Measuring a moving target: the complex story of public health and prevention spending in local government

Prevention remains a central aspect of the government’s reform story for health and one of the three shifts the 10 Year Health Plan set out. One useful yardstick of how rhetorical commitments to prevention translate into hard cash is how much central government allocates to the local government public health grant, data for which goes back over many years. This grant funds preventive activity and treatment across an array of services from smoking cessation to childhood obesity interventions. So, what do the latest set of allocations, and wider trends, reveal? And is that the full story? 

We welcome that the government is now providing local government with more planning certainty than its predecessors by providing a three-year allocation outlook. In 2026-27 this means local government will receive £4.4bn for its public health activity in cash-terms, rising to £4.5bn in 2027-28. However, this still doesn’t get the real value of the grant back to where it was in 2016-17. And, although those figures sound large – and are – this means the government is committing just over £70 per head for local government’s public health spending over a year, the cost of four to five packets of cigarettes.  

However, the headline doesn’t tell the whole story. We have set out before how the raw public health grant numbers have become a less reliable guide over time to how much local government actually spends on public health. In particular, successive governments have made additional time-limited discretionary spending decisions which are separate from the public health grant and ring-fenced for specific purposes. Keeping track of this has been difficult. It causes problems for transparency and scrutiny, and makes it harder for local government and its partners to plan because of lumpy and uncertain funding and cliff-edges as discretionary commitments come to an end.  

From 2026-27 onwards, the public health grant now has brought within it some of the biggest elements of this discretionary funding which up until now was outside the grant numbers, in particular funding for ring-fenced smoking cessation and drug and alcohol services. The jump in the chart from 2025-26 to 2026-27 is largely accounted for by this inclusion of existing funding which was not previously counted as part of the grant itself. Without this adjustment funding continues to flatline, and even with it – as the chart shows – real-term funding through the public health grant will remain below 2016-17 real-term levels.  

However, there is more prevention going on in local government than through the public health grant and the complications around it. Local government’s policies and spending in areas on the wider determinants of health – such as housing, environment, transport, and economic development – are a critical part of local government’s contribution to prevention. It matters hugely therefore that despite some welcome bounce back since Covid-19, local government has been at the sharp end of a triple whammy in terms of its spending power: first, it will still be around 10% lower in real terms in 2028-29 than in 2010-11; second, this is even lower in per capita terms falling 20% lower per person due to population growth; and third, over time the most disadvantaged councils have lost the most funding compared to the least.   

This matters more because when spending is under pressure, prevention is easier to cut than immediate acute service delivery. According to Institute for Government analysis, adult social care and children’s services are the only local government services that have seen real terms growth in spending since 2010-11. But even within children’s services, preventive spending has plummeted, dropping from £4.2bn in 2009-10 to less than £900mn in 2023-24, as local government has had to prioritise responding to growth in acute need in adult social care and children’s services over other spending. 

So, to conclude, measuring preventive spending in local government isn’t as simple as it first appears, and has become a moving target. That means we can’t be as sure as we should be about whether the prevention shift is happening. And while the shift is not just about spending – legislation and regulation can also be effective – we know that much investment in public health and prevention in local government is highly cost-effective. So much ground needs to be made up and the trajectory for the public health grant is not in line with that.