Public health in the UK must be revitalised if the Government hopes to cut waiting lists and tackle health inequality, a report by the BMA warns.
The association has called on ministers to reverse years of insufficient funding resulting from cuts to public health budgets and the disruptive effect of structural reorganisations, which it says have left public health services ‘gutted’.
Published today the report Rebuilding Public Health: Restoring the Foundations of Prevention, also emphasises how diminished public health services alongside a decade of austerity and the COVID-19 pandemic, have resulted in greater levels of ill-health across society.
It warns that, unless the Government takes steps to boost investment and address the sector’s crisis in recruitment and retention of staff, public health services will remain ‘unable to meet the exponentially growing needs of an increasingly sick and economically inactive population’.
In response, the report puts forward a strategy for addressing the crisis in public health totalling 14 recommendations relating to funding and workforce.
Funding restoration
These include a £4.6bn of investment in the public health grant in England across five years, a move the BMA states would restore funding in real terms to 2015/16 levels and a review of the allocation formula used for public health spending.
The report also calls for an audit to assess existing levels of funding and measures to increase transparency around spending on preventive healthcare.
Alongside funding, the report also calls for improvements to pay and conditions of staff, and a commitment that public health specialists be included in workforce planning and the commissioning of services at integrated care board level.
In its introduction and call to action, the report makes clear that a robust renewal and reinvestment in public health is essential not only to address deteriorating standards of health in society but to ensuring the wider NHS is able to meet the demands facing it.
It says: ‘Much of the ill-health in the UK is preventable. This includes around four in 10 cancers, four in 10 cases of dementia and eight in 10 cardiovascular deaths as well as many mental health problems and conditions like type 2 diabetes, chronic kidney disease and alcohol use disorders.
‘Investing in public health will help prevent more ill-health, reduce pressures on the NHS, tackle health inequalities, and grow the economy. However, public health funding is both insufficient and is often opaque. It fails to meet the needs of the population and is difficult to track effectively.
‘The size of the public health workforce is significantly lower than recommended levels. High levels of workforce attrition are fuelled by disparity in pay and conditions, increasing workforce pressures, and worsening population health.’
Healthy generation
It adds: ‘Empowering public health professionals and investing in public health services is essential if the UK governments are to achieve their goals of cutting NHS waiting lists, growing the economy, reducing health inequalities and raising the healthiest generation of children in our history.’
The report's recommendations are informed by the findings of a BMA-led survey of just under 200 public health specialists.
Carried out in July 2023, the survey paints a damning picture of the state of public health from those working on the ground.
This includes the fact that only 12 per cent of those responding to the study said that they believed public health was in a strong position to lead efforts to improve the nation’s health, with 8 per cent agreeing it was in a strong position to reduce health inequalities.
The survey also found that just 14 per cent of survey participants, who were drawn from across the whole of the UK, felt that public health had the level of funding needed to effectively perform its duties.
‘Starting point’
The report states that, while the 2025/26 public health grant to local authorities in England is set to see a real-terms increase of 3 per cent, this figure can only be viewed as a ‘starting point’ to remedying more than a decade of underfunding.
The report also points to the damaging effects resulting from the previous Government’s decision in 2021 to disband Public Health England, replacing it with two new bodies the UK Health Security Agency and the Office for Health Improvement and Disparities.
When asked by the survey whether this restructure had had a positive effect on the public health system, 69 per cent of those taking part said ‘no’.
The report also expresses concern that services could face further disruption as a result of the decision to abolish NHS England, a move that could ultimately see up to 9,000 jobs being cut, which could include some of the more than 100 public health professionals in the organisation.
In response, the report proposes the possibility of placing public health functions in England back under the control of the NHS through the creation of an independent public health agency.
On the back of today’s report, BMA public health committee chair Heather Grimbaldeston has written to Parliamentary under-secretary of state for public health and prevention Ashley Dalton.
She said: ‘We hope this report will support meaningful action by the Government to restore and strengthen public health services across the UK.
‘The BMA would welcome the opportunity to meet with you to discuss the findings and recommendations in more detail, and to explore how we can work together to ensure that public health is properly resourced, empowered, and equipped to meet the growing challenges it faces.’