Commissioners are used to having the finger pointed at them by politicians, but may not have been expecting scrutiny from the Conservatives of how much they are spending on prevention and overcoming health inequalities.
The Tory draft manifesto, published at the beginning of January, said: “Prevention is better than cure, so we will provide separate public health funding to local authorities… And, as a progressive government, we will weight public health funding so that extra resources go to the poorest areas with the worst health outcomes through a new ‘health premium’.”
The Labour response was to point out that primary care trust funding is already linked to deprivation and population health.
PCTs get a sum for each head of their “weighted population”, more or less. That is based on indicators of health, such as mortalities and morbidities, along with others things like age profile and deprivation. If people are old, unwell and poor the “weighted population” is bigger than the “real” population.
This graph (click to open) looks at how PCTs’ total spending relates to health outcomes in their patch. PCTs are ranked by how much they spend per head of real (unweighted) population, to show the effect of the weighting. I’ve ranked them on outcomes by averaging how each one ranks on a set of 50 outcome indicators included in a programme budgeting tool made by the public health observatories for comparing outcomes to spending. Figures are for 2007-08.
There are outliers (Why is North East Lincolnshire PCT spending so much? Why is Luton TPCT not spending more?), but there is definite correlation between outcomes and spending - demonstrating the formula is working to some extent.
As far as I can tell there is uncertainty about which factors the Conservatives are proposing to pay more attention to and which they want to pay less attention to. But they have continued to emphasise that public health spend should be separated and protected.
Andrew Lansley said the party would put in place “a strong local infrastructure, and support it with separate, ring-fenced budgets devoted specifically to tackling these challenges”. This would prevent PCTs diverting public health funds into “deficits in acute care budgets”, he said, citing Association of Directors of Public Health research from 2007 showing how this had happened.
Here I’ve compared PCTs’ rank on a measure of preventative spend to the same outcomes rank. The preventative ranks are based on spend (again per head of real population) in the Healthy Individuals programme, from the 2007-08 programme budgeting data.
Healthy Individuals is meant to measure spending on prevention but the figures come with the strong proviso that they are far from perfect. Preventative or public health includes work in many different areas, particularly primary care, making it very hard to produce separate spending figures.
That said, there is hardly any correlation. It seems to back up the claim that public health budgets are very variable, and those areas which might need preventative spend the most may not be getting it.
At first glance, Sandwell, Barking and Dagenham, Haringey, South Birmingham, Lambeth, Brent and Lewisham PCTs and several others appear to have poor outcomes but be spending relatively little on prevention.
This last graph plots total spending by head of real population, Healthy Individuals spending by head of real population and both of those again but this time per weighted head of population; all against the same outcomes.
It again shows the effect of the existing allocation formula: The population weighting goes to the areas with poorer outcomes, so stripping out those additional heads from the “spend per head” figures has the result of tipping the trend lines in the right direction.
But again it suggests that, despite their weighting, the areas with poor outcomes are often not spending more on public health.