Public Health teams promote healthy lifestyles and prevent people from ill health, not just through medicine but also through wider factors that have an impact on health. The responsibilities of Public Health teams range from sexual health promotion to smoking cessation and interventions can include anything from non-smoking poster to promoting playing football in the local park. But recent budgetary restrictions have posed a real threat to this work.
Until recently, Public Health was managed by the NHS. But since 2013, this responsibility has rested with local government. The transfer was initially accompanied by a ring-fenced grant, which was crucial to support local government as they take on new public health responsibilities. But to ensure the full integration and relocation of public health to local government the eventual removal of this grant will be important. As shown in figure 1 below, local government funding, including the public health grant has been cut in recent years. The black line on the chart shows a significant reduction in the public health grant since 2016/17, reduced by 2.47 per cent in 2017/18.
Figure 1: Public Health Grant Allocation in England
NLGN’s recent report Reaching Out: Influencing the Wider Determinants of Health explores how public health teams are coping with the financial constraints. The increasing pressure on services and resources due to both cuts and rises in demand pose a particular challenge. Public health teams are trying to maximise their resources to best effect but inevitably have to focus on short-term demand reduction rather than long-term prevention, which goes against the grain of what public health is trying to achieve.
Public health teams are increasingly looking to address what is termed the ‘wider determinants’ of health. Given these wider priorities, some councils are changing the way they spend the public health grant in order to make the money go further. Our research reveals an encouraging trend: 62 per cent of respondents reported that Public Health Grants have been used to commission new services to address the wider determinants of health in their councils since 2013.
The Government’s removal of the ring-fenced grant could encourage councils to be more innovative and allow public health work to be integrated within local government (rather than funded in silos). But with continuing uncertainty in local authority funding – coupled with the omission of public health in the Autumn Budget last year – some local authorities are predictably nervous about the complete removal of the ring-fenced grant. In fact, only 21 per cent of our directors of public health respondents were in favour of the ring-fence being removed after 2018. The current pressure on services and resources may mean that the removal of the ring fence grant will lead to essential funds for prevention being cut.
Our research revealed that some Public Health teams are looking to commercialisation strategies to generate more revenue to support the public health work in their councils (54.7 per cent director of public health respondents indicated that they were looking for ways to commercialise). For example, some councils have relied on selling services externally through programmes or training, and public health informatics services to generate additional income to support the public health work in their councils.
Another strategy that councils are adopting is joint working by finding ways to address cross-cutting objectives to deliver public health in a more cost-effective way. Libraries Unlimited in Devon provides just one example of this joint working, where close relationships between the council, the Clinical Commissioning Group and Libraries Unlimited have enabled the pioneering of a Reading Well scheme, through which local GPs can prescribe condition-specific literature to residents.
Our research found many local authorities exploring innovative ways to cope and adapt with increasing pressure on services and continuing cuts on funding. However, even with their maximum efforts to pursue commercialisation or joint working, the additional revenue generated by councils through these methods and strategies will unlikely come close to covering the reductions in grants.
This gap in funding creates enormous uncertainty in local government and forms a barrier to improving public health. Further, the financial constraint is detrimental to the aim of better integrating health and social care services with other activities which influence health, such as housing. Improvement in public health requires a long-term perspective, so it is critical that central government provides clarity and certainty on long-term funding to support essential preventative work.
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