A raft of reductions in the public health budget in Lancashire will see healthy weight courses scrapped, along with a service for people with low-level health and social issues.
Meanwhile, fewer people will be eligible for places on drug and alcohol rehabilitation programmes and the county's stop smoking service will become more targeted, as part of wide-ranging plans agreed by Lancashire County Council’s cabinet.
Total savings of more than £4.1m will be made from public health schemes following the results of public consultations about all of the proposed changes.
The authority will make a one-off investment of £500,000 to help design preventative, community-based schemes to bridge the gap left by the cut to the council’s own programmes.
County Hall has also offered to pool its remaining public health budget with the region's clinical commissioning groups (CCGs) to speed up moves towards closer co-operation between the NHS and local authorities, although no specific agreements have yet been reached.
The meeting heard that there will now be a focus on neighbourhood working to ensure residents are referred to community services in their own areas which may benefit them.
The public health grant given to the county by central government has reduced by more than £5m in the last four years and stands at £66.6m in the current financial year.
Shaun Turner, cabinet member for health and wellbeing, told the meeting: "You cannot measure a service by the money you pour into it.”
“Feedback from the consultation illustrates the importance of health improvement services. However, these proposals do not mean we intend to abandon these services and the positive impacts they have.
“We need to do things differently to help shape new health improvement initiatives. There is an opportunity to develop a much more coherent service offer by working much more closely with our partner organisations,” County Cllr Turner said.
But deputy leader of the Labour opposition group, John Fillis, warned that the worth of the services under discussion went “beyond their cash value”.
“This is about people’s lives, their health and wellbeing in the future - what price do we put on that? That's the question we have to ask ourselves.
“Are we supporting the people of Lancashire by talking about pounds and pence? If we keep people well and happy, that means there are more services for everybody along the line.”
As part of the changes, the authority will promote plans to train the public sector workforce in “making every contact [with an individual] count” by offering lifestyle advice to the people they see in the course of their work and directing them to appropriate organisations.
Digital opportunities will also be developed to improve self-care and wellbeing via apps, a report to cabinet said.
Deputy leader of the Conservative-run authority, Keith Iddon, said the council had to “do the best with what we’ve got”.
“We’ve got to protect vulnerable people and if we do not [make the changes], we are not doing them any good.”
But Labour group leader Azhar Ali said that the proposal to design replacement services with other agencies was based on “empty words”.
“You’ve had a long time to develop alternatives, but there are no details. You’ll end up with a vicious circle where the savings in the short-term will [end up costing] the council more,” County Cllr Ali said.
WHAT IS CHANGING?
Active Lives Healthy Weight Service
The budget will be reduced by £1.5m, leaving £500,000 in the pot from April 2020.
Currently, the service delivers 12-week programmes to anybody with a body mass index which shows that they are overweight, in an attempt to prevent them becoming obese. People who do less than 30 minutes of exercise three days a week are also targeted.
The revamped service will “maximise the use of public open spaces, using digital technology where possible”.
Labour opposition leader Azhar Ali warned that the overhaul was “a false economy”.
“Many people will not use open spaces - they are worried about safety and many prefer the privacy of a sports facility and the coaching that goes with it to help them achieve their weight and reduce blood pressure.
“Some of these people will go back into the NHS or end up being a burden on social care,” he added.
Cabinet member for health and wellbeing, Shaun Turner, said the county council was still “committed to prevention”.
“A lot of this is about connecting [community] organisations into a GP network, so doctors can [find suitable services for patients].
“We’ve got to plug the gaps in the system, because we have got a national health service in name, but there are gaps in various parts of the county - and we’ve got to do something about that.”
Responses to the public consultation into the changes found 60 percent of public respondents disagreed with the proposals - but so did 74 percent of the partner organisations which will be needed to deliver replacement services.
A third of the current services users who responded said they already used digital technology to improve their activity levels, but 36 percent said they would not consider doing so.
Lancashire Wellbeing Service (LWS)
The service will cease by the end of the year, saving £2m - although a support worker for the deaf community will be retained.
Delivered by a consortium of three charities, the service was designed to support vulnerable adults with low-level health and social care issues, to prevent them escalating into a crisis.
Respondents to a public consultation said they valued the “holistic approach” to the multiple challenges they face and many described it as “an important safety net” in their lives.
Around 11,000 people a year receive support from the LWS, including help with mental health problems.
Cabinet has agreed to promote the increased use of community organisations by people who would previously have been referred to the wellbeing service.
