‘Public health refers to all organized measures to prevent disease, promote health, and prolong life among the population as a whole. Its activities aim to provide conditions in which people can be healthy and focus on entire populations, not on individual patients or diseases.’
World Health Organisation
Major threats have emerged over the summer to an important range of public health services which are the responsibility of Birmingham Council. They are faced with a possible new round of cuts and possible outsourcing and privatisation. In July the Government launched a national consultation over proposals to cut the amount the NHS pays to local Councils to improve the health of the public. The favoured option is a 6.2% across the board cut to all Councils.
Also in July Birmingham’s Council Cabinet made decisions to move to procure School Nursing Advisory service and for the Health Visiting service to be included in a procurement for Early years services. These services are currently provided by Birmingham Community Healthcare NHS Trust.
Recently the City Council had recommissioned other public health services for Substance Misuse and Sexual Health. In the case of the Substance Misuse Service the existing NHS provider the Birmingham and Solihull Mental Health Trust was replaced by CRI a leading drug and alcohol charity.
This combination of the threat of new cuts to funding together with services being put out to tender was identified by Tracy Taylor, the chief executive of Birmingham Community Healthcare NHS Trust, as a major concern for Health Visiting services:
“There is a danger that the recent work to bring health visitor numbers up to safe levels will be compromised as we have no assurance that these services will not be targeted for savings,” she said.
“The government’s announcement of £200m of new cuts to public health last week adds considerable concern as to the future of universal services for children, and parents and young children are likely to suffer as a result,” she added. (1)
The transfer of Public Health responsibilities out of the NHS and into Local Authorities in April 2013 was welcomed by many Public Health Directors as a huge opportunity to improve the health and wellbeing of their local populations.
This was certainly the case with Dr Adrian Phillips, Birmingham’s Director of Public Health who said, “I am not scared about the move to local government because that is where the levers are to improve public health so that is where you should be. If you are there to make people better and improve their health you can’t do that if they don’t have a job or housing.” (2)
Local authorities have a wide range of statutory responsibilities for housing, social care, and the environment all of which have important public health dimensions for the local communities they serve.
Moving public health into Local Government was part of the wider Con-Dem’s reforms to the NHS. Local authorities’ statutory responsibilities for public health services were set out in the Health and Social Care Act 2012. These general responsibilities included addressing health inequalities, providing facilities for the prevention or treatment of illness, and providing assistance to help individuals minimise risks to health arising from their accommodation or environment. (3)
Funding for these public health services is paid for by the NHS and comes out of the Department of Health budget which is now directly paid to local Councils and is held as a ring-fenced budget. In Birmingham this was nearly £83m in 2014/15. Previously these services were commissioned by the Primary Care Trusts (NHS bodies abolished by the Health and Social Care Act 2012), who commissioned services from NHS provider trusts. This responsibility now falls upon local Councils which are now re-commissioning public health services.
By placing the administration of public health outside of NHS George Osborne’s political game can now start to be seen two years on. While providing political guarantees not to directly cut NHS core funding Osborne has placed public health outside of this commitment.
The new proposed cuts to public health funding are to be made midway through the financial year.
Birmingham’s Director of Public Health, Dr Adrian Phillips, stated: “Our plans for 2015/16 are based on funding agreed with the chancellor just six months ago but this announcement could mean we have £6.5 million less to spend on vital services.”
Objections to the proposed cuts are that they will also fall disproportionately on larger cities with high levels of health inequality and greater clinical need. Birmingham’s Labour Council has been quick to respond in condemning the false economy of cutting preventative services.
Cllr Paulette Hamilton, Cabinet Member for Health and Social Care, has warned:
“Our work in Birmingham tackling obesity and physical activity, for example, is vital if we want to reduce the burden of preventable disease on the NHS. If we’re forced to cut that work, we will see an increase in heart disease, stroke, some cancers, diabetes and much more.” (4)
But Birmingham TUC Health Campaign has criticised the Council leadership for continuing to go down the road of procuring the Health Visiting and School Nursing services which could allow private health care providers such as Virgin Healthcare to tender to run them.
The campaign has written to Sir Albert Bore pointing out that the impact of increased privatisation of NHS services leading to the fragmentation of services was a major issue for the Labour Party during the General Election in May. The Labour Party Manifesto made the commitment that:
‘We will establish a sensible commissioning framework, based on the principle of an NHS preferred provider, to stop the drive towards privatisation and make sure that NHS services are not destabilised by competition and fragmentation.’ (5)
The BTUC Health campaign has argued that a Labour Council should not potentially be privatising NHS services and has grounds to treat NHS provider trusts as ‘preferred providers’ at a local level.
Maintaining the capacity and integration of NHS provider services in Birmingham should be regarded as a justified social goal by Birmingham City Council. As such the Council should positively interpret by the Public Services (Social Value) Act and latest EU Procurement Regulations to defend the NHS in Birmingham and contract with NHS provider trusts.
In the Letter to Sir Albert Bore the campaign reminded him of the decision of Cornwall Council to discontinue their procurement of local Community Health services on the grounds that they want to consider the opportunities for closer integration between health and social care services offered by the Cornwall Devolution Deal.
Birmingham remains a city of significant health inequalities.
It’s startling that just eight miles separates the highest and lowest life expectancy areas in the city. If we use the cross-city rail network to illustrate the issue, we find that:
• Within only eight stops you can shave nine years off the average life expectancy of a citizen.
• Within eleven stops you can shave eleven years off the average life expectancy of a male citizen.
• Within only five stops you can shave five years off the average life expectancy of a female citizen. (6)
Reducing health inequalities has been seen an explicit goal of public health services and policies. The Tory attack on the public health system is an attack on that commitment to reduce health inequality in our city and nationally. Birmingham’s Labour Group should stop the possible privatisation of the School Health Advisory and Health Visiting services by suspending the procurements.
This Labour leadership has claimed that its priority has been to ‘protect the most vulnerable’ and acknowledges these cuts will hurt the most vulnerable. It is now time for this Council to ‘step up to the plate’ and to take on the Tory Government over these cuts.
Defending the NHS locally and fighting against health inequality should be key rallying points for this Labour Council in publicly campaigning against Tory austerity policies in the Birmingham.
Get involved in the campaigning against the privatisation and cuts to the NHS with BTUC Health Campaign /KONP by contacting firstname.lastname@example.org
(1). Fears health visitors will be target in £200m public health cuts.
11 June 2015. David Williams. Nursing Times
(2). How to get ahead … as a director of public health. The Guardian Tuesday 2 April 2013
(3). p4. Local authorities’ public health responsibilities (England). House of Commons Library (2014)
(4). Health funding cuts could be disastrous. Birmingham Newsroom 05/06/2015
(5). Britain can be better – The Labour Party Manifesto 2015
(6). The 2013 challenge is to bridge the public health gap. Birmingham Newsroom. 24/12/2012