Cuts to public health spending storing up trouble for future

Wednesday 25 November 2015

Responding to the cuts in public health spending announced today in the Chancellor’s Comprehensive Spending Review [1] ASH warned that the policy was short-sighted and would cause greater pressure on NHS finances. To quote the NHS England Five Year Forward View “the future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health.” [2] The public health budget is tiny compared to NHS funding, this year, following in-year cuts of £200 million it was reduced to a total of £2.6 billion, [3] compared to over £100 billion for the NHS, and now, following the Autumn Statement, it faces further cuts.[1]

Smoking-related disease places a huge burden on NHS services. Currently the cost to the NHS of treating people with diseases caused by smoking is £2bn a year in England alone. But the total cost to society which includes costs to employers, families and the environment, is conservatively estimated to be £13.8 billion a year [4] Investment in public health, including tobacco control, is therefore essential to reduce the health care costs as well as the misery and suffering that smoking causes. Tobacco control measures such as the Stop Smoking Services and mass media campaigns are proven to be highly cost effective. [5]

Deborah Arnott, Chief Executive of health charity ASH said:

“To cut local authorities’ public health budgets at this time is penny pinching and will cost lives. Even after the funding commitment to the NHS by the Chancellor, Simon Stevens, head of the NHS, has acknowledged that there will be a £22 billion funding gap by 2020 which can only be bridged by a radical upgrade in prevention and public health. If this gap isn’t closed the outcome will be major cuts in services.”

In addition, the proposal to fully fund local authorities’ public health spending from retained business rates receipts which is to be put out for consultation is potentially problematic. Local authorities with the highest levels of disadvantage, and highest levels of smoking and other public health problems, tend to have the lowest business rates. This will need to be properly thought through to ensure that public health can be properly funded. [6]

ASH has welcomed the Government’s commitment to a new tobacco control strategy but stresses that this needs to be sustainably funded from general taxation and/or from a levy on the tobacco industry if it is to be effective. [7] ASH also welcomed the planned consultation on the licensing of tobacco retailers. [8]


Notes and Links:

[1] Autumn Statement & Comprehensive Spending Review
[2] NHS England: Five Year Forward View: Executive Summary point 3. The full quote reads, “the future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health Twelve years ago Derek Wanless’ health review warned that unless the country took prevention seriously we would be faced with a sharply rising burden of avoidable illness. That warning has not been heeded – and the NHS is on the hook for the consequences.”
[3] DH. Local authority public health grant allocations 2015/16
[4] Costs include:

  • The additional cost to the NHS of illnesses among non-smokers due to exposure to secondhand smoke: £242m
  • The cost to individuals and local authorities of meeting care needs arising from smoking-related illness: £1.1bn (£608m to local authorities and £451m to individuals to self-fund their care)
  • Lost productivity due to smoking breaks: £6.5bn
  • Lost productivity due to smoking-related early deaths: £3bn
  • Lost productivity due to smoking-related sick days: £1bn
  • The costs arising from smoking-related fires (there are more than 2,700 in England every year): £259m
  • The cost of disposal of 32bn cigarette filters every year (5,494 tonnes): not quantified

ASH Ready Reckoner. ASH & LeLan Solutions, 2015.
[5] Smoking Still Kills.
[6] Para. 1.104 Autumn Statement
[7] ASH’s submission to the Comprehensive Spending Review set out the case for an additional investment of £100 million per annum for tobacco control measures over the next 5 years. An Inquiry by the APPG on Smoking and Health found that measures to reduce smoking prevalence, including by tobacco taxation, are not only cost-effective but have a positive impact on public finances.
[8] Autumn Statement Para 3.65