Public health funds should be restored, CMO urges

19 Jul 07
The chief medical officer for England and Wales, Sir Liam Donaldson, has used his annual report to call for 'raided' public health funds to be restored.

20 July 2007

The Chief Medical Officer Liam Donaldson has used his annual report to call for 'raided' public health funds to be restored. But his report also noted that, a year after his initial request, a review of public health capacity and funding has not yet begun, despite the emphasis put on the area in the 2006 Choosing Health white paper.

Donaldson's July 17 report called for a new 'opt-out' organ donor scheme to stem the increasing numbers of people dying 'needlessly' for want of a donor transplant and announced a pilot project to empower patients to request health professionals wash their hands before treating them.

But the CMO also returned to the controversial theme of his last report.

'In last year's annual report, I drew attention to the dangerous practice of raiding public health budgets to prop up hospitals with financial problems,' he said. 'Now that the financial problems of the NHS have shifted to a surplus, it is important that public health budgets are restored.'

However Donaldson told Public Finance it was not possible to quantify by how much public health funds had been cut. 'I don't have a precise figure. Much of the information was anecdotal. But many, many directors of public health have told me that they were constrained from doing the things by their [financial] situation,' he said.

Donaldson added that threats to public health such as rising obesity rates, smoking, health inequalities and alcohol misuse meant public health action needed to be stepped up, and he reiterated his 2006 demand for a comprehensive review of public health capacity to help understand precisely what is needed. 'This is not a resource-neutral step. Work of this order needs to increase with protected budgets,' he added.

But Donaldson admitted that the government was unlikely to ring-fence budgets for public health. 'We're in an era where it is unfashionable to ring-fence budgets,' he told PF. 'The managerial philosophy in the NHS is that it's better to give people flexibility in how they manage their budgets. I think that's OK, as long as they do give priority to public health and we will be monitoring that quite closely.'

'There are lots of big problems that need to be addressed and I think that the government is fully aware of that, so I hope that we wont see a return to the days of smash and grab raids on public health budgets.'

Tim Crayford, president of the Association of Directors of Public Health, said he recognised that the department of health was reluctant to ring-fence any funds, but added: 'From a public health point of view, this decision is probably more in the interests of expediency than of securing good public health. The evidence of recent years is that today's priorities in the NHS invariably trump tomorrow's investment in public health. This is short-sighted, needs to be reversed, and ring-fencing would be one way of doing this.'

Crayford also questioned Donaldson's claim that it was not possible to quantify the extent to which public health funds had been raided.

'Clearly, monitoring of whether and how [primary care trust] Choosing Health funds have been allocated would be one way to look at this issue. At present, there seems to be no central initiative to do this. Having said that, the £330M allocated to Choosing Health is but a small part of how the NHS can influence better public health, and it would not be right to focus on this area alone.'


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