How the public health grant is spent

The public health grant is used to provide a range of services, some of which are mandatory functions, whereas others, reflecting variation in local need, are discretionary so long as they are intended to improve the health of the population. Local authority returns capture the areas in which the grant is being spent but, because of this local flexibility, the range of activities carried out within these categories can vary significantly between local areas.

Figure 2 shows the greatest areas of public health grant spend in 2018/19:

  • services for children aged 0–5 years (£875m)
  • adult drug and alcohol services (£640m)
  • sexual health services (£565m).

Figure 2: Public health grant net expenditure and percentage change in spend since 2014/15 by element of provision (England only; 2018/19 real terms)

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 will be in line with the previous year and future cuts will fall in line with historic trends. Real terms refers to 2018/19 prices, using the Gross Domestic Product deflator from the Office for Budget Responsibility. NCMP, National Child Measurement Programme; LA, local authority; CCG, Clinical Commissioning Group.

Source: Health Foundation analysis of published data.,,

Although most of the grant is spent on the mandatory services mentioned above, a significant portion (£475m) is also spent on ‘miscellaneous services’. This usually includes staff, which partly represents the time and resources public health teams can allocate to influencing other areas of local authority policy. Improvements in long-term health outcomes can come from this – for example, ensuring that other local authority action with the potential to improve health is effectively designed and delivered.

The areas of highest spend may not necessarily be those that have the most impact on population health. Drug and alcohol services are an area of high spend for a relatively small number of people, because support is so resource intensive.

Figure 2 also shows how spending on each of those areas has changed: both the real-terms fall in spending on each component between 2014/15 and 2018/19 and how those cuts will look if the pattern continues into 2019/20, when a further reduction in overall spend is expected. Spending has fallen across all functions other than child obesity. The largest proportional reductions to date have been in stop-smoking services (–32%) and drug and alcohol services for young people (–29%). If this pattern continues, by 2019/20 we can anticipate allocations to these categories to have fallen by 45% and 41%, respectively.

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