With just two weeks to go until the end of the financial year, the government finally announced the Public Health grant allocation – how much money councils will have to spend on public health services over 2023/24.
The response from those working in public health – the councils and NHS bodies – can be summed up by that from Professor Jim McManus, President of the Association of Directors of Public Health (ADPH), “once again far too little, far too late.”
The government is giving local authorities a 3.3% cash terms increase to their grants, with the total allocation in 2023/24 up to £3.529 billion. Inflation currently hovers around 10%. In addition, there will be time-limited investment up to 2025 of £516 million going to local authorities to improve drug and alcohol addiction treatment and £170 million to improve the Start for Life services available to families.
However, in the light of the fact that since 2015/16 spending on public health services has fallen by 26%, according to The Health Foundation, this increase does nothing to address the growing need. The Faculty of Public Health (FPH) stated that the allocation:
“represents an inadequate investment in essential public health services at a time when populations across England are in desperate need of support to protect and improve their health.”
The Health Foundation noted that:
‘Even accounting for the extra £154m allocated for 2023/24 to improve drug and alcohol addiction treatment and recovery this leaves public health funding significantly below 2015/16 levels.”
Lack of money has meant that services have been cut and this will continue, as Prof Jim McManus, President of the Association of Directors of Public Health (ADPH) President noted:
“In order to provide public health measures that will equate to people living healthier, longer lives and reduce the burden on the NHS, we need to see a much larger increase to our budgets – today’s increase is simply not enough to make up for the years of cuts.”
If the low level of grant wasn’t bad enough, the delay in announcing it has led to difficulties for councils.
Back in early March over 30 leaders of public health, NHS bodies and health charities called on the Government to urgently publish next year’s public health grant allocation.They noted that the Government’s delay in publishing the Public Health Grant allocation for 2023/24 was “putting public health services at risk and adding unnecessary strain on an already pressured system.”
Now Dr Layla McCay director of policy at the NHS Confederation noted:
“Unfortunately, the late allocation of this year’s grant has undermined the ability of local health leaders to make best use of it in the interests of the communities they serve.”
The Health Foundation noted that the delay was a problem, but also that allocating time-limited funding also made planning difficult:
‘Delaying the announcement until now has created uncertainty, making it difficult for local authorities to plan, and comes at a time of high cost pressures. Continuing with separate pots of time limited funding for specific issues, such as drugs and alcohol, or Start for Life Services, will do little to help the effective future delivery of services.”
Once again, the importance of well-funded public health services has been overlooked, as it has been by successive Conservative governments, who have repeatedly cut funds, in particular in the most deprived areas of the country with the poorest health outcomes – in fact those areas that are most in need of and will benefit the most from public health services.
It comes as no surprise then that Britain has an issue with its workforce, with data showing an increase in working-age people not working due to ill health.
In late 2022, the Health Foundation published data on the increasing number of people aged 50-69 not working due to ill health, and noted that although the reason for this are complicated a major factor is that just as public health services have been the main driver of increasing the health of the population for more than one hundred years, their downgrading and underfunding over successive Conservative governments is now a major contributor to a reversal of all those years of progress and a reduction in the health and wellbeing of the nation.
The think-tank, The Resolution Foundation has just warned that Britain will end the decade with the lowest rates of workforce participation in almost 30 years, unless the government takes urgent action to reform childcare and help people with health conditions.
The Chancellor, Jeremy Hunt, however has said that the workforce issue is due to people retiring early and has said that getting early retirees off the golf course and back into work is what will boost the UK’s workforce.
Official figures do not support his comments, however. The consultancy LCP, noted in a report published at the end of February, that based on an analysis of official data early retirement explains none of the increase in inactivity since the start of the pandemic. The report finds that the increase in economic inactivity is now 516,000, but the number in the ‘retired’ category has actually fallen.
Analysis of the figures by LCP led to the conclusion that the sharp rise in working-age adults that are neither in work nor looking for a job is likely to be due to people waiting for treatment on NHS waiting lists and those that live permanently with poor health.
LCP notes that the government is “barking up the wrong tree” by trying to get people in retirement back to work to fix chronic staff shortages.
In economic terms investment in public health services makes sense. The public health interventions put in place by local authorities are excellent value for money. Calculations by researchers at Cambridge University show that each additional year of good health achieved in the population by public health interventions costs £3,800, which is three to four times lower than the cost resulting from NHS interventions of £13,500.
The researchers note that investing in local public health programmes would generate longer and more healthy lives than equivalent spend in the NHS.
And the Health Foundation notes:
“The government must focus on health as a national economic asset. For example, preventing people from falling into poor health could help reduce economic inactivity, increase workforce size, and boost the economy. Without appropriate long term investment, opportunities to prevent the early deterioration of health are already being missed.”
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