Public health and prevention is rising up the political agenda. But can it really help the NHS out if its mounting deficit crisis?
It’s election time. So naturally the NHS – its current troubles and future fate – is high up the political agenda. Polls indicate that it still tops voters’ concerns. There’s no shortage of ammunition to fuel the debate. A rash of ‘major incidents’ point to a mounting A&E crisis, with four out of five acute trusts reporting a deficit. Meanwhile a row has erupted over next year’s hospital funding tariff.
The King’s Fund think-tank has concluded that Andrew Lansley’s NHS reforms were ‘damaging’ and a ‘strategic error’. Former health committee chair Stephen Dorrell calls them ’the biggest mistake of this parliament’.
None of which is the kind of news the government wants in the run-up to election day. Even so, the Opposition’s attempts to make capital out of the coalition’s difficulties have been undermined by political infighting.
At root, the rows are about financial credibility. All the main parties have pledged extra NHS funding (who would dare not?). But none have coherent answers to the really tough questions about sustainability.
Step forward public health and its close cousin, prevention. Both get a starring role in the NHS Five Year Forward View, which sees big savings from tackling the drivers of ill-health. In fact, quietly, without fanfare, local authorities have been doing just that. Public Health England has been overseeing the transfer of public health responsibilities from the NHS to local government (Healthy options: examining the new public health landscape).
And local councils are enthusiastically using their new powers to – in the words of one chief executive – ‘throw the kitchen sink’ at health inequalities.
All of which makes good economic sense. The problem is, there’s not that much to throw. The £2.8bn public health grant has been frozen for next year, and there are unresolved issues about its distribution. Nor is it clear whether the funding will be ringfenced in future.
Many of the things councils want to do are in precisely the areas suffering cutbacks. Expanding recreational facilities, or curbing fast food outlets, for example, are not priorities for authorities struggling to meet even their statutory requirements.
And if preventative remedies (remember Wanless?) were hard to implement in the years of plenty, that’s even truer now.
All the more reason then to take seriously the recommendations from the Independent Commission on Local Government Finance about promoting local fiscal self-sufficiency (Give councils tax control in ‘decade of devolution’).
Councils are good at being resilient and self-reliant. And long-term, locally-delivered health initiatives could certainly come to the aid of a beleagured NHS. But without the financial clout to make well-intentioned resolutions a reality, they remain just that – good intentions.
This opinion piece was fist published in the March issue of Public Finance magzine
