Cuts to the public health budget of local authorities are putting the government’s goal of a smoke-free England by 2030 at risk, according to the new report – Many Ways Forward – from Action for Smoking and Health (ASH) and Cancer Research UK.

This annual survey of local authorities found that due to cuts, a third (31%) no longer provide a specialist stop smoking service, and three quarters (74%) say that budget pressure means that their stop smoking services are threatened. Cuts to public health budgets mean that spending on stop smoking services and tobacco control fell by 36% from 2014/15 to 2018/19, according to the report.

The survey also looked at what was provided around England for those trying to give up smoking. In a quarter of local authorities GPs did not prescribe any nicotine replacement therapy (NRT), despite guidance that to give smokers the best chance of quitting they should be offered a combination of NRT or the drug varenicline, in conjunction with behaviour support.

Of the local authorities that still had specialist stop smoking advisors, 21% had advisers that had had less than two days training, which ASH notes is not adequate training in line with nationally recognised standards to give effective support to smokers.

One in ten local authorities only offer a stop smoking service via primary care and these services are the least likely to be targeting groups with a high prevalence of smoking, although ASH notes that this is key if the inequalities in smoking are to be addressed. There are also 2% of local authorities that only offer stop smoking support by telephone.

ASH and Cancer Research UK say that cuts to the budget need to be reversed if prevention targets are to be achieved, but also advocate a “polluter pays” strategy: Deborah Arnott, Chief Executive of Action on Smoking and Health (ASH) said

“To fund the support smokers need to quit, the Government should impose a ‘polluter pays’ charge on the tobacco industry which could raise at least £265m annually. This could adequately fund stop smoking services, local authority enforcement against the illicit tobacco trade and underage sales, and adequately funded public health campaigns to reduce smoking.”

False economy

Although focused on anti-smoking services, the survey is yet another example of how budget cuts are setting back plans to improve the health of the population. In the long term, skimping on such services does not add-up financially – according to Cancer Research UK, smoking is the biggest preventable cause of cancer and every year smoking related illness costs the NHS £2.5 billion.

Indeed overall, ASH calculates that smoking in England costs society £12.5 billion each year, costs include healthcare, social care costs, house fires, and loss in productivity. Yet the entire budget allocated to local councils for public health is only £3.1 billion and a small and reducing proportion of this is allocated to smoking cessation. Since 2014, the public health budget has fallen by £850 million.


In late 2019, a report from the IPPR compared those public health cuts in the most and the least deprived ten local authorities, and showed that the absolute cuts in the poorest places were six times larger than in the least deprived. In relative terms, the poorest ten places have lost approximately 35p in every £1 of their budget, compared to the least deprived areas where approximately 20p in every £1 of their budget has been cut.

When individual services are considered then it’s smoking services, drug and alcohol services and sexual health services that have taken the brunt of the cuts, according to the IPPR, down 85.1%, 260.9% and 196.4% from 2014/15 to 2019/20 spending levels.

Charities have called upon the government to increase the funding allocated to public health by £1 billion to bring it back to the 2014 level, without this the government’s aim to prevent ill health and increase the number of years spent in good health outlined in the long-term plan in 2019 will be impossible.

Although the government signalled that there will be a real term increase in money for public health in its provisional local government finance settlement for 2020/21, the Local Government Association noted in late December 2019 that the settlement includes no information about the national total, or individual council allocations, of the public health grant for 2020/21. The LGA called on the government to provide councils with clarity on the funding available in 2020/21, saying the delay to the announcement is making it extremely difficult for councils to plan effectively.

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