In an increasingly complex landscape with limited local budgets, PHE and the LGA are committed to provide as much support as possible to local authorities.
The main aim of our work is to enable local teams to create public health systems that have the greatest impact on improving the public’s health and get the most out of every pound.
That’s why, this week, PHE has updated the Spend and Outcome Tool (SPOT). SPOT allows users to see how much is being spent and the impact it is having on relevant outcomes, meaning they can compare across public health programmes, and compare these data against other local authorities.
The tool provides insight and understanding of the relationship between spend and outcomes by identifying areas where there is significant variation that warrants further investigation.
SPOT does not estimate value for money or return on investment (RoI). PHE has produced several topic specific RoI tools, which we talk about later.
By using SPOT, public health teams and commissioners can:
- compare spending and impact data against that of other local authorities or CCGs
- look at spend against a selection of outcomes across public health interventions and frameworks, including the Public Health Outcomes Framework
- identify programmes with outcomes that are significantly different to similar local authorities or CCGs, which may need more analysis
- use the tool alongside return on investment and health economics tools
A video introduction to the use of SPOT is available on the SPOT website.
We asked some local users for their feedback on SPOT:
“We find the SPOT tool a very useful way to explore our spend and outcomes in public health and identify where we may need to adjust our priorities. We use it in our prioritisation process both within public health and in discussions with colleagues in other parts of our local authority, helping us to argue for investment in the wider determinants of health.” - David Whiting, Consultant in Public Health, Medway
“We used the SPOT tool to present to Dorset County Council’s Forward Together Board. We used it to compare spend and outcomes by programme in Dorset in comparison to its CIPFA nearest neighbours. The impact it had was to help inform the priorities set by Cabinet Members and the Corporate Leadership Team.” - Lee Robertson, Senior Public Health Analyst, Dorset
The Prioritisation Framework
Local areas can use the updated SPOT tool together with the Prioritisation Framework to enable them to put their budget to best use.
We know that decision making in local authorities is becoming increasingly complex and the Prioritisation Framework is a flexible tool, which alongside the SPOT tool, can enable local authorities to make evidence-based spending decisions.
By going through the process outlined in the framework, local public health teams can evaluate public health programmes through triangulation of the potential state, the current state and the programme budgets, all the while considering what is feasible.
The framework does not tell you how to allocate budgets between programmes; rather it allows local public health teams to break down big decisions into smaller manageable pieces by considering:
- which programmes could offer the greatest value in the future
- the current state of programmes that are being delivered
- the budget currently divided across programmes
- how easy it is for programmes to change
By thinking in this structured way, local public health leaders will be able to make recommendations on whether to increase, decrease or maintain spend in each programme area.
Topic specific economic tools
Taking things one step further, PHE’s Health Economics team has produced a number of resources, which can be used to estimate the value of investing in prevention and early diagnosis in specific areas.
These tools pull together the best available evidence on costs, savings, and health benefits for specific topic areas in a single place, thus simplifying the process of commissioning cost-effective services.
The interactive tools produced by PHE are:
- Colorectal cancer
- NHS Diabetes Prevention Programme
- End of life care
- Weight management
- Oral health in pre-school children
- Mental health service
- Musculoskeletal conditions
- Movement into employment
- Falls prevention
- Best Start in Life
- Air pollution
It is important to remember that the Prioritisation Framework, SPOT or the various RoI tools will not tell local areas how to spend their public health budget.
We strongly believe local public health teams are best placed to make these decisions and we want to help them to compare and prioritise so the process is evidence based, while having the biggest impact on the health of their population.