Guidance

Public health ring-fenced grant 2023 to 2024: local authority circular

Updated 27 November 2023

Applies to England

This circular sets out:

• allocations of the local government public health grant for 2023 to 2024
• the conditions that will apply to that grant
• guidance intended to assist local authorities

Background

In 2023 to 2024, the total public health grant to local authorities will be £3.530 billion.

Some grant allocations have been updated to include additional in-year cost impact of the consolidated element of the NHS AfC pay award for non-NHS providers commissioned by local authorities. Column J in the accompanying ‘Public health local authority allocations 2023 to 2024’ spreadsheet shows the 26 local authorities that will receive this additional funding. The funding will be paid through an uplift to their quarter 4 public health grant payment.

The grant will be ring-fenced for use on public health functions. This may include public health challenges arising directly or indirectly from coronavirus (COVID-19).

The Secretary of State has determined, pursuant to section 31 of the Local Government Act 2003, to pay grants to relevant authorities in the amounts indicated for the financial year 2023 to 2024.

This circular is accompanied by 4 annexes:

Annex A: public health ring-fenced grant determination and conditions 2023 to 2024

Annex B: public health grant allocations for 2023 to 2024

Annex C: public health reporting categories for 2023 to 2024

Annex D: assurance letter

The grant

The 2023 to 2024 grant will be paid in quarterly instalments:

Quarter 1 - Thursday 6 April 2023

Quarter 2 - Friday 7 July 2023

Quarter 3 - Friday 6 October 2023

Quarter 4 - Friday 5 January 2024

Pursuant to section 31(4) of the Local Government Act 2003 the Secretary of State has attached conditions to the payment of the grant, which are set out at Annex A and are unchanged from 2022 to 2023. When assessing whether local authorities have complied with these conditions, the Department of Health and Social Care (DHSC) will continue to look at the primary purpose of local authorities’ spending.

The department’s presumption is that the grant will be spent in-year. If at the end of the financial year there is any underspend, local authorities may carry these over, as part of a public health reserve, into the next financial year. In using those funds the next year, local authorities will still need to comply with the grant conditions. The department may consider reducing future grant amounts to local authorities that report significant and repeated underspends.

The grant in 2023 to 2024 includes an adjustment to cover the cost of the roll out of the £1.41 million provided to local authorities to support implementation of their duties under the Botulinum Toxin and Cosmetic Fillers (Children) Act 2021. The distribution of this funding can be found on the ‘Public health local authority allocations 2023 to 2024’ spreadsheet published alongside this circular.

Reporting of grant expenditure

Local authorities will need to forecast and report against the sub-categories in the Revenue Account (RA) and Revenue Outturn (RO) returns to the Department for Levelling Up, Housing and Communities (DLUHC) which will share data with DHSC. The main and primary purpose of all spend from the grant is public health.

Given that the RO return is used as a way of monitoring the usage of the grant, it is important that both the finance contacts and public health teams responsible for this section of financing are content with the figures submitted. Local authorities will need to ensure that the figures are verified and in line with the purpose set out in the grant conditions. A list of the reporting categories is at Annex C. Local authorities’ Chief Executives (or section 151 officers) and Directors of Public Health will also need to return a statement confirming that the grant has been spent in accordance with the conditions. The required statement is at Annex D.

Year-end reporting

At the end of the financial year, local authorities will need to submit a more detailed RO return to DLUHC. Local authorities must record expenditure against each of the prescribed functions categories which are classified in Annex C, to demonstrate that they are undertaking activity in these areas.

The full value of the grant must be accounted for in the RO returns. As such, the closing value of a local authority’s public health reserve minus the opening value of the public health reserve when added to the net spend reported in the year, must be greater than or equal to the value of the grant for the year.

Where income relating to public health activities is received from other sources than the ring-fenced grant, and such income is recorded on the RO return as public health, then the corresponding expenditure should also be recorded as public health, and any income not spent at the year-end should be carried forward in the public health reserve.

Guidance on reporting and categorisation of spend is available to local authorities in the Service Reporting Code of Practice (SeRCOP) on how activity should be recorded against the sub-categories.

Enquiries

Enquires about this circular should be addressed to the Department of Health and Social Care at phgfinance@dhsc.gov.uk.

Annex A: Determination under section 31 of the Local Government Act 2003 of a ring-fenced public health grant to local authorities for 2023 to 2024

Public health ring-fenced grant determination 2023 to 2024: No 31/6550

The Secretary of State for Health and Social Care (‘the Secretary of State’), in exercise of the powers conferred by section 31 of the Local Government Act 2003, makes the following determination:

Citation

This determination may be cited as the ‘Public health ring-fenced grant determination 2023 to 2024: No 31/6550’.

Purpose of the grant

This grant can be used for both revenue and capital purposes.

The purpose of the grant is to provide local authorities in England with the funding required to discharge the public health functions detailed in paragraphs 2 to 4 below under ‘Grant conditions’.

