Never mind dry January, there’s a drought ahead for public health

January 8, 2019   By Sarah Lawson, Policy Researcher, NLGN

The NHS 10-year plan has been heralded by the Prime Minister as a “historic step to secure its future”. While elements of the plan are welcome – including greater investment in community care and mental health – it falls far short of creating history. The Government’s renewed focus on prevention is undermined by the drying up of funds for the preventative services that councils deliver to keep people well.

The public health grant was cut by £85 million ahead of the Christmas break, contributing to an overall decline in funding of 25 per cent over the last five years. To put this £85 million into perspective, Jim McManus (Director of Public Health for Hertfordshire) translated the figure into a loss of 1634 health visitors, 3000 drug workers or 1700 school nurses.

Meanwhile, the NHS is set to receive a 3.4 per cent real-terms increase in funding over the next five years. The Government continues to take a siloed and clinical focus, investing in diagnosis and treatment at the expense of wider prevention. The Health Foundation have argued that the public health grant requires a boost of £3.2 billion a year to restore real-terms losses and align the grant with changing population needs.

A blinkered focus on the NHS isn’t improving health, nor is it sustainable as demand for health services becomes increasingly complex: two-thirds of adults over 65 are expected to be living with multiple health conditions by 2035. More years are being spent in poor health and health inequalities between the most and least disadvantaged parts of the country equate to nearly two decades of healthy life. Meanwhile, local government is not only bearing the brunt of further cuts but is picking up the costs of a lack of investment in prevention. For example, in early years, late intervention cost the public sector an annual £17 billion in 2016. Local government picked up 39 per cent of this cost, the NHS nearly half as much (22 per cent). The evidence isn’t pointing in favour of the current clinical focus.

The evidence does however point to the value of investing in prevention in its broadest sense, be this in costs avoided to health services or the value provided to the health of the population more widely. For example, the NHS is currently spending 10 per cent of its budget on diabetes, costs that could largely be avoided if at-risk groups were targeted through preventative measures such as changes to our unhealthy food environment. Meanwhile, improvements to the quality of people’s homes have been linked to reductions in emergency hospital admissions.

These examples show the cost of a lack of investment in prevention, but they are far from the full picture. Perhaps the most convincing cases for prevention are made when we move beyond the health service framing towards the value of health as a driver of positive societal outcomes. For example, the link between high self-reported levels of health and GDP growth in areas of the UK. Few would argue that a healthier and happier population is also a more productive one.

The potential for prevention extends beyond easing pressures on acute services. Done well – moving beyond individuals and clinical settings alone, to communities and local systems – it could help to reconfigure public service delivery towards a more sustainable future. NLGN will soon be releasing the third report in our Changemaking series, which will call for a paradigm shift to put communities at the heart of public service delivery. Prevention is a key part of this shift, but it relies on public health teams – and wider local government – being able to continue and expand valuable work. As we have previously called for, this must be enabled through a sizeable chunk of the recently announced £20.5 billion for the NHS.

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