Public health and community services ‘bear the brunt of NHS cuts’

14 Mar 17

Community and public health services in England have been worst hit by financial pressures on the NHS, says a King’s Fund report out today.  

This marks a departure from the ambitions of the NHS’s five-year vision for its future – set out just over two years ago – which focused on public health and prevention, the think-tank said as it called for greater investment in these services.

The study, Understanding NHS financial pressures, looked in detail at four NHS services: sexual health testing and treatment; district nursing; elective hip replacements; and neonatal care. It found that acute and specialist services have so far been relatively protected but this is not the case for community and public health services.

For instance, some local authorities were spending 20% less on sexual health testing and treatment clinics – so-called GUM clinics – from 2013-14 to 2015-16 and further cuts are planned in this area.

In district nursing, the think-tank highlighted that workforce shortages were leading to increasing levels of stress for district nurses and a lower quality of care to some patients.  

“Our research shows that services like district nursing and sexual health, where we found evidence that access and quality are deteriorating for some patients, have been hardest hit by the financial pressures facing the NHS but that this is often going unseen,” Ruth Robertson, a fellow in health policy at the King’s Fund and lead author of the report said.

For neonatal care, the research found no clear evidence of a deterioration in patient care, but noted babies were being transferred a long way from home causing strain on families, because of long-standing pressures on neonatal departments, such as staff shortages.

Elsewhere, the research found the number of hip replacements recorded in 2015/16 was slightly lower than the previous year, with average wait times increasing. More patients were waiting longer than 18 weeks for a hip replacement.

The King’s Fund says that, although between 2009/10 to 2014/15 English NHS funding rose by £14.9bn, from £98.4bn to £113.3bn, the economy expanded faster – reducing health care’s share of GDP.

According to the ONS, the UK is ranked 6th out of the G7 countries for healthcare expenditure as a proportion of GDP – spending £179bn, or 9.9% of GDP, in 2014.

NHS England published its Five-year Forward View in October 2014, which focused on strengthening prevention and public health. 

Robertson said the King’s Fund’s findings “undermines” the vision set out in that five-year vision.

“If the NHS wants to transform care and keep patients healthy and out of hospital it will need to invest more in community and public health services,” she stated.

Responding to the report, Saffron Cordery, director of policy and strategy at NHS Providers, said the gap between what the NHS is being asked to deliver and its resources was growing, with an increasingly visible impact on patients.

“It is particularly worrying that these effects have been most pronounced in community services and public health,” said Cordery.

“The vision outlined in the NHS five year forward view was predicated on improvements in prevention, and providing more care closer to home rather than in hospital, to help balance the equation of rising demand and costs with no additional resources.  This report suggests the NHS is moving in the wrong direction and that although times are hard now, there’s worse to come.”

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