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Public health funding: finding the right formula

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Setting councils’ budgets for public health has, perhaps unsurprisingly, become a complicated and controversial task.

Troubles arose when it became clear there was no record of what primary care trusts had been spending on public health.

“The fact that we didn’t know what was being spent on it was a reflection of how the department hadn’t paid sufficient attention,” Mr Selbie said.

“The department was asking about waiting times in acute hospitals and about A&E performance and reducing hospital-acquired infections and about cancer outcomes, and those are good things.

“But because the department wasn’t asking about improving health … that understanding didn’t exist.”

To find out how much money councils would need for their public health role, the department asked PCTs to calculate how much they had been spending on it, a process that had to be repeated several times and the results of which are still disputed.

It has, however, provided what the department calls “baseline” spending levels - and councils have been promised that unless there are “exceptional circumstances” they will receive at least this amount.

“I would’ve preferred the conversation to be [about] what we should be spending, not what we are spending, but we were starting at a place where we’d never asked the question before,” Mr Selbie says. “You start from where you are.”

The department has asked the independent Advisory Committee for Resource Allocation to draw up a formula for how the total budget for councils - estimated by the DH at £2.2bn but not confirmed - should be split between authorities.

Its first proposal, published in June, attracted controversy, with councils in the north-west and north-east saying it would hit the most deprived areas the hardest.

So is there still scope for radical changes to be made to the proposals before they are finalised in November or December?

“I don’t think there’s any doubt that the formula was constructed in a thoughtful way,” Mr Selbie said.

“The Department of Health knows a great deal about formulas and I think it would argue there’s not a perfect one. But I expect that we’ll get to a place where it’s as good as it can be.

“I don’t know the extent to which it means radical or marginal [changes to the proposed formula].”

Mr Selbie does, however, appreciate councils’ frustrations at the prospect of a long wait to find out about their budgets.

“What folk have been saying to me around the country is they don’t necessarily expect fairness, but they are expecting to know what the number is.

“They want to know it at the same time as the rest of the finances are communicated, which I think means November.

It is not helpful for local government to be hearing about the public health component in February.”

This could be the first big test for Mr Selbie: a prompt announcement of funding levels would reassure the sector of his ability to deliver on his good intentions.

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