First things first, the spending round included a ‘real-terms increase to the Public Health Grant budget'. The exact amount is yet to be confirmed. After years of deep cuts, a settlement even slightly above inflation is positive and we warmly welcome it.
However, this modest and short-term rise falls short of ending austerity for public health. Inflation is just one of the cost pressures facing public health budgets. Across many services, such as sexual health, demand continues to grow. We can expect new calls to achieve ‘more for less' – while performance has largely held up partly due to innovation, this perilous juggling act will continue to be a huge challenge next year.
The huge reduction in funding in recent years matters. Analysis by the Health Foundation shows that the Public Health Grant, which currently amounts to £3.1bn a year, is now £850m lower in real-terms than initial allocations in 2015/16. With population growth factored in, £1bn will be needed to restore funding to 2015/16 levels. The Spending Round has not undone the cuts of recent years that have led to a reduction in, for example, smoking services to help people quit and fewer health visitors to support families.
Finally, directors of public health and colleagues in local government know all too well that public health is about more than the Public Health Grant and health services. It is the social determinants – education, housing, transport, income – that do more to shape our health than the services that pick up the pieces when ill-health strikes. The Spending Round addresses a few of these issues to some extent, notably more money for children and young people with Special Educational Needs and Disabilities, homelessness and rough sleeping and social care. The prospect of a Youth Investment Fund to refurbish existing youth centres and build new ones offers cause to be upbeat too.
But when set against stalling life expectancy and growing health inequalities, the aspirations of the NHS Long Term Plan, and complex challenges such as violent crime and climate change, we need bigger and braver thinking. New Zealand and Wales point the way to the kind of change that is possible when governments commit to put health and wellbeing at the heart of funding and policy decisions.
Over the last year, a more effective public health voice, made up of charities, professional bodies and commissioners (including us) has campaigned for substantial, sustainable investment. The outcome of the Spending Round reflects the power of this coalition.
The conclusion of the spending round ushers in the start of the Spending Review, pencilled in for next year, and the chance for valuable conversations about the Prevention Green Paper. The presumption of year-on-year of cuts to public health is hopefully a thing of the past. We must now fortify our collective voice to renew the case for an ambitious, long-term settlement for public health and local government. We need a multi-year package which ensures properly funded core services and enables councils to invest in prevention and wellbeing, in creating heathy places where communities can live well and flourish.
Dr Jeanelle de Gruchy is president of the Association of Directors of Public Health (ADPH)
