'The government must stop treating public health as the poor relation in the health system'


Public health is the epitome of common sense. It is all about preventing people getting ill. It’s about promoting good health and supporting us all to stay as healthy as we can.

Public health includes sexual health services - HIV prevention and the prevention of sexually transmitted infections (STIs) are all part of public health.

In April 2013, responsibility for public health services in England transferred to local councils. This can be confusing I know. When you visit a sexual health clinic you are often visiting an NHS building and being seen by a member of staff with an NHS badge. The fact is that the NHS is providing this sexual health service but your local council is paying for it.

Why should you care about all this? Does it really matter?

Yes – it really does matter. Whilst the budget for NHS-funded services continues to increase, funding for local council public health services – including sexual health services - is reducing. Earlier this year, the prime minister announced extra funding for NHS-funded services – to the tune of £20.5bn of funding over 5 years or about a 3.4% increase in funding per year. In contrast, since 2014, funding for local council public health services continues to be cut by £700 million – this is on average about a 3.9% real terms cut in funding per year.

A recent report from the influential Health Foundation has shown that sexual health budgets will be cut by a quarter in this time. NHS-funded services have funding agreed until March 2024. In contrast, there is no future funding agreed for local council public health services after March 2020 and this week we are expecting to hear that £85 million of cuts to public health budgets will go ahead in 2019-20.

So how does this work exactly? We know public health is common sense – we have the evidence to show that preventing ill health is cheaper than treatment once someone gets ill; we know that the NHS is buckling under the demand of ill patients and that prevention could help to elevate this pressure; and most importantly – we know that on an individual level – preventing someone getting ill is better for that individuals physical and mental wellbeing.

Yet, rather than investing in public health services, central government has consistently cut local council public health budgets. To the point that doctors and people who use these services are saying they are no longer able to cope with demand.

Public Health England is clear that demand for sexual health services is rising – there has been a 13% increase in attendance of these services since 2013. Data collected by South East London sexual health clinics and new data from BASHH indicates that a worryingly high proportion of sexual health doctors are having to turn away patients because they don’t have capacity. And these patients include some who have symptoms of STIs.

That is why, alongside other HIV and sexual health organisations, we are calling on the government to reverse the cuts it has made and increase public health funding within its Departmental Spending Review.

It is great that the NHS has seen an injection in cash. It is much needed. But this is just part of the picture. The government must stop treating public health as the poor relation in the health system and start funding services so that they can actually meet the needs of local people.

Debbie Laycock is Head of Policy at Terrence Higgins Trust

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