Health experts join forces in plea to Government

In an open letter to the Prime Minister and Chancellor, over 45 health experts and organisations have urged the Government to increase funding for public health ahead of this month’s budget.

The letter, written by the Association of Directors of Public Health (ADPH), and signed by 47 organisations including the Faculty of Public Health, NHS Confederation and Royal Society of Medicine, welcomes the positive start to the mission to improve the nation’s health, but warns that a coherent, cross-government approach, backed by investment in public health services is needed to achieve their public health policy ambitions.

The letter also calls on the Government to create an environment where everyone has the access to the basic building blocks needed to live healthier lives for longer.

Greg Fell, ADPH President, said:

“The new Government has shown they are committed to improving health with the promise to re-introduce the tobacco and vapes legislation and bring in restrictions on junk food advertising. These measures will help to prevent people from ever becoming sick, something that investing in treatment alone can’t do.  However, to be truly effective, these – and other – measures that tackle the root causes of physical and mental health, need to be resourced properly.

“Health is more than just the NHS – every single decision made both nationally and locally impacts our health, whether it be to do with education, housing, jobs, or the environment. Only by acknowledging this joint responsibility and getting everyone involved in making the places in which we live, learn and work healthier will we be able to improve the nation’s health, and reduce the currently unacceptable gap in healthy life expectancy between the richest and poorest members of our society.”

The letter also highlights a decade of real-terms cuts to public health funding and urges the Government to restore funding to 2015/16 levels so that Directors of Public Health and their teams are able to work with cross-sector partners to deliver improved health for all.

Kevin Fenton CBE, President of the Faculty of Public Health said:

“Recognising the need for a rapid shift towards prevention, the recently-published investigation of NHS performance led by Lord Darzi noted that the Public Health Grant has been slashed by more than 25 percent since 2015, and that ‘too many people end up in hospital, because too little is spent in the community’.

“By investing in primary and secondary preventative services led by public health teams at local, regional and national level and supported by the Public Health Grant, this Government now has the opportunity to take additional meaningful action on prevention and early intervention; help to reduce the burden on our struggling NHS; and sustainably improve our nation’s health and productivity.”

Prof. Maggie Rae, President of the Royal Society of Medicine, Epidemiology and Public Health section, said:

“Nothing is more important than the Public’s Health and the UK is moving to be the unhealthiest country in Europe. The consequences are severe and far reaching. We have stark inequalities and austerity and Covid-19 have had a major impact. We want to support the Government and the public to turn this around.”

Matthew Taylor, Chief Executive of the NHS Confederation, said:

“Health and care leaders strongly welcome the emphasis the new Government has put on moving towards prevention as one of their three big shifts for the NHS. But achieving this shift will be impossible without key reforms and investment.

“Our members understand the difficult financial situation the Government has inherited but the reality is, investing in public health saves our wider public services money in the medium to long-term and supports the economic vibrancy of our local communities, particularly those with the highest levels of deprivation.

“In addition to the restoration of the public health grant, NHS leaders want to see the government incentivise a preventative approach by working with Treasury to change financial flows that currently act as a barrier to this way of working. This is just one example of why a cross-government approach to health, delivering through the Health Mission Board, is so critical to ensuring government can deliver on their ambition.”

Fiona Howie, Chief Executive of the Town and Country Planning Association, said:

“The homes, places and environments in which people spend their lives have a powerful influence over their health. If the Government wants to help people stay healthy it must take a cross-departmental approach to ensure that health is prioritised in all policies, including national planning policy.”

Jacob Lant, Chief Executive of National Voices, said:

“We are pleased to show our support for ADPH’s joint letter to the Prime Minister and Chancellor today and echo its call for a cross-government approach to reduce the gap in healthy life expectancy, of which public health will play a vital role. Unless we act now to reduce this gap and slow down the projected growth in people with major illness for long periods of their life, the future of the NHS will also be in jeopardy.

“Our new organisational strategy emphasises the importance of meaningful engagement with people and communities, so policies and investment are reflective of what people really want and need from health and care. It is vital that as we proceed towards our shared ambition of closing the healthy life expectancy gap and improving our public health offer that decision-making is democratised to ensure that patients, carers, communities and VCSE organisations are all able to have their say about how best to tackle these entrenched health challenges.”

