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Government announces £5.2bn public health spend

The government has announced £5.2bn will be spent on public health next year, and published its first Public Health Outcomes Framework.

The figure for total public health spend in 2013-14 of “around” £5.2bn was announced in a speech by health secretary Andrew Lansley at the Royal Society of Public Health.

Full responsibility for public health will pass to councils from April 2013 but they are set to receive shadow budgets for 2012-13.

The Department of Health has told HSJ that around £2.2bn would go to local authorities, £2.2bn to the NHS Commissioning Board for national programmes such as screening, £210m to Public Health England, and £620m to the DH for public campaigns.

Mr Lansley confirmed that the money for councils will be ringfenced for public health. He also said that public health spending will be increased in real terms in following years.

He said: “From April next year, councils will be given a ring-fenced budget – a share of around £5.2bn based on 2012-13 funding – and will be able to choose how they spend it according to the needs of their population.”

The £5.2bn figure is slightly higher than the £4bn estimate of current public health spending mentioned in the public health white paper and the £3.6bn which HSJ calculated was spent by PCTs on public health in November.

The health secretary also set out details of the public health outcomes framework, which is published today by the DH.

Under the new system, local authorities will be judged against a range of measures including tooth decay in children, reducing the number of falls in older people and levels of breastfeeding.

The framework concentrates on two high-level outcomes to be achieved across the public health system. These are increased healthy life expectancy and reduced differences in life expectancy and healthy life expectancy between communities.

The DH said the outcomes in the framework “reflect a focus not only on how long people live but on how well they live at all stages of life”.

“Using a measure of both life expectancy and healthy life expectancy will enable the use of the most reliable information available to understand the nature of health inequalities both within areas and between areas,” it said.

A set of supporting public health indicators has also been developed to “help focus understanding of progress year by year nationally and locally on those things that matter most to public health”.

The indicators are grouped into four “domains”:

  • improving the wider determinants of health
  • health improvement
  • health protection
  • healthcare public health and preventing premature mortality

Mr Lansley said: “The framework is about giving local authorities the ability to focus on the most effective ways to improve the public’s health and reduce health inequalities, long-term, from cradle to grave.

“Moving away from an old-style, top-down, target-driven regime, and towards outcomes that we all want to see.  Some are straightforward and obvious. Others are more complex, maybe things you wouldn’t immediately think of.”

David Buck, senior fellow on public health at The King’s Fund, said: “We support the focus in on improving population health outcomes and reducing health inequalities.

“However, publishing data alone will not be enough. The key tests of whether ministerial rhetoric on public health is matched by reality will follow in the next few weeks, with the announcement of how shadow budgets will be allocated to local authorities and the publication of the alcohol strategy.”

Shadow public health minister Diane Abbott said: “Labour welcomes handing local authorities new responsibility for public health. In principle, this should make it easier to deal with the social determinants of ill health and issues like obesity. 

“But in practise, these powers are being given at a time of unprecedented financial pressures on local councils. The government has not demonstrated how it can effectively ring fence the money and stop cash-strapped councils from diverting the funds to related issues like social care.” 

She added: “The truth is that the cuts in public spending overall, and the chaos and confusion caused by the NHS reforms, mean that today’s announcement just masks a growing crisis in healthcare. These proposals are dead on arrival.”

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