Fears over health information gap

With fears growing over “asset stripping” on the part of primary care trusts (PCTs), the creation of a new funding formula could be the only realistic option for resourcing councils’ health improvement work properly.

An LGC straw poll of unitary and upper-tier council chief executives, launched after the unveiling of the Healthy Lives, Healthy People white paper last week, found about half in favour of creating a new funding formula, as opposed to distributing funds to compensate for historic levels of expenditure.

The remainder of respondents reserved judgment until the launch of the Department of Health’s funding consultation, which is believed to be days away.

Most chief executives expect their authorities to receive less funding to fulfil the new health improvement and wellbeing responsibilities they will be taking over than their local primary care trusts currently spend.

While some chiefs are known to be in favour of distributing funding according to “historic” levels, there is growing evidence that the wider reorganisation of the NHS and looming abolition of PCTs is prompting sharp cutbacks in public health spending, and uncertainty over their remit.

Reorganisation of PCTs in London is expected to result in cuts in the public health budget of up to 50%, while it also appears that some PCTs may be offering misleadingly low estimates of their spending, possibly in an attempt to cover the full extent to which public health work is being asset stripped.

A recent NHS North West report stated that some PCTs may have decided to classify prevention spending differently, following proposals to create ring-fenced public health budgets.

It said that “speculation regarding the purpose of the audit … may have influenced which costs were apportioned to prevention spend”.

A senior local government figure told LGC that most authorities would find it “impossible” to identify levels of public health spending, and that asset-stripping was hard to track.

“[Expenditure] is so variable [in terms of size] and definition too, that distribution will be a nightmare,” he said.

Launching the white paper, health secretary Andrew Lansley said Department of Health staff had so far identified some £4bn of public health funding within the NHS, a chunk of which will go to councils for health improvement.

But public health experts admit there is a significant lack of clarity over what was spent at a local and national level, and pointed to cutbacks within PCTs as a complicating factor.

Earlier this year, the DH itself admitted to MPs on the health select committee that it “does not collect detailed information” on expenditure on public health and on tackling health inequalities because of “local discretion on how the funding is spent”.

Instead, it pointed to Health England data from 2009, which cited a figure of £3.7bn spent on public health and health improvement in 2006-07, increasing to £5bn if some categories of medication were included.

The same report identified a further £1.3bn when environmental health services, food safety measures and health visiting services were factored in.

Some see a mismatch between this figure and Mr Lansley’s £4bn calculation, which represents a nominal figure for the new DH body Public Health England to spend on research and health protection, and to fund local authority health improvement budgets.

Dr John Middleton, vice- president of the UK Faculty of Public Health, said the lack of clarity over allocations was affecting authorities’ willingness to commit to hiring PCT staff.

“Not knowing what the budget will be is making [councils] quite rightly very cautious about taking on staff they might find they can’t afford in future years,” he said.

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