Moving beyond the short term in public health investment: can you help?


Rob Whiteman presented to the Public Health Conference held on 3 February 2016 by the Local Government Association.

Download the presentation slides here


Citing the view that ‘culture eats strategy for breakfast’, Rob emphasised the importance of ensuring that, as a matter of course, managers understand and act on the need for integration and early intervention in their everyday thinking. This means paying attention to both allocative efficiency (is the money allocated to where it is best spent?) and technical efficiency (are we spending the money allocated in the best way?).

In his presentation, he described a ‘tax trap’ which currently affects health spending: although Britain spends a relatively low proportion of its GDP on health compared with other like nations, the fact that it is almost all funded from taxes means that the spend is more politicised than elsewhere. This direct connection with the current political cycle makes it very hard to prioritise the radical investments for future benefit which a building consensus deems necessary. 

It’s not that reallocation or bids for more funding are impossible, for example those over working age now have (for the first time) a better financial position than those of working age, suggesting that the ‘triple lock’ which protects pensioners’ positions might sensibly be ended. Rather, the choices needed to increase tax income for health and social care purposes, or increase charges, are in the ‘too difficult box’, at least for the short term.

Consequently, the main hope to escape the ‘tax trap’ is to harness the energy and alternative thinking brought about by devolution. Yet another problem, Whiteman said, was that whether devolved or not, there isn’t the same agreement about how to measure the return on investment for revenue spend as there is for capital projects.

In that context, he announced a new project whereby CIPFA and Public Health England will work jointly on:

What are the right indicators to measure value in public health?

How can we best understand revenue investment? For example what should be the revenue equivalent of the ‘assessment of net present value return’ which is widely recognised as an objective means of assessing capital investment?

It is hoped that this project, together with continuing to work on developing the right behavioural instincts across the sector, will underpin a more rational way forward in which investment in Public Health can be reviewed and prioritised appropriately against competing pressures.

We would be delighted to have your input on this important area of work. Please contact E: if you are interested in contributing or commenting.