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

Public Health: Maintaining our momentum

To mark the 10^th anniversary of the transfer of public health from primary care trusts to local government, the Local Government Association (LGA) interviewed key people closest to the reforms on what they think has worked well, what can be improved on, and learnings to take forward for the future – including iHV CEO, Alison Morton.

Some of the interviews that the LGA conducted were deliberately challenging and provocative. Some of them present a picture of what is already happening in local government, whereas some of them look to what more local and national government could do in the future, either with additional powers or by using their existing powers and remit.

In Alison’s interview, she says:

“The role of the health visitor is unique. There is no other service which sees every family before the age of five. That puts them in a position to make a difference to people’s lives. Health visitors could play a crucial role in addressing the challenges of the cost-of-living crisis, but only if they are properly funded to do so… we can do it – in fact we cannot afford not to.”

Read Alison's LGA interview here

Read all LGA interviews here

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 and SAPHNA joint response to Autumn Budget 2022

Yesterday’s budget provides some welcome investment in the NHS, social care and education. However, a quick search for the terms ‘children’, ‘babies’, ‘prevention’ or ‘early intervention’ will leave you disappointed. We know that the country faces a tight fiscal settlement – money is tight. But are we spending our money on what matters?

The autumn budget misses the mark and is focused on firefighting. The settlement is presented as sound economics in the ‘here and now’. However, our children will not thank us for failing to grasp the evidence on prevention and early intervention. We have more evidence than any other generation that the foundations for future health and wellbeing are laid in the earliest years of life. It therefore follows that ‘smart economics’ will ensure that spending on babies, children and young people is front-loaded in any fiscal settlement and seen as the smart investment that it is, rather than a cost.

Failing to invest in the public health budget at a time when inequalities are widening, preventable deaths in children are increasing, and 1 in 3 vulnerable children are not known to services, is short sighted and will end up costing much more in the long run. Public health has been at the bottom of the list for investment for too long and this is undermining the Government’s ambition to improve the nation’s health and reduce the long-term burden on the NHS and adult social care.

Health visitors and school nurses working in local government play a pivotal role in ensuring all children get the best possible start in life and can thrive throughout their school years. Their work includes both prevention and direct support for babies, children, young people and families for a range of health needs, and often during times of great distress.

Failing to invest in these services will lead to significant pressures and reductions in capacity across the country. Where services are reduced or cut, this will have a real impact on families, babies and children, and many will be left without the support they need.

The public health grant has already been cut by 24% on a real terms per person basis since 2015/16. There is nothing left to cut. Health visitor and school nurse numbers are continuing to decline without additional investment, whilst pressure grows for both professions as demand continues to soar.

Further investment is urgently needed to enable councils to develop strong and innovative health visiting and school nursing teams in their local areas. Increased funding in this area will protect and support parents, babies and children so they can achieve the best possible outcomes.

Read the Chancellor's full Autumn Budget Statement

Key headlines relevant to babies, children and families:

NHS funding – The government is providing additional funding of £3.3 billion in each of the next 2 years to support the NHS in England in response to the significant financial pressures it faces, and enabling rapid action to improve emergency, elective and primary care performance. There is no mention of public health.

NHS workforce plan – The government is publishing a comprehensive NHS workforce plan, including independently verified workforce forecasts, next year. This will include measures to make the best use of training to get doctors, nurses and allied health professionals into the workforce, increase workforce productivity and retention. At face value, this offers nothing for staff working in public health – we are awaiting confirmation.

Maternity services – The government is bolstering maternity services by meeting recommendations supported by the Ockenden Review for 2,000 more midwives. This is welcome news for maternity services but fails to tackle the national shortage of more than 5,000 health visitors who have a significant role to play in improving pregnancy outcomes and supporting safer postnatal care.

Children’s Social Care – £1.3 billion in 2023-24 and £1.9 billion in 2024-25 will be distributed to local authorities through the Social Care Grant for adult and children’s social care. This much needed investment is welcomed, but any efforts to improve outcomes for our most vulnerable children, and reduce the risks of harm, will also require a strengthened ‘upstream’ approach through preventative public health and early intervention services.

Schools – The government has committed to, “redouble its commitment to support schools, enabling school leaders to continue investing in the areas that positively impact educational attainment”. The core schools’ budget in England will receive an additional £2.3 billion of funding in 2023-24 and £2.3 billion in 2024-25.

From a school nursing perspective, whilst investment in schools is welcomed, the link between attainment and good health cannot be ignored. Without a parallel investment into school nursing to improve the worsening outcomes for so many school-aged children, this is somewhat futile.

Similarly, for health visiting, it is also disappointing to see that there is no similar commitment to the first five years of a child’s life, despite compelling evidence that the early years are vital for social mobility as this is where gaps in outcomes first begin to take hold.

