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Health: Public Health Grant

Volume 795: debated on Monday 4 February 2019


Asked by

To ask Her Majesty’s Government what assessment they have made of the impact of the decision announced on 20 December 2018 to reduce the Public Health Grant to local authorities for 2019/20 by £85 million.

My Lords, despite funding pressures, councils are successfully improving people’s health, and most indicators of public health are stable or improving. Since 2011, the number of smokers has dropped by a fifth. Last year, 98% of adults accessing drug treatment services did so within three weeks and 90% of people with HIV were treated successfully. Future budgets will be influenced by the next spending review, when we intend to make a robust case for the value of prevention.

My Lords, local authority public health budgets have been reduced by £700 million since 2014. Due to rising rates of gonorrhea and syphilis and the problems young people have in accessing contraception, does the Minister not think there is an urgent need to rethink the Government’s strategy?

My Lords, as I said, we will be making a robust case for the value of prevention in the spending review. The reduction to the grant to which the noble Baroness refers is not a new cut. It was agreed in the 2015 spending review in a difficult financial environment. Local authorities have been aware of these cuts for over a year and have been able to plan accordingly. But there is much more to public health than the grant itself—for example, our national childhood obesity strategy and NHS England’s world-leading diabetes prevention programme. As the noble Baroness knows, the NHS long-term plan has an emphasis on prevention.

My Lords, I was the Secretary of State who introduced the public health grant to local government. Is my noble friend the Minister aware that this was done because many of the wider social determinants of health can be better influenced through the action of local authorities than by the NHS alone? That was the reason why the public health grant was included within the ring fence in 2010 to 2014, which guaranteed a real-terms increase in the public health grant to local authorities; this was reversed in 2014. Will my noble friend the Minister consider restoring the value and growth of the public health grant in the context of an agreement with local authorities to act on those wider social determinants of health?

I agree with my noble friend, and that is why we are making a robust case to the Treasury in relation to the spending review. Health improvement is about far more than the services funded through the grant, as my noble friend says. The transfer of local health responsibility to local government provided the opportunity to join up public health with decisions on other local services such as housing and economic regeneration. We see local authorities commissioning different kinds of public health services which better fit local circumstances and priorities and deliver improved value. We therefore recognise the importance of the grant.

My Lords, I refer to my entry in the register of interests. I want to develop the question from the noble Lord, Lord Lansley. Demand for sexual and reproductive health services is rising. Public health data has indicated a 13% increase in attendance at sexual health services between 2013 and 2017, and over the same period the Health Foundation has found that health budgets have been cut by 25%. Will the Government’s prevention Green Paper therefore include a call for fully funded local authority public health services?

My Lords, the noble Lord, Lord Cashman, is right: spending on sexual health in 2017-18 has reduced by 4.3% from 2016-17. However, a reduction in spend does not necessarily mean a deterioration in outcomes. For example, the number of hospital admissions for drug-related mental health and behavioural disorders has dropped 16% since 2015-16. The Green Paper on prevention will set out further plans in much more detail, considering the best available evidence.

My Lords, does the Minister agree that it is actually not in the interests of the NHS to cut local authority public health services? Local authorities should be celebrated for what they are doing in many different fields, not least in supporting charitable bodies that are doing so much, in addition to what we have all heard of, by supporting people who are socially isolated and depressed and would otherwise be admitted to hospital.

My Lords, local authorities and charities are doing an excellent job and I commend the work they are doing, but the Government are investing £16 billion during the current spending review period on the provision of local authority public health services. That is on top of funding for Public Health England and what the NHS itself spends, which includes over £1 billion on immunisation and screening programmes and £340 million in 2016-17 on vaccine stocks. I agree that local authorities do a great job in challenging times.

My Lords, can we return the Minister to the original Question? Does she agree that increasing spending for the NHS, including a prevention vision, in the 10-year plan while cutting funding for services that impact on public health is a false economy? Could she please explain to the House the dichotomy of saying, “We want to spend more money on public health”, but actually cutting public health spending? Frankly, I am stumped.

I think I have already answered the Question. The reduction in the grant to which the noble Baroness has referred is not a new cut, as I have already said. It was agreed in the 2015 spending review, in a difficult financial environment. Difficult decisions had to be made. Local authorities have been aware of these cuts for over a year and have been able to plan accordingly. I have already stressed the balance we have between prevention and ensuring we address that. We are going to be putting £4.5 billion into primary and community care services, in addition to the money we are already putting into current services.

My Lords, we seem to be relying more on local government: additional preventive health campaigns; local five-year plans as part of the integrated care system; and greater social care provisions. Can the Minister please articulate exactly how the December 2018 reduction of the public health grant can have any positive impact for local authorities?

I understand the point that the noble Baroness is making, but I have already said that this is part of a longer plan. The grant in itself is not the only part of the NHS plan. There is much wider spending by the local authorities and joined-up thinking. The Green Paper that I have already mentioned, Prevention is Better than Cure, was published on 5 November 2018. This will support healthy life expectancy, by at least five extra years by 2035, and close the gap between the richest and the poorest. The Government are taking concerted and proper action to address these issues.