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BMJ: Public health service cash cut

Cash aimed at improving the nation's health is being diverted to to other areas due to Government funding cuts, research has found.

An investigation by the British Medical Journal (BMJ) concluded that cuts were having an impact on how local authorities manage their money, with some spending public health cash on other areas such as housing.

It also found public health staffing in some parts of the country is being scaled back to save cash while the existing workforce is being spread too thinly.

A report in the journal said: "The investigation found examples of councils reducing funding for a wide range of public health services, including those for substance misuse, sexual health, smoking cessation, obesity, and school nursing.

"The BMJ found that many local authorities have deployed public health funds to support wider council services that are vulnerable to cuts, such as trading standards, citizens' advice bureaux, domestic abuse services, housing, parks and green spaces, and sport and leisure centres."

Using the Freedom of Information Act, the BMJ requested information from 152 councils on all services commissioned and decommissioned since April 2013 and for details of commissioning intentions for the coming year.

Of the 143 that replied, almost a third (45) had cut at least one service, while others had slashed funding to other services.

The local authority in Sheffield admitted to "topslicing" the public health budget to pay for some health-related services that it had previously funded from elsewhere in its budget.

It told the BMJ: " The rationale for the topslicing was in order to release funding to pay for public health activity previously paid for by city council mainstream revenue funding, which otherwise would have been vulnerable, due to the significant reductions in central government support to local government."

Sheffield said it anticipated further "efficiency savings" in 2014/15 from the likes of drug treatment and sexual health services, alongside a reduction in public health staffing at consultant and non-consultant level.

This would be achieved through "a combination of deleting vacant posts from the establishment as well as a small number of (voluntary) redundancies."

Jeremy Wight, director of public health at Sheffield City Council, said local government was being forced to act "creatively" because of central government cuts.

He said: "Local authorities have for many years, in various ways, funded programmes and activities which have either explicitly or implicitly benefited public health through their mainstream revenue funding.

"It is the very significant cuts in this funding - particularly in the northern metropolitan authorities - that is leading us to have to use public health grant funding creatively.

"For the Government to say that public health funding is being protected or increased is only true at a very simplistic level. The wider substantive cuts to local authority funding are very damaging to public health more broadly."

In another example, Derby City Council said that it would "continue to invest in prevention, early intervention and enablement," but admitted: "We have had to make difficult decisions to re-prioritise aspects of public health spending to better support statutory council services."

Gateshead has also consulted on a proposal to reduce funding for the provision of drug and alcohol treatment by 30%.

Gabriel Scally, formerly the Department of Health's regional director of public health for the south west and now professor of public health and planning at the University of the West of England, Bristol, told the BMJ: " There is a long history of public health budgets being plundered by organisations that are having financial difficulties.

"This time it isn't NHS managers who are playing fast and loose with public health budgets, it is local authorities. Of course, local authorities are having their budgets reduced, but the Department of Health has provided that funding to local authorities to spend on public health, not to be siphoned off to prop up other services.

"It's robbing Peter to pay Paul. They maintain that NHS funding will be protected, but it is being used for non-NHS purposes."

England has 132 permanent public health director posts, but currently 31 positions are vacant, the investigation also found.

A Local Government Association spokesman said: "This is scaremongering. Spending levels on public health have remained consistent and it is inaccurate and wholly misleading to suggest that local authorities have been siphoning off funds to prop up services elsewhere.

"Councils are investing just as much as previous arrangements in public health services, and indeed are supporting wider determinants of health too. Many services - such as housing, planning, leisure and recreation, and environmental services - are crucial in keeping people fit and healthy.

"We are convinced that the most effective use of resources to improve public health is to combine the public health professional workforce, with its specialist expertise and intelligence, with mainstream council plans and services. The key is to develop services that are locally appropriate, efficient and effective in improving outcomes.

"Councils must account each quarter for their public health spend across 18 areas. The rules are clear and involve sign off by the director of finance or chief executive."

Duncan Selbie, chief executive at Public Health England, said: "We have been perfectly clear that the public health grant is there for improving the public's health and the conditions describing what this means preclude substitution and savings towards balancing the books.

"It is for each local authority to confirm that they have met the grant conditions and this is subject to their own external audit.

"We are not anxious about local government taking their new public health responsibilities extremely seriously - we know they are.

"Local authorities don't have to tell us or ask permission as to how they spend their public health grant, but they will be judged on their outcomes against the measures in the Public Health Outcomes Framework.

"As the accountable officer, I have written to every local authority in England explaining what I need by way of assurance that councils are using their ring-fenced public health grant appropriately."


From Belfast Telegraph