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ADPH Submission: Comprehensive Spending Review 2020

Consultations · Public health funding | September 25, 2020


In 21st century Britain, life expectancy is stalling and health inequalities are rising; with the gap in life expectancy between the richest and poorest areas of England and Wales widening over the past decade. COVID-19 has further exposed and exacerbated the inequalities in our society and should strengthen our collective resolve to level up and increase our commitment to public health.

While the Comprehensive Spending Review takes place against a backdrop of uncertainty over the future structure of the public health system and the footprint and funding model for local government, there should be no doubt about the clear and compelling argument for more significant investment at national, regional and local levels to improve public health in the years ahead.

Directors of Public Health, rooted in place and local communities, have demonstrated the value of their skills, knowledge and experience throughout the response to COVID-19 and delivered reformed services and good outcomes for their populations through the Public Health Grant. However, the lack of financial support for local public health during COVID-19 has been deeply concerning and must be addressed as an urgent priority. After years of cuts, it is now time for public health teams and responsibilities to be properly resourced so that they can play their part in creating healthier people, places and economies across the UK.

The written submission to the Comprehensive Spending Review from the ADPH focusses on three areas:

  • Reducing health inequalities and improving wellbeing through cross-government action;

  • Resourcing the health protection system at all levels to manage COVID-19 and future pandemics effectively;
  • Valuing the role of place and local public health leadership.

Summary and recommendations

The ADPH welcomes the opportunity to make the case for significant and sustainable investment in public health as part of the Comprehensive Spending Review.

ADPH has identified two overarching priorities for the Comprehensive Spending Review:

  • Preventing and managing COVID-19 effectively for as long as necessary; and building a stronger health protection system to respond to future pandemics, including local public health capacity.

  • Enabling economic and social renewal that puts the health and wellbeing of people and communities first; and reducing the health inequalities which have been exposed and exacerbated by COVID-19.

The ADPH is calling for the Comprehensive Spending Review to commit to funding and action across three areas:

  1. Reducing health inequalities and improving wellbeing through cross-government action.

Too often health is a second order priority when it should be the foundation on which to build individual flourishing and economic prosperity. Across all government departments, improving health and wellbeing should be considered as a key outcome. The levers of tax, regulation and policy should be fully utilised to tackle the biggest public health challenges – including excessive alcohol consumption, smoking, poverty, poor air quality, obesity and mental health – in a coherent way. COVID-19 has shone a light on health inequalities and the Comprehensive Spending Review should focus on addressing the social determinants of health in a coherent way UK-wide, learning from the wellbeing-based approaches adopted by Wales, Scotland and New Zealand.

Recommendation: Wellbeing should be built into the fabric of Government decision-making both when it comes to policy development and funding allocation. A Health Inequalities Strategy should be developed and binding national targets to reduce child poverty established.

  1. Resourcing the health protection system at all levels to manage COVID-19 effectively; including building capacity in local public health teams for the long-term.

Cutting funding for local public health over the last five years has meant fewer staff and resources to respond to COVID-19. This capacity should be rebuilt to protect and save lives now; and in the years ahead. The Government must invest in all parts of the system and ensure that local government is properly resourced to carry out its responsibilities (both current and future) working in collaboration with partners, including the National Institute for Health Protection.

Recommendation: Funding for Local Outbreak Plans should be made available in each year of the Comprehensive Spending Review period to meet the full costs of the continuing work of public health teams in responding to COVID-19 and establishing long-term health protection resilience. Any new responsibilities for councils in respect of the NHS Test and Trace Service must be fully funded.

  1. Valuing the role of place and local public health leadership

The case for local government being the home of public health is stronger than ever. Independent reports consistently set out the benefits – and strong outcomes – of this move. Even more progress is possible; however, the cause has been hampered by years of cuts; both to local government as a whole and public health specifically.

As a minimum, the Government should commit to restoring what will amount to £1bn in cuts to the Public Health Grant by 2021/2. Local government must also be placed on a sustainable footing for the future by addressing the £6.5 billion black hole.

Recommendation: The Government should invest at least £1 billion more a year in the Public Health Grant. Any new responsibilities devolved to local public health teams as a result of the dissolution of Public Health England should be fully funded in addition.

Read the full submission here

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