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Public Health England’s grant to local authorities

The new public health agency Public Health England (PHE) has made a good start in supporting local authorities with their new responsibilities for public health. The National Audit Office considers, however, that it is too soon to tell whether the agency’s approach is achieving value for money.

PHE was set up in April 2013 to be the nation’s expert agency on public health. It gives local authorities advice and evidence on what works, and gives them a ring-fenced grant to carry out their new public health responsibilities – £2.7 billion in 2013-14. The agency has, however, encountered some problems with the accuracy of how local authorities record what has been spent on public health.

The public health activities expected from the grant include encouraging healthier lifestyles and reducing the large health inequalities across England, especially in life expectancy. It is too soon to see progress in many areas, although today’s report highlights some areas where improvements have been seen. Recent data on NHS Health Checks, for example, show these checks, which include checking blood pressure and cholesterol levels, are now being offered by every local authority.

Spending on different aspects of public health varies significantly between local authorities, reflecting the differing needs and circumstances of different areas. The NAO found, however, examples where spending decisions were not obviously aligned to local needs and priorities. The NAO found that PHE could be doing more to identify these examples and offer appropriate advice and support to local authorities.

Public health funding increased by 5.5% in 2013-14, reflecting the importance the Department of Health places on this issue. Historic local decisions on public health funding by the NHS have, however, left some local authorities receiving a significantly greater or lesser proportion of the funding than they would have been allocated based on need. The Department has not decided how long the ring-fence will remain in place. According to the NAO, PHE’s ability to influence and support public health outcomes will be put to the test in future, should the grant cease to be ring-fenced.

The agency was formed from staff from over 100 different bodies, but unequal terms and conditions in both PHE and local authorities has led to dissatisfaction among some public health professionals. At local authorities, interim positions still account for 16% of directors of public health.

“Public Health England is accountable for achieving the public health outcomes the Department of Health wants, but it is local authorities who are responsible for delivering improved public health. The agency is developing a good relationship with its local stakeholders to whom it is providing tools, support and advice. There is a difficult balance to be struck between localism and the agency’s responsibility for improving health. The agency’s ability to influence and support public health outcomes will be tested further if the grant paid to local authorities were no longer to be ring-fenced.”

Amyas Morse, head of the National Audit Office

Notes for Editors

£5.8bn

Total Department of Health funding for public health in 2013-14

£2.7bn

Public Health England's grant to local authorities for public health in 2013-14

152

Local authorities spending public health grants from Public Health England

1 April 2013

Public Health England established (implementation of the Health and Social Care Act 2012)

£3.5 billion

Estimated annual cost to the NHS of alcohol-related harm in England

52.5 to 70 years

Range in healthy male life expectancy in local authorities in England

£5 million

Value of the health premium incentive in 2015-16

68

Public health outcome framework indicators of health and wellbeing, supported by 196 measures

2.8 million         

People offered an NHS Health Check in 2013-14

1. Press notices and reports are available from the date of publication on the NAO website, which is at www.nao.org.uk. Hard copies can be obtained by using the relevant links on our website.

2. The National Audit Office scrutinises public spending for Parliament and is independent of government. The Comptroller and Auditor General (C&AG), Amyas Morse, is an Officer of the House of Commons and leads the NAO, which employs some 820 employees. The C&AG certifies the accounts of all government departments and many other public sector bodies. He has statutory authority to examine and report to Parliament on whether departments and the bodies they fund have used their resources efficiently, effectively, and with economy. Our studies evaluate the value for money of public spending, nationally and locally. Our recommendations and reports on good practice help government improve public services, and our work led to audited savings of £1.1 billion in 2013.

PN: 70/14