THE BLOG
15/06/2015 07:54 BST | Updated 14/06/2016 06:59 BST

Why Cutting Public Health Will Hurt the NHS

Earlier this month, with the stroke of a pen, the Chancellor reduced the Department for Health's annual budget by some £200 million. These cuts were explained simply as "non NHS savings" - a point which may be technically correct, but neatly articulates the Government's position that where the money comes from is more important that what it actually does.

In actual fact this "saving" is being found in the public health budgets of local councils. So while it won't lead to the closure of a hospital or the laying-off of any doctors, it will likely cause a reduction in things like sexual health services, drug and alcohol treatment centres and school nurses.

It may be unintentional, but one of the consequences of ring-fencing the NHS budget is the creation of an artificial double standard where everything inside of the fence is classed as indispensable, while everything outside is seen as expendable.

Only they are not. What we stand to lose - or see diminished - from this decision, are vital programmes which help to reduce the demand for acute treatment and make the NHS more affordable and more efficient. Cutting them is not only callous, it is also counterproductive.

The role of public health is to promote healthy living among the whole of the population and prevent people from becoming ill. Considered against the frontline services provided by the NHS, this can seem a bit intangible. After all, it's very hard to envisage the number of people who don't turn up at hospital with lung cancer because they were supported to give up smoking ten years previously. But to make this comparison is to fall into the old trap of seeing public health and the NHS as unrelated entities, or worse, competitors for potential funding.

If we neglect services that are designed to keep people healthy and focus exclusively on services that are designed to treat people when they are sick, then it's a pretty safe bet that you're going to have plenty of sick people requiring those services. In the modern era, where the demand on the health service is greater than ever, we cannot afford to just focus on the supply of treatment, we also have to invest in methods that reduce the demand for it in the first place.

As recently as October Simon Stevens, the Chief Executive of the NHS, published Five Year Forward View, a planning document for the future of the health service, which made this point in no uncertain terms: "The future health of millions of children, the sustainability of the NHS and the economic prosperity of Britain all now depend on a radical upgrade, in prevention and public health."

Viewed within that context, last week's announcement can be seen as a major retrograde step. This isn't just about a 7 percent reduction in funding for public health, significant though that is. It's also the signal it sends that those in charge of health funding have failed to grasp that the 'traditional' view of the health service - as an institution designed just to treat sick people - has become outdated.

When the NHS was founded in 1948 the demands and pressures it faced were very different to today. Back then average life expectancy in the UK was around 69; nowadays it's closer to 82. The vast majority of patients the fledgling NHS saw were those suffering from life-threatening conditions, today it's shifted to those living with long-term conditions - and many of these are directly related to people's lifestyles. Where I serve in Haringey for example, each year we see approximately 1,400 alcohol related hospital visits and more than 200 smoking related deaths.

Working together, practitioners in public health and the NHS have made great improvements in reducing these rates year-on-year. But I am concerned that these cuts will inhibit preventative work, meaning that less people will feel encouraged and supported to make positive lifestyle changes themselves. Without this early intervention work it's hard to see how the Prime Minister's desire to tackle the epidemic we face in obesity can succeed.

"Non NHS" cuts like these may be easy to make politically, but practically speaking they make no sense. They go against the spirit of what both the Prime Minister and Chief Executive of the NHS have said publically; and they entrench an old-fashioned idea that healthcare is about providing cures, when increasingly the consensus says it must be about prioritising prevention.