In an examination of the majority Conservative government’s policies for the health service in its first 100 days in power, the think-tank described George Osborne’s decision to cut local government public health spending by £200m in 2015/16 as “worrying”.
The saving was set out as part of a £3bn round of in-year cuts announced in June, with the Department of Health subsequently proposing a 6.2% across the board cut to reach the total.
Although public health featured prominently in the NHS Five Year Forward View, which has been backed by government, the King’s Fund said ministers have not yet set out any tangible policy initiatives.
“Meanwhile, the chancellor’s decision to cut local authority public health budgets by £200m sends a worrying signal that public health funding – which lies outside the NHS ring-fence – may be vulnerable to further cuts,” the report stated.
The government’s health spending plans are expected to be clarified in the Spending Review due to be announced on 25 November.
“The Spending Review will provide a litmus test of whether the government is serious about its commitment to prevention,” the King’s Fund said.
Its report also highlighted that devolution of health spending to local authorities, as part of an effort to better integrate provision with social care, has emerged as one of the new government’s key policy agendas.
An agreement in February to devolve substantial responsibilities for health and social care to Greater Manchester was followed by a further deal for Cornwall. Similar agreements are being developed for at least three other city regions.
“These developments have been greeted with cautious optimism,” the King’s Fund stated. “They promise a range of benefits including the opportunity to integrate commissioning and provision of health services, and services across health and social care. However, significant questions remain about the implications of devolution for the NHS given its national characteristics and tensions between central control and local decision-making.”
However, the think-tank added that health secretary Jeremy Hunt’s drive to establish a ‘seven-day NHS’ has not been as well received.
Although the principle has attracted widespread support, the King’s Fund highlighted that a number of practical issues remain to be overcome before the government’s ambition can become a reality.
In particular, it will be a challenge to ensure that sufficient hospital consultants and other staff are available at weekends.
“Proposed changes to the consultant contract raise the prospect of difficult negotiations with the British Medical Association,” the review stated. “It will also require additional investment at a time when most providers are already in deficit.”
