Faculty of Public Health
Of the Royal Colleges of Physicians of the United Kingdom
Working to improve the public’s health
Nick Adkin
Deputy Director – Children and Young People’s Public Health Nursing
Department of Health
79 Whitehall, SW1A 2NS
Dear Nick
Please accept my apologies for the late arrival of this response today, to the short engagement on 0-5
funding, which closed on 27 March. I am afraid I do not recall FPH having been invited to respond,
and hope that the brief responses below might be taken into account.
Question 1: Should the population base be the projected number of under 5 year olds in each
local authority?
As the two options are both estimates, and for the reasons set out in the paper, it would seem best to
use the projected number.
Question 2: Should population churn be taken into account, and if so what are the higher costs
imposed?
We would agree that it would be helpful to take churn into account.
Families that move will generate additional costs and many (for example migrant families), will have
specific needs.
However, we would highlight that determining the costs will not be easy. FPH would be happy to work
with/advise ACRA on this as they continue to work on developing the formula.
Question 3: What should be the measure of relative need per head and what are the relative
merits of child poverty versus other measures?
Child poverty should be the measure. The other two suggested may be positively influenced by other
public health initiatives, penalising a successful PH directorate.
4 St Andrews Place  London  NW1 4LB  Tel: 020 3696 1452  Fax: 020 3696 1457
Email: [email protected]  Website: www.fph.org.uk  Registered Charity No: 263894
Question 4: How should the measure of relative need per head be weighted and what factors
should be taken into account in the weights?
Weighting depends on evidence of need and cost. It requires arbitrary selection of a multiplier – there
is no clear empirical base for the multiplier, or whether it is appropriate to apply single multiplier across
different sized populations.
Question 5: What evidence is there for a weight per head?
FPH is not in a position to offer specific comment.
Question 6. Is a weight per head of three times that for families in poverty compared with other
families representative?
No. Weight is dependent on evidence of cost and need. A weight of 3 is arbitrary and assumes the
same weight should apply regardless of numbers or proportions of populations.
Question 7. Should the measure for relative need be applied at small area level to take account
of differences in need within local authorities as well as between local authorities, subject to
the data being reliable for small areas?
Yes – there is a need for reliable small area level data. FPH is keen to look at the lower level of
distribution, although is cautious about assumptions in absence of figures with which to judge.
Question 8. Should differences in unavoidable costs across the country be taken into account
using the Market Forces Factor (MFF)?
Yes, but these costs should reflect nature of the service and balance between activity at fixed sites
and home visits.
Question 9. Are longer travel times for home visits by health visitors a significant higher
unavoidable cost for some areas?
Yes, e.g. rural areas
Question 10: Is the travelling salesman model a suitable methodology and what should be the
parameters required for the model?
4 St Andrews Place  London  NW1 4LB  Tel: 020 3696 1452  Fax: 020 3696 1457
Email: [email protected]  Website: www.fph.org.uk  Registered Charity No: 263894
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FPH is not in a position to offer specific comment.
Question 11: Is it appropriate not to have a separate formula for the FNP on the grounds of
materiality in the context of the size of the combined budgets for 0-5s and other public health
duties?
At the present time a separate formula for this element does not appear necessary.
Best wishes
Mark Weiss
Senior Policy Officer
[email protected]
020 3696 1479
4 St Andrews Place  London  NW1 4LB  Tel: 020 3696 1452  Fax: 020 3696 1457
Email: [email protected]  Website: www.fph.org.uk  Registered Charity No: 263894
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