Public health services cut
Since 2015, public health services have suffered some of the biggest cuts to funding and service provision within health services in England and Wales. The cuts began in November 2015 when the Conservative government separated the budgets for public health, education and training, capital and national bodies. By 2024, the budget for public health services was 26% lower in real-terms compared to 2015/16.
Public health services provide preventative services, including smoking cessation, drug and alcohol services, children's health services and sexual health services, as well as broader public health support across local authorities and the NHS. The importance of public health services to the economic strength of a country is overlooked by those in power. If there is reduced investment in vital preventive services population health worsens, health inequalities widen and less people are economically active. It has been shown that investment in prevention represents excellent value for money compared with health care spend.
Below is an outline of how the public health system was downgraded and services cut by successive Conservative governments. The question now is whether the Labour Government will step up and realise the importance of public health services, increase funding and improve services.
The public health system has been broken
Over a decade of Conservative government has left England and Wales with a public health service that is much reduced and underfunded. This was highlighted in September 2022 by an editorial in the BMJ that noted how successive Conservative-led governments had downgraded and underfunded public health services.
Almost twelve years ago, soon after the Conservative party took control of government, the previous pattern of slow, steady improvement in life expectancy halted, and health inequalities began to grow.
The editorial notes that since 2010, successive Westminster governments have “dismantled and defunded public health rather than recognising the importance of a healthy population and a robust and effective public health function.”
Evidence of this includes the transfer of local directors of public health from the NHS to a poorly resourced role within a simultaneously weakened local authority system.
The central public health agency, Public Health England, was abolished and replaced by the UK Health Security Agency, and this has dropped public health from its title. Three of the four chief medical officers in the UK are not public health doctors.
The public health system is broken, according to the editorial, which called for “a far-reaching review of how internationally recognised essential public health functions are being carried out in the UK.”
The cost of not investing in public health is clear when the cost of interventions at different stages of disease are considered. Calculations by researchers at Cambridge University show that each additional year of good health achieved in the population by public health interventions costs £3,800, which is three to four times lower than the cost resulting from NHS interventions of £13,500.
The researchers suggest that investing in local public health programmes would generate longer and more healthy lives than equivalent spend in the NHS.
In May 2023, a study presented at the European Congress on Obesity in Dublin, showed that the NHS spent an average of £1,375 annually on morbidly obese patients with a body mass index (BMI) of more than 40. Obese patients with a BMI of 30 to 35 cost the health service an average of £979 annually, and those with a BMI between 35 and 40 cost £1,178 per year.
The study suggested that if everyone were a healthy weight the NHS would save nearly £14bn annually. It is public health services that are in a position to help people maintain a healthy weight and to save the NHS billions.
The charity ASH (Action on Smoking and Health) presented an analysis in January 2022, that found that, the cost of smoking to society is significantly higher than previous estimates. They show the cost of smoking to society totals £17.04bn for England each year. This compares to £12.5bn under the previous estimate.
The analysis found smokers are more likely than non-smokers to become ill while of working age and more likely to die while they are still of working age creating a further loss to the economy. Smokers are estimated to cost the NHS £2.4bn per year, due to their need for health and social care at a younger age than non-smokers. It is public health services that are in a position to help people give up smoking and to save the NHS billions.
In 2023, there were 10,473 alcohol-specific deaths registered in the UK, a rate of 15.9 deaths per 100,000 people (Office for National Statistic, 2025). This is 4.2% more deaths than in 2022, and 38.4% more deaths than 2019 (pre-coronavirus pandemic). In 2023/24, there were over 1 million alcohol-related hospital admissions in England, at a rate of 1,824 per 100,000 persons (where the primary reason for hospital admission or a secondary diagnosis was linked to alcohol).
Yet, despite the overwhelming evidence of excellent value for money of public health interventions and their importance for a healthy population that would ultimately rely less on the NHS and contribute more to the economy, over the last 13 years the Conservative government has actively cut spending on public health and worked to reduce its ability to save lives.