Grant conditions

Pursuant to section 31(4) of the Local Government Act 2003, the Secretary of State determines that the grant will be paid subject to the conditions set out under ‘Grant conditions’, ‘Reporting’ and ‘Financial management’ below.

The ring-fence on the grant will remain in 2023 to 2024.

Determination

The Secretary of State determines as the authorities to which the grant is to be paid and the amount of grant to be paid in the financial year 2023 to 2024, the authorities and the amounts for the financial year 2023 to 2024 are set out in Annex B.

Treasury consent

Before making this determination the Secretary of State obtained the consent of the Treasury.

Signed by authority of the Secretary of State for Health and Social Care

Simon Reeve
Deputy Director – Public Health Systems and Workforce
Department of Health and Social Care

Grant conditions

1. In this determination:

• ‘an authority’ means an upper tier or unitary local authority identified in Annex B

• ‘the department’ means the Department of Health and Social Care

• ‘financial year’ means a period of 12 months ending 31 March 2024

• ‘NHS body’ means an NHS body within the meaning of section 75 of the National Health Service Act 2006

• ‘grant’ means the amounts set out in the ‘Ring-fenced public health grant determination 2023 to 2024’

• ‘Upper tier and unitary local authorities’ means:

  • a county council in England
  • a district council in England, other than a council for a district in a county for which there is a county council
  • a London borough council
  • the Council of the Isles of Scilly
  • the Common Council of the City of London

Use of the grant

2. Pursuant to section 31 of the Local Government Act 2003, the Secretary of State hereby determines that the public health grant shall be paid towards expenditure incurred, or to be incurred, by upper tier and unitary local authorities in the financial year 2023 to 2024. The relevant authorities are shown in the exposition book.

3. Subject to paragraph 5, the grant must be used only for meeting eligible expenditure incurred or to be incurred by local authorities for the purposes of their public health functions as specified in section 73B(2) of the National Health Service Act 2006 (‘the 2006 Act’).

4. The functions mentioned in that subsection are:

(a) functions under section 2B, 111 or 249 of, or schedule 1 to, the 2006 Act

(b) functions by virtue of section 6C of the 2006 Act

(c) the Secretary of State’s public health functions exercised by local authorities in pursuance of arrangements under section 7A of the 2006 Act

(d) the functions of a local authority under section 325 of the Criminal Justice Act 2003 (co-operating with the police, the probation service and the prison service to assess the risks posed by violent or sexual offenders)

(e) such other functions relating to public health as may be prescribed

5. A local authority may use the grant to contribute to a fund made up of:

(a) contributions by the authority from both the public health grant and other sources of funding - for example, from other local authority funding, or from payments made by a private sector or civil society organisation; or

(b) contributions by the authority and one or more of any of the following bodies, provided the conditions specified in paragraph 6 are met:

(i) another local authority

(ii) an NHS or other public body

(iii) a private sector or civil society organisation

6. The conditions referred to in paragraph 5 are that:

(a) the fund must be one out of which payments are made towards expenditure incurred in the exercise of, or for the purposes of, the functions described in paragraph 3

(b) if payments are made out of the fund towards expenditure on other functions of a local authority or the functions of an NHS body, other public body, or a private sector or civil society organisation, the authority must be of opinion that those functions have a significant effect on public health or have a significant effect on, or in connection with, the exercise of the functions described in paragraph 3

(c) the authority must be satisfied that, having regard to the contribution from the public health grant, the total expenditure to be met from the fund and the public health benefit to be derived from the use of the fund, the arrangements provide value for money

7. A local authority must, in using the grant:

• have regard to the need to reduce inequalities between the people in its area with respect to the benefits that they can obtain from that part of the health service provided in exercise of the functions referred to in paragraph 3

• have regard to the need to improve the take up of, and outcomes from, its drug and alcohol misuse treatment services, based on an assessment of local need and a plan which has been developed with local health and criminal justice partners

8. The public health grant will only be paid to local authorities to support eligible expenditure. Grant carried over to the following year is governed by the grant conditions.

Eligible expenditure

9. Eligible expenditure means expenditure incurred by an authority or any person acting on behalf of an authority, between 1 April 2023 and 31 March 2024, for the purposes of carrying out the public health functions referred to in paragraphs 3 and 4.

10. If an authority incurs any of the following costs, those costs must be excluded from eligible expenditure:

a) contributions in kind

b) payments for activities of a political or exclusively religious nature

c) depreciation, amortisation or impairment of fixed assets owned by the authority

d) input VAT reclaimable by the authority from HM Revenue and Customs

e) interest payments or service charge payments for finance leases

f) gifts, other than promotional items, with a value of no more than £10 in a year to any one-person subject to the exception in paragraph 11

g) entertaining (entertaining for this purpose means anything that would be a taxable benefit to the person being entertained, according to current UK tax regulations)

h) statutory fines, criminal fines or penalties

11. Expenditure on promotional items in fulfilment of the local authority’s health improvement duty under section 2B of the 2006 Act such as products, goods or services which are given for health improvement purposes may form part of eligible expenditure. This could include for example, vouchers for gym or fitness classes, nicotine patches or other expenditure which corresponds with the health improvement objectives of the public health grant.

