‘IT IS concerning that the Department of Health is not getting local authorities to their target funding allocations for public health quickly enough,’ says parliament’s Public Accounts Committee (PAC) Chair, Labour MP Margaret Hodge.
‘With nearly one third of 152 local authorities currently receiving funding that is more than 20% above or below what would be their fair share.’
Introducing the 43rd PAC Report 2014-2015 ‘Public Health England’s grant to local authorities’, Hodge stressed on Friday: ‘Good public health is vital to tackling health inequalities, reducing burdens on the NHS and creating an economically and socially active population.’
She added: ‘Thirteen local authorities currently remain more than 20% below their target funding proportions.
‘The Department has decided not to change the grant distribution for 2015-2016, with the total amount remaining the same, meaning inequalities in funding will persist.
‘Local authorities are also presently constrained by being tied into contracts to which the Department had previously committed, such as for sexual health interventions, limiting their ability to respond to local priorities.
‘It is not clear whether the £2.7 billion public health grant to local authorities will remain ring-fenced. If the ring-fence is removed, there is a risk that spending on public health will decline as councils come under increasing financial pressures.
‘The Department should set out clear plans for how quickly it will move local authorities to their target funding allocations for public health and prioritise a quick decision on whether the ring-fence will remain.
‘There are still unacceptable health inequalities across the country – for example, healthy life expectancy for men ranges from 52.5 years to 70 years depending on where they live.
‘These inequalities make Public Health England’s support at a local level particularly important, but we are concerned that PHE does not have strong enough ways of influencing local authorities to ensure progress against all of its top public health priorities.
‘Given how important it is to tackle the many wider causes of poor public health, PHE needs to influence departments more effectively and translate its own passion into action across Whitehall.’
Among the PAC report’s Conclusions and recommendations, the MPs state: ‘Many local authorities do not yet receive a proportion of public health funding that fairly reflects their needs.
‘In 2013-14, a third of local authorities (51 out of 152) received more than 20% above or below their target funding allocation – the amount that would be their fair share taking account of relative needs.
‘The Department has moved local authorities closer to their target allocations and, in 2014 – 15, has reduced the number to 41 out of 152, 13 of which remain more than 20% below their target funding proportions.
‘However, the Department has decided not to change the distribution of monies in 2015-16, with the total amount remaining the same, meaning inequalities in funding will persist …
Recommendation: ‘The Department should set out clear plans for how quickly it will move local authorities to their target funding allocations for public health.
‘The Department has not yet decided whether the public health grant to local authorities will remain ring-fenced after 2015-16. The ring-fencing of grants to local authorities is unusual.
‘There is a risk that spending on public health will decline if the ring fence is lifted and councils come under ever greater financial pressure.
‘However, the Department has not yet decided whether the grant will remain ring-fenced after 2015-16 and said that this would be a decision for the new Government.
‘The Department told us that the decision would be informed by further evidence of what has worked in terms of outcomes, and that at the moment “the jury is out” on whether to retain the ring-fence.’
Recommendation: ‘The Department should do all it can to provide more certainty to local authorities, by prioritising a quick decision on whether the ring fence will remain. If the ring fence is lifted it needs to implement other levers to protect investment in public health.’
The report concluded: ‘PHE does not yet have a prioritised approach to influencing wider government policies …
‘There are unacceptable health inequalities across England, with healthy life expectancy for men ranging from 52.5 to 70 years in different areas.
‘There are real benefits of local authorities deciding their own local public health priorities so that they can focus on specific local needs.’
Recommendation: ‘PHE should target its advice and support on those areas which would benefit most from such support. It should encourage local authorities to use the tools it has developed to improve public health outcomes.’
The report noted: ‘From 2015-16 there will be a new premium awarded to local authorities based on performance, which is designed to incentivise further improvement; but again it does not cover PHE’s priorities and, at £5 million in total, to be shared across the whole country, it is too small to make a real difference.
‘PHE also has a “Public Health Outcomes Framework” which covers a wide range of outcomes. The purpose is to increase transparency and accountability by bringing together disparate datasets and highlighting inequalities between local authorities.
‘But although the majority of directors of public health are using the framework, there are still no data for some measures and data for others take a long time to collect.’
The MPs stress: ‘PHE does not provide local authorities with sufficient evidence or support to drive better decision making at the local level. . .
‘PHE’s remit includes developing and supporting a skilled public health workforce. A strong director of public health in local authorities is vital to promote public health locally. However, about 20% of director of public health positions are filled by interim appointments, which weakens their impact and undermines consistency, training and development.
‘PHE has developed a programme for aspiring directors of public health, and had some success in building a pipeline, but further progress is required.
‘One problem with recruitment is unfavourable pay and conditions compared with previous terms for staff moving from the NHS …’
