Council plans to slash school nursing and sexual health services by 50% have been labelled a “cash-grab opportunity”, sparking fears that other financially stretched local authorities will follow suit.
Ministers handed councils control of budgets for the majority of public health services, including school nursing, in April 2013. But since then there have been concerns that cash-strapped local authorities would attempt to use the funding to plug gaps elsewhere.
“We know that councils are being hit hard by funding cuts, and public health is being affected by this”
John Ashton
While the grant provided to local authorities by the Department of Health is ring-fenced for public health, there is no obligation for it to be used to fund specific activities, meaning that what is defined as public health is open to interpretation.
It has now emerged that Ealing Council wants to “re-profile” its public health grant, which involves slashing some public health services by up to 50% to boost other areas.
However, it has been claimed that some of the activities it plans to provide extra funding to are more akin to “traditional” areas of council responsibilities, such as safe communities, welfare and job creation, rather than public health.
Ealing Council has proposed to reduce its £1.25m school nursing budget by £200,000 in 2015-16, with further reductions of more than £400,000 by 2017.
If the 50% cuts were go ahead, the service – which is run by 23 members of staff covering 86 schools with around 50,000 children – would have to be reduced, according to the council’s own assessment of the equality impact of the plans.
It noted that “one option would be to cease or reduce their role in safeguarding, for example by not requiring their attendance at all meetings and reducing their role in safeguarding plans”.
It added: “It would be difficult to retain full coverage of 86 schools and the growing school age population, even if the work of the service is reduced considerably.”
“Significant budgets have been transferred for public health to local authorities at the same time as some of the most severe efficiency requirements they have ever faced”
Howard Catton
Meanwhile, the local authority plans to cut its community sexual health contract by 50%, its GUM services by 50% and its HIV prevention and support contracts by 48% by 2017-18. Overall, the changes would see around £10m cut and reallocated to other areas of public health.
Concerns have been raised that local authorities around the country will follow suit, as they try to achieve the financial efficiencies many are expected to make during the coming years.
Dr Paul Fox, consultant physician and clinical lead for the GUM service in Ealing, claimed councils were using their new public health commissioning money as a “cash-grab opportunity”.
“It was only going to be matter time before they would start restricting funds for sexual health, which was going to mean clinic reductions,” warned Dr Fox.
“They’ve [Ealing Council] planned to cut more than £10m from school nursing, community contraception, sexual health, HIV prevention and so on – basically the things handed over to them from the NHS,” he told Nursing Times.
He said the 13 nurses at Ealing’s GUM clinic, based at London North West Healthcare Trust, were concerned that the reduced funding could mean the clinic would be reduced in scale or have to close altogether.
He warned there would be a “tidal wave” of other local authorities looking to make similar sexual health service cuts.
Dr Fox’s views were echoed by Royal College of Nursing head of policy Howard Catton, who said discussions around cutting public health services by Ealing Council would “mirror similar conversations happening in other boroughs”.
“Significant budgets have been transferred for public health to local authorities at the same time as local authorities are facing some of the most severe budget cuts and efficiency requirements that they have ever faced,” he said.
Mr Catton noted that Ealing Council had used a “wide definition” of what constituted public health, when drawing up its proposals.
“It seems the re-prioritisation is in favour of traditional local government responsibility and concerns around safe communities and employment, rather than traditional public health measures,” he said.
He said he was concerned that locally elected councillors across boroughs were not being supported with advice from nursing leaders when taking decisions about spending allocations.
“It is crucial from a nursing perspective that these decisions are informed by and supported by both cost and quality advice about the full range of what nursing services and interventions are delivering,” he added.
Mr Catton warned that when local authorities received further funding in October to take over the commissioning of health visiting services that local councils would have further opportunity to make cuts to nurse-led services.
As a result of the government’s 2010 NHS reforms, responsibility for commissioning public health services for five-to-19-year-olds was switched from the NHS to local councils in 2013.
However, the transfer of commissioning for under-fives was delayed until 2015 – so that it fell after the government’s deadline for recruiting an extra 4,200 health visitors.
Professor John Ashton, president of the Faculty of Public Health, said: “We know that councils are being hit hard by funding cuts, and public health is being affected by this. We are concerned about the impact of decisions on high priority areas such as these.”
A spokesman from Ealing Council said the proposed changes to public health funding had been subject to “appropriate consultation” and a final report on them would be presented at a meeting on 16 June.
“Our priorities continue to be preventing illness, health promotion, tackling health inequality and the protection of vulnerable residents,” he said.
Concern as councils seek to cut-back on public health nursing
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