Key points

  • Over the past decade of austerity, the ability of councils to maintain and improve the health of their residents has been jeopardised by substantial cuts to local services and investments, many of which directly affect health. Local authority budgets (excluding social care) fell by 32.6% between 2011/12 and 2016/17.
  • The public health grant allows local authorities to provide services that maintain and improve people’s health. 2019 marks the final year of the Five year forward view for the NHS in England, which called for a ‘radical upgrade in prevention’.
  • However, a reduction of almost a quarter in spending per person is expected between 2014/15 and 2019/20. Based on current spending plans, there will be a £0.7bn real-terms reduction in the public health grant in that period.
  • These funding cuts come at a time when key indicators of health are causing concern. Mortality improvements have slowed and there are large inequalities in health outcomes between local areas. For example, there is a 19-year gap in healthy life expectancy for women in England’s 10% most- and least-deprived areas. Despite this, the areas of greatest need have not been protected from funding cuts. The lack of strategic approach, coupled with real-terms cuts, risks widening health inequalities at a time when the government has pledged to tackle such injustices.
  • Current allocations to local authorities are largely based on historical spending patterns. The Advisory Committee on Resource Allocation (ACRA) recommends how various forms of health funding should be distributed.
  • Re-allocating the public health grant according to its recommendation, while restoring real-terms losses and preventing any local area experiencing a reduction, would ultimately require an extra £3.2bn of funding per year.
  • Our recommendation is that, at a minimum, the government should reverse real-terms cuts and allow additional investment in the most-deprived areas by providing an additional £1.3bn in 2019/20. The remaining £1.9bn should then be allocated in phased budget increases by 2023/24, with further adjustments for inflation.
  • This increase will bring a more equitable distribution of funding for public health but is still far short of the upgrade called for in the Five year forward view.