Centre for Public Policy & Health

Commissioning Public Health Services:

the impact of the health reforms on

access, health inequalities and innovation

in service provision

The ring-fenced public health budget /

spend and outcomes

Anne Mason, Dan Liu

University of York

Commissioning Public Health Services:

the impact of the health reforms on access,

health inequalities and innovation in service

provision

Research team: Linda Marks (PI), David Hunter, Shelina Visram, Llinos

Jehu, (Durham University); Anne Mason, Dan Liu (University of York);

Howard Davis (Coventry University); Joanne Smithson, Voluntary

Organisations’ Network North East.

Project administrator: Michelle Cook / Lisa Monkhouse

Funding: Department of Health Policy Research Programme (Jan 2015 -

June 2017)

Disclaimer

This presentation is independent research commissioned and funded by the Department of Health Policy Research

Programme (Commissioning public health services: the impact of the health reforms on access, health inequalities

and innovation in service provision, PR-R6-1113-25002). The views expressed in this publication are those of the

authors and not necessarily those of the Department of Health.

Overview

Ring-fenced budget for public health

– Expenditure trends

– Findings from 2 national surveys

Spend and outcomes

– Childhood obesity

Public health budget

• Ring-fenced to 2018/19

• Increases annually, but in-year/planned cuts

– 2015/16 to 2017/18

• Reporting categories

– aid transparency

• Under 5s services

– added 2015/16

• Mandated vs. non-mandated functions

Public health spend actual vs. planned

0

1

2

3

4

£ b

illio

n

2013 2014 2015 2016

RO RA RO RA RO RA RO RA

Note: Data on actual spend in 2016 will be published Nov 2017

RO: revenue outturn (actual); RA: revenue account budget (planned)

Mandatory - other Non-mandatory - other

Mandatory - under 5s Non-mandatory - under 5s

National surveys – key findings I

% Yes

2015

N=39

% Yes

2016

N=36

Changes in how ring-fenced budget distributed

across public health budget categories 64% 81%

Ring-fenced budget top-sliced38% 47%

Ring-fenced budget used for public health

activities across local authority directorates 87% 89%

Part of ring-fenced budget pooled with CCG

funds 18% 25%

National surveys – key findings II

Views on ring-fenced public

health budget

% Agree

2015

N=39

% Agree

2016

N=36

Protects public health services59% 67%

Provides an accurate picture of public health spend

across a local authority 36% 36%

Should be retained in its present form51% 64%

We should preserve distinction between mandated /

non-mandated public health services33% 42%

Provides useful data for comparison with other LAs 51% 64%

Used to stimulate public health changes across LA

directorates56% 67%

National surveys – key findings III

Ring-fenced public health budget

adequate?

% Agree

2015

N=36/37

% Agree

2016

N=34/35

Obesity (adults) 19% 26%

Obesity (children) 19% 29%

National Child Measurement Programme 81% 79%

Exercise schemes (adults) 28% 29%

Exercise schemes (children) 19% 23%

NHS Health Checks 69% 69%

STI testing and treatment 62% 71%

Contraception (excluding routine GP provision) 65% 69%

Sexual health services - advice, prevention and

promotion 57% 68%

Childhood obesity – national trends0

51

01

52

02

53

03

54

0

% c

hild

ren o

verw

eig

ht / ob

ese

06/07 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16

Aged 4-5 years old Aged 10-11 years old

Note: 150 LAs for each year

The prevalence of overweight and obesity for the upper tier

LAs in England (2015/16)

10 - 15

15 - 20

20 - 25

25 - 30

30 - 35

35 - 40

40 - 45

0 10050 Km

¯

Aged 4 to 5 Aged 10 to 11

Spend in 2013/14

Spend Mean LAs

Obesity (children) £194,227 150

Physical activity (children) £151,707 150

Children Public Health Programme (PHP) £1,610,360 150

Total public health £16,701,260 150

Per capita: obesity (children) £3.84 150

Per capita: physical activity (children) £2.50 150

Per capita: Children PHP £28.41 150

Per capita: total public health £51.99 150

Obesity/Total public health 1.12% 150

Physical activity/Total public health 0.82% 150

Children PHP/Total public health 9.75% 150

Total 11.69% 150

Relationship between outcomes and deprivation

02

04

06

08

01

00

% o

verw

eig

ht a

nd

obe

sity (

20

15

/16)

0 20 40 60 80 100% population living in 20% most deprived LSOAs (2015/16)

% overweight and obesity for children aged 4-5 Fitted values

% overweight and obesity for children aged 10-11 Fitted values

Note: 150 LAs

Method: Regression analysis

Variables

• Outcome

• Main explanatory

variables (2013/14)

• Other covariates

(controls)

Equation

overweight / obesity 2015/16 =

spend (Ob) 2013/14 +

spend (PA) 2013/14 +

spend (PHP) 2013/14 +

overweight / obesity 2013/14 +

% male + IMD + ethnicity +

rurality + class +

fast food outlet rate

Key findings

• No measure of LA spend in 2013/14 significantly

associated with proportion of obese or overweight

children

• The higher the levels of obesity in 2013/14, the

higher the levels of obesity in 2015/16

• Higher levels of LA deprivation associated with

higher levels of obesity

• The higher the levels of minority ethnic children,

the lower the levels of obesity

• 4-5 age group only