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.
(LD)
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.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
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.
(LD)
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?
(Con)
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?
(Con)
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.
(Con)
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?
(Con)
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.
(CB)
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?
(Con)
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.
(Lab)
My Lords, the noble Lords, and , 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?
(Con)
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.
(Con)
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?
(Con)
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.
(Lab)
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?
(Con)
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.
(Lab)
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?
(Con)
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.
