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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 2024/2025. 

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 context

Following publication by government of the public health grant allocation in England in 2023/24 on 14 March 2023, The Health Foundation published the following Public health grant, in which it uses the GDP deflator published by the OBR in March 2023 as its baseline.

  • The public health grant has been cut by 26% on a real-terms per person basis since 2015/16
  • Additional but time-limited funding for drug and alcohol treatment has been allocated to local authorities. Taking account of this additional spend leaves broader public health funding 21% lower on a real terms per person basis since 2015/16
  • Some of the largest reductions in spend over this period were for stop smoking services and tobacco control, falling by 45% in real terms, as well as drug and alcohol services for adults (17%) and sexual health services (29%)
  • Poor health is strongly associated with living in socioeconomically deprived areas. A girl born today in the most deprived 10% of local areas is expected to live 19 fewer years in good health than a girl born in the least deprived
  • However, real-terms per person cuts to the grant have tended to be greater in more deprived areas. In Blackpool, ranked as the most deprived upper tier local authority in England, the cut to the grant (including new drug and alcohol treatment funding) has been one of the largest - at £33 in real terms per person since 2015/16
  • Local authority public health interventions funded by the grant provide excellent value for money, with each additional year of good health achieved in the population by public health interventions costing £3,800. This is three to four times lower than the cost resulting from NHS interventions of £13,500

A number of public health commissioned services are delivered by NHS organisations with their employees paid through the nationally negotiated Agenda for Change mechanism.

With a 2023/24 settlement achieved, consisting of a non-consolidated award for 2022/23 (with national eligibility for staff directly employed by NHS organisations for example permanent and fixed term contracts as of 31 March 2023); and a consolidated pay award for 2023/24 worth an average 5.2% for staff on AfC terms, shortly after publication of the 2023/24 public health grant allocations information was relayed to local authorities that they would need to manage the incremental cost burden of this on NHS delivered services from within their allocations (in previous years additional funds had been provided directly to NHS organisations towards meeting incremental pay costs).

Subsequently, on 28 June 2023, the Department of Health & Social Care wrote to the Chairman of the Local Government Associations Wellbeing Board and the President of the Association of Directors of Public Health to say that an uplift to ICB allocations would be made "to fund the additional cost impact of the AfC pay award", with an expectation that as a result "Local Authorities should not expect additional in-year costs related to the pay award from NHS providers to be passed to them ".

The financial year 2024/25 will mark the third and final year of the governments published spending plans as issued on 27 October 2021 following completion of the Comprehensive Spending Review 2021 (SR21).

Following the publication of SR21, on 1 April 2022, OHID announced that the announced "... additional funding for local authority commissioned adult tier 2 behavioural weight management services... will not be available in the financial year 2022-23". Subsequently these funds were not made available in 2023/24 either.

On 4 October 2023 the Secretary of State for Health and Social Care wrote to Directors of Public Health announcing the "governments historic plan to create a smokefree generation". This includes investment of an "additional £70 million a year over the next five years (2024/25-2028/29) to expand locally delivered and cost-effective services".

Norfolk context

Norfolk Public Health is also responsible for commissioning drug and alcohol services, school-based health provision (excluding vaccination programmes), and lifestyle services such as smoking cessation, weight management, and suicide prevention programmes.

NCCs public health grant for 2023/2024 was £43,639,932, or £46.60 per head of population (estimated at 936,363); an increase in funding of 3.3% in cash terms, but only a 1.9% on a funding per head of population basis.

As of October 2023 it is not possible to state the value of the public health grant to NCC in 2024/2025, however for the first time ever government published indicative figures for the next financial year. For Norfolk these indicative values are a public health grant allocation of £44,214,977, or £46.90 per head of population (estimated at 924,255). Were these figures to be subsequently confirmed, it would make an increase in cash terms of 1.3%, whilst when equated to a per head of population investment the increase would be just 0.6%.

A Commissioning Work Programme for 2024/2025:

Our 2024/25 commissioning intentions reflect the need to further develop the programmes we commission. In relation to investment in public healthcare services, though the national context set-out above has been one of change and uncertainty, locally we continue to be in a position of stability both in terms of our funding levels and commissioning infrastructure.

Indeed, as a result of various additional grant awards and a series of strategic investment decisions, Norfolk County Council will be increasing its public health associated budgets over and above the rise in the allocation values of the core public health grant in 2024/25.

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 & wellbeing, and smoking cessation; and we will enter into new initiatives throughout 2024/25.

Norfolk Public Health's Place & Community team will develop and embed a Work and Health Programme, and further their already established work focusing on how Partnerships can support improvements to local populations health, and promotion of and access to our public health commissioned services.

A priority reflected through these commissioning intentions is a desire to gather the views of those eligible to benefit from our commissioned services, but who are not currently engaged; to understand what barriers are being perceived and/ or experienced that may be deterring people from accessing the care and support we are procuring on their behalf.

Finally, we committed in 2023/24 to undertaking a series of strategic reviews; ensuring our future services are designed to best meet the needs of communities, families, and individuals requiring them.

These have been completed and having begun preparations to secure the best placed providers to deliver to the needs of our populations over the years to come, we will see through a programme of procurement activities during 2024/25 and support the associated changes in service offer and entry of new providers to our County.

Though not an exhaustive list, some additional key drivers to our future work are listed here:

Locally there will also be several key initiatives that have a bearing on our priorities and approaches, examples being:

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