Blenheim is extremely concerned that Local Authorities are diverting ring fenced funds for public health which includes money for drug and alcohol services to fund other services. Blenheim adds its voice to that of the Faculty of Public Health which has called on Ministers and the National Audit Office to more closely scrutinise how the system is working.
Local authorities across England are diverting ring fenced funds for public health to wider council services to plug gaps caused by government budget cuts a BMJ investigation has found. The BMJ also found that public health staffing in some parts of the country is being scaled back to save money. Professional organisations have warned that public health’s voice may be drowned out in local government and that its workforce is spread too thinly.
The investigation found examples of councils reducing funding for a wide range of public health services, including those for substance misuse, sexual health, smoking cessation, obesity, and school nursing. The BMJ found that many local authorities have deployed public health funds to support wider council services that are vulnerable to cuts, such as trading standards, citizens’ advice bureaux, domestic abuse services, housing, parks and green spaces, and sport and leisure centres.
Only 45% of respondents to a recent BMA survey of public health professionals working in local authorities and at Public Health England believed that the public health grant was being used appropriately in their area, while almost half (49.6%) believed that the grant was seen “as a resource to be raided” by local government.
The BMA’s survey also highlighted fear about future staffing levels in public health, with just 12% of respondents believing that there would be enough substantive consultant posts available to serve the needs of the population in 10 years’ time.
The Association of Directors of Public Health told the BMJ that it was particularly concerned about a vacuum in public health leadership at the top of local government, with a quarter of director posts currently unfilled or filled by temporary appointments.
I am even more concerned about Public Health England’s (PHE) apparent failure to adequately ensure that the public health money is spent in line with the ring fence.
The national authority, Public Health England, has said that it supported local authorities making tough decisions and that it was right for public health grants—totalling £2.8bn across England for 2014-15 – to be used to leverage wider public health benefits across the far larger spend of local government.
Duncan Selbie the head of PHE said “The duty is to improve the public’s health, not to provide a public health service.”
At Blenheim our translation is it is about improving the health of the overall population not treating people who are ill. This is particularly unfortunate for those whose treatment is the responsibility of local authorities and PHE. PHE seems to be giving the green light to local authorities to loot and plunder the ring fenced public health grant at will.
This will then come as little comfort to those who now rely on the specialist health services to support them overcome problems with drugs and alcohol and brings into question whether these services and a relevant proportion of the funding should be transferred back to NHS England which is about providing a public health service.
As part of its investigation the BMJ issued requests under freedom of information legislation to all 152 upper tier local authorities in England (most of which are unitary, county or city councils), asking for details of all services commissioned and decommissioned since April 2013 and for details of commissioning intentions for the coming year.
Of the 143 authorities that provided information, almost a third (45) have decommissioned at least one service since April 2013, while others have cut funding to certain services, the BMJ found. Many councils are decommissioning individual contracts for services such as sexual health and substance misuse and then re-commissioning new integrated services to make efficiency savings. Other authorities have decommissioned services that they said were not having the desired outcome on public health or delivering value for money.
In total, more than half of authorities (78) have commissioned or re-commissioned at least one service since April 2013, and the pace of change is set to escalate this year as councils carry out root and branch reviews of services after the year of consolidation.