Cuts to frontline services
The Government has always maintained that there will be no cuts to frontline services - money must be saved through efficiency savings, and the NHS budget is ring-fenced, it says. In reality the healthcare budget has been cut and frontline services are being axed.
Public health budget cut
Some of deepest cuts to frontline services are taking place in the area of public health, where the Government has made severe cuts to the budget. Public health services are funded by local authorities using a budget from the Department of Health.
In November 2015, the government separated the budgets for public health, education and training, capital and national bodies, from the budget for NHS England. This paved the way for cuts to public health services.
But public health is still NHS healthcare and of vital importance to the health of the nation. Sexual health, drug and alcohol addiction, weight management, stop smoking programmes are all frontline public health services. Cuts to these have significant effects on the future health of the population.
Public health spending will have fallen by another £600 million between now and 2020/21.
At the end of 2018, a further £1bn of cuts to public health services and the training of nurses and doctors over the following year were concealed within Government plans to boost the NHS budget by £20bn by 2023.
Frontline public health services cut
One of the major targets for cuts has been sexual health services and contraceptive services. King's Fund research found that between 2013/14 and 2017/18, total local authority spending of sexual health services fell by 14% in real terms. This is despite the rapid rise in the spread of STIs, including gonorrhoea and syphilis, that is a worrying trend being investigated by a Health and Social Care Committee Inquiry.
Smoking cessation services have also been a major target for cuts. Budgets for smoking cessation services and wider tobacco controls across the country fell by £20m this year, from £120.6m in 2016/17 to £99.8m. Analysis shows two thirds of the 152 local authorities in England reduced their spending on smoking cessation this year. This is despite Stop Smoking Services being the most effective measures for people to quit smoking.
It was revealed in a survey by Pulse that in 2018, 90% of councils had their budgets for public health programmes cut which affected weight loss, stopping smoking and sexual health services. More than half of doctors surveyed reported cuts to weight management and alcohol addictions services. 48% had also lost services to help smokers quit and 49 per cent had lost sexual health clinics or testing.
Further examples of specific council cuts are:
- Lincolnshire County Council has completely cut GP referral services for weight management and exercise;
- Leeds council has cut the only support service for vulnerable people with HIV;
- Camden council has cut £1 million from weight management services, including £400,000 from a programme to manage child obesity;
- a £100,000 cut to programmes to reduce levels of infant mortality and low birth weight in Calderdale, West Yorkshire;
- a £50,000 cut to falls prevention services in Cambridgeshire;
- Harrow council has announced plans to cut public health services including health visiting, drug and alcohol, and sexual health over the next three years by up to 60%;
- North Somerset has cut a family nurse partnership service;
- Southampton has cut a population chlamydia screening;
- Hartlepool has cut its bereavement care service.
Children and young people hardest hit
The July 2016 investigation by the HSJ found that the groups hardest hit by the cuts in public health were children and young people's services. Overall, the analysis found planned spending reductions worth £50.5m in 2016-17, across 77 local authorities which provided information; the biggest area for cuts was services for children and young people.
These findings were reiterated by children's doctors in 2019. The Royal College of Paediatrics and Child Health said: "Children deserve better. It is they who are disadvantaged most by inefficient health services, cuts to public health and the rising tide of poverty.”
The HSJ investigation found that the biggest single area was a £7m reduction to services directly aimed at improving the health of children and young people, such as health visiting, school nursing and childhood obesity programmes.
Critics of the cuts emphasised that in the long-term, cutting spending on public health leads to a much greater costs for the NHS. According to the Family Planning Association cuts in the area of sexual health services could end up costing the NHS around £3.5 billion due to the increase in unintended pregnancies and sexually transmitted infections.
In February 2016 academics and organisations representing health visiting, paediatrics, midwifery and family services wrote an open letter to Government ministers raising concerns that recent statistics show UK breastfeeding rates at 12 months after birth are the lowest in the world: they attribute this to cuts in public health spending that have led to cuts in support for new mothers.
Budgets continue to fall despite promises
The Government promised money for improving mental health services in January 2016, however in reality cuts are still taking place: in April 2016 Manchester Mental Health and Social Care Trust cut seven frontline community-based services to save £1 million. The cuts to the seven frontline services were not supported by the three CCGs affected.
In May 2016 research undertaken by NHS Providers and the Healthcare Financial Management Association, found that only half of the 32 mental health trusts they spoke to had received a real-terms increase in their budgets in 2015-16 and only 25% said they expected clinical commissioning groups (CCGs) to increase the value of their contracts for 2016-17.
In July 2016 an investigation by Pulse highlighted the consequences of these budget cuts; information from 15 mental health trusts revealed that 60% of GP referrals to child and adolescent mental health services (CAMHS) lead to no treatment and a third are not even assessed.
Despite the government promises on action on mental health, the situation for young people is worsening, with the numbers of referrals that progress to treatment decreasing from 44% in 2013 to 39% in 2015. Several GPs told Pulse that CAMHS were refusing to treat patients unless they had attempted suicide or self-harmed.
In early 2019, doctors once again revealed their fears that young people would come to harm as a result of long waiting times for mental health treatment.