Tag Archives: public health

Retreating to the bunker

If there’s one thing worse the swingeing cuts to public services, it’s the expectation of more swingeing cuts to public services and the evidence so far suggests both local and national battles for resources are going to get messy.

In one recent example, many will sympathise with the desire of health campaigners and GPs in the London Borough of Hackney to campaign for as much funding as possible allocated to frontline health services but some may question whether slagging off council funding for specialist voluntary sector public health initiatives is the most useful way of making that point.

Last week’s Hackney Gazette saw local campaign group, Hackney Coalition To Save the NHS take aim at Hackney Council’s Healthier Hackney Fund – a funding scheme set up by the council as (one, relatively small) part of their new responsibilities for local public health services under the 2012 Health and Social Care Act.

In its first year of operation the fund has awarded £370,000 to 32 projects run by charities and social enterprises with intention of finding: “new ways to tackle some of Hackney’s most complex health challenges such as smoking, mental health, substance misuse and sexual health.

In a storming interview with the Hackney Gazette, Bronwen Handyside from Hackney Coalition To Save the NHS explains that: “These are all good projects but they are niche services, they are quite specialised small projects.

And that: “I would prefer the money was allocated to the NHS which is suffering a haemorrhage of cash funds because of the £22billion cuts which are taking place.

Before adding: “We have a huge problem with the NHS being broken up and sold off to the private sector and the voluntary sector has been used as a stalking horse for the private sector – you might start off commissioning services to the voluntary and charity sector and you will eventually end up with the private sector.

Beyond the (perfectly legitimate) statment of principle, it’s not clear what Hackney Coalition To Save the NHS actually would actually like their council to do in this context.

As of 2013, Public Health is not part of the NHS and councils receive government funding to deliver it. Whether or not it would be desirable for Hackney Council to stop doing public health and send a cheque to the local CCG for general provision of local health services, it’s not an option that’s open to them.

While it might be acceptable for volunteer campaign groups to be unaware of (or uninterested in) the overall funding framework that councils operate within in, the Hackney Gazette article also contains quote from a local GP who, given his job, should know better.

Dr Nick Mann of Well Street Surgery notes that the £370,000 could’ve funded a ‘full clinical team’ for a year before storming: “At a time when basic medical services are under threat, it seems wrong to be further fragmenting the limited health budget.

Adding: “However well-meaning, this diversion of essential health funding will lead to further fragmentation, not integration, of health services in Hackney.

And that: “Voluntary organisations do great work, but cannot substitute for properly planned and funded public health services.

This, like the Coalition’s statement, is wrong on a basic level – the funding in question isn’t being ‘diverted’, it’s being spent for the purposes it’s allocated for, rather than on something else that Dr Mann thinks would be better – but that’s just the tip of his reductive iceberg.

The more important question is whether a £370,000 block of extra ‘properly planned and funded’ basic health services is a useful alternative to 32 community projects looking for new approaches to complex health challenges.

If you take £370,000 and split it between City and Hackney CCG’s 43 GP Practices they’d get just over £8,600 each. It’s £1.43 of extra basic service for each of Hackney’s 257379 residents. It’s 3% of the cost one GP appoitment per person.

None of these figures tell us anything much because you can’t make meaningful comparisons between general healthcare and the kind of projects that Healthier Hackney Fund is supporting. They’re not alternative forms of healthcare but they are projects that – in various different ways – aim to help people to be less dependent on healthcare.

Dr Mann takes the view that: “Voluntary organisations do great work, but cannot substitute for properly planned and funded public health services.

This may be true but it presuppposes: (a) that we’d he’d consider ‘properly planned and funded public health services’ are an option and (b) that they’re the best solution to ‘complex health challenges’.

It’s equally true that GPs and hospitals should not be put in the position of substituting for services that could be better provided by the voluntary sector.

One of the projects funded by the Healthier Hackney Fund is: “Hackney Posh Club – a weekly entertainment and social club for elderly and older people, which will reduce social isolation and prevent the onset of mental ill health.” GPs cannot cure loneliness – and generalist public health information delivered by medical professionals isn’t much help either – but effective voluntary sector projects may be able to reduce it.

It’s understandable that GPs and campaigners feel and embattled, and it’s right that they do defend core services but not expense of being open to new ideas that might ultimatly help them and their patients more than a bit more of what they’re already doing.

Basic medical services are vitally important but arguing that funding for those services should always take precedence over new ideas and projects that might reduce the need for those services – and help people general medical professionals are not best placed to help – is ultimately just an argument for things to get worse more slowly.

The challenge for charities and social enterprises operating in these fields is to develop projects and services that genuinely do make things better.

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