Local authorities have a legal duty to ‘take such steps as they consider appropriate for improving the health of the people in its area' and since 2013 have taken responsibility for allocating the ringfenced public health grant to support this duty.
In the 10 years since the transfer of these funds, local authorities have taken different approaches to applying the grant, with some councils focusing on the services outlined in the grant conditions and others ‘reinvesting' the fund in the provision of wider council services to support health improvement.
I joined Nottingham City Council in 2021 during a period of review of structures and finances, so it was timely to have a fresh look at how the grant was being used to impact on the health of the local communities. I had amazing support from both the corporate leadership team and lead politicians which meant I was able to really explore the possibilities for a new approach to using the funds.
This work resulted in Nottingham developing a new approach to using the public health grant which is now informing similar reviews at a number of other councils across England.
Over eight weeks, every line of investment into council services was reviewed for its eligibility against the grant conditions and contribution to public health outcomes. Discussions were held with every division within the council to explore possible areas for joint working. To support understanding in the use of the grant a model was developed and a ‘reasonableness' test established, which considered if the current investment would continue if the council was no longer responsible for the grant.
The findings of this review were presented in a three-year transition plan embedded into the council's medium-term financial plan. The transition plan supports a reinvestment of nearly £8m into interventions where the greatest impact on health and inequalities can be realised. These investments are guided by a refreshed approach to the Joint Strategic Needs Assessment and a co-produced Joint Health and Wellbeing Strategy (JHWS).
The use of the public health grant is overseen by the Office of Health Improvement and Disparities (OHID). The transition plan was shared with the regional OHID team, who provided assurance both of the process undertaken and planned investments. This ongoing close working has provided validity to the findings and helped disseminate learning across both regional and national networks.
Mike Wade, interim regional director of public health, highlighted that the council has been very proactive about reviewing the use of the grant and the robustness and openness of our approach has provided the opportunity for joint working with regional OHID in the development of future plans. The use of the grant is only one aspect of the role of public health teams.
Directors of public health have statutory duties relating to improving and protecting the health and wellbeing of the population and providing expert public health advice to the local system. The review of the use of the public health grant within Nottingham both informed and enabled a refresh of the ability of the director of public health to meet these wider duties and the skills of the team needed to facilitate them. A restructure of the public health function followed, with enhanced provision for epidemiology, research and intelligence to support system planning of interventions and a comprehensive training and continuous professional development programme to ensure embedding of robust public health practice across the whole team.
Councillor Linda Woodings, portfolio holder for adults and health and chair of the health and wellbeing board, believes the review of the public health grant was a catalyst for positive change in the role of public health within the local system.
The enhanced core offer from the team has meant public health is at the core of the integrated care strategy, we are able to invest in services that will have a huge impact for our population, and our joint implementation of the JHWS with the place-based partnership is recognised in a national award for its innovation and impact.
Another benefit of the review is enhanced governance and decision-making relating to the grant. An officer-led programme board reviews every decision about proposed spend to assure its impact on outcomes and eligibility of use, as well as reviewing existing investments, including commissioned services. Annual reports on the grant are provided to the council member-led executive and presented to the council's overview and scrutiny committee.
Ross Brown, the council's corporate director for finance and resources has said the review of public health funding is a positive example of how the council is implementing best practice in financial planning and governance, as demonstrated by a number of other councils looking to take a similar approach to Nottingham.
The learning from Nottingham has been shared widely by the Association of Directors of Public Health and the public health team are keen to learn from good practice elsewhere in the country.
Lucy Hubber is director of public health, Nottingham City Council
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