• DHSC and NHSE understood to have discussed requirement for councils to use grant to cover Agenda for Change and PrEP trial costs
  • Duncan Selbie recently confirmed real-terms increase in grant amounted to inflation plus 1 per cent
  • Cost of potential new burdens is £90m, while pledged uplift for 2020-21 only £85m

New significant public health burdens could be imposed on councils, wiping out a promised real-terms increase in the public health grant next year.

As reported by LGC, talks are understood to have been held between the Department of Health and Social Care and NHS England on a requirement for councils to use the grant to cover the cost of pay rises for NHS public health provider staff on Agenda for Change contract terms, such as health visitors, and also costs associated with the expansion of impact trials for the HIV drug pre-exposure prophylaxis.

Public Health England chief executive Duncan Selbie recently confirmed the real-terms increase in the public health grant announced in the spending round earlier this month would amount to inflation plus 1 per cent.

Councils this year received £3.13bn in public health grant, an £85m reduction in funding in 2018-19. An increase in the grant of inflation plus 1 per cent would amount to an estimated extra £85m in 2020-21, taking the grant back to last year’s level.

NHSE in January announced the expansion of the PrEP Impact Trial to 26,000 participants by 2020. The extra sexual health appointments required will cost an estimated £10m a year, discounting the cost of the drug itself. LGC understands NHSE is of the opinion that councils should pay for this.

DHSC has committed to funding the Agenda for Change pay and pensions increases, which occur each year. LGC has learned the money set aside to fund this year’s increase is currently held by NHSE, with one senior local government figure with knowledge of the process indicating the national body was refusing to pass it on to councils.

The cumulative £90m cost of the potential new burdens on the public health grant would exceed the pledged £85m uplift in 2020-21.

A senior director of public health, who asked not to be named, said: “If this turns out – contrary to what [health and social care secretary] Matt Hancock and [chancellor] Sajid Javid have both said – to be just inflation or, even worse, inflation with new burdens like PrEP and Agenda for Change burdens added, councils will feel they have been misled and government has reneged on yet another promise.

“The agencies who campaigned for fair funding will feel government has been disingenuous. Flat growth with burdens will still mean cuts to services and redundancies. Because the money for agenda for change was already in the NHS system, this means yet another bung for the NHS and yet another cut for public health.”

The public health grant is £850m lower in real terms in 2019-20 than the allocation in 2015-16.

NHSE referred LGC to DHSC for a response. DHSC is yet to comment.

A Local Government Association spokesman said clarification was being sought on the public health grant.