But a report by council officers acknowledges that there has been a reduction in support for vulnerable people in recent years, particularly from voluntary groups - which are likely to face increased demand as a result of the LWS being cancelled. It also notes that the authority’s own adult social care department may experience added pressure, having referred over 2,800 people to the service last year.
But deputy county council leader, Keith Iddon, condemned the criticism made by some partner organisations - and the county’s MPs - during the consultation process.
“None of them say, ‘this is what we can do to help you’. It’s easy to criticise, but that’s empty to me - if you are going to criticise, come up with some solution.”
But Labour opposition group leader Azhar Ali warned of the possible of the effects of the closure of the service.
“Many of the people suffering from mental health issues don’t need a digital offer, they need someone to talk to.
“Some of the people using this service are warning us that they’d be dead without it - and that’s falling on deaf ears,” County Cllr Ali said.
Council leader Geoff Driver told members that leaders of all the local authorities in Lancashire - including the standalone councils in Blackpool and Blackburn - had recently agreed to meet with the county’s mental health provider, Lancashire Care NHS Foundation Trust, to discuss pooling resources.
“We will always be there for the people of Lancashire if they have a crisis in their lives,” County Cllr Driver said.
Drug and alcohol rehabilitation services
The budget for county council-provided programmes will be cut by £675,000.
The saving will be made by changing the “thresholds” at which people become eligible for rehabilitation schemes, many of which are currently residential. It is expected that at least 100 fewer placements will be offered each year.
To offset the changes, the authority will promote the use of community-based services offered by voluntary organisations, as well as “maximum utilisation of wider community assets”.
A report by council officers notes that the new policy is likely to make it more difficult for the NHS in the county to respond to the impact which drug and alcohol misuse is currently having mental health and Accident and Emergency services.
Responses by partner organisations to a consultation expressed concern about the capacity of community organisations to cope with an uptake in demand.
Stop smoking services
There is no reduction in the budget for smoking cessation programmes, but they will become more targeted at groups who will benefit from them most and where smoking rates are highest.
The focus will shift from a universal scheme to pregnant women who smoke, people with long-term conditions or mental health problems and manual workers. Currently, anybody over the age of 12 can access the service.
Anybody seeking help who does not fall into the new priority categories will be referred to digital services, although they will be assessed for direct help if they indicate that they have difficulty accessing the necessary technology.
A campaign encouraging smoke-free future generations will continue.
Lancashire’s smoking rate is in line with the England average at 14.8 percent - but is higher in some areas, including Preston and Pendle, where one in five people smoke - the highest number in the county.
WHAT DOES THE NHS SAY?
Many of the public health changes being made by Lancashire County Council are underpinned by a promise to work more closely with the NHS.
An offer has been to the county’s clinical commissioning groups (CCGs) to pool the remainder of the council’s public health budget with the health service.
Cabinet member for health and health and wellbeing, Shaun Turner, said the need to make financial savings could “kick start” long-discussed plans for closer co-operation.
"Getting ourselves aligned is a big piece of work - the organisations don't dock with each other. So it was almost half-expected that [the NHS] wouldn't be able to get involved with maintaining some of the services [which have been cut], but our finance teams are meeting about how this might happen [in future]," he said.
The local democracy reporting service contacted every CCG in the county council area. This is what those which responded had to say:
Greater Preston and Chorley and South Ribble CCGs
“In order to make the best use of our collective resources and better join up care for local people, we continue to work with our partners across the whole health and care system, including Lancashire County Council, through our local Integrated Care Partnership,” Denis Gizzi, chief officer for the two CCGs, said.
“The recently approved new model of care for central Lancashire, outlines how we need to increase our focus on prevention of ill health and better support local residents wellbeing. Although this proposal is at an early stage and still being discussed, it has the potential to strengthen our plans to deliver this vision and improve lots of positive work already taking place across our neighbourhood networks.”
Morecambe Bay CCG
Chief officer Jerry Hawker said: “Morecambe Bay CCG is working with fellow CCGs across Lancashire to consider new ways of working with Lancashire County Council in regards to preventative services in our neighbourhoods.
“We are naturally disappointed with the proposed cuts in the public health budget but we are committed to working with the council to explore how better joint working would help maximise available resources and deliver better preventative services to the people in Morecambe Bay.”
East Lancashire CCG
“CCG officers have been having initial high level and preliminary discussions with officers of LCC to understand the proposal and its scope,” a spokesperson said.
“Ninety percent of the first contact people have with the NHS is through their GP, and primary care services in local communities. As such, the CCG is keen to explore any possible developments that can support GPs and primary care as well as promote prevention of ill health.”
West Lancs CCG
A spokesperson said: “We are aware of the proposal and we’re currently in discussions with Lancashire County Council.”