Peering through the gloom: the near and medium-term future for public health funding

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At The King’s Fund, we’ve just updated our nutshell on public health funding to 2020/21, but what will the coming year look like? With less than two months to go, directors of public health are still waiting to know what their allocation from the Department of Health and Social Care will be from this April for the following financial year.

This is the money that allows them to fulfil their baseline responsibilities including commissioning services for drug and alcohol treatment, tobacco cessation, obesity and sexual health, as well as their wider support to local government and the NHS. Imagine if the NHS or schools were in this situation, unaware six weeks out how money they would be receiving for the year to come, and how much of a public outcry there would be. This creates financial uncertainty for public health professionals and all those they contract with, with councils forced into being risk averse, and likely to prioritise mandatory services over more discretionary spending, for example with the voluntary sector. The government has form on this, not releasing allocations for 2020/21 until March last year, despite warnings of the consequences from the Association of Directors of Public Health.

However, this has been an unusual year, to put it mildly, and local government like other public services, has received additional funds to help support the Covid-19 response. We’ve heard in our work understanding the role and experience of directors of public health throughout the Covid-19 pandemic that funding through the Contain Outbreak Management Fund has helped increase capacity and strengthen their teams, at least in the short term. The government has also announced an £80 million increase in drugs services funding, in response to early findings from Dame Carol Black’s independent review of the misuse of drugs.

Even though welcome, all of this adds to the uncertainty and lack of stability in funding that local government faces around public health. And this is unlikely to change any time soon. We are entering a significant period of change in public health, and wider health policy, which will have implications for how much money goes where for public health.

There are three broad economic and political changes at work here. First, is the overall economics of the local government funding model, which was already broken, and to which Covid-19 may have delivered a fatal blow. The government’s plans pre-Covid were to allow more local retention of locally-raised funds (business rates), essentially local economic growth paying for local services including public health (with some redistribution to poorer areas). That aim had already been repeatedly delayed, and with Covid-19 reliance on the current model of business rates looks very shaky for the future, so will need to change. Second, is the government’s eagerly awaited proposals on the future public health system (a consequence of the decision to split Public Health England and create a new National Institute for Health Protection). It would be odd if these proposals did not look at how money was allocated for local government public health. Third, and connected to this, is what follows from the government’s recent White Paper. Although primarily focused on health and care integration, it does include provisions for greater direct control over the NHS and public health from the Department of Health and Social Care. How will that shift align with plans for the future of public health systems, and how will existing responsibilities and funding flows be affected?

In conclusion, despite some welcome short-term funding relief this year, uncertainty prevails over the medium-term funding models for public health. That needs to be put right, public health will have a critical role in recovery from the pandemic and clarity on resources and where they are coming from is vital to that role.

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