Report of the Director Public Health attached

The report of the Director of Public Health explained how the budget proposals for the Directorate had been developed.

Public Health was funded nationally through a specific ringfenced grant. However, the Greater Manchester locality had been part of the governments business rates pilot for a number of years whereby the funding ringfence is removed and an equivalent allocation received as an adjustment to business rates.  The gross 2023/24 budget was £54.126m with a net budget of £43.266m.  Income of £10.860m included use of reserves £3.753m, government grants £4.489m and other contributions from NHS partners, from other local authorities and Better Care Fund totalling £2.618m.

The latest 2023/24 global monitoring report to the Executive outlined a £0.8m underspend.  Consequently, the  required 2023/24 savings of £0.730m had been achieved in full through a mixture of  underspends across the staffing budgets due to vacant posts and the maximisation of external funding, and underspends on other indirect staffing costs.

The provisional public health settlement had been received for 2024/25, a 1.318% increase totalling £0.752m. The final confirmation was expected before the end of March 2024. No additional growth and pressures were approved for 2024-26.  Provision had been made for inflationary price increases and potential pay awards. This was held corporately and would be allocated to service budgets when the details were available and considered together with the funding settlement for Public Health

The 2023/24 budget for the Manchester Locality Structure for health was provisionally set at £8.3m, which was lower than the existing cost of the locality structure. The budget and structures were subject to consultation prior to a final agreed position with the Integrated Care Board (ICB). The final allocation for running costs was £7.8m.

To avoid losing capacity that was essential to the provision of NHS services in Manchester and to ensure there was a managed transition to reducing costs, the Council had agreed to fund the public health, population health and equality, inclusion and engagement teams, recurrently by applying £0.5m of public health grant. In addition, a one off £1m from the Public Health reserve was proposed to smooth the transition from the CCG to the locality place based budgets and underwrite any potential shortfall.

Further work was being undertaken to reduce costs and ensure the 2024/25 budget was within the resources available. The 2024/25 planning round was currently underway to understand what recurrent allocations were available from the ICB to support running costs. This was focused on further aligning health and care within Manchester, working across the partnership to create a more integrated model for the City, focused on delivering the right outcomes for Manchester’s population in a financially sustainable way.  Further discussions were being held on the locality budget and there was a need to manage the use of all available resources to support the integration of health and care across Manchester.

The public health budget had been allocated to ensure sustainable funding for the previously funded CCG/GMICB health protection posts and the CCG/GMICB Engagement and Equalities function, which would be fully integrated into the Manchester Locality (MLCO and MCC) from 1 April 2024.

The other budget priorities for public health related to the demand pressures on commissioned services such as sexual health, along with the investments in the Making Manchester Fairer Programme which was a priority for the City Council and partners. This work needed to be concluded before the final decisions on the allocation of the funding could be made.

In terms of Making Manchester Fairer (MMF) (the Council’s five-year action plan to address health inequalities in the city focussing on the social determinants of health), investment of up to £2.989m over the 2023/24 and 2024/25 financial years had been identified from Public Health reserves. This was one off funding of which £2.281m had been used to support the Kickstarters programme, and this was phased over 2023/24 (£944k) and 2024/25 (£1.337m). The remaining £0.708m budget was allocated to programme delivery that included, staffing costs, communications and other commissioned activity.

In addition, It had been agreed that a 5% of the Cost of Living Group budget (£178k) would be made available to support the Anti Poverty Strategy work.

There were no workforce implications based on the budget proposals. More generally, work had taken place over the past 12 months to establish virtual teams aligned to thematic delivery. This had provided a better environment in which to share skills and expertise across the Department and provided clarity and stability to the workforce post-pandemic

It was noted that the report had also been considered at a recent meeting of the Health Scrutiny Committee where the committee had endorsed the budget proposals (Minute HSC/24/08)

Decision

The Executive approve the budget proposals as set out in the report.