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Local Authorities: Public Health Budget

Volume 764: debated on Wednesday 15 July 2015

Question

Tabled by

To ask Her Majesty’s Government what is their assessment of the impact of the £200 million reduction in the public health budget on local authorities in the current financial year.

My Lords, with the leave of the House and at the request of my noble friend Lord Beecham, I beg leave to ask this Question.

My Lords, the Department of Health recognises the importance of implementing this saving in ways that minimise any possible disruption to services. It is about to consult publicly on how best to do that, and on how best to monitor the impact on services.

I thank the Minister for that reply. In view of the very strong statements that we have had in recent weeks from the Prime Minister and the Secretary of State for Health—and indeed from the Minister himself from this Dispatch Box—about the importance of prevention to help the NHS cope with future demand, is it not extraordinarily short-sighted to impose reductions which inevitably will result in cuts to preventive services, such as contraceptive services, drug and alcohol services and weight reduction? Does this not absolutely undermine the Government’s objective of improving public health?

I shall give a short quote from the Prime Minister:

“when you look at the costs of obesity, smoking, alcohol and diabetes, we know we need a completely new approach to public health and preventable diseases. A real focus on healthy living. That’s why it’s at the heart of the plan”;

that is, the Five Year Forward View. We accept that prevention is extremely important. This reduction in spending is £200 million out of a grant for local authorities of £3.2 billion—a reduction of about 6%. Local authorities have demonstrated in many other areas an ability to extract savings. I am sure they will do the same in this case.

My Lords, I am not the only doctor to have expressed some reservations when the Health and Social Care Act decided to transfer funding for public health from the National Health Service to the local authorities. Do the Government now regret that decision in the light of the problems highlighted in the Question—particularly at a time when public health is facing enormous challenges, not least due to the obesity epidemic and the alarming increase in the incidence of type 2 diabetes?

My Lords, I am hesitant to disagree with the noble Lord in view of the fact that he told me earlier that he qualified as a doctor in 1945, which was nine years before I was born. However, the devolution of responsibility to local authorities has been fairly universally welcomed. They are better able to take into account local priorities. I should also add that just over £2 billion of the public health budget is held centrally as well.

My Lords, is the noble Lord aware that many of the local authorities commission these important prevention services from NHS providers? Has any impact assessment been made of the effect on the NHS of this loss of income?

I think that the noble Baroness will know that we are due to go out to consultation on this matter, and that is an important issue that will be taken into consideration.

My Lords, does the noble Lord not recognise that this Question goes much broader than just the confines of the issue that we are discussing? Local authorities have an effect on the environment, transport, housing, poverty and a whole range of social issues that absolutely affect public health. Until that is sorted out, this is going to be a major problem in this country.

The noble Lord makes a good point that goes considerably broader than the Question. I accept that many of these things are inextricably linked.

My Lords, does the noble Lord accept the report from NICE, which showed that investment in public health improves not only the health of individuals but the economy? Can I tempt him to agree that cutting funding by as much as—I think—7.5% is counterproductive in trying to improve the nation’s health?

The noble Lord may be interested to know that the McKinsey institute assessed that the cost of obesity to the British economy was some £46 billion. I am under no illusion about the importance of proper prevention.

My Lords, health inequalities continue the gap in access to services and equity in our health services. The gap remains the same and has not become narrower between various socioeconomic groups, 20 years on. That means the rich, poor, black and indigenous white population. Exactly what is going to be done with part of the health prevention budget to try to reduce the gap?

A condition of the grant to local authorities is that they take on the responsibilities that the Secretary of State has under the Health and Social Care Act to reduce inequalities. As statutory bodies, local authorities have a duty under the Equality Act 2010 to provide equal opportunities for people with protected characteristics.

My Lords, just last month, the Secretary of State for Health told the Commons:

“The big change we need to see in the NHS over this Parliament is a move from a focus on cure to a focus on prevention”.—[Official Report, Commons, 2/6/15; col. 459.]

Two days later, on 4 June, the Chancellor announced a £200 million cut in the Budget. How joined up is that, and how is it justified?

Most people in this House will recognise that a strong and successful National Health Service depends on a strong and successful economy. Sometimes Governments have to take difficult decisions to improve the long-term strength of the economy, which is what we did in that case.