• Public Health England chief executive says he has been pushing for “decent” local government settlement
  • Says biggest determinant to people’s health outcomes is their wealth
  • Stresses need to “put our money… where the evidence takes us”

Local government should stop talking about “big numbers” when making the case in Whitehall for an improved financial settlement, Public Health England’s chief executive has said.

Instead, Duncan Selbie told delegates at the Chartered Institute of Public Finance and Accountancy conference on Wednesday they should demonstrate how spending will improve inclusive economic growth.

As reported by LGC, Mr Selbie also told the audience he has been arguing for a “decent” settlement for local government, but said he was expecting small improvements rather than major change.

“Things are getting better, but it is still quite difficult,” he said. “I am looking for marginal shifts over time; I am not interested in radical. We are not living in a world where there is a money tree.

“Difficult decisions will need to be made and they will need to be made locally.”

Mr Selbie also said the biggest determinant of people’s health outcomes is their income, with striking differences across the country based on relative wealth between areas.

Using the example of a 19-year difference in healthy life expectancy between Bradford and Guildford in Surrey, he said a person’s job “is the single biggest driver of closing that gap”.

Mr Selbie added: “We need to put our money where our mouths are and where the evidence takes us.

“In every level of government, if you want to improve the health of people it is about the economic improvement of this country.

“I don’t think talking big numbers works because big numbers frighten the government – it will be ‘join the queue’. Talk with them about how that money might be used in a place where there is confidence in leadership.”

Mr Selbie said he strongly agreed with the conclusion of a recent government review that responsibility for public health should stay with local government.

“It’s obvious,” he said. “When local government was formed 150 years ago it was based on sorting out what was killing people early. It remains the case today.

“I would turn [the question] around. Why did you ever think it would be better in the NHS? It is just not borne out by the evidence. When public health went back into local government the NHS couldn’t say what it was spending [on public health].”