Local councillors will be tearing their hair out trying to make their budget stretch to cover their responsibilities

Chair of Pharmacy Voice Claire Ward explains why cuts to public health funding are shortsighted and mean that pharmacy will have to try even harder to make its case to deliver local services

Just three months after the general election and we are starting to see the real impact of the result. Buoyant with confidence from winning an overall majority, the Chancellor has set about implementing his promise to reduce the deficit with haste. The Prime Minister promised that NHS spending would be ring fenced. Although savings would be required – £22 billion – there would also be more money over the next five years – £8 billion to be precise.

None of us are under any illusion just how tough that will be on frontline services. Despite these challenges, the message was clear – whilst almost every other government department would be forced to take the axe to services and spending, the Department of Health budgets would be protected. At least that is what most of us understood from the election promises.

But all is not quite what it seems. Sometimes health spending is not health spending. Sometimes it is health spending but not NHS spending and at this point it is no longer protected. The Chancellor of the Exchequer has found a new way to make health spending cuts by referring to the affected budget as Department of Health non-NHS funds.

Public health to suffer

A sum of £4billion was transferred from the Department of Health to local authorities to support the development of public health. However, as this is not NHS funding it has no protection and the Chancellor has announced that £200 million will now be cut from local authorities in the current financial year. Local government is already struggling to meet the demand in austere times. With even less money from both Departments of Health and Communities and Local Government, local councillors will be tearing their hair out trying to make their budget stretch to cover their responsibilities.

The government wisely transferred responsibility for public health to local authorities in the last Parliament because, I hope, they understood that if we want to tackle some of the really big issues affecting the health of the nation we have to start at the grass roots. We need to support people in communities where smoking, alcohol abuse and obesity are highly prevalent. Failing to tackle this simply leads to more people with cancer, COPD, diabetes and mobility issues who then fall heavily reliant upon the NHS both in primary and secondary care.

In some cases, local authorities have been slow to respond to their new public health responsibility, but in others we have seen commissioning of new NHS services to tackle obesity and smoking. Some of these services are successfully delivered in pharmacy and many more need to be.

Just recently I listened to a presentation by Professor Kevin Fenton, director of health and wellbeing at Public Health England. A very impressive man, he spoke passionately and articulately about the cost in financial and human terms of failing to deal with a nation becoming increasingly unhealthy. He talked about the need to improve public health and how pharmacy must be at the heart of delivering those improvements. His job is about to become even harder.

Commissioning decision time

Local authorities will be forced to think about which services they can afford to commission. Should they reduce smoking cessation services and simply hope that e-cigarettes will make the difference? Should they hope that Jamie Oliver’s latest campaign for healthy eating will make a bigger impact on obesity than their diminishing public health budgets? Or perhaps the government will rush forward with an alcohol unit minimum price and local councils will not need to worry about commissioning alcohol intervention projects.

The truth is that Professor Fenton is still right, despite the more challenging environment for local commissioning of public health services. Pharmacy must be at the heart of delivering improved public health. In order for councils to get the best possible value for the money they have, they need pharmacy to engage with them on how it can deliver efficient and cost effective services.

Community pharmacy can and must show that it is the right vehicle for delivering smoking cessation, sexual health advice, weight management support and many other public health initiatives. We need local pharmacy leaders to champion their pharmacy community to local government and, above all, to make sure that where services are commissioned they are delivered effectively, efficiently and on time.

This is a shortsighted decision by the Chancellor. He may save £200 million but he will simply make it harder for the NHS to deliver its efficiency savings. He will make it harder to prevent poor health and support healthy living. More importantly, it may well cost lives, earlier than they need to be lost. If a local pharmacy can support a smoker to quit, this in turn becomes a saving in care needed at the local hospital as smoking-related illnesses develop, and ultimately the saving of a life.