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Councils issue warning over further cuts to public health funding

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Council leaders have warned that fresh cuts to public health budgets are counter-productive in trying to “keep the pressure off the NHS and adult social care”.

The government has this month published the public health allocations to local authorities in England for 2018-19 along with indicative allocations for 2019-20

“Cutting the public health budget is short-sighted and will undermine the objectives we all share”

Izzi Seccombe

The figures show the total public health grant for 2018-19 will be £3.21bn, which is down from £3.30bn this year – a reduction of 2.6%. In addition, the indicative total for the grant in 2019-20 will be 3.13bn – also a 2.6% reduction, according to the figures included in a parliamentary written statement.

These decreases are part of planned cuts to public health funding of at least £600m by 2020-21, on top of a £200m reduction in the 2015-16 budget.

In the statement, health minister Steve Brine said: Today I am publishing the public health allocations to local authorities in England for 2018-19 along with indicative allocations for 2019-20.

“We are investing £3.215bn for public health in 2018-19. We will be investing over £16bn for public health over the five years of the 2015 spending review until 2020, in addition to what the NHS spends on preventative interventions such as immunisation and screening,” he said.

“The grant in both 2018-19 and 2019-20 continue to be subject to conditions, including a ring-fence requiring local authorities to use the grant exclusively for public health activity,” he added.

The Local Government Association said the ministerial statement confirmed that councils’ public health grant funding was being cut by £531m between 2015-16 and 2019-20. It follows reductions in funding for previous years, as reported by Nursing Times.

Izzi Seccombe, chair of the Local Government Association’s community wellbeing board, warned that councils would “continue to face significant spending reductions over the next two years”.

“The government announced an extra £2.8bn for the NHS in the autumn budget. But to then take vital money away from the services which can be used to prevent illness and the need for treatment later down the line and ease the pressure on the NHS is extremely counter-productive,” she said.

Izzi Seccombe

Izzi Seccombe

Izzi Seccombe

“Cutting the public health budget is short-sighted and will undermine the objectives we all share to improve the public’s health and to keep the pressure off the NHS and adult social care,” said Ms Seccombe.

“Further reductions to the public health budget reinforces the view that central government sees prevention services as nice-to-do but ultimately non-essential,” she said.

“Interventions to tackle teenage pregnancy, child obesity, physical inactivity, sexually transmitted infections and substance misuse cannot be seen as an added extra for health budgets,” she added.

Local authorities were given responsibility for commissioning public health services in 2013, with the exception of health visiting, which followed later in October 2015 due to government concerns about policy targets.

Meanwhile, the government has also confirmed that it plans to reform the way in which public health was funded from 2020 onwards, by changing from the grant to the use of retained business rates.

Business rates are a charge on most non-domestic properties in England, which is collected by local authorities.

Before April 2013 all business rate income collected by local authorities formed a single, national pot, which was then distributed by government in the form of formula grant.

Since then, the government has given councils the power to keep up to 50% of business rate income, giving them more financial control, Following a pilot in Greater Manchester, it now plans to let councils retain 100%. 

However, the Association of Directors of Public Health said that the future funding of the public health grant through retained business rates could be a “double edged sword”.

The provisional finance settlement, published on Tuesday, said councils would be allowed to keep business rates to the value of the public health, revenue support, rural services and Greater London Authority transport grants from 2020-21.

This represents business rates retention of at least 75%, based on the value of the grants in 2019-20, and the government has said a set of measures will now be developed to support a “smooth transition” from the public health funding grant.

“Normally when you fund any health services is to give more money to poorer areas”

Nicola Close

ADPH chief executive Nicola Close said she was not against the principle of public health being funded through business rates, but warned poorer areas with higher health inequalities will generate less revenue and this will need to be addressed through the “fair funding” review.

The review, announced by the government in February 2016, will set new funding baselines for every authority alongside the introduction of 100% business rate retention in 2019-20.

Ms Close said: “It is a double-edged sword. It is good to be treated the same as most of what local authorities do rather than being an add-on but there are implications, particularly around health inequalities.

“It all depends on what sort of redistribution there might be,” she said. “Normally when you fund any health services is to give more money to poorer areas. The devil will be in the detail.”

Ms Close also said the new funding arrangement could also create an opportunity for health to be “important across the whole local authority spend”.

She added that ADPH was in discussions with Public Health England, the Department of Health and the Department of Communities and Local Government on the implementation of the new funding arrangements.

Duncan selbie

Duncan selbie

Duncan Selbie

In a letter published on Thursday, Public Health England chief executive Duncan Selbie warned that the move to retained business rates relied on the understanding that “assurance arrangements” would be established, to replace his role as accounting officer to parliament.

He said: “We are therefore working with the DH to agree the assurance arrangements that will need to be in place before the grant comes to an end and expect to confirm those measures by spring 2019.

“Should this not be possible, the government may wish to consider retaining the ring-fenced grant beyond 2020,” he added.

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