Quantifying the unmet need that currently exists for Public Health Grant (PHG) services - Phase 1 and 2

Phase One (completed at the end of EEPRU2)

Quantifying the unmet need that currently exists for Public Health Grant services, and how this has changed over time [Phase 1 – Feasibility Study]

Aims:

To create an agreed definition of unmet need for each service area
To scope out existing or potential data sources to inform estimates of unmet need for each service area of the PH Grant, at the national level
To outline possible methodologies for measuring and monetizing unmet need, justifying for areas where this isn’t feasible, and to report on the feasibility to backdate estimates.
To provide information on what qualitative information would be valuable in understanding unmet need
To provide recommendations on which programme areas should be prioritised

Phase Two (EEPRU3)

Quantifying the unmet need that currently exists for Public Health Grant (PHG) services [Phase 2 – Delivery]

Aims:

To produce estimates of unmet need for specific PHG funded services for LA and national populations, with the main measure being a monetary amount
To use qualitative information from a national survey, and interviews in a sub-sample of up to 25 LAs, selected for maximum diversity, to gain insight into the major limitations of the estimates, and explore the factors that may facilitate closing the gap between identified unmet need and PHG spend at LA level.
To provide recommendations for future research, including areas with poor data availability

Project Team

Lindsay Blank, George Daly, Brigitte Delaney, Elizabeth Goyder

Contact

Lindsay Blank l.blank@sheffield.ac.uk

Plain English Summary

Background

Local Authorities (LAs) in England receive a significant amount of funding, known as the Public Health Grant (PHG), to provide essential public health services. However, the value of this grant has decreased over time, making it difficult for LAs to meet the needs of their communities.

Aims and Objectives

The goal of this research project is to:

Estimate Unmet Need: Calculate the amount of additional funding needed to fully address public health needs in each LA.
Understand the Problem: Explore the reasons why LAs struggle to meet these needs, including data limitations and decision-making processes.
Track Trends: Monitor changes in unmet need over time and compare these to changes in funding levels.
Identify Data Gaps: Pinpoint areas where better data is needed to improve future estimates.

Methods

The researchers will use a combination of data analysis and interviews with LA staff to achieve their goals. They will (the below may overlap):

Analyze Data: Use existing public data and data collected from LAs to estimate unmet need for various public health services.
Conduct Surveys and Interviews: Survey LAs to understand their current practices and challenges, and conduct in-depth interviews with a select group of LAs to gain a deeper understanding of their experiences.
Consult with Stakeholders: Work closely with government officials, public health experts, and other stakeholders to ensure the relevance and feasibility of the research.

Policy Relevance and Dissemination

The findings of this research will be valuable to policymakers and public health practitioners. By providing evidence-based estimates of unmet need, the research can help inform decisions about how to allocate PHG funding and prioritize public health services.

The research team will share their findings through various channels, including:

Reports: A public report summarizing the key findings.
Academic Publications: Peer-reviewed articles in scientific journals.
Conferences and Workshops: Presentations at relevant conferences and workshops.
Wider Engagement: Regular meetings with government officials and other interested parties to share findings and discuss implications.

Report and Research Summary

Blank L, Daly G, Delaney B, Goyder E (2026) Quantifying the unmet need that currently exists for Public Health (PH) Grant services: Combined final report of qualitative and quantitative data collection, methods of estimation and analysis of results. Policy Research Unit in Economic Evaluation of Health and Social Care Interventions. Universities of Sheffield and York. Report 084. doi: https://doi.org/10.15131/shef.data.34030941

Research Summary

Key messages:

A 25% real-terms reduction in the Public Health grant between 2015/16 and 2025/26 has put substantial strain on local authorities. Using a conservative "return-to-peak" (R2P) methodology comparing current spending to historic 2015/16 peak spending, the total estimated unmet public health need across England is £1.2 billion.

Service-area spending shortfalls: Based on R2P calculations, the largest service-specific unmet needs include children’s 0–5 services (£520m), sexual health (£447m), substance misuse (£370m), children’s 5–19 & NCMP (£223m), and obesity & physical activity (£222m). Specific modelling approaches also estimated sexual health unmet need separately at £552m.

Policy implications and systemic challenges: Unmet need is exacerbated by "unfair" historical funding allocations that failed to account for population shifts, competing pressures from acute services that threaten preventive spending, and instances where Directors of Public Health lack direct influence over spending decisions.

Data and workforce barriers: Effectively identifying and targeting population groups with high unmet need is severely hindered by inconsistent, non-granular local data as well as workforce shortages, particularly in specialized data analysis roles.

Key recommendations: Reversing unmet need requires restoring funding to 2015/16 peak levels alongside systemic reforms: improving local data collection quality, investing in workforce capacity development, and establishing local prioritisation and commissioning processes to target health inequalities and underserved groups.

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