The National Audit Office have produced an assessment of whether the new public health grant to local authorities is likely to lead to intended outcomes and achieve value for money.
The report makes clear that despite increases in the overall budget allocated for public health (up by 5.5% in 2013-14) allocations within the overall envelope are changing slowly as local authorities exercise their judgement on local priorities.
They report that in 2013-14 local authorities had budgeted 54.3% of spending on sexual health, drugs and alcohol services; in 2014-15 this proportion had reduced to 52.8%. They also found:
Other key messages from the report are:
“between 2010-11 and 2012-13 alcohol-related admissions to hospital increased by more than 6% in 26 local authorities. These 26 local authorities spent on average 6% of their public health spending on alcohol services for adults. This was significantly less than the 9% spent by the 26 local authorities where alcohol-related admissions reduced the most.”
- A survey of stakeholders found that three-quarters of respondents have a good working relationship with PHE, although it is generally too early to tell whether public health outcomes are improving. That said, the report points out that PHE prioritised 54 local authority areas for intensive diagnostic and support work to improve recovery and reduce relapse rates leading to a 1.3% increase in recovery rates.
- The Department of Health has not decided how long the ring-fence for the public health grant will remain in place.
- There have been limitations in the quality of data, for example, 81 local authorities initially reported not spending anything against 1 or more of the 6 prescribed public health functions, and there are lags of at least 18 months for publishing much of the public health outcomes data.
- Some stakeholders think PHE should display stronger system leadership. However, the formal levers available to PHE for securing better public health outcomes are limited and the autonomy of local authorities gives no guarantee that PHE can secure improvements in outcomes (and at £5 million, the health premium risks being too small to bring about significant change).
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