Public health services cut
Since November 2015, when the government separated the budgets for public health, education and training, capital and national bodies, there have been major cuts to public health services.
Public health services provide preventative services, including smoking cessation, drug and alcohol services, children's health services and sexual health services, as well as broader public health support across local authorities and the NHS.
In July 2022, NHS England warned of ‘cuts’ to services and investment in cancer and primary care if it wasn't given extra funding for staff pay-rises above 3%. No extra funding has been forthcoming, so cuts in these frontline services are likely.
The public health system is broken
A September 2022 editorial in the BMJ highlighted how after over 10 years of Conservative government the importance of public health measures has been downgraded and underfunded and warns that this is likely to continue with Liz Truss, as the new Prime Minister.
Almost twelve years ago, soon after the Conservative party took control of government, the previous pattern of slow, steady improvement in life expectancy halted, and health inequalities began to grow.
The editorial notes that since 2010, successive Westminster governments have “dismantled and defunded public health rather than recognising the importance of a healthy population and a robust and effective public health function.”
Evidence of this includes the transfer of local directors of public health from the NHS to a poorly resourced role within a simultaneously weakened local authority system.
The central public health agency, Public Health England, has been abolished and replaced by the UK Health Security Agency, and this has dropped public health from its title. Three of the four chief medical officers in the UK are not public health doctors.
The public health system is broken, according to the editorial, which called for “a far-reaching review of how internationally recognised essential public health functions are being carried out in the UK.”
Deep funding cuts lead to service cuts
The government separated the budgets for public health, education and training, capital and national bodies, from the budget for NHS England in November 2015 and this paved the way for cuts to public health services.
The cuts have taken place despite public health still being NHS healthcare and of vital importance to the health of the nation. Public health services are interventions that are based on the common-sense idea that it is better and much cheaper to prevent illness in people than to treat it at a later date.
The budget for public health services is now £850 million lower than in 2015/16 and by 2021/22 the budget had been cut by 24% from its 2015/16 level in real-terms.
The Health Foundation has found cuts in all areas of public health, apart from obesity services.
At the end of 2018 £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.
In October 2021, an open letter from the Association of Directors of Public Health, signed by more than 50 representative bodies and charities (including the Alcohol Health Alliance UK, the British Liver Trust, and Cancer Research UK), backed a call for increased funding.
The figure for the cut in budget is for England as a whole, however an investigation by the IPPR found that the cuts in public health disproportionately affect the most deprived areas. It is the poorest communities that are being hit the hardest by these cuts in public health. When the IPPR compared the cuts in the most and least deprived ten local authorities, they found that "Almost £1 in every £7 cut from public health services has come from England’s ten most deprived communities - compared to just £1 in every £46 in the country’s ten least deprived places. The total, absolute cuts in the poorest places have thus been six times larger than in the least deprived."
Sexual health, drug and alcohol addiction, weight management, stop smoking programmes are all frontline public health services. Cuts to these services have significant effects on the future health of the population and the cost of healthcare in the future.
Sexual health and smoking cessation targeted
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. In November 2019, the IPPR estimated that spending on sexual health services had fallen by £196.4 million from 2014/15 to 2018/19.
Based on The Health Foundation's research, Smoking cessation services have been hit the hardest down 33%. Budgets for smoking cessation services and wider tobacco controls across the country fell by £20m in 2017/18, 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% had lost sexual health clinics or testing.
In April 2022 the government removed £100 million in funding for NHS weight management services, despite research showing that these services, a broad range of health advice, information and behaviour change support services, can be an effective intervention to support lasting health improvement.
The cut to services was condemned at the time by the Obesity Alliance, which accused the government of “‘short-termism’, where services that deliver long-term benefits are sacrificed for short-term savings.”
Young people hit hard
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.
Widespread criticism of cuts
Critics of the cuts emphasised that in the long-term, cutting spending on public health leads to much greater costs for the NHS.
In March 2019, the BMA's report Prevention before cure: Prioritising population health, highlighted the deterioration of public health services and called for the cuts to the budget to be stopped.
In June 2019, The Health Foundation and the King's Fund issued a joint statement urging the government to "make a clear and urgent commitment to restoring £1bn of real-terms per head cuts to the public health grant."
The two organisations said that cuts to the public health grant made since 2015/16 are having a major impact on local services. They said "that failing to act now would be a false economy, placing further pressure on the NHS and wider public services." The statement noted that the cuts in funding had come at a time when life expectancy improvements have slowed dramatically and health inequalities are widening. The two organisations said "that the cuts run counter to the government’s commitment to preventing ill health as stated in the NHS Long Term Plan and its mission to increase years spent in good health, while reducing inequalities."
The Health Foundation reports that the public health grant should be increased even further, requiring a total of over £3bn a year above current levels, to "both reverse the impact of cuts and ensure that the grant is reallocated to allow additional investment in the most deprived areas where there is greatest need."
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.
