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

A recovery plan for health? or only for sickness and the NHS?

Waiting for policy announcements is a bit like waiting for buses. Yesterday saw the long-awaited announcement of the local authority public health grant settlements, and this was followed swiftly today with Sajid Javid’s announcement of the elective recovery plan for the NHS.

The announcements lay bare the glaringly different priorities afforded to ‘sickness treatment’ in the NHS and the poor relation of preventative public health and early intervention.

It has been estimated by the NHS that 10 million people did not seek treatment during the pandemic, and around 6 million people are waiting for elective treatment. To address this backlog, Sajid Javid says the government has already allocated an extra £2bn to tackle waiting lists this year, with another £8bn being spent over the next three years – alongside this, there is a further £6bn of spending announced for capital investment in the NHS.

In contrast, England’s public health grant allocation for 2022-23 saw a 2.81% rise to council’s public health budgets, which brings total funding to £3.42bn in 2022-23, up by £93m from 2021-2022. The Government had previously pledged to maintain public health funding in real terms in the autumn budget, however, when compared to the current rate of inflation of 5.4%, this settlement represents a cut in real terms.

Recently, Sir Michael Marmot said: “It shouldn’t be that we either invest in treatment services or improving public health, we need to do both if we want to create better societies for people.”

Alison Morton, Executive Director iHV, responded:

“Yesterday’s funding settlement for local authorities in England is not good news. With long-standing workforce shortages, rising levels of vulnerability and a backlog of babies, children and families missed in the pandemic, this is another blow for public health. Where is the public health recovery plan?

“Our role at the iHV and as health visitors is not to be party political but to stay true to the key principle of health visiting to ‘Influence policies affecting health’ – and it is in our view that the Government needs to reconsider its priorities for babies, children and families as a matter of urgency. Whilst we are all acutely aware of the costs that this country faces in the wake of the pandemic, to gain perspective we need to view these decisions in the light of other policy decisions. In the autumn Spending Review, the price of a pint of beer was cut by 3p – this came at a cost to the Treasury of £3bn.”

We have escalated our concerns in a recent letter to the Minister, Maggie Throup, and officials in the Office for Health Improvement and Disparities. Whilst we welcome their plans for a workforce roundtable in February and the commitment of £10m for workforce pilot schemes, action is urgently needed to address the much bigger problem posed by the ever-increasing health visitor workforce shortages now – this cannot wait for another 2 years for these pilots to report their findings. Babies, young children and their families are at risk because we know that we have a shortfall of about 5,000 health visitors and this is having a significant impact on the service and the level of support offered to them.

Further details on the Public Health grant settlement are available here

Read Alison Morton and Dr Cheryll Adams recent paper: Health visiting in England: The impact of the COVID-19 pandemic

PHE: 2018 child health profiles

Annual update of data in the child health profiles interactive tool. Profiles providing an overview of child health and wellbeing for each local authority in England.

The profiles draw together information to present a picture of child health and wellbeing in each local area in a user-friendly format.

Those working in local government and health services can use the profiles as a tool to help:

understand the needs of their communities
improve the health and wellbeing of children and young people
reduce health inequalities

Go to PHE Child Health Profiles

PHE: Child Health Profiles 2017

The 2017 Child Health Profiles, produced by Public Health England (PHE), were released on Tuesday 7 March 2017.

The profiles draw together information to present a picture of the health of children and young people in each local area in a user-friendly format. They provide a snapshot of child .health and wellbeing for each local authority in England using key health indicators which enable comparison locally, regionally and nationally. They are a valuable tool for local government and health services in helping them to understand the needs of their community, so that they can work to improve the health and wellbeing of children and young people and reduce health inequalities.

There is a four-page profile for each local authority in England which includes:

An ‘At a glance’ summary description of child health in the area which highlights key findings
Maps and charts showing how the health of the area compares to the national view and other local authorities in England
A ‘spine chart’ health summary showing the difference in health between the area and the England average for 32 indicators within the five domains of the Public Health Outcomes Framework.

Go to PHE 2017 Child Health Profiles

2 new briefings on the 5 mandated visits

We are delighted to share 2 new briefings in the “Why a HV?” series around the 5 mandated visits:

This series of briefings on the 5 mandated visits can be used by Service Leads who are redesigning their service specification with their local commissioners.

With one more briefing to come (very soon), the series of “Why a HV?” briefings can be found on the Working in partnership with your local authority page, under the section for Health Visitors/School Nurses/Leads.

New – iHV Local Authority Briefing (9): The Health Visiting contribution to Child Accident Prevention

Local authorities are charged with commissioning children’s public health services as part of a wider remit for children’s services.

This new briefing for commissioners of children’s services provides an overview of the central role that health visitors play in reducing unintentional injuries in the under-fives, along with the associated high personal and financial costs to children, families, communities and society.

Unintentional injuries in and around the home are a major cause of death and disability among the under-fives in England.

Local Authority Child Public Health Briefing (9): The Health Visiting contribution to Child Accident Prevention

Please share this Local Authority Public Health briefing with your local commissioners – along with the other briefings in the series (under the “For commissioners” section on the link below).

Working in partnership with your local authority

Launch of Commissioning Guidance for Infant Feeding

PHE and Unicef UK are delighted to announce the launch of “Commissioning Infant Feeding Services: A toolkit for Local Authorities”.

This publication provides guidance to help local commissioners protect, promote and support breastfeeding. The document is jointly branded by Public Health England and Unicef UK and includes endorsements from:

Sally Davis, Chief Medical Officer
Viv Bennett, Chief Nurse
Kevin Fenton, Director, Public Health England

The document has several parts:

Summary: highlights key messages and themes.
Part 1, Infographics: these colourful, easy to use slides give a concise and accessible overview. Please feel free to use these in your own presentations.
Part 2, Toolkit: details what success would look like for a commissioner working within their local authority to promote, protect and support breastfeeding.
Part 3, Data: sets out guidance on effective data collection, monitoring and reporting.

Commissioning Infant Feeding Services: A toolkit for Local Authorities

Child Health Profiles 2016 published by Public Health England

The Child Health Profiles 2016, published today (15 March 2016) by PHE, present data across 32 key health indicators of child health and wellbeing. The data will help local organisations work in partnership to improve health in their local area.

The profiles provide a snapshot of children and young people’s health by local authority and CCG in England.

The data is updated annually. There is a 4 page profile for each local authority in England which includes:

an ‘At a glance’ summary description of child health in the area which highlights key findings
maps and charts showing how the health of the area compares to the national view and other local authorities in England
a ‘spine chart’ health summary showing the difference in health between the area and the England average for 32 indicators within the 5 domains of the Public Health Outcomes Framework.

Go to Local Authority Child Health Profiles 2016