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Public health budgets ‘diverted’ by local councils

Public health budgets ‘diverted’ by local councils


Ring-fenced public health funds are being diverted to council services to plug gaps caused by government cuts, a BMJ investigation has revealed.

Using freedom of information (FOI) requests, the BMJ found numerous examples of councils disinvesting in a wide range of public health services, including those for substance misuse, sexual health, smoking cessation, obesity, and school nursing.

The money is instead being used to support wider council services vulnerable to cuts, such as trading standards, domestic abuse services, housing, parks and leisure centres.

The BMJ asked all 152 upper-tier local authorities in England how they have been spending the money that was transferred to them for public health from April 2013, and how they intend to spend it in the coming year.

Of the 143 (94%) of councils that responded, almost a third (45) said they have decommissioned at least one service since April 2013, while others have reduced funding to certain services. The majority also indicated that more ambitious service changes would occur in 2014/15.

For example, Sheffield said it had “top sliced” 11% of contract values on almost all of the services commissioned from the public health grant last year, freeing up funds to pay for activities previously paid for by mainstream council funds.

In Derbyshire, there are plans to reduce investment in substance misuse, sexual health, smoking, and obesity services and re-invest £2m “to support wider preventative programmes that are under review due to council financial pressures.”

A recent survey from the British Medical Association (BMA) found the only 45% of respondents working in both local authorities and at Public Health England believed that public health funding was being used appropriately. 

It also uncovered fears amongst professionals over future staffing levels, and that many council’s have not fully understood the huge potential their new public health function offers. 

Dr Penelope Toff, co-chair of the BMA’s Public Health Medicine Committee, said: "We are concerned that a significant number of local authorities are reducing vital drug and alcohol, sexual health and smoking cessation services. This is likely to have devastating short and longer term effects well beyond local authority boundaries. 

“We would expect Public Health England to be keeping a very close eye on this situation, and to escalate concerns about any local authority they do not believe able to properly exercise their public health responsibilities." 

Public Health England said it was right for public health grants – totalling £2.8bn across England for 2014/15 – to be used to leverage wider public health benefit across the far larger spend of local government.

Its chief executive, Duncan Selbie, said he welcomed local government reviewing where the money has been spent, saying “the duty is to improve the public’s health, not to provide a public health service.” 


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