Halt the redistribution of health

One of the elements of health reform that could have real positive impact is the move of public health into local government. If we get this right, I believe it can have a major impact for our communities and see a more joined up approach in many areas of activity.

There is however a huge problem on the horizon which could have a key impact on the voluntary and community sector and the people we seek to serve.

While government has agreed to ring-fence public health spend for the next financial year – essentially guaranteeing local authorities the same money as the primary care trust was spending in their area – the future is not so rosy in the longer term for the most deprived areas.

The new formula, from the Advisory Council of Resource Allocation, does not have a heavy bias to deprivation and as a result will, if implemented in full, see the redistribution of public health spend away from areas of deprivation to wealthier areas. The most deprived authorities across the north west are set to lose around £8 per head in the proposals, leading to a net loss of £18m for the region. Colleagues in London and the north east ought to be equally concerned – the north east is set to lose out at £17 per head – or over £50m across just a handful of authorities.

This change in spending is unlikely to see the government move forward with its aim of reducing health inequalities and will have implications for local economies and the wider health system as resources are redistributed from our most deprived areas to our most affluent.

A more scary aspect of the reform is that the secretary of state is now floating a similar formula for the clinical commissioning groups’ allocations. Any such shift would be even more devastating for the most deprived communities across the country and we must not allow this to happen.

The voluntary and community sector plays a huge role in the delivery of public health services and this redistribution would impact hugely on many local organisations as well as the communities they operate in. The fact that it will hit some of the areas that have suffered most at the hands of the cuts already will make it harder to bear.

According to the Almanac produced by the National Council for Voluntary Organisations, 57% of the voluntary sector workforce are employed in ‘health & social work’ – the equivalent of 437,000 people. A massive reallocation of public health spending is therefore going to have impact, and while some of that may be a positive impact, in the south east for example, it will be hugely negative for the sector in the north west, and, as I keep saying, negative for some of our most deprived communities.

So what could the government do? At Voluntary Sector North West we think there are a number of options:

• Reassess the formula by increasing the weighting based on poverty
• Divert a higher proportion of savings made through the Quality Innovation Productivity and Prevention programme into public health to raise the lower spenders to a minimum level of public health spend rather than penalising current bigger spenders
• Introduce a minimum funding guarantee – as they did with schools – which will guarantee that no local authority will receive a ‘cut’ of greater than 1% in any year: to do otherwise would be to ignore local decision making in the past which created this level of spending

Ultimately I find it hard to believe the government will not see the lack of logic in the proposed redistribution of spending as is currently proposed, but just in case they do, we need to open their eyes to the damage these changes could bring about. Across the deprived areas of the north and London, the sector needs to work alongside our colleagues in public health and ensure this is one redistribution that is not allowed to happen.