How are public health services funded?
Public health services are also funded centrally through national bodies. NHS England receives funding (known as ‘section 7A’) to fund NHS public health services such as screening and routine immunisation. Other central bodies also have budgets for public health improvement and health protection – currently the main bodies are the United Kingdom Health Security Agency (UKHSA) and the Office for Health Improvement and Disparities (OHID), which collectively replaced Public Health England at the end of 2021. The government also makes discretionary additional funds available for some services, for example drugs services and obesity management, and for national emergencies such as the Covid-19 pandemic.
The government does not reconcile this funding in one place so it is difficult to say with precision how much is spent in total on public health each year.
How has spending on public health changed over time?
The most stable public health funding is the grant that central government gives to local authorities; this gives a good guide to the overall flows and trends in public health spending over time.
In 2023/24, the value of the public health grant will mean that planned spending on public health services by local authorities will be £3.5 billion (in real terms 2021/22 prices). On a like-for-like basis, this is 10% less than 10 years ago in 2013/14, and per person this spending cut is even greater.
Prior to the Covid-19 pandemic, the public health grant had faced several years of spending cuts. During the pandemic, the value of the grant grew, with like-for-like spending peaking at £3.3 billion in 2021/22. However, this uplift was short-lived – like-for-like planned spending for 2022/23 was 22% lower than the previous year in real terms.
What do local authorities spend public health grants on?
Local authorities have a number of mandated services they must provide, while the remainder of the public health grant funding can be used flexibly for public health purposes. Spending on most services has fallen since the pre-pandemic peak in spending in 2016/17. The biggest cuts in spending were for smoking prevention, sexual health services and substance misuse. This is despite these services having a substantial positive impact on the public’s health.
Exceptions to this trend are spending on public mental health services, which has steadily increased over the last seven years, and spending on health protection, which has increased in more recent years, likely in response to the pandemic