Public health budgets ‘raided’ to pay for council cuts

An investigation by the British Medical Journal (BMJ) says millions in cash is being diverted by councils even though public health spending is officially ring-fenced from cuts.

In Sheffield, it found £3 million had been re-directed from public health budgets to pay for health-related services previously funded by the council among them breastfeeding support, adult physical activity programmes and domestic abuse work.

The authority blamed national funding cuts for the decision and anticipated further cuts in the coming year to pay for £1m investment in programmes to address the root causes of ill health in the city.

Sheffield’s director of public health, Jeremy Wight, told the BMJ local government was being forced to act “creatively” due to the scale of cuts to wider services.

“It is the very significant cuts in this funding - particularly in the northern metropolitan authorities - that is leading us to have to use public health grant funding creatively,” he said.

“For the government to say that public health funding is being protected or increased is only true at a very simplistic level. The wider substantive cuts to local authority funding are very damaging to public health more broadly.”

The BMJ, which received responses from 143 councils across England, found nearly a third had decommissioned at least one service since being given responsibility for public health last April.

It claimed authorities were using public health funds to support services vulnerable to cuts including trading standards, housing, parks and sport.

It detailed plans in Rotherham to reduce spending on school nursing, fall services, dental public health and sexual health, and moves in Derbyshire to cut investment in substance misuse, sexual health, smoking and obesity services by £2m to support “wider preventative programmes that are under review due to council financial pressures”.

Gabriel Scally, formerly the Department of Health’s regional director of public health for the south west and now professor of public health and planning at the University of the West of England in Bristol, told the BMJ: “There is a long history of public health budgets being plundered by organisations that are having financial difficulties.

“This time it isn’t NHS managers who are playing fast and loose with public health budgets, it is local authorities. Of course, local authorities are having their budgets reduced, but the Department of Health has provided that funding to local authorities to spend on public health, not to be siphoned off to prop up other services.

“It’s robbing Peter to pay Paul. They maintain that NHS funding will be protected, but it is being used for non-NHS purposes.”

England has 132 permanent public health director posts, but currently 31 positions are vacant, the investigation also found.

Janet Atherton, president of the Association of Directors of Public Health, said strong stable leadership in public health was needed to help councils address the challenges they faced and it was a concern that a quarter of posts were held by temporary appointees or lay vacant, leaving some authorities “at a real disadvantage when it comes to delivering their public health functions”.

She added: “Public health responsibilities have transferred into local government at a particularly challenging time financially for councils. This makes it more important than ever that the ring-fenced public health grant is used well to achieve the best health outcomes and value for money.

“Using this funding effectively will help councils and the health system more widely to manage increasing demand for high cost health and social care interventions. The pattern of spend within the public health grant should rightly change over time, by decommissioning services that are not achieving good outcomes and reinvesting in higher priority areas. Many of the case studies given in the BMJ article are examples of this happening in practice.”

The Local Government Association branded the claims “scaremongering”.

“Spending levels on public health have remained consistent and it is inaccurate and wholly misleading to suggest that local authorities have been siphoning off funds to prop up services elsewhere,” said a spokesman.

“Councils are investing just as much as previous arrangements in public health services, and indeed are supporting wider determinants of health too. Many services - such as housing, planning, leisure and recreation, and environmental services - are crucial in keeping people fit and healthy.

“We are convinced that the most effective use of resources to improve public health is to combine the public health professional workforce, with its specialist expertise and intelligence, with mainstream council plans and services. The key is to develop services that are locally appropriate, efficient and effective in improving outcomes.

“Councils must account each quarter for their public health spend across 18 areas. The rules are clear and involve sign off by the director of finance or chief executive.”

In a statement, John Radford, director of public health in Rotherham, said he was not expecting any reduction in service provision although he admitted efficiencies were being sought.

He added: “When it comes to Rotherham our focus is on maintaining the quality of services while seeking efficiency savings. These efficiencies are not at the cost of the services delivered but are there to ensure that we get the maximum value for the Rotherham pound. The public expect us to make efficiency savings and it is incorrect to suggest that we would allow the service quality to lessen.”

Bradford Council leader Coun David Green said the public health budget was being used “to improve public health outcomes as intended”.

But he added: “The council also fundamentally delivers many functions which influence the wider determinants of health. In some instances, the public health department has decided to support services which achieve public health outcomes that would otherwise no longer existdue to cuts in council funding.”

Officials in North Yorkshire said the public health budget was rising by £700,000 to £19.7m in 2014-15.

“We are reviewing all our public health services to maximise their productivity. We have no immediate plans to reduce services,” said a spokeswoman.

Duncan Selbie, chief executive at Public Health England, said: “We have been perfectly clear that the public health grant is there for improving the public’s health and the conditions describing what this means preclude substitution and savings towards balancing the books.

“It is for each local authority to confirm that they have met the grant conditions and this is subject to their own external audit.

“We are not anxious about local government taking their new public health responsibilities extremely seriously - we know they are.

“As the accountable officer, I have written to every local authority in England explaining what I need by way of assurance that councils are using their ring-fenced public health grant appropriately.”