Public Health Commissioning Intentions
Introduction
Purpose
This document sets-out the commissioning intentions for Norfolk County Council (NCC) in relation to its Public Health services for the financial year 2025/2026.
Context
The Health and Social Care Act 2012 (effective 1 April 2013) gave upper tier local authorities duties both to improve the health of their populations as well to directly deliver, or arrange the provision of, some specialised healthcare services that previously had been the responsibility of the NHS. There is a requirement to appoint a Director of Public Health (DPH), who as a statutory chief officer holds a leadership role spanning health improvement; health protection; and public health support to NHS commissioning bodies.
Through the Department of Health & Social Care (DHSC), LAs receive a ring-fenced public health grant to fulfil these duties, which includes a series of mandated functions:
- Steps must be taken to protect the health of the local population
- Providing NHS commissioners with the specialist public health advice they need
- Providing or arranging the provision of a range of services, namely: 0-5 public health services (Health Visiting), the National Child Measurement Programme (NCMP), open-access sexual & reproductive health services, and NHS Health Checks.
National picture
Since publication of the Public health grant allocation in England for 2024/25 on 5 February 2024, there was a change of government in July 2024 following which an Independent Investigation of the National Health Service in England was commissioned, which incorporated an overview of the public health grant and associated services.
Published in September 2024, the report found that "the public health grant has been slashed by more than 25 per cent in real terms since 2015" and stated that "given the potential power of preventative interventions, it is perverse that the public health grant to local authorities has been cut so substantially".
The author of the independent reviews report, the Rt Hon. Professor the Lord Darzi, and ministers of the new government alike have spoken repeatedly about the potential benefits of prevention, and the role of local authorities in relation to public health.
However, neither were specifically spoken to in the governments budget announcement on 30 October 2024 and as of publication of these commissioning intentions we are yet to have details of our funding allocations for 2025/26.
This includes whether there will be any inflation to our core public health grant allocation (£45,456,561 in 2024/25), or if all other government public health funding streams will continue (£6,055,240 to Norfolk in 2024/25).
We also do not know what additional expectations may be placed on Norfolk public health from central government come 2025/26. For example, the public health grant for 24/25 increased by 5.1% from the previous year, however for the first time the local authority was expected to manage the incremental cost burden of the Agenda for Change pay award within NHS delivered services from within our allocation (in previous years additional funds had been provided directly to NHS organisations towards meeting incremental pay costs).
Norfolk picture
As stated above, Norfolk County Council's public health grant for 2024/2025 was £45,456,561 or £48.78 per head of population (estimated at 931,943). However, of the total sum a value of £1,241,584 was explicitly aligned to meeting Agenda for Change pay costs within NHS delivered services.
When taking Agenda for Change monies into account, the actual baseline value of the public health grant allocation increased by 2.2% whilst inflation sat at 5.7% in 2023/24 (though fell to 3.2% in February 2024, the month of the announcement of public health grant allocations for the financial year 2024/25).
A Commissioning Work Programme for 2025/2026:
Our 2025/26 commissioning intentions reflect our continued programme of investment in and improvement of our externally commissioned public healthcare services. It sits alongside functions we deliver directly, many of which seek to deliver primary prevention activities, which in turn can alleviate demand for interventional services that are not only funded by public health but also by other key partners across Norfolk's integrated care system such as the NHS ICB, Adults Social Care, and Children's Social Services.
In the financial years of 2022/23, 2023/24, and 2024/25 NCC public health made a series of decisions around investment of its reserves, which had built-up over a number of years but were particularly a result of the COVID pandemic when a number of routine services could not be delivered in full and greater impacts on the public's health were observed.
Initially the investment of reserves looked at recovery, for example in expanding our NHS Health Check programme that had seen some 36,000 health checks missed during the pandemic; whilst in more recent times investment decisions have been made in relation to addressing health inequalities and reaching those in our 'Core20PLUS5' communities.
NCC public health will invest more of its reserves in 2025/26, though the context of this is that by 2026/27 those reserves will have been exhausted and so steps will need to be taken to return public health annual expenditure to balance with our annual grant allocation.
Key to ensuring maximum impact is achieved from public health investment is our part in the emerging Integrated Care System in Norfolk. We have already established a number of joint commissioning approaches to care including aspects of women's health, mental health and wellbeing, and smoking cessation; and we will enter into new initiatives throughout 2025/26.
Locally there will also be several key initiatives that have a bearing on our priorities and approaches, examples being:
Locally there will also be several key initiatives that have a bearing on our priorities and approaches, examples being:
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