Public Health: County Durham

Seema Kennedy Excerpts

Wednesday 12th June 2019 Westminster Hall

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

It is a great pleasure to serve under your chairmanship, Mr Owen. I thank the right hon. Member for North Durham (Mr Jones) for raising this important issue, and the hon. Members for Sedgefield (Phil Wilson) and for City of Durham (Dr Blackman-Woods) for their contributions.

The Government fully appreciate the importance of protecting and improving the health of the population. We share hon. Members’ commitment to prevention and public health, which this debate has highlighted. The costs, both to individual lives and to the NHS, are simply too great to ignore.

The population in England is growing, ageing and diversifying rapidly. Some 40% of morbidity is preventable, and 60% of 60-year-olds have at least one long-term condition. Helping people to stay well, in work and in their own homes for longer is vital. As hon. Members have highlighted, the gap in healthy life expectancy between the most and least deprived areas of England is approximately 19 years for both sexes. As somebody who was born in Lancashire and represents a Lancashire seat, I see that disparity in my constituency. It is a great motivating factor for me in my role, as it was for my right hon. Friend the Prime Minister when she set her grand challenge of extending a person’s period of healthy, independent and active life by five years by 2035.

However, we will not achieve that by simply adding five extra years at the end of life; as with many things, the earlier we start, the more we stand to gain. Investment in early years and onwards is essential if we want positively to influence future lifestyle choices, prevent disabling conditions and enable people to contribute fully to society. We must continue to focus our efforts on areas such as digital technology and behavioural science so that we can show the public that the healthy choice is the easy choice.

We are doing work—on childhood obesity, smoking, air quality and more—that has the potential to make a real difference to people’s health and wellbeing. The amount of sugar in drinks has been reduced by 11% and average calories per portion have been cut by 6% in response to our soft drinks industry levy. By 2020, the NHS diabetes prevention programme will support 100,000 people at risk of diabetes each year across England. Last year’s ambitious prevention vision statement and the forthcoming prevention Green Paper will enable us to meet the ageing grand challenge and address health inequalities, supporting people to live longer, healthier lives.

We recognise that the funding position for local authorities is extremely challenging and understand the huge efforts that local government has made to focus on securing best value for every pound it spends. The 2015 spending review made available £16 billion of funding for local authorities in England over the five-year period. I remind the House that that is in addition to the money the NHS spends, which is part of the public health offer on prevention and includes our world-leading screening and immunisation programme and the world’s first national diabetes prevention programme.

Today’s debate has highlighted an important issue about the distribution of funding for local authority public health functions. Historically, funding for public health services in the NHS was left to local decision and was not necessarily based on need, which led to wide disparities in the amount of funding dedicated locally to public health services. Before these functions were transferred to local government, we asked the independent Advisory Committee on Resource Allocation to develop a needs-based formula for the distribution of the public health grant. The introduction of that formula meant that some local authorities received more than their target allocation under the ACRA formula and others received funding under target. In 2013-14 and 2014-15, when the overall grant was subject to growth, local authorities’ funding was iterated closer to their target through a mechanism called “pace of change”.

In 2015, ACRA was asked to update the formula to take account of the transfer of responsibility for commissioning health visiting services from NHS England to local authorities. We consulted on this formula and ACRA made recommendations to Government in 2016. I understand that the public health formula is more heavily weighted towards deprivation than either the adult social care formula or the clinical commissioning group formulation.

[Mrs Hodgson]

It is not working.

[Seema Kennedy]

Of course we want evidence. The shadow Minister says from a sedentary position that it is not working. We did an impact assessment in 2015-16 and we are reviewing all the evidence in preparation for the next spending review.

[Phil Wilson]

Just for clarification, did the Minister actually say that the formula is not working?

--- Later in debate ---

[Seema Kennedy]

No, I was repeating what the shadow Minister had said.

The recommended formula, which would create winners and losers in terms of overall levels of funding because of the disparity in historical spend compared with current need, has not been implemented because of the Government’s intention to extend the system of retained business rates. We continue to review the position, and future spending levels will be decided as part of the spending review, where we will review all available evidence.

I commend all local authorities on the efforts they are making to improve population health, as well as third-sector groups such as the children in Cleves Cross with their edible walkways. We continue to believe that local authorities are best placed to make decisions about the services that best meet the needs of their populations.

[Dr Blackman-Woods]

I am sure the Minister would accept that any formula that moves services from areas of relatively high need to areas of low need cannot be working properly. Does she also accept that it is simply not fair to push the onus to provide more services on to local authorities? As my right hon. Friend the Member for North Durham (Mr Jones) made clear, Durham County Council’s budget has been cut by 60% since 2010.

[Seema Kennedy]

I believe that local authorities and local communities are the right place for public health to be situated, because they best understand the needs of their communities.

[Mr Kevan Jones]

Will the Minister give way?

[Seema Kennedy]

May I just finish addressing the point made by the hon. Member for City of Durham? I also want to ensure I give the right hon. Gentleman, who moved the motion, time to wind up the debate. We recognise that there has been pressure on local authorities and we commend them for the work they have done. As I have said, we continue to review the position, and future spending levels will be decided as part of the spending review.

[Mr Jones]

I agree with the Minister that local communities are best placed to decide these things, but is she happy with the fact that under the new funding formula, there is no onus on local government at all to use money for public health?

[Seema Kennedy]

I think public health is ring-fenced, and local government does have to use the funding for that. We are reviewing the position, and we will look at all the evidence carefully in the upcoming spending review.

Across England, we are seeing examples of councils adopting new service models and commissioning more effectively and innovatively. Stakeholders often tell us, most recently through the review of commissioning sexual health and health visiting services, that councils are achieving better value for money while maintaining or improving outcomes in challenging financial circumstances.

However, we need to acknowledge that improving public health is about far more than the grant, and we know that spending more money does not necessarily improve outcomes. What we spend it on matters a lot. That covers all local government activity, including transport, planning, housing and the economy, all of which contribute to population health and wellbeing. The work that local government does on the ground through place-based approaches makes joining up those different factors easier, and the NHS long-term plan has a significant focus on prevention and reducing health inequalities.

We do not know what the outcome of the spending review will be, but I am committed to working closely with local government and other partners to build on the achievements of the past six years. We need to take action on a local, national and global level to meet the public health needs of the present and rise to the public health challenges of the future.