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(Monday 22 June 2015)
Children’s health could be affected by Treasury cuts, say public health experts
Children’s health could suffer and drug related crime may increase if Treasury plans to cut £200 million from local authority budgets by next March are implemented, according to a survey of members of the Faculty of Public Health.
The Faculty of Public Health (FPH), which is the leading professional body for over 3,300 public health specialists in the UK, works to improve people’s health and wellbeing.
• Nearly 300 (259) of our members responded to a rapid survey about the potential impact of the cuts. The majority thought the following services would be affected by the cuts:
o Interventions to reduce obesity: 77%
o Smoking cessation: 66%
o Child health: 63%
o Drug treatment services: 61%
o Sexual health (including contraception): 61%
• One of FPH’s expert members has also analysed the potential impact of the cuts. They found that the 20 local authorities that could be hardest hit include areas as diverse as Chelsea, Cornwall, Knowsley and Norfolk (see Appendix 2 below).
Professor John Ashton, President of FPH, said: “No matter where people live in England, these cuts are a potential disaster for their health and healthcare. For example, these cuts could lead to an increase in unplanned pregnancies and drug related crime if people cannot access sexual health or drug treatment services.
“Even people living in wealthy areas will be affected. In addition, the growing divide between the ‘health-haves’ and ‘have-nots’ will get wider.
“It is a false distinction to think of NHS and public health funding as separate. The £200 million cut to the public health budget will hit the NHS, because councils commission some valuable NHS services, including sexual health clinics and quit smoking services. At a time when the NHS is already struggling, it can ill afford to take on this further strain.
“These cuts cannot be managed in a fair way: in particular, they will hit vital services where contracts have not yet been signed during the current financial year, and many already have been. FPH’s members are concerned that when the NHS budget for 0-5 year-olds - which funds health visitors - moves to local authorities in October, it will be especially vulnerable to such cuts.
“Cutting the prevention budget is a false economy. It will make it impossible to deliver the NHS Five Year Forward Plan, which stresses the importance of action on prevention and public health, was recently endorsed by ministers and which FPH supports.
“Rather than cutting public health budgets, we call on the government to protect them by maintaining the ringfence and introducing evidence-based public health measures that wi
ll make big savings, such as a minimum unit price for alcohol, duty on sugary drinks and levy on tobacco.
“It is time to match government rhetoric on tackling obesity with the necessary policies and budgets to create a healthy society”.
NOTES TO EDITORS
For further comment or to request an interview with Professor Ashton, please contact Liz Skinner, Senior Media and PR Officer, tel 020 369 1478020 369 1478, mobile 07703 71510607703 715106 or email .
FPH is the leading professional body for over 3,300 public health specialists in the UK. It works to improve people’s health and wellbeing through its core aims of setting the standards for and quality assuring the specialist public health workforce and advocating for action on public health issues.
Appendix 1: Impact of Treasury cuts to local authority budgets – Initial Survey Analysis
Number of respondents: 259
To which nation or English region do you belong?
Answer Options Response Percent Response Count
International 4.3% 11
Scotland 2.0% 5
Wales 3.2% 8
Northern Ireland 0.8% 2
East of England 7.5% 19
East Midlands 5.5% 14
West Midlands 8.3% 21
London 17.8% 45
South Central 4.7% 12
South East Coast 5.1% 13
South West 11.5% 29
North East 5.1% 13
North West 15.8% 40
Yorks and the Humber 9.1% 23
Other (please specify) 6
answered question 253
What is your current employment status?
• 81.1% of respondents are currently in work.
How would you describe your role? If you are looking for work, please indicate what level of post you are qualified to take up.
• Two thirds (61.8%) of respondents (marked in bold below) are directly involved in managing the budgets that these cuts will affect:
Answer Options Response Percent Response Count
Director of Public Health 13.8% 35
Consultant in Public Health 48.0% 122
Public Health Specialist 7.9% 20
Academic in Public Health 9.8% 25
Public Health Trainee 13.8% 35
Unemployed 0.8% 2
Retired 5.1% 13
Other (please specify) 4.7% 12
Other (please specify) 15
answered question 254
What type of organisation is your primary employer?
Answer Options Response Percent Response Count
Central or National government 2.5% 6
Local government 58.0% 141
Public Health England 9.9% 24
Private sector 0.8% 2
Academic and Research 10.3% 25
Self-employed 2.5% 6
NHS 14.0% 34
Retired 4.1% 10
Unemployed 0.8% 2
Other (please specify) 13
Has the impact of the Treasury announcement been discussed (verbally or via email) in your workplace?
In the majority of cases (72.2%) it has been discussed but these discussions have varied due to the uncertainty of the how the cuts will be implemented within each local authority.
If yes, have there been any preliminary discussions about what the scale of the cuts might be?
