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NHS needs a flourishing public health sector, inquiry told

Cuts to public health threaten the sustainability of the NHS, peers have heard.

The Faculty of Public Health (FPH) told the House of Lords Select Committee’s inquiry into the long-term sustainability of the NHS that health service funding cannot be looked at in isolation from the cuts to public health, social care, social housing and preventive services.

In its submission FPH noted that hard-pressed councils in England have cut £200 million from public health budgets this year with further cuts of 3.9% pencilled in by 2020/21.

The submission quoted a King’s Fund senior fellow who described the cuts as "the falsest of false economies". Reductions in public health services will inevitably leave the NHS struggling with an obesity and diabetes epidemic and diseases and long-term conditions associated with smoking, excessive drinking and other poor lifestyle choices.

FPH President John Middleton said: "There is a massive and damaging mis-match between protected funding for NHS treatment and funding for prevention and public health services that would reduce the level of ill-health and therefore demand for such treatments. We need real-terms increases in ring-fenced public health budgets.

"This blinkered approach to health spending is bad for our people, our communities and the taxpayer. It calls into question the very sustainability of our NHS."

FPH's submission to the Lords’ inquiry said that 39% of local authorities made cuts to their smoking cessation services this year – at the same time HM Treasury put the economic and social cost of smoking related ill-health and mortality at £13.9 billion.

The submission also warns that the funding squeeze is compounded by a failure to take strong action on key public health challenges such as childhood obesity.

John Middleton said: "The Government’s recent childhood obesity strategy was a tragic missed opportunity to save thousands of children and young people from the misery of life-long diseases such as diabetes. These conditions place an enormous strain on individuals, carers and the NHS. Treatment of type 2 diabetes consumes around 10% of NHS spending yet ministers have ignored the evidence on the impact of junk food marketing aimed squarely at our children."

The submission notes that action on the marketing of junk food to children is one of the key elements of FPH’s public health manifesto, Start Well, Live Better.

FPH’s submission also calls for genuine parity of esteem between physical and mental health – together with local and national initiatives to improve mental health and reduce the life-time impact of deprivation, abuse and violence.

It says councils and their local NHS partners need to gather and analyse local data and evidence.

John Middleton said: "We all need to understand the communities we work in and the needs of local people so we can understand what preventive work will be most effective in improving their long-term health and wellbeing. That is crucial to managing demand for NHS services today, tomorrow and in the next generation."

FPH has also highlighted to the committee cuts in public health specialists in some councils. This has meant less support for the NHS in ensuring the efficient use of public resources by promoting the most effective and efficient treatments and other health interventions.

The submission suggests the NHS should be more imaginative in tackling the root causes of ill-health – including through investing with councils and others in healthy housing programmes.

FPH also urges policymakers and the NHS to recognise that environmental sustainability can promote efficiency – saving money on prescribing, transport and energy use.

Written: 23/09/2016 , last modified: 27/10/2016