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Public Health Grant to Local Authorities

Volume 815: debated on Tuesday 2 November 2021


Asked by

To ask Her Majesty’s Government by what percentage the public health grant to local authorities has (1) increased, or (2) decreased, since 2016.

My Lords, in begging leave to ask the Question standing in my name on the Order Paper, I declare my interest as a vice-president of the Local Government Association.

Since 2016, the local authority public health grant has decreased by 2% in cash terms, but we increased the grant in 2020-21, and in 2021-22, and it now stands at over £3.3 billion. We are maintaining the grant in real terms over the next three years to enable local authorities to deliver preventive and front-line health services which will improve the health and well-being of their communities.

My Lords, even with the recent cash increases, the public health grant has been cut in money terms since 2016 by £1 billion, curtailing services such as smoking cessation, healthy families, and sexual health clinics. If the Government really are committed to preventing poor health, why did the Chancellor not restore in the Budget the £1 billion to improve public heath, rather than prioritising giving banks a £4 billion tax break?

The public health grant will be maintained in real terms over the spending review period, and we will confirm local authority allocations in due course, but this is not the only money going to public health. In addition to the grant, the Government are investing £300 million over the SR period to tackle obesity and £500 million over the SR period to improve the “best start in life” offer available to families. The NHS is spending over £1.3 billion on national public health services.

My Lords, during my time as the Government’s Chief Nursing Officer for England I witnessed the unique value of public health nurses in the community. The pandemic has further highlighted the importance of such roles and the significance of a whole-system approach. Given this, will Her Majesty’s Government consider increasing funding specifically to build up or rebuild the capacity of public health nurses to tackle localised health inequalities?

The Government have allocated more money for local authorities but we think that it is best left to local authorities to decide how to spend that portion of their grant, for they are closer to the people in the communities that they serve.

Does my noble friend agree that a public health capability in local authorities is very important? I was very impressed by the work the head of the public health office did in my home town of Salisbury during the poisonings of the Skripals. I have heard reports that some of the duties of the office or its funding might be transferred to the NHS, which has enough on its plate. Is there any truth in this report?

It is true that some of the allocation for the National Health Service is being used for public health spending, but we want to make sure that across the health system the NHS not only focuses on prevention and therapeutics but works in partnership with the public health authorities.

My Lords, the good news is that in the Budget last week, it was announced that local councils are to receive £1.6 billion in grants for each of the next three years. The bad news is that that does not take them close to what the councils were receiving and spending in 2010. Will the Minister do all that he can to press for adequate funding, especially for the public health services but also to meet today’s needs and not those of a decade ago?

There are many bodies tackling public health and raising awareness of some of the worst health problems we have—not only the Office for Health Improvement and Disparities and public health officials in local authorities but the NHS, which wants to move more towards prevention because in the long term that saves money.

My Lords, the noble Lords, Lord Laming and Lord Scriven, have pointed out that the loss of £1 billion over the last decade or so from the public health teams’ budgets has impaired their ability to deal with issues, including those related to Covid. Does the Minister recognise that the increase just announced goes nowhere near to closing that gap? Does he also recognise the parallel problem that the limitation on local authorities’ support for care homes is greatly impairing their ability to care for the health of elderly and other disadvantaged people resident in care homes?

As noble Lords will know, the Chancellor has confirmed additional spend for public health, and the public health grant will be maintained in real terms over the spending review period, enabling local authorities to invest in prevention and front-line services such as child health visits. There will also be continued funding of £100 million per year over the period to tackle obesity in adults and children, as well as investment in a new start for life offer for families, with an additional £66 million in 2024-25. We know and recognise the importance of public health. At the same time, the NHS is committed to rebalancing between public health, prevention and therapeutics.

Has my noble friend seen analysis by the University of York showing that expenditure on public health is three to four times more effective in terms of health outcomes than investment in the NHS? Will he take steps to ensure that we now invest in the resilience of the public health network to ensure that we are better placed for any future pandemics?

I thank my noble friend for that very important question. We continually assess our preparedness plans for infectious disease outbreaks and pandemics to ensure that they remain as robust as possible. This assessment includes, as appropriate, incorporating lessons learned from exercises that test the readiness of our plans and from our experience in responding to pandemics, disease outbreaks and other types of incident in the UK. The UK Health Security Agency will be dedicated to ensuring that we are protected from all future threats, including pandemics.

My Lords, areas of greater deprivation have disproportionately borne the brunt of cuts to the public health grant, despite many people in these areas having poorer health. In Blackpool, ranked as the most deprived upper-tier local authority in England, the per capita cut to the grant has been one of the largest, at £43 per person per year. Can the Minister explain to the House how and why these decisions are made, and will he ensure that fairness in funding is restored for those who need it most?

The noble Baroness raises a very important point about needing to tackle disparities across our nations. The ring-fenced grant that we provide to local authorities to spend on public health services comes with a condition that they consider the need to reduce health inequalities in their areas. Also, the grant’s distribution is heavily weighted towards areas facing the greatest population health challenges. Per capita grant funding for the most deprived decile of local authorities is nearly 2.5 times greater than that for the least deprived. In addition, noble Lords will be aware of the new Office for Health Improvement and Disparities. The pin-light focus of that office is on health disparities and how we tackle them.

My Lords, I must say that that is a rather surprising answer. The Minister will know that the Prime Minister has promised to help level up the health expectancy of the poorest areas, but I take the Minister to his answer. The Health Foundation stated in the summer that there is no sign of concerted action to do this and:

“Current plans appear to be partial and fragmented, and many deprived areas where people are likely to have poorest health have not been identified as priorities for investment.”

Will the Minister reconsider his answer to my noble friend?

The noble Lord raises a very important point about how we tackle these disparities. This is one of the reasons. Given that a lot of powers to intervene at local level are in the form of local authority grants and local public health officials, it may well sometimes come across as fragmented. This is why the Office for Health Improvement and Disparities is very important to take an national overview of areas of disparity and target them.