Wiltshire Council is using public health funds for the county's youth grantsWhen tax rises are suggested as a way to pay for the necessary increase in funding for the NHS, you will hear the cry "Why don't they spend more on prevention, then the NHS wouldn't need so much money?"
The trouble is that the government sees the public health budget - the main way it funds prevention of ill health and sickness - as a soft target for austerity cuts. The money paid to local councils for public health is due to fall from £2.44bn this year to £2.27bn in 2019-20. That will be the fifth year running that it has been reduced.
Last week the new Secretary of State for Health and Social Care, Matt Hancock, tweeted that he was writing his first speech and listed his three first, top priorities: workforce, technology and prevention. Public health is all about prevention - it is the NHS' first and most important line of defence.
Local authorities' public health remit is wide: health visitors, school nurse services, immunisation, reducing smoking, tackling alcohol and substance abuse, promoting healthy eating and healthy lifestyles and especially exercise, promoting wellbeing to prevent the onset of mental health issues, promoting sexual health, protecting the public from external threats & preventing infections, ensuring safety of food and water - and being prepared for emergencies brought on by weather events and pandemics.
However, the money provided to councils for public health is not ring fenced - it is up to each council to decide how and where they use it.
Wiltshire Council's overall budget for 2018-2019 includes a saving of £200,000 on what it terms the 'Youth Area grants' - these are the grants made through the area boards and the Local Youth Networks (LYNs) that were set up when the Council made deep cuts to it youth services.
The saving will be achieved by shifting the £200,000 for 2018-2019's grants onto the already reduced public health budget. The actual wording in the budget document reads: "Review Youth Area grants to ensure a focus on health and prevention of poor health, and fund from Public health."
However, so far as we can discover - and one third of the way into Wiltshire Council's budget year - the 'review' has not taken place and the criteria have certainly not been changed.
Youth grants are being handed out against the 2017-2018 criteria - with no specific 'focus on health and prevention of poor health'. The old criteria are very broad and include grants for away-day visits and any number of 'projects/activities/programmes'. Three recent grants went to 'youth cafés' - totalling about £16,000.
Of the 24 youth grants so far logged there is only one that is specifically focused on 'health and prevention of poor health' - and that is for a scheme that probably ought to have come from the public health budget and been overseen by their staff.
The application form does have a box for 'Health', but it also combines 'Sports/Leisure'. This allowed the Brinkworth Board Game Group to win a grant. Nothing wrong with that in itself, but it hardly fits the new 'focus' required when the funding for the grant is switched to the public health budget.
The Marlborough Area Board approved a LYN grant for the Marlborough Area Development Trust's 'digital making' programme. A very educational and very worthwhile enterprise, but more likely to keep kids in their bedrooms, in front of their computer screens rather than running round an athletics track or learning gymnastics.
This use of money provided by the government for public health comes at a time when all the talk is of integration between Wiltshire's NHS and Wiltshire Council's social services.
Short-changing public health will merely pile costs onto the NHS. If, for example, immunisation is not given full attention, more people will become sick or if anti-smoking programmes are diluted, more people will be in danger of cancer.
If we are not to see this integration of Wilthsire health and social services as more than merely a struggle to gain control over budgets, then public health must be seen to be properly funded.
NOTE: the informative illustration at the head of this article comes from the cover of Wiltshire Council's latest annual public health report.