A short history of the public health grant

The public health grant was introduced in 2013/14 when, under the 2012 Health and Social Care Act, public health functions previously the responsibility of the NHS were transferred to local government. Many of the most important levers to improve health sit outside the NHS and require broader interventions designed to meet the needs of local populations. Directors of public health and their teams became employed by local authorities with a ring-fenced public health grant.

In 2014/15 the government set out the Five year forward view for the NHS in England, which called for a ‘radical upgrade in prevention’. However, in every subsequent year the public health grant has fallen in real terms (and even in cash terms between 2015/16 and 2019/20). The total fall in spend per person between 2014/15 and 2019/20 is expected to reach 23.5% .

Figure 1 shows that the core public health grant reached £2.9bn in 2014/15 (in 2018/19 real terms), before starting to fall in successive years. We have used spend reported by councils (out-turn spend) where available and spending allocations for future years (from 2018/19). Allocated spending to these core functions is now set to reach £2.3bn by 2019/20 – a fall of £0.6bn. It is possible that allocations will be topped up via wider local authority resources.

Figure 1: Annual public health grant net expenditure between 2013/14 and 2019/20 in real terms (2018/19 prices)

Note: Data for 2013/14 to 2016/17 is out-turn spend. Estimates for 2017/18 and 2018/19 are published allocations. Estimate for 2019/20 is based on provisional allocation; it is assumed the share of the overall grant allocated to children’s services is in line with the previous year. Real terms refers to 2018/19 prices, using the Gross Domestic Product deflator from the Office for Budget Responsibility.

Source: Health Foundation analysis of published data.,,

The picture is complicated by the additional transfer of services for children 0–5 years of age (largely health visitors for infants and mothers) from the NHS partway through the 2015/16 financial year. This portion of the grant increases from £0.6bn in the year of transition to £1.0bn in the first full year of allocation (2016/17). By 2019/20, this spend is set to fall to £0.8bn. How fast spending has fallen at the local level in the grant will depend on how the relevant services are prioritised. It is assumed in this briefing that future allocations will follow the pattern of historic spending.

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