Proposals to cut the budget for improving public health in Scotland have been criticised by NHS experts.
Directors of public health in Tayside and Lanarkshire say that spending on initiatives to enhance wellbeing and protect the public from diseases will shrink next year under the Scottish government’s spending plans. They described the cutbacks as counterproductive, suggesting that they would damage national aims to help people to live in good health for longer.
The two public health directorates made the criticism in submissions to the health and sport committee of the Scottish parliament. In their responses to the committee’s request for comments on the draft health budget for next year, the two public health departments said: “In the proposed budget for 2018-19, there is a reduction in spend on ‘health improvement and protection’. We think reducing the spend on health improvement is counterproductive in achieving the national indicators.”
The two directorates also said that the Scottish government’s much-trumpeted merger of NHS and social care budgets had done “very little” to promote physical activity and reduce sedentary behaviour — although they argued that it should be a core component of programmes to improve public health.
They added: “The diversity of available funding makes it difficult to access and the NHS is required to ‘match fund’ with partners. The NHS generally has no allocation to match despite this being a priority and despite the evidence. This is a missed opportunity in the health and social care sector.”
In its response to the committee the Royal College of Physicians of Edinburgh also discussed how resources had to be prioritised, arguing that services at some hospitals would have to close, despite protests from the public. In the college’s view “with limited national wealth, decision-makers and influencers must realise that the removal of redundant, although cherished facilities, practices and remedies is essential”.
Derek Bell, president of the college, said: “When making any changes to the current and future provision of hospital services in Scotland, decisions must be based upon the best evidence available — and resources, demand and patient safety all need to be taken into account.” He added: “Making difficult choices is inevitable for decision-makers in Scotland and we urge that there is good public dialogue so that people understand the reasons for the proposals and any changes that are made.
“It is essential to reassure the public that these decisions are made with the best interests of patients as the priority.”
The health secretary Shona Robison said that the Scottish government had delivered record funding for Scotland’s health service and that more than half of frontline spending would soon be in community health services.
She added: “We have also delivered the integration of health and social care, which is one of the most significant reforms since the establishment of the NHS, and which is helping improve service delivery.”