Public Health Funding: Bexley

The result is that Bexley’s public health funding does not reflect its population, public health needs or ambitions to reduce health inequality. That has to be addressed by the Government. The covid-19 pandemic has worsened our position and exacerbated the conditions of poor health in Bexley, especially in the north of our borough, where there are the greatest pre-existing, underlying health inequalities. Covid-19 has also disproportionately impacted and exacerbated the health inequalities of our growing black, Asian and minority ethnic population, and our over-75 population, which is higher than the London average.

Bexley has also seen some of the highest covid-19 case rates in London, which reflects the underlying issues caused by the lower public health grant and therefore lower investment in public health measures to counteract the effects of disproportionality and inequality. Even the pandemic response in Bexley, which covers outbreak management, surveillance, monitoring, communications and engagement, community testing and contact tracing, would not have been possible without the additional grants made available by the Department of Health and Social Care, and the Ministry of Housing, Communities and Local Government. Other local authorities have more in-built capacity and workforce resilience, which allows them to divert resources to address a future health protection challenge, such as a major epidemic, or the pandemic that we are experiencing. Bexley does not have the flexibility in the core public health capacity.

We are also seeing the development of the NHS South East London integrated care system. The ICS has set out its key priorities to be tackling health inequalities, prevention, and improving the health and wellbeing of residents. Each place-based system will play a significant role in delivering those priorities. With Bexley having such a low base for the public health grant, it will be extremely difficult to achieve parity with what the other south-east London boroughs can offer their residents due to significantly higher budgets. That alone will create further inequalities and highlights the importance of levelling-up grant allocation.

Bexley experiences the same public health challenges as other London boroughs and has an ambitious prevention strategy. Bexley’s prevention strategy is a whole-system, five-year plan to prevent illness as well as poor health and social care outcomes, and also actively to promote a positive state of health and wellbeing for our residents. However, its funding allocation does not allow us the same opportunities to make positive changes to residents’ lives.

Bexley is a diverse, quickly changing and growing borough. It is a collection of communities working together and it is a great place. We anticipate a 7.6% population increase by 2030 and a 7.2% increase in the number of children living in Bexley. Some 30% of Bexley’s residents are young people under the age of 25, and Bexley has the fourth highest rate of people aged 65 and over in London, at 16.5%. That will increase to 21.8% by 2050. Our infant mortality rate is also 3.7 per 1,000 population and our neonatal maternity rate is 2.75 per 100,000, both of which are higher than the London average.

Hospital admissions for young people due to substance misuse are higher than the London average and our vaccination rates for childhood illnesses and for adult vaccinations, such as flu, are nationally lower. We have done a great job during the covid situation and our health service, our council and the doctors and pharmacists have done a fantastic job on vaccinations.

We recognise that the funding position for local authorities is challenging and we understand the huge efforts that local government has made to focus on securing the best value for every pound it spends. Today’s debate has highlighted an important issue about the distribution of funding for local authority public health functions. Prior to 2013, funding for individual local health services, including public health, was determined by NHS primary care trusts. As for all local authorities, Bexley London Borough Council’s allocation is heavily based on historical NHS spend prior to 2013.

However, the introduction of the public health grant to local authorities in 2013 has meant that spending on this set of services is now much more transparent. Before these functions were transferred to local government, we asked the independent Advisory Committee on Resource Allocation to develop a needs-based formula for distribution of the public health grant. The introduction of this formula meant that some local authorities received more than their target allocation, and others received funding under target. In 2013-14 and 2014-15, when the overall grant was subject growth, local authorities’ funding was iterated closer to their target through a mechanism called “pace of change”. Bexley Council benefited from this policy and received the maximum amount of funding growth, which I am sure my right hon. Friend appreciated.

The Government decided in 2015 that the fairest way to make subsequent changes to public health grant allocations was via flat percentage adjustments. Since 2019-20, adjustments have been made to the grant to take account of additional cost pressures such as the 2018 NHS “Agenda for Change” pay deal and the launch of routine pre-exposure prophylaxis—PrEP—commissioning, with all local authorities receiving a cash increase last year and this year to the public health grant, so that they can continue to invest in prevention and essential health services. For this financial year, Bexley Council received more than £9 million for the grant. We also allocated additional funding of £358,000 to Bexley this year to tackle obesity and drug addiction.

Nationally, the Government have made more than £12 billion available to local councils since the start of the pandemic to address the costs and impacts of covid-19, with £6 billion non-ringfenced in recognition of local authorities being best placed to decide how to manage the major covid-19 pressures in their local areas. I thank the hon. Member for Erith and Thamesmead (Abena Oppong-Asare) for mentioning the covid booster vaccine and my right hon. Friend the Member for Bexleyheath and Crayford for having it, which is probably the most important thing that people can do to continue to build our wall of defence, protect lives and reduce hospitalisations from the pandemic. While Bexley’s per capita funding is different from other London boroughs, a per-capita basis is not a meaningful way to compare or determine allocations, as it takes no account of different levels of need. We will consider the allocation of public health grant funding for future years following the outcome of the spending review; we do not have long to wait.

I commend all local authorities on their efforts to improve population health. Local authorities are ideally placed to make decisions about the services that best meet the needs of their populations. Across England, local authorities are commissioning more effectively and innovatively and delivering improved value, but we need to acknowledge that improving public health is about far more than the grant. We know that spending more money does not necessarily improve outcomes. However, what we spend it on really matters. The range of local government activity, including transport, planning and housing, contributes to population health and wellbeing. The place-based work led by local authorities makes joining up these different factors much easier, and the new Office for Health Improvement and Disparities supports all areas of the country to drive improvements in health.