Abstract
Background: In 2013, public health moved into Local Authorities, but initial optimism has been overtaken by serious ongoing financial constraints and an uncertain future. Hard choices have become an everyday reality across local authorities and for their public health teams. Assessing the return-on-investment of public health interventions and possessing economic evaluation skills have become more critical than ever before.Methods: Using the New Economy cost-benefits-analysis model developed at the Greater Manchester Combined Authority, we undertook cost benefit analyses of some of our largest areas of commissioned spend in local public health practice to better understand both the public and fiscal returns of our interventions.Results: The cost-benefit analyses indicated considerable variation in the public (economic and social) returns-on-investment for our spend on services purchased as a commissioner with £1.37 to 6.81 returned for every £1 spent, and a fiscal return for every £1 invested of between £0.54 and 1.37. Additionally, the fiscal benefits (reduced service costs) of these public health interventions appear to primarily flow to the NHS, which accounts for about 94% of the fiscal return.Conclusion: While cost-benefit modeling cannot provide a complete picture of “value,” it does provide decision-makers with a transparent metric that facilitates a whole-of system discussion on “intervention value” and prevention at scale investments. This approach will support investment strategies when implementing Sustainability and Transformation Partnerships and Integrated Care Systems. However, these tools should be used to support robust decision-making processes, not as a replacement for or a short-circuiting of existing processes.
Highlights
Scarcity and austerity have become the “new norm” in the UK public service and this is very apparent in the funding of local public health services [1, 2]
Summarized evidence relating to approximately 200 public health interventions, including areas of smoking, alcohol and physical activity, shows that the vast majority of these interventions are highly cost-effective, and in most cases are far below the recommended National Institute for Health and Care Excellence (NICE) threshold of £20,000 per Quality-Adjusted Life Year (QALY) [22]
We provide a clear ranking of return on investment from five public health programmes that we commission
Summary
Scarcity and austerity have become the “new norm” in the UK public service and this is very apparent in the funding of local public health services [1, 2]. Mandated programmes and ring-fenced grants reinforced notions of a more secure future This initial optimism has been overtaken by harsh local and national financial realities with significant reductions to both local authority general funding and to the national public health grant over the period 2015–2020 and with a very uncertain future beyond that. Against this backdrop and that of increasing need, inequality and poverty [3, 4], hard choices have become an everyday reality for public health teams. Assessing the return-on-investment of public health interventions and possessing economic evaluation skills have become more critical than ever before
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