Local government public health budgets: a time for turning?

In her first month as Prime Minister, Theresa May has signalled that she will focus on inequalities and life chances. Unlike the first woman to occupy Number 10, she may even be one for turning, as evidenced by the Hinkley Point reappraisal. Given this fresh thinking, I wonder whether the Prime Minister will be interested in the current situation with public health budgets.

After a welcome commitment to better funding of public health services in the early years of the coalition (it’s easy to forget that growth in the local government public health grant initially outpaced clinical commissioning group allocations) the ex-Chancellor first slammed the brakes on, then made a £200 million in-year reduction, and finally announced in the Spending Review a further real-terms cut averaging 3.9 per cent each year until 2020/21.

The King’s Fund and many others warned of the false economy of these cuts; the arguments are well rehearsed so I won’t repeat them here. What is worth underlining, though, is how local authorities are planning to cope with these cuts – the first tranche of data on this has now been released – buried though it is on the Department for Communities and Local Government’s website.

Figure 1 below shows the percentage changes in local authorities’ planned spending on public health services between 2015/16 and 2016/17 – a 9 per cent cut on a like-for-like basis.1

Figure 1

The biggest percentage cuts are in smoking and tobacco control (perhaps to some extent a reaction to e-cigarettes) and public health advice to NHS commissioners – very worrying given the supposed move to a more place-based approach to health from both the NHS and local government. There are also substantial cuts in spending on adult obesity; given the recent findings that we are systematically under-counting calorie consumption, this is a cause for concern.

The only areas that escape the axe (at least in cash terms) are physical activity and obesity services for children, and alcohol misuse services for adults.2

Figure 2 below shows the same categories, but this time the absolute differences. The biggest absolute cuts beyond miscellaneous spend (which includes spending on accident prevention, dental public health and environmental hazards, for example) are in drug misuse for adults,3 smoking cessation services, and testing and treatment of sexually transmitted infections. The only significant increase is for adult alcohol misuse services.4

Figure 2

Of course these are only plans, and actual spend might be different – though radical changes are unlikely. The 2015/16 out-turn spending figures will be released soon, but we will have to wait until next summer to check final spending against the plans outlined above.

Can we really wait that long? Planned spending on some of the key determinants of our health in wider local government budgets is also falling; for example, culture and related services, which includes spending on open spaces, recreation and sport, is down by 6 per cent, and housing services, which includes homelessness, benefits and strategy, down by 7.5 per cent using the same data source. Given Theresa May’s interest in social justice and relaxation of the ex-Chancellor’s target to achieve a budgetary surplus, might these figures persuade her to turn?

• 1The eagle-eyed will spot that there are a few omissions: services for children aged 0-5 (responsibility for these services was transferred from the NHS to local authorities in October 2015), public mental health and health at work. If these categories were included, it would appear as an overall increase of 5 per cent in planned expenditure. But this would be misleading, because 2016/17 includes a full year of funding for children’s services (around £800 million transferred from the NHS) whereas 2015/16 only included six months (around £400 million). This money is not growth, but a simple transfer. Taking these numbers out, as Figure 1 does, compares the expenditure on a like-for-like basis, a fairer and a truer reflection of the overall pressures on local authorities, and shows an overall reduction in budgeted spend of 9 per cent.
• 2However, it is important to be aware that for 2016/17 there are two categories of alcohol misuse services (treatment and prevention) whereas in 2015/16 there was only treatment. We have combined both categories for 2016/17; if we had only compared budgets for treatment then there would have been a reduction of 14 per cent.
• 3Though there are the same differences in classification for drug misuse categories in 2016/17 as there are for alcohol misuse.
• 4But again if we only compared budgets under the treatment category for 2016/17, then this £20 million increase (which includes the new line for prevention in 2016/17) would be turned into a £24.8 million reduction.