England

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Public health funding in England

GP surgery, Derry, Northern Ireland
18 October 2016
Blood pressure examination

The BMA has consistently highlighted that the contribution of public health to the future sustainability of the NHS and keeping the population healthy is being undermined by funding constraints. Services and interventions vital for improving population health are not being implemented, or are being cut back.

Doctors have expressed particular concern that recent budget changes will result in public health services that are inadequate for meeting the needs of the local populations which they serve.

 

Our analysis of funding trends for public health services

Our latest analysis demonstrates continued reductions in budgets for vital public health services.

In recent years funding to deliver public health services across England has been significantly cut, both in real and cash terms.

The Government has confirmed this trend will continue in 2019-20. 

Our analysis using the most recent data shows the impact this is having on individual public health services such as stop smoking, obesity, alcohol and drug treatment services, all of which have seen a reduction in their funding over the last three years. This is despite related hospital admissions for key lifestyle factors such as alcohol, obesity and smoking increasing significantly in recent years. 

Our heatmap (below) also shows changes in public health allocations in local areas across England*. By hovering over each unitary or local authority, it is possible to see the percentage change from 2016-17 to 2018-19 (the most recent date). The fifth chart allows for a comparison of local areas against the national average (4.8%). The biggest increase being 14.6% in Waltham Forest compared to the biggest decrease of 17.6% in North Lincolnshire. 

It is clear that despite Government rhetoric that prevention is a priority area for action, this is not being matched by funding in England. This needs urgent action including:

  1. Cuts to public health funding should be reversed, and sufficient funding made available to meet the health needs of local populations.
  2. The impact of changes to funding for public health services should be routinely monitored for its impact on health inequalities and reflected in future funding settlements.

This funding needs to be part of a comprehensive approach to population health. The BMA has recently set out the framework that is needed in order to meet an ambition of society where we all spend more years in good physical and mental health. 

Read more about our approach here 

 

Feeling the squeeze: the local impact of cuts to public health budgets in England

We explored whether changes to public health funding are reflective of local population health need, and assess the impact that public health funding cuts are having on the delivery of services locally.

 

Key findings

  1. Changes to public health spending in local areas do not reflect the needs of local populations. Many areas with poor health outcomes are seeing substantial cuts to funding for a range of key public health services.
  2. Budget reductions are leading to unacceptable variation in the quality and quantity of services available to the public. This is likely to have a detrimental impact on population health, increase future demand for treatment services, and risks widening health inequalities.

 

Recommendations

  1. Cuts to public health funding should be reversed, and sufficient funding made available to ensure that public health services can meet the health needs of local populations.
  2. Any new mechanism for funding public health services in England must be adequate and sustainable, and should be monitored for its impact on health inequalities.
  3. Common, minimum standards for the provision of public health services in England should be established, to address local variation in the quality and quantity. These standards should be monitored and maintained by an independent body.
  4. Any proposed changes to the funding of public health services locally should be clearly assessed for their potential impact on population health, and any new models of service provision routinely audited for their effectiveness and cost-benefit.
  5. There should be greater recognition of the evidence that prevention and early intervention is cost effective, and a renewed focus on maintaining access to cost-effective public health services that reduce future demand for healthcare. 

Read the full research briefing, which explores the local impact of cuts to public health funding in England.

Public health budgets: feeling the squeeze

 

Further resources

A doctor on the frontline of public health funding cuts - blog by Sohail Bhatti

Help to quit goes up in smoke - BMA News feature

Worst hit areas lose public funding - BMA News story