Public Health Funding: Enfield

Seema Kennedy Excerpts

Tuesday 16th July 2019 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Seema Kennedy)]

It is a pleasure to serve under your chairmanship, Mr Betts. I thank the right hon. Member for Enfield North (Joan Ryan) for raising this issue. She is a great champion for her constituency, as is the hon. Member for Enfield, Southgate (Bambos Charalambous) for his.

I reassure the right hon. Lady that the Government are fully committed to improving public health. We want to place prevention at the heart of our health and social care system, because that is the only way to make the NHS sustainable in the long term. That is challenging, as we all know. We need to tackle the root causes of poor health, not only the symptoms. The population of our country is growing. As both the right hon. Lady and the hon. Gentleman pointed out, growth in London boroughs is particularly acute and has been rapid over the six years since the formula was put in place, and we recognise the demand on the NHS, social care and other public services. My right hon. Friend the Secretary of State for Health and Social Care and the Prime Minister are aware of the great gaps in life expectancy in London boroughs and across the country. We also know that lots of diseases that people die from nowadays are preventable, which is why we want to put prevention at the heart of what we do. The Prime Minister’s ambition is to extend healthy life expectancy by five years by 2035 and to reduce the gap between the richest and the poorest. We have made great strides in many areas.

Childhood obesity is an international problem, but we are being ambitious on it, as well as on air quality and tobacco. All these measures have the potential to make a real difference to people’s health and wellbeing. We have reduced sugar in fizzy drinks by 11%, we have cut average calories per portion by 6% through the soft drinks levy, and by 2020 the NHS diabetes prevention programme will support 100,000 people at risk of diabetes across England each year. On screening, the right hon. Lady will be aware that Professor Sir Mike Richards is undertaking a screening review at the moment, so issues such as those she raises about bowel screening will be brought up. That review will report later in the year.

The Green Paper is coming up and I hope that that will take us even further. We need action across local government, central Government and the NHS. Of course, the over-50s group to which the right hon. Lady has referred is an important part of that, because only through everybody working together will we be able to tackle the determinants of health and be far more successful at improving and protecting health outcomes.

To move specifically to public health and where it sits now, we gave back to councils responsibility for public health in 2013. That was important. They recognise what is relevant for their communities and are uniquely placed to use the full range of their activity—levers such as planning, transport, housing and the local economy—to promote better health.

[Joan Ryan]

I realise that there is not a great deal of time today, but the Minister says that the funding given to Enfield Council is relevant to its needs. Is she saying that the funding that it has been given is adequate to cover the public health requirements in Enfield?

--- Later in debate ---

[Seema Kennedy]

I will move on to the specific issue of the funding formula, how it came into being and how it might change. Of course public health is a question of the investment that national Government put in and how local authorities spend it, but there is a lot of innovation. I applaud Enfield Council and all local authorities for what they have done, because different authorities have used it in different ways. They are adopting innovative approaches. They are renegotiating contracts that perhaps had been untouched for years before the 2013 transfer. I will address funding later in my remarks. Councils are adopting new service models that have the potential to reach communities that have often been left out by traditional service delivery models.

I recognise that in the last spending review, there were difficult decisions to be made to ensure the sustainability of public finances, but over the five-year period, £16 billion has been available to local government for use on public health, including £3 billion for the current financial year.

The right hon. Lady raised a very important issue about the distribution of funding for local authority public health activity. I recognise the pressures that she has referred to specifically in relation to Enfield. When responsibility for local health functions moved from the NHS to local government in 2013, funding for relevant services was transferred to individual local authorities. That was based on historical local spend for the NHS, and the process revealed huge variation across the country. The funding for Enfield is based on what the NHS had been spending there up until 2013.

The Government are now carefully considering how to allocate public health funding in a more needs-based way, rather than continuing to allocate funding based on NHS historical spend. We recognise that Enfield’s per capita funding breakdown is different from that of other London boroughs, but a per capita basis is not actually a meaningful way of comparing allocations or the best way of determining funding. That is precisely because it takes no account of different levels of need and it disregards significant variables that have a major influence on the need for public health interventions. An example is the age profile of a local authority’s population. We will look carefully during the next spending review at future funding arrangements and the best way to allocate funding to each local authority.

On the letters from the Enfield Borough Over 50s Forum, if the right hon. Lady would like to distil those messages into a letter to me, I will happily respond to her and she can make that response available to her constituents.

[Bambos Charalambous]

A future funding formula needs to take account of need. There should not be the current differentiation. Kensington and Chelsea receives £82 per person more in funding than Enfield. It cannot be right that two boroughs that are about 8 miles apart have such a variance in funding. Will a future funding formula take more account of local needs?

[Seema Kennedy]

As I have said, the Department is looking at the funding formula. The hon. Gentleman says that the boroughs are only 8 miles apart, but we know that in areas that are very close together, life expectancy and, importantly, the length of time a person lives in good health can vary hugely. That is why we need to look very carefully at all the factors before the new formula is created. That will be assessed in the next spending review in the light of all the available evidence.

I am committed to working closely with local government, and with other partners and colleagues, to build on the achievements of the last six years. We need to act on a local, national and global level to meet the public health needs of the present and to rise to the public health challenges of the future.

Question put and agreed to.