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Proposed cuts to public health budgets are short-sighted

In June 2015, the UK government announced a £200m cut to public health funding for local authorities – a 6.2% cut to their budgets that was supposedly based on projected underspend.

The announcement was particularly worrying as the public health budgets of local authorities are only ring-fenced until October 2016, and the government plans a 40% real-terms cut to councils’ core funding over the life of this parliament.

It is not difficult to envisage that cash-strapped local councils could be tempted to raid the public health budget in order to bolster the ever-increasing demand for social care funding

When the ring-fencing ends in 2016, it is not difficult to envisage that cash-strapped local councils could be tempted to raid the public health budget in order to bolster the ever-increasing demand for social care funding.

The proposed cut in public health spending flies very much in the face of the NHS Five Year Forward View, in which NHS chief executive Simon Stevens calls for “a radical upgrade in prevention and public health”. When money is tight the pressure is always on to spend money on the immediate challenges, so inevitably the public health piggy bank will be raided to pay for social care. This is depressing, as there is growing evidence of the long-term financial benefits of investing in public health interventions and services. For example, every £1 spent preventing teenage pregnancy saves £11 in longer term health costs.

All of this comes amid a drive from the Pharmacy and Public Health Forum to encourage the commissioning of more healthy living pharmacies (HLPs), which provide public health services. However, the English Pharmacy Board knows of cases where these plans have been reversed because of the planned reduction to public health funding. Hackney Public Health intended to develop HLPs within their locality but because of the proposed cuts this will no longer go ahead. As a member of Hampshire HLP accreditation board, I have particular concerns about this.

The proposal to cut the budget is already having an impact in other areas. Plymouth City Council intended to put NHS Health Checks out to tender into community pharmacies but plans have been put on the back burner because of the current lack of clarity on budgets and the cuts.

It will also come as no surprise that services have already been decommissioned. The City of York Council is cutting its emergency hormonal contraception service through pharmacy as a direct result of the cuts and community pharmacists in York have already been informed that their public health services are only guaranteed for this financial year.

We do not yet know whether there will be an across-the-board reduction or whether areas of greatest deprivation will suffer least. There is a 20-year gap in healthy life expectancy between the most affluent and most deprived areas of the country, but the funding formula already reflects this to a high degree. The evidence base for pharmacy’s contribution to public health has never been more needed, but this on its own is not enough.

The English Pharmacy Board has responded to the consultation on how to operate the cuts, starting with the premise that we believe cutting public health budgets to be a short-sighted move. We are also working with the Royal Colleges on this issue but will await the results of the consultation before deciding on specific further action.

If individual pharmacists feel strongly about this matter – particularly if they are already aware of local implications – then they can take action in two ways. The first is to write to the local member of parliament expressing concern, and the second is to lobby local councillors who may have an influence over which services are commissioned and which aren’t. They may not have much of a clue about the range of services offered by the modern pharmacy, so invite them along to find out. 

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2015.20069632

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