Public Health

At Leicestershire Full Council meeting, Labour Councillors asked the Lead Member for Health to give a position statement on the planned cuts to the local government Public Health budget.

Leicestershire’s Public Health department has already responded to local government budget reductions by commissioning more efficient services. It was difficult for Leicestershire’s Lead Member for Health to give a detailed response. Even though these cuts are to take place in the current year, the Government still hasn’t made up its mind.

Chief executive of the Association of Directors of Public Health Nicola Close said on the 15th July, “Most local authorities are deciding where the axe will fall even though they don’t know how much the cut will be yet.”

In the meeting, I tried to raise a concern that these cuts will not just impair Public Health’s ability to what we already do, but leave us unable to tackle a bigger problem heading our way. Despite concerns being raised at the highest clinical level, Tory politicians appear unwilling to address the “post-antibiotic era”.

Nearby Sexual Health services in Leeds are having to deal with extremely drug resistant gonorrhoea. This is not an isolated problem. Most people will have heard of multi-drug resistant staphylococcus aureus MRSA. Few realise the horrors that will be leashed on the public when extremely and even pan-drug resistant organisms become common.

Dr. Arjun Srinivasan associate director at the Centers for Disease Control and Prevention said in 2013,
“We’re here. We’re in the post-antibiotic era. There are patients for whom we have no therapy, and we are literally in a position of having a patient in a bed who has an infection, something that five years ago even we could have treated, but now we can’t.”

Chief Medical Officer Professor Dame Sally is not alone in blaming a neoliberal belief that ‘the market will provide’. She points out,

“There have been no new classes of antibiotics discovered and marketed that have been developed since 1987. We expect antibiotics to be cheap, yet we only take them on average once a year – so there is no profit to be made in developing new ones. Of the 41 antibiotics currently being developed, only three will work in humans and reach the market.

“We need to develop new antibiotics. That means we need a totally different market system. And while we have gone through a phase of not making new antibiotics, we have disinvested in the scientific underpinning that could produce new antibiotics. So it is going to take a long time to put the problem right.”

As this avoidable disaster unfolds, patients being treated for cancer, receiving kidney transplants or hip replacements will survive the original condition only to die horribly of previously treatable chest, bladder or wound infections.

Managing all the responses to this apocalypse is beyond the powers of a County Council. But there are things Public Health should and could do, if properly funded.

Chief Medical Officer Professor Dame Sally Davies said this year

“We must do more to explain to patients and doctors the limitations on the effectiveness of antibiotics. We need to persuade doctors not to prescribe them where they will not work and patients not to expect them where they will not work. There is no clinical benefit in taking an antibiotic for a viral infection.”

At a recent educational meeting in West Leicestershire, GPs explained to microbiologists the pressures being placed on doctors by patients who are often sent to get an antibiotic by work colleagues, employers and, most disturbingly, some pharmacists. Local GPs asked for assistance from Public Health to educate these groups in the non-drug management of self-limiting infections.

During the Council meeting, I did attempt to ask Leicestershire’s Health Lead how the new cuts might impact on the ability of Public Health to deal with this scenario. I can’t blame him for his failure to reply. Sadly, the mutterings, rumblings and spurious points of order raised by the controlling Group drowned out the question.

I am disappointed, but not surprised at the head-in-sand attitude of local Tories. While they like to mock “Corbynomics’ and describe themselves as realists, The King’s Fund have told their Government that “cuts to public health spending and activity will be the falsest of false economies, not least for the NHS” and “make a mockery of prevention rhetoric”.

Perhaps some Tories actually support this approach? Profiting from the elephantine level of income inequality their austerity has brought about, the post-antibiotic era could provide a Machiavellian solution to the problem of the frail and multi-morbid elderly.

None of us may get to live that long.