Opinion  

Incidence of type-2 diabetes is set to rise by 70 per cent; stroke by 30 per cent; and CHD by 20 per cent, the report said. And by 2050 obesity-related diseases will cost the nation an extra £45.5 billion a year in both direct costs to the NHS and indirect costs, such as the financial implications of those obese people who are unable to work.

Against this backdrop it is disheartening to see that PCTs in England have been using money earmarked for public health projects, such as tackling obesity, to pay off deficits (page 6). Most primary care nurses will have been aware that this was happening, but it is only with last week's publication of research by the Association of Directors of Public Health that the scale of the problem has become clear.

PCTs have used £95 million of money earmarked to tackle issues like obesity, sexual health and alcohol abuse to pay off deficits, according to the research. Just £46 million of the £141 million allocated for public health in 2006/7 was spent there. More concerning is that directors of public health expect that only 28 per cent of the money earmarked for 2007/8 will be spent on public health.

The DoH now adopts an 'arms length' approach with PCTs. It does not want to interfere in how trusts use their budgets, arguing that local managers should decide on spending based on local priorities. However, surely there is a case for ring-fencing public health funding?

Of course PCTs should be able to decide how the money is spent in their area and which projects to fund - but it should be spent on public health and the DoH must take steps to enforce this.

Preventive health is often low on trusts' list of priorities because the results of any spending are very difficult to quantify and frequently not seen until many years later. But, as the obesity figures show, this short-term approach is no longer an option for the NHS. Unless the government spends money on prevention now, the long-term financial and social costs will be huge and have far-reaching implications for us all.

Emma Bower, editor, Independent Nurse, emma.bower@haymarket.com