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March 29, 2023
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Calculations, collaborations and cuts

Now is not the time for further cuts causing further harm to health. Instead, what we need is public health and preventive services, not just healthcare.

Prof Jim McManus
ADPH President

The past few weeks have been challenging for many reasons – not least the impact of the continued cost of living crisis – but the challenge I want to focus on today, is that of the Public Health Grant.

Every year, the Government allocate a ring-fenced amount of money to Local Authorities in England to spend on public health. Pre-pandemic, the amount was generally announced in December, last year it was announced at the start of February and so, by the beginning of March, with no word, Directors of Public Health were getting understandably concerned.

Every day that passed was one closer to the start of the new financial year, meaning disruption and uncertainty for our members, who were unable to plan provision of services properly and who were having to negotiate contracts with NHS and Voluntary sector providers on best guessed information. As a result, ADPH coordinated a call by 38 organisations for the Grant to be published.

Then, on 14 March, with little over two weeks until the new financial year, the new Public Health Grant allocation was finally published.

In his written statement, Neil O’Brien said that there would be a real-terms increase of more than 5% over the next two years, made up of a cash terms increase of 3.3% for 2023/24 with the indicative allocation for 2024/25 suggesting a 1.3% cash terms increase.

The Minister said that the award would enable “local authorities to invest in prevention of ill-health and in essential frontline services.”

Taken at face value, what was not to like? It sounded like the Government have delivered on their promise to protect the Public Health Grant – a promise made back in 2021 after the period of intense focus on public health as a result of the pandemic.

However, when we sat down and crunched the numbers, it became very clear that the Government had announced yet another real-terms cut to those very same “essential frontline services” by adding extra burdens onto the Grant – namely, the NHS pay award.

There are tens of thousands of NHS staff – not to mention even more voluntary sector workers – working on programmes and initiatives commissioned by DsPH and funded by the Public Health Grant. The impact of the NHS deal is therefore significant. So significant in fact that these extra burdens equate to more than the uplift given.

Another figure the headlines hide is that the Grant’s increases were based on the previous GDP deflator measures. Not only is this measure less than either the CPI or FPI inflation indices, the figure used by Government in calculating the settlement is also 0.3% less than the most recent GDP deflator forecast. That 0.3% adds up to several millions of pounds, or, put another way, over 200 health visitors, sexual health workers, school nurses and drug and alcohol workers we won’t be able to afford because of the way the settlement has been calculated.

Introduce then, the spring budget with its focus on economic inactivity and ill-health and public health teams can be forgiven for being confused.

In order to “invest in prevention of ill-health and in essential frontline services” which will, in time, support people back into the workforce and boost both our economy and health and wellbeing, DsPH need funding.

However, the Grant settlement means that, far from being able to invest, DsPH in England are facing their eighth consecutive year of impossible choices and cuts to the very services that would prevent a large proportion of future ill-health.

The Institute for Government warned in 2020 that “funding cuts meant public services were not well prepared to handle the Coronavirus crisis.”  Now, cuts in public health mean that the services the Government wants to help keep people in work – and out of hospital – are becoming less available. This is a potentially harmful policy choice, and one which is unlikely to result in a competitive, thriving sustainable future.

As Sally Warren, Director of Policy at the  King’s Fund, says, “The health of the nation also stagnated during the [last] decade, as starkly demonstrated by stalling life expectancy gains.”

Now is not the time for further cuts causing further harm to health. Instead, what we need is public health and preventive services, not just healthcare. Indeed, this need for preventive policy and adequate funding for public health was echoed strongly by the recent TBI Global Institute report.

There has been a positive though, and it is this positive that I want to finish on: partnership. Our call to Government was supported by a huge range of people. We had support from large scale organisations dealing with multi-faceted health issues on an international stage and small, single issue charities – all of us with a common purpose of working to prevent ill-health.

In the face of such overwhelming support and shared responsibility, it is important that we remember to harness that positive, not just focus on the negative.

While we are clearly facing difficult decisions ahead, with lifesaving services under real threat, I know that DsPH will continue to collaborate and work in partnership to be resourceful and find efficient, effective ways to make as big a difference as we can to help people live healthier, longer lives. For not only is our voice stronger together, but so too is our impact.

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