Ends

The following case studies demonstrate the impact that the cuts to the Public Health Grant in England have had.

Drug and alcohol provision: Newcastle

Public health grant allocation: £30.55 per person, per year

Providing effective drug and alcohol services improves healthy life expectancy, reduces deaths and addresses a range of health issues, including blood borne virus transmission, mental health problems, sexual health and pregnancy. They also have a positive impact on families and the wider community by providing a gateway to financial inclusion, employability, education and training, and supporting people affected by a loved one’s use.

Although the city meets all standards required by delivering safe and effective services for clients, the public health grant funding is not enough to develop them. This means not everyone who would benefit can be supported. Nor can the services adapt to changing trends in drug and alcohol use. Meanwhile, extra ring-fenced funding that supports these services is only guaranteed until March 2025.

Alice Wiseman, Director of Public Health for Newcastle, said:

“The staff on the ground in our drug and alcohol treatment services work exceptionally hard and do a fantastic job to provide a safe, non-judgemental environment for people to get help and support. However, they are working at maximum capacity.

“Take into account that we are currently supporting just 40% of Newcastle’s opiate and crack cocaine users, and only 26% of the people who would benefit from support for alcohol use, and you can see just how difficult the situation is. We simply can’t meet the city’s needs without increased – and longer-term – funding.”

Obesity and overweight: Royal Borough of Windsor and Maidenhead

Public health grant allocation: £34.10 per person, per year

Life expectancy and healthy life expectancy in this area are significantly better than national rates. However, there are still inequalities with, for example, an average 6.1 year difference in life expectancy between boys born in the least and most deprived areas. For girls, this is a 3.9 year difference.

The borough’s public health grant allocation is the second lowest in England and by law, there are a number of areas that this money has to be spent on (prescribed functions), including sexual health services, health checks, health visiting and school nursing and responding to public health emergencies.

Jonas Thompson-McCormick, Interim Director of Public Health for the Royal Borough of Windsor and Maidenhead, said:

“The way the Public Health Grant is allocated means that here, after spending on core public health team staffing and prescribed functions, we only have a small budget over which we have spending choices. Therefore, there is much less money available to spend on non-prescribed public health functions, such as tackling overweight and obesity and physical inactivity. If we are going to improve the health of the population, we have to be able to invest in prevention so that people don’t then become ill from preventable conditions. This is particularly important in tackling health inequalities where there is a higher prevalence of overweight and obesity in the most deprived areas than in the least – a gap that exists even before children start school.

“To be able to deliver on the Government’s ambitions of prevention and increased community support, funding for public health measures – which we know work – must be increased and allocated in such a way that each area can direct the money to initiatives that will make the biggest difference for local residents.”

Mental health: Redbridge

Public health grant allocation: £50 per person, per year

In Redbridge, one in five of those aged 16 years and over experience mental ill health, a figure that has steadily been increasing since 2013 and includes those experiencing depression, a well-recognised risk factor for suicide.

In order to maximise impact with limited funds the public health team worked with partners to hold a series of workshops to better understand the reasons behind local residents not seeking support.

By listening to feedback, the team have been able to develop plans for targeted support. For example, extending the mental health champion programme to community leaders, and working with faith leaders and local charities to help reach people without access to the internet – a significant challenge in Redbridge.

Gladys Xavier, Director of Public Health for Redbridge, said:

“With the limited budget we have, we have commissioned services including Thrive London, Good Thinking, and the Coping Through Football programme. These partnerships provide invaluable support to our residents and are undoubtedly improving, and saving, lives. Meanwhile, the workshops and engagement we’ve been involved in have started to reduce stigma and encourage more conversations about mental health.

“However, our ability to fully implement our suicide prevention action plan, which would help us reach the whole community, including those people who are currently not accessing support, is restricted.  We simply don’t have enough money to do the things we know we need to do to prevent future mental ill health and, without a sustained increase in funding, we will never be able to truly tackle this critical issue.”