In 2014, the Five Year Forward View said ‘… the future health 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’ — to which the chancellor has responded by cutting public health budgets. Twice — and with more on the way.
The impact of the cuts in areas such as drug misuse and alcohol was a major focus of this year’s BMA annual representative meeting.
In his keynote address, BMA council chair Mark Porter condemned the ‘shoddy sleight of hand’ by which the Government had circumvented its promise not to decrease NHS spending by placing public health outside the NHS.
He said smoking cessation and sexual health services were among those under threat, adding: ‘You can't trade a public health policy for an e-cigarette and crossed fingers.’
At the ARM, doctors condemned the cuts in strong terms — for their impact on patients and on the workload of doctors as the opportunity to tackle the burden of avoidable illness was squandered.
Cambridge GP Alice Hodkinson said the Government had ‘initially supported public health’ before embarking on the damaging cuts.
She added: ‘What will those cuts mean? Reductions in services, impacting on the poorest families… Public health cuts put pressure on the NHS. These cuts will impact most on the vulnerable.’
The threat posed by the reduction in public health budgets, now in the hands of local authorities, are very real, according to our research.
Cuts to Brighton and Hove’s sexual health service risk ‘increasing the prevalence of sexually transmitted diseases, including HIV’, its council says.
Meanwhile, cuts in Surrey are predicted to have an adverse effect on support for women suffering domestic abuse, while older and vulnerable adults in south London are likely to be lonelier and more isolated when its befriending service is cut, according to an impact report from Merton Council.
BMA public medicine committee chair Iain Kennedy told the BMA that the complete closure of services highlighted the ‘desperate situation’ faced by public health.
At the ARM, he welcomed the ‘first step’ taken by NHS England’s chief executive Simon Stevens — to point out that public health was underfunded.
He added: ‘He must take the next step to fully fund what is not just a fundamental part of health service but a basic right.’
But after enforcing the chancellor’s recent round of cuts, public health doctors face an even more uncertain future under Government plans.
The chancellor announced in November that he was phasing out the grant to local government over the course of this Parliament, and the shortfall would come from business rates.
Dr Kennedy said this would ‘punish’ deprived areas that lacked such a tax base, adding: ‘Using business rates to pay for public health services is simply bad policy.’
He proposed a new strategy to convince ministers of the importance of public health.
‘Perhaps we should start to begin using the language of business? Perhaps we should sell public health? For every pound we spend [on substance abuse] the economy saves £2.50.’
The rewards to the economy were even higher for other services, like smoking cessation, he said.
A public opinion survey, commissioned by the BMA before the ARM, certainly suggests that informing people about public health can convince an audience of its importance.
When given information about public health and what it funds, 75 per cent said they were concerned about cuts.
Fundamentally, public health is an investment — one that is extraordinarily good in financial terms, and vitally necessary in tackling NHS demand, as well as inequalities.
The Government has to do the investing, and can be somewhat removed from those who benefit — or fail to benefit if investment is cut.
They are some of the poorest people in society. Their voices tend to get ignored.
But as the ARM showed, there is at least no shortage of doctors willing to speak up for them.
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