Public health grant

What did the Chancellor announce?

A real-terms increase in the public health grant.

Is it enough?

It will end five years of cuts that had reduced the grant by a fifth, but will fall significantly short of the £1bn required to reverse them.

A real-terms increase in the public health grant will end five years of cuts that had reduced the grant by a fifth, but will fall significantly short of the £1bn required to reverse them. It fails to match the rate of increase in budget for NHS front-line services and so will represent a shrinking share of overall health spend.

This is despite evidence that further public health spending is three times more productive than spending on health services.

Other departments

What did the Chancellor announce?

Some welcome signs of support for the wider determinants of health, including real-term boosts to education and homelessness reduction.

Is it enough?

There is a real risk that additional spend in 2020/21 simply papers over the cracks dealing with the most acute need, rather than the long-term investments needed to bring about a healthier population.

There are also some welcome signs of support for the wider determinants of health including: 

  • a commitment to boost real-terms education spending by £2.2bn, including £0.4bn specifically for further education – a key and historically underfunded area, which can help to ensure qualification and career routes for young people
  • a £50m real-terms boost to help reduce homelessness and rough sleeping, following rough sleeping more than doubling since 2012
  • allocating £0.2bn in 2020/21 to pilot approaches to cross-public sector working, bringing potential to capture wider benefits that accrue from some interventions such as health programmes that lead to improved employment outcomes.

However, the round, for the most part, only sets out spend for next year. Longer-term thinking is required to create sustained improvements in our health. There is a real risk that additional spend in 2020/21 simply papers over the cracks by dealing with the most acute need, rather than the long-term investments needed to bring about a healthier population.

For example, additional investment to support homelessness is likely to add to the shift in recent years away from more upstream housing services that can help prevent homelessness in the first place, towards dealing with acute need when people reach crisis point.

For local government, which plays a key role in creating healthy places to live, work and age, much of the real-terms boost announced yesterday will be needed to patch up social care funding for a further year.

And while there is some redress to past cuts, this is against a backdrop of increased demand. For example, the number of looked after children rose by 11% between 2014 and 2018 to reach 75,420, putting pressure on local government budgets.

Crucially, while poverty is the strongest determinant of poor health, the Spending Round failed to end austerity for working age welfare, as it was limited to planned departmental resource spending. The four-year benefit freeze has led to a 6% real-terms reduction in the value of most working age benefits since April 2016.  And a growing number of families will continue to be affected by the limiting of support to two children. These welfare cuts are expected to drive child poverty rates back to their previous peak in the 1990s, and in doing so are likely to further widen health inequalities.

The Chancellor may be technically right to say that austerity has ended. But as things stand, most of the additional spending will be picking up the pieces from past cuts, rather than investing in the conditions that are needed to create a healthy population, and with it a prosperous future.

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