Deep funding cuts lead to service cuts
The government separated the budgets for public health, education and training, capital and national bodies, from the budget for NHS England in November 2015 and this paved the way for cuts to public health services.
The cuts have taken place despite public health still being NHS healthcare and of vital importance to the health of the nation. Public health services are interventions that are based on the fact that it is better and much cheaper to prevent illness in people than to treat it at a later date.
By 2022, the budget for public health services was £850 million lower than in 2015/16, a cut of 24% from its 2015/16 level in real-terms. By February 2025, the Health Foundation calculated that there has been a 26% real-terms per person cut in the value of the grant between the initial allocations for 2015/16 and 2025/26.
The Labour government 2025/26 allocations mark the most significant real-terms increase since 2015/16.
The Health Foundation notes that "while additional but time-limited funding to stop smoking services and support has been allocated to local authorities, separate funding for drug and alcohol treatment has not yet been confirmed (which has been allocated in previous years). If this is not confirmed, overall public health spending across these activities will have fallen by 4% since 2024/25 in real terms per person."
The figure for the cut in budget was for England as a whole, however an investigation by the IPPR found that the cuts in public health disproportionately affected the most deprived areas. It is the poorest communities that are being hit the hardest by these cuts in public health. When the IPPR compared the cuts in the most and least deprived ten local authorities, they found that "Almost £1 in every £7 cut from public health services has come from England’s ten most deprived communities - compared to just £1 in every £46 in the country’s ten least deprived places. The total, absolute cuts in the poorest places have thus been six times larger than in the least deprived."
This phenomenon was also found by The Health Foundation in their more recent analysis. Their analysis found that per person reductions in the public health grant tend to be largest in more deprived areas. In Blackpool, ranked as the most deprived upper tier local authority in England, the per person cut to the grant has been one of the largest at £43 per person.
Sexual health, drug and alcohol addiction, weight management, stop smoking programmes are all frontline public health services. Cuts to these services have significant effects on the future health of the population and the cost of healthcare in the future.
Sexual health targeted
Very few areas of public health have avoided a cut in funding as the Health Foundation research (see above) shows, but sexual health services and contraceptive services have been hit the hardest. King's Fund research found that between 2013/14 and 2017/18, total local authority spending of sexual health services fell by 14% in real terms. This is despite the rapid rise in the spread of STIs, including gonorrhoea and syphilis. The Health Foundation found a 32% reduction in funding between 2015/16 to allocations for 2025/26. The Health Foundation estimate that the other big losers in public health funding are drug and alcohol services for adults (down 25%) and children’s services (down 25%).
Smoking cessation services had been hit hard with wider tobacco controls across the country down by £20m in 2017/18, from £120.6m in 2016/17 to £99.8m. Analysis showed two thirds of the 152 local authorities in England reduced their spending on smoking cessation in 2016/17. This is despite Stop Smoking Services being the most effective measures for people to quit smoking. In recent years additional time-limited funding has been allocated to smoking services and support, which has increased funding.
It was revealed in a survey by Pulse that in 2018, 90% of councils had their budgets for public health programmes cut which affected weight loss, stopping smoking and sexual health services. More than half of doctors surveyed reported cuts to weight management and alcohol addictions services. 48% had also lost services to help smokers quit and 49% had lost sexual health clinics or testing.
In April 2022 the Conservative government removed £100 million in funding for NHS weight management services, despite research showing that these services, a broad range of health advice, information and behaviour change support services, can be an effective intervention to support lasting health improvement.
The cut to services was condemned at the time by the Obesity Alliance, which accused the government of “‘short-termism’, where services that deliver long-term benefits are sacrificed for short-term savings.”
