Better Health For All

By Professor John Middleton

Last month I let you know about the progress we’ve made in our Public Health Funding campaign. A new FPH project group – made up of staff and registrars – will be focussing its efforts on making the case for greater investment in public health services in local government and moving the dial towards prevention in the health and care system.

I’m blogging today to let you know about the Government’s recent response to the House of Lords Select Committee report on the Long-Term Sustainability of the NHS and Adult Social Care and what it means for our new campaign.

In their response, the Government dismissed recommendations to reverse past cuts and cancel future ones to the public health grant and to extend the ring-fence for the next decade.

The Government’s argument rested on four central planks.

Firstly, the Government argued that ‘public health is about far more than the services funded through the grant’. With the transfer of public health to local government, prevention interventions are now delivered by many other local services, such as housing, which are not necessarily funded by the grant. These types of joined-up services are exactly what public health reform has sought to achieve.

Secondly, the Government argued that public health teams are now ‘demonstrating real innovation’ to achieve more with less. Now that local authorities have the autonomy to redesign services in a holistic and place-based way, councils are achieving better value for money while still producing good outcomes. These innovations are very welcome.

Thirdly, the Government argued that despite a challenging period for public finances overall, local authorities will still receive more than £16 billion for public health over the 2015 spending review period. This is not an insubstantial amount.

Lastly, the Government argued that any conversation about public health funding must include the role of the NHS. Local authority public health spend is bolstered by ‘well over £1 billion a year’ that the NHS spends on key public health functions, alongside the commitments to prevention outlined in the Five Year Forward View. Prevention is a core priority for the whole health system.

So what does the Government’s response mean for our campaign?

Firstly, we think the public health community needs to be able to respond to the Government’s key arguments if we are to make an effective case for greater investment in public health. We’re pleased that the focus of our campaign is seeking to address these points.

We are calling for increases to public health spending, but we’re not simply asking for greater investment in current services for ‘business as usual.’ We agree with the Government’s point that public health teams achieve great results when they are able to innovate. While recent reforms have provided local authorities with the autonomy and the responsibility to innovate, they have so far not provided proper funding in order to enable this to happen in a systematic or equitable way.

That’s why we’re calling for investment in an ‘Innovation and Transformation Fund’ to enable local authority teams to transform services to match the needs of their fast changing local populations. This investment is needed now in the short-term to allow public health teams to respond to the challenges of the future. We believe that investment in public health innovation needs to be placed centre stage during the next spending review period if public health reforms are to be viable for the long-term.

We know that the £16 billion allocated to local authorities for public health over the 2015 spending review period is no small figure when placed within the context of overall central Government funding for councils. We would contend, however, that when compared to the over half a trillion in funding allocated for NHS treatment and care over the same period, £16 billion for public health is a modest investment.

This is why our campaign will also be driving forward a programme of work around prevention activity within the NHS. The Government is right to point out that local authorities are not alone in providing prevention interventions. Around 40% of all accounted-for public health spending originates from the NHS, on Section 7A services like immunisations as well as other initiatives like the national diabetes prevention programme. The NHS itself, with its long reach into every community, is also a wider determinant of health.

But we believe that to deliver the ‘radical upgrade’ the NHS needs to make better use of its existing preventative spend and also explore further opportunities for targeted increases in investment. In order to achieve this, we first need to know what the health system actually spends on prevention. While most estimates of public health spend place it at between 4-5% of total government spending on health, according to PHE’s Chief Economist, ‘we do not actually know what the whole health and social care system currently spends on prevention’.

That’s why our campaign is calling on the Government to conduct a review into NHS spending on public health and prevention. We need to know where we are now before we’re able to move forward and ensure that the NHS and local authorities are truly providing the kind of joined-up care envisioned in Sustainability and Transformation Partnerships.

Finally, we believe we’ll have the best chance of securing increases in public health investment if we’re able to tell our story in a compelling way to policy-makers and the public. We’re proud of the work our members do every day in their communities to protect and improve the health of the public. We have a good record, as demonstrated by major successes in our screening, immunisation, and smoking cessation programmes.

And that’s why we’re supporting PHE’s work on their new public health dashboard. This dashboard will enable a lay audience to understand and see the incredible range of services that public health teams provide and allow us access to up-to-date evidence that we can use to support our calls for greater investment in services.

In my last blog I asked for your help in marshalling our arguments, developing our policy thinking, and spreading the word to your networks. I’d like to say a big thank you to members and partners across the public health community who have already been in touch to say they would like to be involved in the campaign.

The strategic case for investment in prevention and investing in better outcomes has lessons which can apply in all four nations of the UK and indeed anywhere in the world. We will build on our four nations work as this campaign takes shape.

If you’d like to contribute to our campaign and help shape our thinking then please contact policy@fph.org.uk.