On the election of the Conservative Government in 2015 the Chancellor announced plans for further cuts to public expenditure. Yes, there would be cuts of £200million to the Department of Health budget but he assured us these cuts were to 'non-NHS spending'.
'Non-NHS spending' sounds like cuts to bureaucracy, faceless middle managers, unnecessary office furniture. We could rest assured that there would be no cuts to frontline health services.
But that is not in fact the case. These £200million cuts will be made to local councils' public health budget. This budget is used by local councils to fund frontline healthcare services. In particular, sexual health clinics and drugs and alcohol services.
These healthcare services whilst often provided by an NHS hospital are not strictly and legally speaking NHS services because they are not commissioned by the NHS, but instead by local authorities. But this is a technicality - they are healthcare just like any other kind of healthcare - they test, treat, care, cure. It is, however, a technicality that the Chancellor seems happy to hide behind.
Why target sexual health and drug services?
Perhaps George Osborne is counting on the fact that no fuss will be made, that the users of these services are often marginalised with little power or media capital. Or often embarrassed or shy about publicising their use of services which touch on some of the most intimate and sensitive areas of our lives. But people who inject drugs will suffer. As will those who use sexual health services.
Gay men in particular have a heavy burden of sexual ill-health and disproportionately use sexual health services. It is hard to see this cut as anything other than an attack on gay men's health. It comes at absolutely the wrong time. In just one year, between 2013 and 2014, gonorrhoea diagnoses amongst gay men have increased by 32% and syphilis diagnoses by 46%. There is a sexual health crisis affecting gay men but the Government is cutting the funds available to address it.
A cut to prevention is a cut to the NHS
The public health budget of course does more than just fund these direct healthcare services. It also funds essential prevention and health promotion work. Here are some telling sentences from Simon Stevens, Chief Executive of the NHS, in his NHS Five Year Forward View -
'The future 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. Twelve years ago Derek Wanless' health review warned that unless the country took prevention seriously we would be faced with a sharply rising burden of avoidable illness. The warning has not been heeded - and the NHS is on the hook for the consequences'
The point is eloquently made - that prevention and public health are not some luxury add-on for the good times. They directly affect the call on NHS services. To cut prevention is to increase ill-health and so force the NHS budget to go further and be spread more thinly. A cut to prevention is a cut to the NHS. They are inextricably linked.
NAT's recent report 'HIV prevention in high prevalence local authorities in England' looked at local council HIV prevention expenditure in 2013/15 and 2014/15, and showed there is still a very long way to go before we even match the levels of funding of ten or fifteen years ago, when there was a much smaller epidemic. We called for increases in expenditure on HIV prevention to address the climbing HIV rates, especially among gay men. Instead the public health budget is cut in-year, astonishing local councils, who have already made spending commitments and have little room for manoeuvre when it comes to further cuts.
The Chancellor should acknowledge, to others and to himself, the inevitable impact of this £200million cut on some of the most sensitive and important frontline healthcare services. And he should then change his mind.
The public health budget is ring-fenced, meaning that local councils have to spend the money on public health and not anything else. The ring-fence was introduced to stop local councils being tempted to divert public health funds to other services which might deliver more immediate political rewards. Little did we know it wasn't local councils who posed a threat to the public health budget - it was the Chancellor, against whom no protection had been arranged.