Young people hit hard
The July 2016 investigation by the HSJ found that the groups hardest hit by the cuts in public health were children and young people's services. Overall, the analysis found planned spending reductions worth £50.5m in 2016-17, across 77 local authorities which provided information; the biggest area for cuts was services for children and young people.
These findings were reiterated by children's doctors in 2019. The Royal College of Paediatrics and Child Health said: "Children deserve better. It is they who are disadvantaged most by inefficient health services, cuts to public health and the rising tide of poverty.”
The HSJ investigation found that the biggest single area was a £7m reduction to services directly aimed at improving the health of children and young people, such as health visiting, school nursing and childhood obesity programmes.
Widespread criticism of cuts
Over the years, numerous organisations (charities, royal colleges etc.) railed against the cuts to public health services and to the training of nurses and doctors. In October 2021, an open letter from the Association of Directors of Public Health, signed by more than 50 representative bodies and charities (including the Alcohol Health Alliance UK, the British Liver Trust, and Cancer Research UK), backed a call for increased funding. This was of course ignored by the Conservative government. Critics of the cuts emphasised that in the long-term, cutting spending on public health leads to much greater costs for the NHS.
In March 2019, the BMA's report Prevention before cure: Prioritising population health, highlighted the deterioration of public health services and called for the cuts to the budget to be stopped.
In June 2019, The Health Foundation and the King's Fund issued a joint statement urging the government to "make a clear and urgent commitment to restoring £1bn of real-terms per head cuts to the public health grant."
The two organisations said that cuts to the public health grant made since 2015/16 are having a major impact on local services. They said "that failing to act now would be a false economy, placing further pressure on the NHS and wider public services." The statement noted that the cuts in funding had come at a time when life expectancy improvements have slowed dramatically and health inequalities are widening. The two organisations said "that the cuts run counter to the government’s commitment to preventing ill health as stated in the NHS Long Term Plan and its mission to increase years spent in good health, while reducing inequalities."
The Health Foundation reports that the public health grant should be increased even further, requiring a total of over £3bn a year above current levels, to "both reverse the impact of cuts and ensure that the grant is reallocated to allow additional investment in the most deprived areas where there is greatest need."
In February 2016 academics and organisations representing health visiting, paediatrics, midwifery and family services wrote an open letter to Government ministers raising concerns that recent statistics show UK breastfeeding rates at 12 months after birth are the lowest in the world: they attribute this to cuts in public health spending that have led to cuts in support for new mothers.
Recent government action
If a Labour government (or any government) is committed to improving the health of the country's population and reducing inequalities it needs to take steps to restore the public health grant and allocate it on an equitable basis.
Using economic assumptions from October 2024, The Health Foundation estimates that restoring the public health grant to its 2015/16 real-terms per person value would require an additional £1bn in 2024/25 price terms in 2025/26.
Commenting on the budget in October 2024, the Royal Society for Public Health (RSPH) said "for the public health world, it was a mixed bag. There is more money for the NHS, and welcome measures around commercial determinants of health and employment. But there is unlikely to be any major movement on core public health spending, and – as always – there is more that could be done to invest in genuinely preventative services."
Adding,
"It was disappointing to see that there has been no explicit investment in services which will prevent health problems from arising. This early intervention is how we can best tackle ill health, and every part of Government has a role to play in delivering it. A rhetorical shift to prevention is welcome, but we need to see more details from the Government on what this will look like in practice."
On a more positive note, the RSPH commented:
"news of higher duty for tobacco, as well as a new flat vaping duty, is welcome....Alongside this, the Government is reforming alcohol duty to reflect the difference in harm between drinking in a pub, and drinking high-ABV products purchased from off licenses. This is a welcome change – with draft duty falling, while other alcohol duties rise with inflation – which should help encourage healthier drinking. Similarly, the decision to review the highly effective Soft Drinks Industry Levy – uprating it in line with inflation since its introduction – is a positive step to ensure that the work of promoting healthier soft drinks does not stall at a time when obesity rates are continuing to rise."