Static public health funding will increase pressure on local governmentBMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g7825 (Published 29 December 2014) Cite this as: BMJ 2014;349:g7825
The government has not increased the annual pot of cash it gives to local authorities to carry out its ambitious public health programme in England, prompting concerns that this will only add to the financial pressures faced by local councils, amid swingeing cuts to their core budgets.1
Last week the Department of Health pledged a global ringfenced sum of £2.8bn (€3.6bn; $4.4bn) for public health for 2015-16, with an additional £5bn in incentives (the “health premium”) to be shared out among those councils that met designated public health improvement targets in 2014-15. The grant excludes the cost of councils taking on public health responsibility from October 2015 for children aged up to 5 years. A separate allocation has been made for this.
After some financial adjustments 18 local authorities will get less than last year, with Warwickshire the biggest loser at £2333 less per person, while 17 will gain amounts ranging from just £7 per person in Rutland to £4188 in Manchester.
But most councils will receive the same amount as last year, after two consecutive years of funding increases, which aimed to bring per person spending up to target levels and iron out wide variations in public health outcomes across the country. In around a third of the 151 councils the funding boost amounted to an additional 10% of the historical sum spent on public health by the NHS. But the increases still left two thirds of councils falling short of the monies needed to meet their targeted threshold over the next two financial years.2
The targets were worked out by the independent Advisory Committee on Resource Allocation, using a formula that was based on premature death rates among people aged under 75 and weighted towards those areas with the poorest public health outcomes. But the formula produced some funding anomalies, whereby some wealthy boroughs have been allocated more than deprived ones, which next year’s allocations will allow to persist.
Janet Atherton, president of the Association of Directors of Public Health, said that demand for expensive health and social care interventions was rising. “In view of this, it is disappointing that, whilst the NHS has had increases in funding, the public health grant for local authorities has not been increased for 2015-16, which will only add to financial pressures faced by local government,” she said.
Councils across England are set to receive 8.8% less funding from that government to run local services in April 2015. The Local Government Association, their representative body, has calculated that this will require £2.6bn of savings to be made next year. Core government funding to councils has been cut by 40% since 2010, it said.
John Ashton, president of the Faculty of Public Health, said that, given the scale of public spending cuts, public health had got off relatively lightly. “It could have been worse,” he said. But he warned that the cuts would inevitably have a knock- on effect. “Local authorities have been hammered by central government settlements, and the poorest boroughs have suffered more than the wealthiest ones,” he said. “Whether there is any resilience left across a range of local authority functions essential to public health is a big question.”
Tim Allison, director of public health in the East Riding of Yorkshire and public health finance lead for the Association of Directors of Public Health, said, “Lots of improvements in public health come about from improvements to employment, education, and housing, which are affected by government spending elsewhere.”
He added, “It’s disappointing that we haven’t got an increase, given the need for prevention, but we appreciate the pressures other parts of the system are under.” But he warned, “There will be a halt to the pace of change in areas with low per capita funding. And that will be quite challenging.” His own locality funding was 29% below the target threshold, equating to around £3m, he said.
Izzi Seccombe, chair of the Local Government Association Community Wellbeing Board, said, “We are disappointed with the department’s decision not to protect real terms funding for 2015-16 by making it inflation proof. We have consistently maintained that local government can only fulfil the new duties if it is sufficiently resourced to do so. It was good that public health was transferred from central government, and it has to be adequately funded.”
Cite this as: BMJ 2014;349:g7825