Earlier this year the Chancellor announced that £200million was to be cut from the public health budget for the year 2015/16. One might have thought this impossible given that the NHS budget is protected but the government had cleverly moved the public health budget out of the hands of the NHS and into the hands of Local Authorities in 2013. This enabled them to make cuts on health spending whilst keeping to the letter of their pledge if not the spirit.
Public health is an easy target too. It is the un-sexy arm of medicine concerned with improving the health of the whole population with measures such as weight loss and smoking cessation campaigns the results of which are difficult to measure and often only apparent after decades. No one will die tomorrow because a public health measure wasn't implemented today but they will die in their droves in 50 years. This is of no concern to dead eyed, blubber brained politicians concerned only with surviving the five year election cycle.
Public health is very important and last year the Kings Fund and this year the World Health Organisation have made compelling arguments regarding the importance of investing in public health particularly in a population such as ours that is ageing and getting more obese. This seemed to have been acknowledged in the Five Year Forward View announced by NHS England last year, which put preventative medicine at the heart of the national healthcare strategy for the next five years.
Cutting this budget is incredibly short-sighted. £200million saved now will result in massive expenditure and massive suffering in the future. Unfortunately these cuts are already coming and getting into a lather about it now is unlikely to change that.
The way these savings will be made has not yet been decided. The Department of Health has recently opened a consultation process on this matter so that interested parties such as the local authorities and the royal colleges of physicians, surgeons and nurses may have a say. The fact that they are conducting this for just four weeks during parliament's summer recess is probably indicative of how much attention they will pay to the results of the consultation.
The Department of Health's favoured solution is a blanket 6.2% cut from the budget of all local authorities. They consider this the 'simplest and most transparent' solution although many others would consider it the laziest and most foolish option. Academics are currently queuing up to demonstrate that this un-nuanced solution will disproportionately affect local authorities with the highest levels of deprivation and population density. There is evidence too that areas with high black and ethnic minority populations will suffer.
There are obvious regional differences in public health issues such as rates of tuberculosis, childhood obesity and drug and alcohol misuse and treating all local authorities in the same way simply ignores this fact. The solution is typical of the back-of-a-fag packet planning by which major decisions concerning the NHS are routinely made. Implementing the budget cut in this way will serve to heighten health inequalities and punish those already suffering the worst deprivation.
All the good work that has been implemented since the announcement of the Five Year Forward View, measures such as increasing numbers of health visitors to look after infant and maternal health, is now at risk because those projects most recently established will be the easiest to ax. And if the Department of Health implement the cuts in the way they propose it is likely that these projects will be lost in the areas where they are most needed.