As NHS waiting lists grow and staff shortages persist, it’s become general knowledge that the impact of austerity and cuts to public services have pushed the UK’s healthcare system to breaking point. But exclusive polling of England’s councillors conducted by New Statesman Spotlight* reveals that it’s not just the government’s opponents who think this.
Overall, more than four fifths (86.4 per cent) of all councillors surveyed said that the state of health and social care was “worse” or “much worse” compared to 2010. Nearly half of Conservative councillors (47.7 per cent) said the same, compared to a staggering 97.3 per cent of Labour councillors. Of all respondents, four fifths (83 per cent) also said they would trust Keir Starmer over Rishi Sunak to run the NHS.
Despite the fact that the NHS is one of the biggest recipients of government spending, receiving 9.9 per cent of the UK’s overall gross domestic product (GDP), this investment has not been sufficient. The majority of councillors surveyed (56.8 per cent) said the state of their local NHS services was either “bad” or “very bad”, while only 16.6 per cent said it was “good” or “very good”. More than a quarter (27.5 per cent) of Conservative councillors agreed with this sentiment, compared to nearly two thirds (63.8 per cent) of Labour councillors.
The NHS aside, there is another undercurrent of underfunding facing the UK’s health that has received far less media attention – investment into prevention and public health has severely stagnated in the past decade.
The Public Health Grant is distributed from central government to local authorities to deal with public health issues in their areas. This includes smoking, alcohol and weight management services, sexual health, exercise programmes, “social prescribing” access to community groups to tackle loneliness, and any other interventions that aim to prevent worsening health and improve life expectancy.
The grant was £3.5bn for 2023-24, a meagre increase of 3.3 per cent on last year that was nowhere near in line with inflation. This is compared to the NHS England budget of £160.4bn for 2023-24. This means the NHS currently receives 45 times more money than prevention services.
This huge discrepancy in funding exists even though 9.1 million people in England are expected to be living with serious diseases such as diabetes and heart disease by 2040 – conditions which can be partly preventable through lifestyle changes. Health experts have long sounded the alarm on preventable illness – children’s doctors, for instance, have said that youth vaping is “fast becoming an epidemic”, while just this week, obesity has been linked to 3,000 hospital ward admissions a day.
More than half of the councillors surveyed (54.1 per cent) said that their council’s public health grant had been cut in real terms since 2010. Perhaps more shocking is the fact that only 3.8 per cent said definitively that their grant had not been cut, and a huge 42.1 per cent said they didn’t know either way.
This speaks volumes about the low precedence that prevention has taken on the national and local agenda, despite the fact that it could save the economy, and NHS, so much money in the long-term. It costs roughly £3,800 in public health services to give someone an extra year of good health, compared with roughly four times the amount (£13,500) for NHS interventions that would do the same.
Despite the negative outlook surrounding the state of the NHS since the Conservatives came into power, Tory councillors appear to have a slightly rosier view of public health funding than the opposition. Only a quarter of Conservative councillors (23.5 per cent) said there had been cuts to their public health grant since 2010, compared to two thirds (66.4 per cent) of Labour councillors.
Prevention spans far further than traditional NHS or health services, into early years and school education, parks and recreational grounds, public transport options and adequate housing. In Spotlight’s survey, many councillors made the link between traffic measures to tackle pollution, for example, and better health.
One said that measures such as low-traffic neighbourhoods (LTNs) and pedestrianised areas “have a role to play in creating healthier, more liveable cities”, while another said they would help the “health of the environment and the health of our residents”. Others cited the dual benefits of tackling both climate change while improving air quality and health outcomes, while another mentioned the impact of pollution on disadvantaged communities.
While 40.3 per cent of respondents said their local authority had not introduced any form of traffic calming measures – such as a London-style ultra-low emission zone (Ulez), LTNs or 20 miles-per-hour limits – four fifths (84.8 per cent) of all councillors said they would support such measures. However, there was a clear divide between the parties on this issue, with more than half of Conservatives (55.8 per cent) reporting that they would not support low-traffic measures being introduced, compared to just 8.7 per cent of Labour councillors.
*The full councillor survey results, made up of responses from 528 councillors across English local authority districts, are available here, and in a special policy supplement with the New Statesman issue published on 24 November. Read it here.