, and the enthusiasm may get cut because there isn’t enough money.

“I think the whole public health community and many other people are concerned about the disinvestment in prevention.”

Nevertheless, Cramer was pleased that public health was now based in local government. “Public health in local authorities is working well and getting better all the time,” she said.

MPs asked four directors of public health about the impact of funding cuts.

Eugene Milne, director of public health at Newcastle City Council, said, “So far, thanks to efficiencies and the way we commission, we have managed to cushion a lot, but I don’t think we can carry on doing that.

“Reductions over the next few years will start cutting into some of the core services. It’s quite clear we are going to have to start making reductions in sexual health services.”

Other areas that are likely to see reductions in funding include smoking cessation services and pregnancy care.

The directors had experienced barriers to their work, fellow witness Ros Jervis, director of public health for Wolverhampton City Council, told MPs.

“I can’t fulfil my scrutiny and challenge role as a director of public health in relation to screening and immunisation programmes,” said Jervis. “I feel that information is being deliberately withheld from local authority officers who are part of my team.

“There are some real anxieties in the NHS about sharing data. We finally managed to get information at a GP practice level in relation to seasonal flu vaccine uptake, but we do not get any information at a practice level in relation to childhood immunisations. We need to improve data sharing.”

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