London primary care trust boards are being forced to slash funding set aside to meet the targets set out in the Choosing Health white paper by more than three-quarters as a result of financial problems in the NHS, HSJcan reveal.

London primary care trust boards are being forced to slash funding set aside to meet the targets set out in the Choosing Health white paper by more than three-quarters as a result of financial problems in the NHS, HSJcan reveal.

A survey of public health directors in the capital reveals fears that sexual health and obesity targets will not be met because Choosing Health money, which is not ring-fenced by the Department of Health, is being diverted to help PCTs break even.

The Association of Directors of Public Health polled directors in London's 31 PCTs and found that PCT boards in 12 of the 24 who responded had decided not to spend any of their allocated funding for Choosing Health initiatives in 2006-07.

The other 12 PCT public health directors said that although their PCT boards had decided to spend some of the money, not all of it would be allocated for public health.

Between them the 24 PCT have been allocated a total of£26.7m for 2006-07 to spend on implementing policies outlined in the 2004 white paper.

The first-quarter estimates of the 24 PCTs show that they expect to spend£4.1m on Choosing Health - less than a sixth of their allocations. ADPH president Dr Tim Crayford said that over the year the estimates of total funding were expected to decrease progressively.

Respondents blamed the public health funding crisis on the DoH and the decision by London strategic health authorities to top-slice PCT budgets by 3 per cent in the current financial year.

They also cited other financial pressures that are seeing allocations swallowed by deficits as PCTs struggle to meet the DoH's demands to break even by March 2007.

London public health directors said that cuts in public health funding would be most keenly felt in trying to tackle the sexual health crisis and obesity epidemic.

Dr Crayford, who is also Croydon PCT public health director, told HSJ that not allocating Choosing Health funding was 'short-sighted'. 'The two Wanless reports demonstrate that if we do not spend this money now we will have to spend an awful lot more on health in 15 to 20 years' time,' he said. But he added that it was important to work 'constructively' with the NHS to achieve financial balance.

Terrence Higgins Trust chief executive Nick Partridge said that unless public health was properly funded the government would be unable to achieve the fully-engaged scenario set out by Sir Derek Wanless in his 2002 review of health and social care.

'The additional Choosing Health money is not getting through to the frontline for sexual health services and this means that people are going to have to be very, very innovative and imaginative in their service redesign to have any chance of meeting the DoH's 48-hour genito-urinary medicine access target,' said Mr Partridge. He added that the current situation was a 'massive disappointment'.

National Obesity Forum chair Dr Colin Waine said: 'It is terribly disappointing and a very short-sighted decision to rob public health funds and means that healthcare costs are going to rise inexorably.'

However, asked if the DoH would consider ring-fencing public health funding deputy chief medical officer for public health Dr Fiona Adshead said: 'We want to see how we can improve outcomes and it is not just about focusing on the money. It is about getting public health delivered through a range of different services. We are clearly still committed to delivering Choosing Health,' she added.

Meanwhile, chief medical officer Professor Sir Liam Donaldson has issued a stark warning that 'raiding the public health budget can kill'.

In his annual report on public health, Sir Liam said that 'striking local and regional differences in population health expenditure and infrastructure' were cause for 'serious concern'.

He said that expressed commitment to public health was not matched with concerted action and that public health budgets were regularly being 'raided' to find funding to reduce hospital financial deficits or to meet productivity targets in clinical services.

Yesterday, prime minister Tony Blair was due to announce that 'social marketing' techniques would be used in the NHS to improve the reach and effectiveness of public health messages.