Is it just me…?

Editor in Chief, Robert Chamberlain, looks at the Health Select Committee’s report into public health and discusses how upfront cuts to funding and the confusing system are making things worse.

The transfer of responsibility to local authorities for the funding of public health from 2013 was cautiously welcomed at the time. It made sense for this budget to be managed at a local level, but there were concerns about handing this additional responsibility to already cash-strapped councils. The latest report from the Health Select Committee, Public health post-2013, examines how effective this transition has been and recognises the challenges faced by local government amid budget cut pressures.

It states, ‘Local authorities face a number of challenges and have had to cope rapidly with major system change. In addition, they face real-terms cuts to public health budgets, including last year’s in-year cut of £200 million. As a result, they are trying to deliver more with less. Whilst we have seen examples of innovative practice, local authorities are now at the limit of the savings they can achieve without a detrimental impact on services and outcomes. There is a growing mismatch between spending on public health and the significance attached to prevention in the NHS Five Year Forward View.’

The Committee also recognises the importance of prevention in the wider system and the impact that these cuts to public health can have on health and social care further down the line.

It states, ‘Cuts to public health and the services they deliver are a false economy as they not only add to the future costs of health and social care but risk widening health inequalities’.

I find this short-sightedness and the upfront cuts to funding baffling. We can all see the impact it is having throughout the NHS and social care systems.

Modest impact

Change is happening, in spite of the cuts and local authority pressures. The Committee found that some local authorities had made good progress in public health, seeing positive impact on public health outcomes. However, in other areas, less progress has been made.

Due to the nature of public health needing to be delivered in communities, where people live and work, the new public health system has been designed to be locally driven, and therefore, a degree of variation between areas is to be expected.

However, the Committee is concerned that, three years’ later, robust systems to address unacceptable variation are not yet in place. It says that the current system of sector-led improvement needs to be more clearly linked to comparable, comprehensible and transparent information on local priorities and performance on public health. It notes that changes to local government funding, especially the removal of the ring-fencing around the public health grant, must be managed so as not to further disadvantage areas with high deprivation and poor health outcomes.

Is it just me?

The cuts to public health funding in cash-strapped local authorities, just after the funding was transferred are ridiculous. Even if you ignore the funding for a moment, the system is bogged down with complex processes of commissioning services, involving many different departments, and a lack of cohesion.

I believe the need for a whole systems approach to address public health in its truest sense, including social care as a key proponent, is blindingly obvious. However, the continuum of a person’s health and care needs currently has to fit around a confusing system of differing budgets, commissioners and departmental objectives, rather than the system being designed around an individual’s needs.

Pooled budgets spent proportionately on all aspects of prevention, support and care, leading to the cessation of social care as a poor relation, would surely have the most positive impact. Throwing the lion’s share of money to fire-fight the NHS crisis, at the other end of the system, while underfunding the very services that would ease the pressure, makes absolutely no sense at all.

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