Trusts raided public health cash in panic over funding
John Carvel, social affairs editor
Friday October 19, 2007
The Guardian
The money was earmarked for primary care trusts to help them promote healthier lifestyles, improve sexual health services and appoint more school nurses. But a survey by the Association of Directors of Public Health has established that most of last year's allocation was raided to compensate for overspending on trust budgets for hospitals and GPs.
Data provided by 103 PCTs showed that half axed almost all the projects promised by the government in the Choosing Health white paper in 2004. Less that 10% of PCTs used the full public health allocation for the intended purpose.
The association said the 103 PCTs, covering more than two-thirds of England, were supposed to spend £141m on projects which should have included alcohol treatment services and action to combat obesity by promoting better diets and exercise. In the year to March the PCTs ended up spending only £46m, saving almost £100m for other purposes.
In spite of increasing alarm about obesity and rising rates of chlamydia infection, finance directors found it easier to cut public health programmes than make economies in hospital services and GP practices with big overheads and rising wage costs.
The public health allocation for England increased to £341m in the current financial year, but the survey forecast that only 28% of this money would be spent as the government intended.
The PCTs have complete discretion on how to spend their allocation.
Tim Crayford, the association's president, said: "Three years after the white paper, funding intended to tackle preventative health problems is still being used to pay for financial deficits in some parts of the NHS." Instead of preventing the dangers, the health service was spending a fortune on treating the medical consequences. "With funding [available] at grassroots level, the government should make sure it is ring-fenced so that it can be used for its intended purpose."
This week the government abandoned its 1997 election manifesto pledge to halt childhood obesity by 2010; the Foresight report said tackling obesity could cost £45bn a year and take 30 years to turn round.
The Choosing Health white paper included plans to spend £20m in 2006-07 to provide a full-time school nurse for every cluster of primary schools. "This commitment will be crucial to the...delivery of the obesity target and targets on health inequalities," it stated.
Other government priorities included £56.5m to modernise sexual health services, £35m for chlamydia screening, and £21m for action on diet, activity and obesity. The association's survey found little of this money had got through.
But a Department of Health spokesman said: "We do not agree with ring fencing [which would mean that] the amount of money spent on individual programmes in each area of the country would be determined centrally from Whitehall." The government had delivered 135 of the 190 public health commitments, he added.
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