Public health cuts a "false economy" that risk widening inequality, MPs warn

Pic: David Sim

Cuts to local authorities' public health funding are a false economy that will only add future costs to health and social care, and risk widening health inequalities, MPs have said.

In a report looking at public health since it became the responsibility of local government in April 2013, the Health Select Committee calls for "bold and brave action" through the Government's life chances and child obesity strategies to tackle inequalities. It recommends the appointment of a Cabinet Office minister with specific responsibility for embedding health across all areas of national policy, including planning and licensing.

Councils saw an in-year cut of £200m to public health funding last year and now face further real-term reductions to budgets.

The committee noted that in her first speech as Prime Minister, Theresa May pledged to tackle the "burning injustice" of health inequalities, saying that someone who is poor will die on average nine years earlier than someone who is rich.

But tackling these inequalities and improving public health will not primarily happen in hospitals, even though they receive the lion's share of health funding, the committee said. Instead, a "whole-life course" approach is needed that tackles the wider determinants of health in communities, provides effective preventative action and early intervention, and is supported by joined-up policy at national level.

However, it added, there is a growing mismatch between spending on public health and the significance attached to prevention in the NHS Five-Year Forward View.

Dr Sarah Wollaston, chair of the Health Select Committee, said: "The disappointing watering down of the childhood obesity strategy, published in August, demonstrates the gap in joined-up evidence-based policy to improve health and wellbeing. Government must match the rhetoric on reducing health inequality with a resolve to take on big industry interests and will need to be prepared to go further if it is serious about achieving its stated aims."

The committee found some local authorities have made good progress, with modest improvements in public health outcomes, but others have struggled. While some variation is to be expected in a localised system, it said, it is concerning that robust processes to address unacceptable differences between areas are not yet in place.

Furthermore, MPs said the current system of sector-led improvement needs to be more clearly linked to "comparable, comprehensible and transparent information on local priorities and performance" on public health.

Changes to local government funding, particularly the removal of ring-fencing for the public health grant, must be managed so as not to further disadvantage areas with high deprivation and poor health outcomes, the committee said.

MPs also called for action on health protection, which encompasses protection, preparedness and response to outbreaks and other threats. This is a critical public health function yet, despite several sets of guidance on responsibilities, the committee heard there is still confusion, duplication and a lack of clarity in some areas. It urged Public Health England to ensure local authorities are clear about their responsibilities to ensure a "seamless and effective response" to outbreaks and other incidents.