Local authorities are facing big cuts in their 2017-18 health budgets with the biggest hits lined up for services relating to sexual health, young children, quitting smoking and drug misuse, according to the healthcare improvement charity The King’s Fund. That is despite the fact that funding appears to have increased by 26% since 2013.
Data from the Department of Communities and Local Government shows that health funding for authorities in England has failed to keep up with new responsibilities that have been landed on them. The figures show that the English local authorities plan to spend £3.4 billion on public health services in 2017-18. But the charity and think tank said that councils will spend only three-quarters of that, which is 3% less than the £2.6 billion spent 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% less in 2017-18 than it was in 2013-14,” it said.
That “like-for-like” basis meant The King’s Fund analysis did not include funding for services transferred to local government, which is now classed as public health spending. On those terms the budget appears to have increased because of the transfer of existing funding from other budgets rather than new funding.
An example given by the King’s fund is that “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.”
More responsibilities and less funding
The Health and Social Care Act in 2012 passed the responsibility for many health services in England to local authorities from the following year. “Local authorities have, since 1 April 2013, been responsible for improving the health of their local population and for public health services including most sexual health services and services aimed at reducing drug and alcohol misuse,” according to a House of Commons Library document on local authorities’ public health responsibilities in England.
The grants provided to the local authorities were generous at first with £2.7 billion given to the then new body Public Health England in 2013-14 and the National Audit Office said that “public health funding increased by 5.5% in 2013-14, reflecting the importance the Department of Health places on this issue.”
Despite that statement annual increases then stopped and more responsibilities were given to local authorities with a transfer of funds that looked like an increased budget but were not really. That is why the apparent £700 million increase since 2013-14 is misleading.
David Buck, a King’s Fund senior fellow of public health and inequalities, said the 2015-16 Spending Review then announced a funding cut of 4% a year to health services, “adding up to a reduction in spending in real terms of at least £600 million a year by 2020-21, on top of the £200 million already cut from the 2015-16 budget.”
The view ahead
“In this context, the new 2017/18 data is important because it is our first sight of what local authorities are planning to spend in the light of these settled responsibilities,” said Buck.
His chart (left, or full size here) demonstrates the strain on the budget compared to 2016-17, let alone back in 2013 when local authorities first took over with decent funding. Some results could be affected to changes of categorisation, as he said Birmingham City Council will spend nothing on “sexual health – promotion and prevention” compared to £14 million in 2016-17 but has increased “sexual health – testing” by £14.4 million.
Physical activity for children received the biggest increase, which was the only category to rise by more than 10%. Other physical activity, health at work and contraception were among the few meagre increases. The biggest cuts were to sexual health services, tobacco control, drug and alcohol services for young people and public mental health.
by Stewart Vickers
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