Big cuts planned to public health budgets

Public health

Central government cuts have forced councils to reduce planned spending on vital public health services such as sexual health clinics and reducing harm from smoking, alcohol and drugs by £85 million, according to new analysis by The King’s Fund.

The analysis, based on Department of Communities and Local Government data, shows that councils in England are planning to spend £3.4 billion on public health services in 2017/18. But on a like-for-like basis (to exclude the impact of changes to how budgets are calculated over different years) councils will spend only £2.52 billion on public health services in 2017/18 compared to £2.60 billion the previous year. Once inflation is factored in, we estimate that, on a like-for-like basis, planned public health spending is more than 5 per cent less in 2017/18 than it was in 2013/14 [1].

While the figures show that councils are planning to spend more on some services – including on promoting physical activity and on some children’s services – most services are planned to be cut. This includes reducing spending on:

sexual health services by £30 million compared to last year, a 5 per cent cut
tackling drug misuse in adults by more than £22 million, a 5.5 per cent cut
stop smoking services by almost £16 million, a 15 per cent cut.

Many services that face spending cuts this year have already had to cope with successive years of falling budgets. Planned spending on sexual health services, for example, has fallen by £64 million, or by 10 per cent, over the past four years. This is despite significant increases in recent years in the number of cases of some sexually transmitted infections including syphilis and gonorrhoea.

These reductions follow government cuts in public health funding of at least £600 million by 2020/21, on top of £200 million already cut from the 2015/16 budget [2]. This is despite Health Secretary Jeremy Hunt highlighting in parliament last year that making good progress on public health often has the biggest effect on health inequalities.

David Buck, Senior Fellow in Public Health and Inequalities at The King’s Fund, said:

‘These planned cuts in services are the result of central government funding cuts that are increasingly forcing councils to make difficult choices about which services they fund.

‘Reducing spending on public health is short-sighted at the best of times. But at a time when the rate of syphilis is at its highest level for 70 years, to cut spending on sexual health services is the falsest of false economies and is storing up problems for the future.

‘The government must reverse these cuts and ensure councils get adequate resources to fund vital public health services.’

Notes to editors

The overall public health budget increased between 2016/17 and 2017/18. However, this is affected by changes to what is classed as public health spending – in mid-2015/16 local government took on responsibility for young children’s public health and received a transfer of approximately £400 million from the NHS to fund this (rising to approximately £800 million in subsequent years). This is not growth but a transfer of funds to pay for additional responsibilities. Our analysis of changes in budgets since 2013/14 looks at like-for-like growth excluding the impact of these transfers (ie, excluding budget lines 383 and 384 to the Department for Communities and Local Government revenue account budget). Figures are expressed in nominal cash terms, except where otherwise noted. Real-terms figures are presented at 2016/17 prices using HM Treasury deflators published in March 2017.
The estimated reduction in public health spending between 2014/15 and 2020/21 is based on a joint analysis from The King’s Fund, Nuffield Trust and the Health Foundation ahead of the 2016 Autumn Statement.
The trend in spending for individual services does not include inflation or population growth, so the real-terms reduction will be even greater.
The reductions in planned sexual health budgets have been calculated by combining the planned budgets for sexual health services – promotion, prevention and advice (non-prescribed); sexual health services – STI testing and treatment (prescribed functions); and sexual health services – contraception (prescribed functions).
While rates of sexually transmitted infections including syphilis and gonorrhoea have increased in recent years, last year saw a slight fall in the gonorrhoea rate.

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The King's Fund is an independent charity working to improve health and care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. Our vision is that the best possible health and care is available to all.