Alison Morton Sharon White
Executive Director CEO
Institute of Health Visiting School and Public Health Nurses Association

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

Last chance to influence the future of the public health workforce!

This is your last chance to complete a short survey to influence the future of the public health workforce!

Survey closes midday tomorrow (12 Jan).

It is a crucial time for public health right now and the Royal Society for Public Health (RSPH) is calling for public health practitioners to take part in a very short survey to represent their views to help influence the future of the public health workforce.

The survey provides a fantastic opportunity for health visitors to highlight the challenges they are facing within their workforce and identify what solutions are needed. The survey focuses specifically on recruitment, retention and training.

Although the survey does not ask about individual public health professions and is quite broad in its approach, there is space to free text and expand on your thoughts so you can be specific about health visiting within these areas.

Your feedback will be used to help influence the RSPH’s submission to the Health and Care Committee’s inquiry into the future of the public health workforce.

It only takes about 10 minutes to complete the survey, so make yourself a cuppa and make sure your views are heard!

Complete the RSPH survey here

The survey closes at midday on Wednesday 12 January 2022.

Help improve new standards for community and public health nurses

The Nursing and Midwifery Council (NMC) has launched their public consultation for specialist community public health nursing (SCPHN) standards – building on ambitions for community and public health nursing.

The new NMC standards offer the opportunity to build on the advances in the evidence base for universal child and family health visiting for the pressing public health challenges of our times. It is vitally important that the views of health visitors are heard and shape these new standards.

We will be responding from the iHV – as well as submitting your own response, look out for our mailings on ways that you can help shape the iHV’s response.

The standards, for specialist community public health nursing (SCPHN) and specialist practice qualifications (SPQs), will equip the next generation of community and public health nurses working in health and social care with the right proficiencies to care for people in a rapidly changing world.

These essential education standards were last updated over 15 years ago. But we need fit for purpose standards that reflect the realities of modern nursing in health and social care now

These draft standards, which have been co-produced with subject experts, will provide the right proficiencies these professionals need to support and care for people in a rapidly changing world.

The consultation will run until Monday 2 August 2021. Normally these NMC consultations run for 12 weeks but they’ve extended this one to more than 16 weeks to give you and your colleagues more time to take part given the continued pressures on services caused by the pandemic.

Go to NMC public consultation - Building on ambitions for community and public health nursing

Government is at risk of failing babies and parents during the coronavirus pandemic

iHV joins a coalition of early years charities to warn government they’re at risk of failing a generation of babies born during the coronavirus pandemic.
Joint Statement on the future of public health in England – giving every child the best start in life.

In a Joint Statement on the future of public health in England, the iHV, alongside nine expert early years charities, put their eight principles to Matt Hancock which must be considered when looking at health visiting. The organisations are urging Government to recognise there is a timely opportunity to rebuild the nation’s public health services for children and families.

The coalition of early years charities consists of Action for Children, the Association of Child Psychotherapists, Best Beginnings, First 1001 Days Movement, Home Start, OXPIP, the Institute of Health Visiting, NCB, NSPCC and the Parent-Infant Foundation.

NSPCC sent the Joint Statement together with an open letter to Secretary of State for Health and Social Care Matt Hancock, saying that England’s health visiting programme is not equipped to meet the challenge of the Coronavirus pandemic, and must be rebuilt according to eight principles developed by the group of early years experts.

Dr Cheryll Adams CBE, Executive Director the Institute of Health Visiting, said:

“We are delighted to be part of this important coalition sharing our joint position on the need to return investment to the health visiting service so that it may fully play its part in ensuring that all parents have the support they need. Then, and only then, will every baby have the opportunity for the best possible start in life.”

The Pandemic has also seen restrictions to the service and redeployment of health visitors, which have resulted in many families not receiving their entitled health visits. According to the Babies in Lockdown report, produced by Best Beginnings, Home Start UK and Parent-Infant Foundation, just 1 in 10 parents with children under two saw a health visitor face-to-face during the pandemic.

The organisations have long warned Government about the history of cuts to public health funding and the significant decline in NHS health visitors, which meant the service struggled to support families across the country even before the pandemic.

The letter, backed by over 2,000 members of the public, highlights that the restructure of Public Health England must prioritise giving every child a fair start in life.

Led by health visitors, all families in England are entitled to receive five check-ins from qualified health visitors via the Healthy Child Programme. However, NSPCC research with over 2,000 mothers in England, conducted with YouGov prior to the pandemic, found only 6% had been supported by the same health professional throughout the perinatal period. One in four mothers had reviews conducted via letter, text message, or a phone call instead of in-person support.

