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Equalities concern prompts alternative public health cut proposal

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The government’s plan to impose a flat-rate cut on council’s public health 2015-16 budgets risks breaching equality laws, new research has indicated.

Analysis of the proposed 6.2% reduction by Benjamin Barr, a research fellow at the University of Liverpool, found that areas hit hardest by the cut had relatively high concentrations of residents from black and minority ethnic backgrounds.

Of 10 council areas facing the biggest reduction under the DH’s preferred approach, seven had a concentration of BME populations above the English national average of 14%.

All of the 10 areas facing the smallest reduction had proportions of BME populations below the national average.

Race is a “protected characteristic” under the Equality Act 2010.

Under the act’s public sector equality duty, public authorities – including government departments – must work to eliminate discrimination and “advance equality of opportunity”.

Rebecca Lawrence, a solicitor at Trowers and Hamlins, told LGC it was a legitimate to ask the DH how it had assessed the impact of the proposed cuts on those people with protected characteristics.

She said: “From a legal perspective, this blanket cut doesn’t seem to have taken such considerations into account, despite mention of these duties in the consultation document. These considerations cannot be ignored.”

Dominic Harrison, a former DH official and director of public health at Blackburn with Darwen BC, said it was a matter of “legal debate” whether the proposed cut would contravene the public sector equality duty.

His authority’s submission to the DH consultation has suggested an alternative means of applying the cut: reducing funding on a per head of population basis.

Mr Harrison described his proposed method as the “least worst option” which would avoid the disproportionate effect on BME populations and areas with high levels of deprivation.

“If the DH are determined to cut prevention spend, which is bizarre and counter intuitive and against their own policy commitments, then we are going to argue that £3.60 flat per head cut will achieve the outcome in a more equitable way.”

Mr Barr’s analysis shows the DH’s preferred method of applying the cut would result in reductions in funding per head of population from £8.80 in Westminster and Kensington and Chelsea to £1.90 in Windsor and Maidenhead, when the City of London is excluded.

He found that Blackburn with Darwen’s proposal to impose a cut of £3.67 per head would result in an “equally negative” reduction in public health, measured in quality adjusted life years.

Mr Barr told LGC that the flat per head cut would not, however, widen health inequalities. “[And] that’s what this [public health] funding is all about”.

His analysis also shows that application of the cut on a per head of population basis would tend to benefit authorities in the north and London and that more affluent areas in the south would lose out.

This meant the per head method was unlikely to win widespread backing, according to Mr Barr.

The Local Government Association and the Society of Local Government Chief Executives & Senior Managers are unlikely to back any of the options proposed as each produces winners and losers among their members.

Meanwhile, the Faculty of Public Health continues to oppose the cut and calls for it to be reversed.

The flat 6.2% cut was one of four options set out in the consultation but highlighted by the DH as its “preferred option” on the basis it would be the “simplest and most transparent” way of applying the cut. None of the options include a flat per capita cut.

The DH said it planned to publish an impact assessment on the reduction but declined to comment further while the consultation was ongoing. Its consultation closes 28 August.

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Readers' comments (1)

  • Cut the Public Health budget and the costs will, as we all know, transfer to secondary care! Any dummy can see that coming. Obviously Jeremy Hunt lives in a strange strategic paradigm.

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