Agenda item

The Director of Public Health submits a report which briefs the Commission on budget savings proposed for 2016/17.

The Director of Public Health submitted a report which briefed the Commission on budget savings proposed for 2016/17.

It was noted that:-

a)         The reductions in the public health budget were a result of the government’s decision to reduce the public health ring fenced grant for local authorities which was announced in the November 2015 spending review.

b)         The public health budget was being reduced year on year nationally by 2.2% in 2016/17, 2.5% in 2017/18, 2.6% in 2018/19 and a further 2.6% in 2019/20.  These reductions were in addition to the in-year subsequently announced in 2015/16.

c)         The savings required were:-

Savings In-year

2015/16          £1.6m

2016/17          £621k

2017/18          £695k

The spending review also announced that the ring-fenced elements of the public health grant would cease from 2018/19 onwards.

d)         The scope for in-year savings was limited as 75%-80% of the public health budgets for 2015-2017 were already commissioned through contracts and the first break point in some of these contracts occurred in 2017/18. 

e)         The proposed savings had also been selected after considering the significant health issues affecting the city and evidence of the effectiveness and performance of the areas suggested for savings.

Following Members’ questions on the suggested proposals for budget reductions the Assistant City Mayor Public Health and the Director of Public Heath commented that:-

a)         Cease Support for weight management in pregnancy service

The service which was originally jointy funded by the CCG and Public Health was reviewed in 2015/16 and found that the service was used by a very small number of women and the completion rates were low. Support and advice was provided by community midwives as a routine part of their care and through ‘Bumps to Babies’; a universal antenatal service provided through children’s centres.

b)         Drugs and Alcohol

Savings of £1.4m could be achieved in 2016/17 following the retendering of a combined drugs and alcohol service across Leicester Leicestershire and Rutland.  The savings would be achieved through economies of scale, reduced management and back office costs.  The purpose of the combined contact was intended to deliver services at a lower cost without affecting the impact of the front line service. 

c)         Alcohol Brief Interventions Advice

Savings could now be achieved as the NHS Heathcheck initiative was now well established and GPs were covering the advice through the routine screening of patients in the programme.

d)         Staffing Review

Savings identified for the staffing review would be developed and would be the subject of separate EIA and consultation. 

The Chair referred to savings in services affecting smoking cessation and healthchecks and asked whether such services could easily be re-introduced in the future if performance reduced or future research indicated that e-cigarettes were not preferable to stop smoking services.

The Director of Public Health commented that with the removal of ring-fenced budgets more and more future decisions on health initiatives would need to be taken in the context of overall budgetary pressure facing the Council.  Work was being undertaken to ensure that as much intervention and treatment for public health was incorporated into core NHS services and that services were focused in areas of the City with poor health.  Both Public Health and NHS services faced the challenge of ensuring maximum benefits were received from reducing budgets.   When service budgets were reduced it would be essential to monitor the impact of services to see if there were any negative impacts on health or reduced performance.

The Assistant City Mayor Public Health commented that public health was facing unprecedented reductions in funding and that he was working closely with other parts of the council to ensure that the maximum benefits to health were achieved from all services.  Savings were being sought from removing duplication wherever possible and achieving best value whilst prioritising and protecting front line services whenever possible.  It should also be recognised that a number of contracts which had transferred to the Council were still in their transition phase.

Members also made the following comments:-

a)         It was important for children to understand and be taught how to cook healthy food as this could have significant benefits in the future.  It was recognised that this had been raised before and it was hoped that this could be captured within the work on health messaging.

b)         Where savings were being identified for services arising from duplication with other providers or where they were being provided by GPs or elsewhere in the health economy: then this should be clearly stated.

c)         There were concerns about the impact of some of the proposed reductions on LGBT communities and women especially in relation to sexual health checks.

d)         The EIA when fully completed in the future should be shared with the Commission.

e)         The important role of the Assistant City Mayor and the City Mayor in making future decisions on health priorities when ring-fenced budgets were removed should be fully recognised and it was important to understand the value of individual services when making such decisions.

In response to the comments made by Members, the Director of Public Health commented that there were no proposals to reduce sexual health and contraceptive services this year.  Screening programmes such as cervical cancer screening were funded separately by NHS England.  Health visitors and school nurses also promoted healthy eating and reinforced health messaging on obesity etc and 0-19 Children’s Services would be central to achieving health benefits in the future.

AGREED:

That the report be received and noted and that the comments made by Members be considered by the Assistant City Mayor Public Health and the City Mayor when taking future budget decisions.