Whilst Public Health England recently announced that health visitors should not be redeployed over the winter, research by UCL found that in some areas of England, as many as 50% of staff were redeployed during the first phase of the pandemic.

Since April, the NSPCC’s helpline has received 1,897 contacts from adults concerned about parental mental health, with over half being referred for further support. The monthly average number of contacts post-lockdown has increased by over a third (34%) when compared to the average for January to March.

Dr Adams commented:

“Over the past five years we have seen an average 30% reduction in the number of health visitors in England, accompanied by a massive variation in these losses across the country. The average health visitor caseload is now 500 children, double the recommended number.

“The number of invisible vulnerable babies will have increased and perinatal mental illness is already reported by health visitors to be ‘sky rocketing’.

“The whole population will also be paying the price – the erosion of the health visitor role results in kicking the can down the road where the impact is picked up by other much more costly services. We urge the Government to listen to the voices of parents, charities and health professionals now and take urgent action to reinstate a robust health visiting service before even more damage is done.”

The NSPCC is inviting people to join the thousands who have already raised their voice and signed the Fight for a Fair Start petition.

Read the Joint Statement on the future of public health in England - giving every child the best start in life

iHV submits powerful evidence to Government’s Comprehensive Spending Review

The Institute of Health Visiting has provided the Treasury with the latest evidence and cost benefits for new investment into health visiting as part of its Comprehensive Spending Review.

As the Institute submits its evidence to the Spending Review, Dr Cheryll Adams CBE, Executive Director iHV, said:

“We hope that this clear rationale and evidence for investing into the early years through the health visiting service will be taken seriously when the Treasury reviews all the submissions. There has never been a greater need to act to support young families as they face the secondary impacts of the COVID-19 pandemic. A loss of 30% of the health visiting workforce, since cuts to public health budgets, is impacting on our most vulnerable citizens and their families, but this will also have a significant long-term legacy for the country as a whole.”

Read iHV's Evidence for the 2020 Comprehensive Spending Review

iHV joins global call to put Public Health at centre of COVID-19 recovery

The Institute of Health Visiting joins over 40 million doctors, nurses and other health professionals from 90 countries, including many working on the frontlines of the COVID-19 pandemic, in sending a letter today to G20 leaders urging them to put public health at the centre of their economic recovery packages, to help avoid future crises and make the world more resilient to them.

In the biggest health community mobilisation since the run-up to the 2015 Paris climate agreement, over 350 medical groups representing health professionals (including the World Medical Association, the International Council of Nurses, the Commonwealth Nurses and Midwives Federation, the World Organization of Family Doctors and the World Federation of Public Health Associations) have signed the letter on behalf of their members, along with thousands of individual health professionals.

The letter asks governments to prioritise investments in public health, clean air, clean water and a stable climate in the economic stimulus packages currently under consideration. Such investments would reduce air pollution and climate-warming emissions, which damage human health, build greater resilience to future pandemics, and simultaneously create more sustainable jobs.

Dr Cheryll Adams CBE, Executive Director iHV, said:

“The world has the opportunity now to ensure that the next generation is not inhibited by the mistakes of the last. By tackling climate change and ensuring better preparedness for any future pandemics, babies can be given the opportunity for a long and healthy life where they have the health, wellbeing and opportunity to contribute to their economy, to future economies, and to the wellbeing of their descendants.”

To achieve this healthy recovery, leaders of the G20 countries must involve their medical and scientific community in developing the stimulus packages. These stimulus decisions must also take into account medical and scientific assessments of how the measures will impact public health in the short- and long-term.

The COVID-19 pandemic has exposed doctors, nurses and other health professionals to death, disease and mental distress at levels not seen in decades. The scale of this pain could have been at least partially mitigated by adequate investments in pandemic preparedness, public health and environmental stewardship, the letter states.

As the COVID-19 pandemic has made very clear, the economy suffers when human health is compromised. A science-based approach to a healthy recovery from COVID-19 must lead to decisions to reduce both air pollution, which weakens the lungs, hearts and other organs, and greenhouse gas emissions, which cause drought, extreme heat, flooding, wildfires and other life-threatening disruptions. This should be alongside ensuring every baby is given the best possible start in life and access to education and their parents supported.

A healthy recovery requires governments to invest in sustainable and innovative industries, jobs, food production and food supply chains. In doing so, leaders will encourage healthier diets, more renewable energy, more walking, cycling and zero-emissions public transport, a radical regeneration of trees and nature and other changes that will underpin human, economic and planetary health well into the future.

This letter is supported and promoted by the Global Climate and Health Alliance, Every Breath Matters, and the World Health Organization in service of the global medical and health community.

Go to full list of letter signatories