Abstract
In this article, Perspectives in Public Health Editorial Board member Professor Jim McManus discusses the state of public health funding in England, following the publication of the Public Health Grant allocation.
With only two weeks to go until the new financial year, the UK Government published the new Public Health Grant allocation for 2023/24 – the main funding stream for public health in England. The delay in announcing the grant has been, in and of itself, a huge constraint on Directors of Public Health, creating uncertainty, hampering planning and putting pressure on discussions with National Health Service (NHS) and Voluntary sector providers. However, even putting the effects of this delay to one side, the announcement has caused consternation among the public health community. In his written statement, Neil O’Brien said that there would be a real-terms increase of more than 5% over the next two years that would enable ‘local authorities to invest in prevention of ill health and in essential frontline services’. Broken down, it means that in 2024, all local authorities in England will receive an increase of 3.3%, with the indicative allocation for 2024/25, suggesting a 1.3% cash terms increase. At first glance, you could be forgiven for thinking that the Government has made good on their promise to protect the Public Health Grant, a promise made back in 2021 as the country was beginning its recovery from one of the worst public health crises the world has ever seen. Yet, delve deeper and it becomes evident that, in fact, the Government has announced another real-terms cut to those essential services.
It is important to acknowledge that extra burdens are being placed onto the Grant, including the impact of NHS pay settlements. This expectation of ongoing funding for pay pressures being covered by the Grant equates to more in cash terms than the entire amount the Grant has been increased by. Aside from the extra burdens, because the Grant’s increases have been based on the previous gross domestic product (GDP) deflator, the uplift is significantly less than either the Consumer Price Index or Retail Price Index inflation indices, or even the 2023/24 GDP deflator forecast, which is 1.6% for 2024/25 as opposed to the 1.3% used to calculate the Grant. When all these factors are taken into consideration, it is clear that the new allocations are indeed another real-terms cut – a trend that started in 2015 and has been consistently applied to public health funding since.
Against a background of rising need, instead of being able to invest further in public health services, Directors of Public Health in England are facing another year of tough choices and cuts to services designed to help us be healthier. The impact this will have cannot be underestimated. Life expectancy figures have plateaued, health inequalities exacerbated by the pandemic are widening, more people than ever are unemployed as a result of ill health, and the cost-of-living crisis is causing a large increase in fuel and food poverty. Consequently, the NHS is in crisis, with demand on its acute services – and pressure on its workforce – untenably high. Services that are commissioned by public health teams are focused on preventing ill-health. However, despite the fact that public health can provide a proven part of the solution, the sector has been left with funding significantly below 2015/16 levels. 1
Our programmes start from the outset, supporting women to make healthier choices in pregnancy, advocating for families to have equal access to amenities and services that promote good health and ensuring that children have the basic good health to succeed as they grow through education and into employment. We provide services to help stop smoking, to reduce alcohol intake and to ensure good sexual health. We also help to develop healthier places to live by, for example, advising on what good working conditions look like or reducing the number of new fast-food outlets. As people age too, public health services are there providing support for a range of things from loneliness to physical fitness. Crucially, we deliver these programmes to everyone. To create a healthy society, there needs to be fairness in the system, and services need to be accessible to the people who need them most, when they need them. Whether it is health visitors, school nurses, sexual health clinics or addiction treatments, a reduced real-terms PH Grant cannot pay for it all. Services will have to be cut, meaning people will have less access to what they need to prevent illness.
The frustration is that we are part of the long-term solution and yet successive Governments have been fixated on short-term interventions. Without adequate public health services at a local level, there soon follows increased demands on GPs, hospitals and social care who will need to treat increasing numbers of people suffering from, largely preventable, illnesses. A healthy population is a necessity for a sustainable and healthy economy. It is time now for both policy and funding to reflect that, instead of embedding messages of personal responsibility and short-termism which will never solve the problem. The Government needs to commit to long-term, consistent funding that can bring about real improvement to the nation’s health, instead of measures that simply add extra burden on the NHS and social care systems. Only then can we hope to achieve a healthy and sustainable workforce, NHS or indeed, country.