Public health grant funding—a welcome boost after a decade of neglect

This year’s above inflation public health grant settlement is welcome.1 But with declining healthy life expectancy and funding still 26% lower per person than a decade ago, we need a multi-year funding plan to truly signify a long term shift to prevention.23

The local authority public health grant provides ring-fenced funding for essential services for disease prevention and tackling inequalities.4 This includes health visitors and sexual health services, as well as mental health programmes and healthy weight services.

The grant provides excellent value for money, costing just £3 800 for each additional quality adjusted life year (QALY) compared to £13 500 per QALY gained from NHS and healthcare interventions.5

The 2025/26 public health grant announcement of £3.9bn includes an uplift of £200m—a 5.4% uplift, or 3% in real terms.1 Though excellent news, real-terms funding is still 26% lower per person compared to its high point in 2015/16 and proportionally, is just 2.0% of the NHS budget compared to 3.6% a decade ago.3 Announced less than two months before the new financial year, it leaves scant time to plan and deliver new services.

Over the past decade, cuts in public health grant funding have directly impacted local public health programmes. For example, spend on sexual health services will have been reduced by an estimated 32% and on services for 0-5 year olds—including health visitors—by 25%.3

When public health first moved into local government in 2013, the grant was weighted based on local needs.6 However, the progressive cuts have not accounted for changing population needs and demographics. Absolute cuts have tended to be bigger in local authorities that serve more deprived communities.3 For example, Blackpool, ranked as the most deprived upper tier local authority in England, has experienced one of the largest absolute cuts to the grant since 2015/2016 of £43 per person in real terms. Compare this to Surrey, ranked 145 places lower, where real term cuts equate to £9 per person.

Moreover, uncertainty remains around additional grant allocations for crucial drug and alcohol services into 2025/26.7 For 2024/25, these additional grants totalled £266.7million. Add to this the challenges with above inflation salary costs. Many public health services are delivered by the NHS where Agenda for Change salaries rose 5.5% in 2024/25.8 And non-NHS providers are also grappling with increased wage bills following high levels of inflation and higher employer National Insurance contributions, with public health teams often having to pick up the tab.

The government has placed prevention at the centre of its health mission.  Investing in public health can build health and address local inequalities, paving the way towards the government’s vision of “a fairer Britain where everyone lives well for longer.”

Yet healthy life expectancy is falling with a gap of 18 years between local authorities in England.29 More than one in 7 deaths are estimated to be preventable through public health and primary prevention but projections indicate that by 2040, an additional 2.5 million people in England will be living with a major illness, placing ever more strain on an already stretched NHS and social care system.1011

Good health is essential for the government’s economic growth ambitions. In 2023, over eight million people aged 16–64 reported a long term health condition limiting the type or amount of work they can do—with four million unable to work at all.12

Restoring the public health grant to 2015/16 levels must be a key part of the government’s spring Spending Review to address these challenges. We have outlined how this can be done over a five-year period alongside more equitable distribution to meet local needs.6

This would cost a total of £5.5bn over five years (based on the 2024/25 grant), with £310m in the first year and building from there. Providing multi-year settlements would also allow for more strategic planning, preventing local authorities from having to adjust plans year on year in response to single year settlements.

While the grant is an essential part of shifting to prevention, this should be supported by a bolder regulatory approach to tackling key risk factors for poor health, including alcohol and unhealthy food.

The Tobacco and Vapes Bill and the creation of a smokefree generation in welcome, but obesity rates and deaths from alcohol continue to rise.131415 Despite public support for greater use of regulation and taxes, unhealthy food policy has been piecemeal and the resounding silence on action to tackle alcohol-related harms remains, with no national strategy for over a decade.16

Action on key risk factors should be underpinned by wider policy action on the building blocks of health such as fair pay, quality housing, clean air and secure employment.17 Local councils play a key role in these but funding pressures in recent years have meant cuts to vital local services.18 If the government is serious about its goal of increasing healthy life expectancy, it needs to embed health across all of government.19

The uplift in the 2025/26 public health grant settlement is welcome, but all eyes now turn to the spring Spending Review. This will be one of the last opportunities to announce a long term investment in public health. It's a chance the government can ill afford to miss.

Footnote: This piece was corrected on 13 March 2025 to correct an error in para 5.