Yes for 64.4% of responders. Comments indicate uncertainty as to the full extent of how much the cuts will be and how they will be combined with existing commitments to reducing their budgets.
If yes, please tell us about the nature of these discussions:
Headline trends from these results:
• Exact figures have not been calculated yet but many LAs have estimated a flat cut of between 7% and 7.4% to their public health budgets
• This cut will be in addition to existing commitments to reduce their budgets so the overall cuts for 2015/16 are likely to be in the region of 10-12% and up to 27% by 2017/18
• Some concerns that a flat cut of this rate applied across the country would have a higher impact in areas with existing health inequalities
• These cuts will directly affect frontline services across all LAs as well as services for vulnerable groups and those focusing on health inequalities and health promotion
• In local authorities where contracts for 2015/16 have already been agreed it is likely that these cuts will be taken from staff budgets
• This is even more likely where contracts have been agreed for three years or more
• The year-on-year nature of the cuts is still unclear so gaps in funding may expand further if more cuts are made next year
• The exact time when any cuts can and will be made is still unclear due to the varying stages of contracts and procurements combined with the timing of this announcement midway through the financial year for many LAs.
Which of the following areas would be likely to be affected by a 7% reduction in LAs budgets?
• All public health services could potentially be targeted for cuts. This could be applied proportionately across all services.
Cuts are expected to be taken from these services the most:
• Interventions to reduce obesity
• Smoking cessation
• Child health
Other services which are also expected to be cut:
• Mental health and wellbeing
• Community development
• Public health intelligence
• Health Checks
• Oral Health
• Occupational Health
• Sports and leisure services
If you have any particular concerns about the impact of these cuts on the health of children or young people, please tell us why:
• Early intervention and universal 0-5 services likely to be cut or merged into general children’s services.
• Long-term impact on children as prevention services, such as obesity and stopping children from smoking programmes, will be cut. Cuts now will negate progress made in these areas over the past few years.
• Any overall cuts will affect children as they are vulnerable group
• Inconsistent picture for health visitors and school nurses as some LAs have secure funding for these for the next few years but others are expecting to include these services as part of their cuts
• Cuts to children’s services undermine the goals of the 5 Year Forward View
Would you support a cut to the budget for NHS Health Checks if it would mean the local authority budget was protected?
• It is unclear why Health Checks would be targeted to offset these cuts
• The evidence base for health checks is still unclear and so it is hard to support them
• The budget for health checks is often small and this offset would not achieve much
• In some LAs the NHS Health Checks budget is not separate from the overall public health budget and so this would not be a practical solution
If a 7% budget is applied to your local authority public health budget, how many people's health could it affect?
• The consensus is that the cuts will affect the entire population of each LA but will have a greater impact on vulnerable communities
• This impact on vulnerable groups could be exacerbated in areas where small contracts for specific services related to these groups can be easily cut. This includes sexual health services, children’s public health services and health promotion and prevention services targeted towards the poorest members of each community (includes homeless people and travellers)
• This will widen the current inequality gap
Is there anything else you'd like to tell us that has not been covered by the previous questions?
The trend that emerges here is how these cuts undermine recent commitments to invest in preventative healthcare across the NHS and the UK.
Relevant comments not covered by the other questions:
• “Public health budgets for health promotion and prevention of illness are relatively easy to cut politically - compared to reducing treatment services, and closing hospitals. But the consequences will quickly be an increase in need and spending on treatment services linked to alcohol, tobacco, obesity and the lack of physical activity.”
Appendix 2: ‘Top 20 losers’: how the cuts could affect people in local authorities across England.
This data analysis was completed by Ben Barr, Senior Clinical Lecturer in Applied Public Health Research, and David Taylor Robinson, Senior Clinical Lecturer in Public Health Research, University of Liverpool. Further information on this analysis is available in this FPH blog
Scenario 1: flat 7.4% cut
Area/borough Cut per person
Kensington and Chelsea: £9.49
Tower Hamlets: £8.32
Hammersmith and Fulham £8.11
Blackburn with Darwen: £6.28
County Durham: £6.25
Kingston upon Hull, City of: £6.20
South Tyneside: 6.16
Scenario 2: Pace of Change cut
Kensington and Chelsea: £19.95
Tower Hamlets: £17.47
Hammersmith and Fulham: £17.04
County Durham: £13.13
South Tyneside: £12.93
Kingston upon Hull, City of: £12.69
Redcar and Cleveland: £12.12
Scenario 3: Needs weighted cut
East Riding of Yorkshire: £5.02
Richmond upon Thames: £5.01
South Gloucestershire: £5.00
North Yorkshire: £4.98
West Sussex: £4.95
West Berkshire: £4.82
East Sussex: £4.77