How proposed public health changes could affect you - and call from the man in charge to share the burden
Planned cuts to public health programmes in Lancashire may have a “silver lining” – by prompting different organisations to co-operate in order to prevent long-term illnesses.
That is the hope of Lancashire County Council’s cabinet member for health and wellbeing, Shaun Turner, who admits that he is being forced to oversee budget reductions which he would prefer not to make.
“We’ve been very honest – we’d rather not be looking at some of these things and, nationally, we are making the case that we’re hitting prevention initiatives. That’s not what we want to be doing, because we know that 40 percent of diseases are preventable – it’s that simple,” County Cllr Turner says.
Less straightforward is how to deal with a declining pot of money ringfenced for public health spending, which has been handed to County Hall since councils took over responsibility for the services from the NHS back in 2013. That grant has fallen by over £5m in the last four years and stands at £66.6m for the financial year ahead.
At the authority’s budget last month, the council unveiled controversial plans to reduce access to schemes to help people lose weight, stop smoking and quit drugs. It also proposed scrapping the Lancashire Wellbeing Service – a programme which supports 11,000 people with social, health and lifestyle issues to prevent them escalating further.
A public consultation into the plans will run until early next month – and council leader Geoff Driver has said County Hall has enough flexibility in its finances to change course if residents persuaded it do so.
But if the savings stand, County Cllr Turner accepts that they will prove challenging – for individuals and the public sector as a whole.
“I’m not going to stand here and say it won’t have an impact – but assessing it is another matter. In the NHS and the wider community, there’ll people rocking up with [problems] that could have been prevented.
“If there is a silver lining, it could make us look at ways of working with partners much more closely and aligning budgets so that we could have more impact.”
Local authorities and the NHS have long had the ability – and, in fact, a duty – to co-operate in order to improve the health of the population.
However, County Cllr Turner hopes the scale of the changes being planned in Lancashire may well focus minds – and allow different parts of the public sector to “spend together and spend wiser.”
“Some of the the conversations I’ve been having are already bearing a bit of fruit, to the point that our position is understood and there is a collective will to try and keep things going to prevent us losing that impact.
“It is a bit cart before the horse, but we’ve never had a space where we can talk about this with partners before. It’s just been domestic housekeeping – [looking at] our own budgets, balancing the books and moving on.”
At a recent meeting of Lancashire County Council’s health scrutiny committee, Andrew Bennett, the commissioning lead for the Healthier Lancashire and South Cumbria partnership, said the NHS “remained open” to working with local authorities to understand the financial pressures they were facing.
“There is a need to make sure that when organisations have to make savings, a clear impact assessment is done before those savings are taken out,” he added, referring specifically to mental health.
The NHS ten-year plan, which was published in January, pledged an additional £20.5bn for the health service by 2023 – £4.5bn of which is reserved for community-based working.
It suggests that a limited number of public health functions could return to NHS control – including school nurses and health visitors. But the County Councils Network said last month that it would resist such a move.
Meanwhile, the long-term plan for the health service states that the NHS cannot be a substitute for the role of local authorities in promoting public health.
And so the responsibility for councils looks set to remain, even if the resources allocated to it are reduced.
WHERE THE AXE MIGHT FALL
These are the services which are subject to public consultation and how the planned changes could affect them:
Physical activity and healthy weight programmes target those people exercising for less than 30 minutes, three times per week and/or with a BMI of between 25 and 34.9. The programmes are free to participants and are delivered over a 12-week period.
Stop current tailored service and introduce a promotional programme for everyone in Lancashire, encouraging use of the county’s existing assets to increase physical activity, particularly in open, green spaces and purpose built leisure facilities.
Stop smoking service is available to everyone over the age of 12 in Lancashire.
Reduce general access to the programme and replace it with a more targeted offer of behavioural support and advice on stop smoking medicines, focusing particularly on pregnant women, those with long-term conditions and people also dependant on other substances.
ALCOHOL AND DRUGS
Residential and single-day programmes, focusing on abstaining from alcohol and drugs and addressing the underlying causes of the addiction to help people cope in real-life situations after treatment.
Reduce access to the programmes and target only the most vulnerable individuals and those most likely to benefit, including people without support. Community services would be increased for those with lower level needs.
LANCASHIRE WELLBEING SERVICE
Support for people with emotional health issues, poor lifestyle choices and those suffering from social isolation or difficult circumstances. Help is usually provided over a period of eight weeks and can include referral to the voluntary sector.
End the service altogether, although some Clinical Commissioning Groups arrange similar schemes in certain parts of Lancashire.
The county-wide service is run by a consortium of three charities. N-Compass North West, the organisation which deals with communications on behalf of the group, was contacted for comment about the proposal.