Public Health Funding: Bexley

Maggie Throup Excerpts

Tuesday 26th October 2021 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maggie Throup)]

It is a pleasure to serve under your chairmanship, Sir Edward. I thank my right hon. Friend the Member for Bexleyheath and Crayford (Sir David Evennett) for raising the important issue of public health. I was delighted to hear of the many measures his local council is already taking on this issue.

This debate has provided an opportunity to clarify an often misunderstood position about how funding for public health is distributed. The Government fully appreciate and share the commitment to prevention and improving the health of the population highlighted today. Improvements in life expectancy appear to have stalled and, on average, 20% of our lives are spent in poor health, with people in the most deprived communities at far higher risk of poor health. The gap in healthy life expectancy between the most and least deprived areas of England is around 19 years for both sexes. Helping people to stay well, in work and in their own homes for longer is vital.

Ill health is not randomly distributed, nor is it inevitable. Our ability to avoid, manage and survive disease is influenced by the choices we make, the job we do, the air we breathe and the neighbourhood in which we live. Service funding is only one of the levers available to us to support better health. For example, our obesity strategy works alongside local public health efforts in reducing childhood obesity. Our overarching goal is to create a healthier environment, helping to improve people’s diets and to make the healthier choice the easier choice. The actions that the Government have taken on this can be seen in people’s daily lives.

For example, since the soft drinks industry levy came into effect, the average sugar content of drinks has decreased by 43.7%. We have also legislated to introduce out-of-home calorie labelling in April 2022, to help people be more informed about the food that they are eating. Moreover, we have put in place regulations to restrict the promotion by volume and location of products high in fat, salt and sugar in supermarkets, which will come into force in October 2022. In June 2021, we confirmed that at the end of 2022 we will introduce both a 9 pm watershed for television advertisements of HFSS products and a restriction of paid-for advertising of HFSS products online. All of these national measures will have a local impact and will undoubtedly help those living in Bexley.

We recognise that the funding position for local authorities is challenging and we understand the huge efforts that local government has made to focus on securing the best value for every pound it spends. Today’s debate has highlighted an important issue about the distribution of funding for local authority public health functions. Prior to 2013, funding for individual local health services, including public health, was determined by NHS primary care trusts. As for all local authorities, Bexley London Borough Council’s allocation is heavily based on historical NHS spend prior to 2013.

However, the introduction of the public health grant to local authorities in 2013 has meant that spending on this set of services is now much more transparent. Before these functions were transferred to local government, we asked the independent Advisory Committee on Resource Allocation to develop a needs-based formula for distribution of the public health grant. The introduction of this formula meant that some local authorities received more than their target allocation, and others received funding under target. In 2013-14 and 2014-15, when the overall grant was subject growth, local authorities’ funding was iterated closer to their target through a mechanism called “pace of change”. Bexley Council benefited from this policy and received the maximum amount of funding growth, which I am sure my right hon. Friend appreciated.

The Government decided in 2015 that the fairest way to make subsequent changes to public health grant allocations was via flat percentage adjustments. Since 2019-20, adjustments have been made to the grant to take account of additional cost pressures such as the 2018 NHS “Agenda for Change” pay deal and the launch of routine pre-exposure prophylaxis—PrEP—commissioning, with all local authorities receiving a cash increase last year and this year to the public health grant, so that they can continue to invest in prevention and essential health services. For this financial year, Bexley Council received more than £9 million for the grant. We also allocated additional funding of £358,000 to Bexley this year to tackle obesity and drug addiction.

Nationally, the Government have made more than £12 billion available to local councils since the start of the pandemic to address the costs and impacts of covid-19, with £6 billion non-ringfenced in recognition of local authorities being best placed to decide how to manage the major covid-19 pressures in their local areas. I thank the hon. Member for Erith and Thamesmead (Abena Oppong-Asare) for mentioning the covid booster vaccine and my right hon. Friend the Member for Bexleyheath and Crayford for having it, which is probably the most important thing that people can do to continue to build our wall of defence, protect lives and reduce hospitalisations from the pandemic. While Bexley’s per capita funding is different from other London boroughs, a per capita basis is not a meaningful way to compare or determine allocations, as it takes no account of different levels of need. We will consider the allocation of public health grant funding for future years following the outcome of the spending review; we do not have long to wait.

I commend all local authorities on their efforts to improve population health. Local authorities are ideally placed to make decisions about the services that best meet the needs of their populations. Across England, local authorities are commissioning more effectively and innovatively and delivering improved value, but we need to acknowledge that improving public health is about far more than only the grant. We know that spending more money does not necessarily improve outcomes. However, what we spend it on really matters. The whole range of local government activity, including transport, planning and housing, all contribute to population health and wellbeing. The place-based work led by local authorities makes joining up these different factors much easier, and the new Office for Health Improvement and Disparities supports all areas of the country to drive improvements in health.

[Sir David Evennett]

We are listening with great interest and are very grateful for what my hon. Friend has said. However, I urge her to look seriously at the funding for boroughs that have a change in demography, because Bexley is a different place from what it was in 2013. We are well led and innovative, so value for money is a top priority for the council.

[Maggie Throup]

My right hon. Friend makes an important point. Obviously, nothing is ever static. We can look forward to having those discussions after the spending review.

The Office for Health Improvement and Disparities has a particular focus on those places and communities where ill health is most prevalent. I thank everybody in Bexley for their dedication to improving the health of people in their area. I am committed to working closely with colleagues in national Government and local government and with partners to ensure that the public health needs of the present and future are met. This has been an extremely important debate. I am delighted that Bexley Council is taking forward so many measures to improve the health of its population.

Question put and agreed to.