Public health grant settlement – not enough to deliver the promised “best start in life”

Today, Rt Hon Andrea Leadsom MP announced the Public Health Grant allocations to local authorities in England for 2024/25. The public health grant provides the financial envelope for a wide range of services including health visiting. The scale of the funding is therefore an important measure of the Government’s priorities and their commitment to improving the nation’s health through prevention and early intervention.

Whilst there has been some additional discretionary funding for some policy areas (smoke-stop services, drug and alcohol addiction treatment, and the Start for Life Vision), no additional funding for health visiting services was forthcoming. The local government allocations for public health in 2024/25 represent a below inflation uplift of only 2.1% on 2023/24 (or a further cut to the grant in real terms). Overall, cuts to the public health grant since 2015 have amounted to more than £850 million. As a result, health visiting services have been scaled back and the health visitor workforce has been cut by more than 40% since 2015. Ultimately, families face the brunt of this, with many families missing out on the vital support that they need during the crucial earliest years of a child’s life.

Commenting on the announcement, Alison Morton, iHV CEO, said:

“Set against a backdrop of increased inflation, and increased pay, today’s public health grant settlement is a huge disappointment. It is nowhere near enough to deliver the Government’s own blueprint for health visiting and represents another cut to funding and a blow to services.

“Today’s announcement must also be viewed in the context of growing pressures on services, as more families are struggling with poverty and vulnerability that increase the demand for health visiting support. Cutting vital health visiting services is a false economy as we know that early intervention can make such a difference to a child’s outcomes and is much cheaper in the long run. We need to act now to turn policy rhetoric on prevention into action – today’s announcement sadly represents another wasted opportunity to turn this situation around.”

More and more reports highlight the dire state of child health and development across our nation that cannot be ignored – immunisation rates are falling, A&E attendance rates for children are increasing, more children are falling behind with their development, babies and children are being harmed by conditions that are entirely preventable, and health inequalities are widening. Health visitors see the realities of family life first-hand and the imperative to act was set out in our recent “State of Health Visiting” survey report published last month.

The iHV is not alone in its concerns about the lack of attention being given to babies and children in the UK. Just today, the hard-hitting report from the Academy of Medical Sciences has been covered in the news, highlighting a growing crisis across the early-years – with wide ranging evidence of declining health that takes root from preconception through pregnancy to the first five years of life.

Read Rt Hon Andrea Leadsom MP announcement on the Public Health Grant settlement, including link to allocation summary

Delay to Public Health Grant will cause ‘avoidable and unacceptable’ harm

With just one month to go before the new financial year, the Institute of Health Visiting has joined over 30 leaders of public health, NHS bodies and health charities calling on the Government to urgently publish next year’s Public Health Grant allocation.

The coalition, led by the Association of Directors of Public Health (ADPH), the NHS Confederation, the Local Government Association (LGA), the Faculty of Public Health (FPH) and the Royal Society for Public Health (RSPH), is also urging ministers to increase investment in public health and prevention – a strategy which, although known to have a long-term benefits to individuals, communities, the NHS and wider economy, has been repeatedly overlooked in recent years.

In a joint statement published today, leaders across the sector have outlined their concerns to the Government:

The Government’s delay in publishing the Public Health Grant allocation for 2023/24 is putting public health services at risk and adding unnecessary strain on an already pressured system.

In addition to not yet knowing what the public health budget will look like for the coming year, we are extremely concerned that the delay will be exacerbated by either only a small increase or another flat cash settlement.

Despite several important Government strategies being sidelined or delayed – including the updated Healthy Child Programme – there have been a series of promising announcements giving a commitment to public health initiatives. However, these initiatives are not being adequately – or consistently – funded. In particular, the Best Start in Life strategy fails to meet the scale of rising need and does not address the workforce shortages in health visiting.

Instead, funding has been cut in real terms by almost a quarter since 2015. While the current investment is of course welcomed, anything less than inflation is in effect a cut and, as a result, it is impossible for providers to keep up either with policy ambitions or the growing demand on these vital public health services. We simply cannot keep delivering more for less.

Without investing in evidence-based measures that are proven to prevent and reduce physical and mental ill health, demand on the NHS will continue to rise, sickness in the workforce will continue to increase and the economy will continue to suffer as a result.

Greg Fell, ADPH Vice President said:

“We can’t plan high quality, value for money, services without knowing how much money there is to spend on them. Individuals, their families – and therefore their communities – will undoubtedly suffer purely as a result of this delay”.

You can support the cross sector call on Government to urgently publish the Public Health Grant allocation by sharing the link to the coalition statement on social media.

iHV welcomes the Health Foundation and The King’s Fund call to restore the public health grant

The Institute of Health Visiting fully supports today’s call by The King’s Fund and the Health Foundation for a reversal to cuts made to public health funding.

We endorse their call for an urgent review of the public health allocation as part of the expected roll-over grant in place of the anticipated full Spending Review. In particular, we call on the Treasury to carefully consider the wealth of evidence and benefits to society and the public purse from investment in supporting families during the crucial first 1000 Days of Life. Our children are this country’s greatest asset for the future, yet disadvantage and inequalities start early and can last a lifetime if not addressed. Recent year-on-year cuts to the public health grant are having an irreversible impact on our most disadvantaged children. These children cannot wait any longer for decent policies to ensure every child has the best start in life, with sufficient national levers and budgets to support full implementation. We are calling for action now, and our case for a strengthened health visiting service is set out in our recent letter to The Rt Hon Elizabeth Truss MP, Chief Secretary to the Treasury.

We fear that the damage done in the last 3 years will take many more to correct without urgent action now. It is fundamentally and morally very wrong that it’s been necessary to cut child health clinics and easy access to health visiting services in many areas of the country and, in so doing, the support they once provided for thousands of parents. Prevention and early intervention is often described as “turning off the tap rather than mopping the floor”. This is essential if we are to tackle key priorities like childhood obesity; infant, child and perinatal mental health problems; falling immunisation rates; and soaring unnecessary A&E attendances in the under-fives that could so easily be addressed with better early support and opportunities for parents to talk about their worries with a trusted professional. There are now massive variations in the type of service that health visitors can offer parents up and down the country, with minimal services most often the norm.

We too call on the Treasury now to fulfill their responsibility to the public by once again investing in public health and early preventative interventions for families.

Download iHV letter to the Treasury - May 2019

Read the Joint press release from the Health Foundation and The King's Fund