Debate: Public health funding

This resolution was passed 

It is estimated that every pound spent on public health interventions delivers health improvements with a value of £14 (Paddison, 2017).

In England, the funding of public health services has been cut by £200 million since 2015 and there are plans to reduce the funding even further by 2020 (Kings Fund, 2018).

The cuts in the funding of public health services have had a deleterious effect across a range of areas, but the impact of reducing public health nurses who work as health visitors and school nurses is of particular concern. These nurses work with families who have children from unborn babies to 19 years. They use evidence-based practice with individuals, families and communities to enhance health and reduce health inequalities by undertaking a universal programme as outlined in the Healthy Child Programme (Department of Health, 2009). They also contribute significantly to safeguarding vulnerable children.

The RCN report The Best Start: The Future of Children’s Health Valuing School Nurses and Health Visitors in England shows a drop of over 1,000 in the number of health visitors following the implementation of the Health Visitors Implementation Plan completed in 2015, and a drop of 16% in the number of school nurses between 2010 and 2017. This was coupled with an increase of 45,000 in the number of school-age pupils in the same period (Royal College of Nursing, 2017). As a result, health visitors and school nurses are carrying bigger caseloads, being overstretched in the work they undertake and in some cases being downgraded.

In Wales, Public Health Wales (PHW) employs general public health nurses from a variety of nursing and midwifery backgrounds. They contribute to the PHW areas: health protection, screening for the Welsh population, and the 1000 Lives Improvement Service. Specialist Community Public Health Nursing roles include health visitors and school nurses, who are employed to meet the health and wellbeing needs of children and families in Wales.

In Scotland, health and social care is a devolved issue and funding is set by the Scottish Government. Investment in nursing services such as health visiting teams who deliver on key public health priorities is key to improving the health and wellbeing of people in Scotland. However, as of 31 December 2017, vacancy rates in health visiting stood at 7.6% (NHS National Services Scotland – Information Services Division, 2018). Scotland’s new Public Health Body is currently working on a set of new public health principles for Scotland.

In Northern Ireland, the Department of Health (DHNI) has systematically cut the post-registration nurse education budget from £12.4 million in 2009-2010 to £8.3 million in 2016-2017, despite rising demand and its own strategic commitment to investment in services that will reduce pressures on secondary care. The RCN does not believe current DHNI projections for commissioned post-registration education places will enable the nursing workforce to meet future demand for public health services or the DHNI’s own strategic commitments.

It is known that early intervention makes a big difference to health outcomes, so a reduction in public health nurses who can deliver this will adversely affect the most vulnerable groups in society. It will also put additional pressure on other NHS services and ultimately cost more. These cuts must be reversed so the work of public health nurses is protected. 

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