12. An authority must not deliberately incur liabilities for eligible expenditure before there is an operational need for it to do so.

13. For the purpose of defining the time of payments, an authority shall account for its spend from the grant using the accrual basis of accounting (for an explanation of accrual accounting please refer to the CIPFA Code of Practice on Local Authority Accounting in the United Kingdom).

Payment arrangements

14. Grants will be paid in quarterly instalments by DHSC.

Reporting

End-of year reporting

15. Each authority shall prepare a return setting out how the grant has been spent using the Revenue Outturn (RO) form at the end of the financial year covering the period 1 April 2023 to 31 March 2024. In accordance with existing practice, this will be submitted to DLUHC which will share the information with DHSC. A list of the lines of expenditure (categories) that will need to be reported on is attached at Annex C. The RO form must provide details of eligible expenditure in the period, against each relevant category.

16. The returns must be certified by the authority’s Chief Executive (or the authority’s S151 Officer) and the Director of Public Health that, to the best of their knowledge, the amounts shown on the statement relate to eligible expenditure on public health and that the grant has been used for the purposes intended, as set out in this determination. Chief executives have been provided with a statement of assurance for their signature at Annex D. This should be submitted to DHSC at phgfinance@dhsc.gov.uk.

17. The Secretary of State may require a further external validation to be carried out by an appropriately qualified independent accountant or auditor of the use of the grant where the RO return referred to in paragraph 16 above fails to provide sufficient assurance to the Secretary of State that the grant has been used in accordance with these conditions.

18. While the grant should not be used for interest or service charge payments or finance leases, it can be used for capital spend on items that do not entail borrowing or a finance lease. Capital expenditure should be noted as a Capital Expenditure from Revenue Account (CERA) payment on the RO form and details provided on the Capital Outturn Return (COR) form issued by the DLUHC. Further guidance will be supplied with the forms that DLUHC send out.

19. In accordance with existing practice, local authorities should send the RO to DLUHC.

Financial management

20. Each authority must maintain a robust system of internal financial controls and inform the department promptly of any significant financial control issues raised by its internal auditors in relation to the use of the public health grant.

21. If an authority identifies any overpayment of the grant, the authority must repay this amount within 30 days of it coming to their attention.

22. If an authority has any grounds for suspecting financial irregularity in the use of any grant paid under this funding agreement, it must notify DHSC immediately, explain what steps are being taken to investigate the suspicion and keep the department informed about the progress of the investigation. For these purposes ‘financial irregularity’ includes fraud or other impropriety, mismanagement, and the use of the grant for purposes other than those for which it was provided.

External audit arrangements

23. Appointed auditors are responsible for auditing the financial statements of each authority and for reaching a conclusion on an authority’s overall arrangements for securing economy, efficiency and effectiveness in the use of resources. The use of, and accounting for, the public health grant and the arrangements for securing economy, efficiency and effectiveness in doing so fall within the scope of the work that appointed auditors may plan to carry out, having regard to the risk of material error in the authority’s accounts and significance.

Records to be kept

24. Each authority must maintain reliable, accessible and up to date accounting records with an adequate audit trail for all expenditure funded by grant monies under this determination.

25. Each authority and any person acting on behalf of an authority must allow a) the Comptroller and Auditor General or appointed representatives and b) the Secretary of State or appointed representatives free access at all reasonable times to all documents (including computerised documents and data) and other information as is connected to the grant payable under this determination, or to the purposes for which the grant was used, subject to the provisions in paragraph 27.

26. The documents, data and information referred to in paragraph 25 are such as the Secretary of State or the Comptroller and Auditor General may reasonably require for the purposes of the Secretary of State’s or the Comptroller and Auditor General’s financial audit or that any department or other public body may reasonably require for the purposes of carrying out examinations into the economy, efficiency and effectiveness with which any department or other public body has used its resources. An authority must provide such further explanations as are reasonably required for these purposes.

27. Paragraphs 24 and 25 do not constitute a requirement for the examination, certification or inspection of the accounts of an authority by the Comptroller and Auditor General under section 6(3) of the National Audit Act 1983. The Comptroller and Auditor General will seek access in a measured manner to minimise any burden on the authority and will avoid duplication of effort by seeking and sharing information with the Audit Commission.

Breach of conditions and recovery of grant

28. If an authority fails to comply with any of these conditions, or any overpayment is made under this grant, or any amount is paid in error, or if an authority’s chief executive or S151 officer and director of public health are unable to provide reasonable assurance that the RO form, in all material respects, fairly presents the eligible expenditure, in the relevant period, in accordance with the definitions and conditions in this determination, or any information provided is incorrect, the Secretary of State may reduce, suspend or withhold grant payments or require the repayment of the whole or any part of the grant monies paid, as may be determined by the Secretary of State and notified in writing to the authority. Such sum as has been notified will immediately become repayable to the Secretary of State who may set off the sum against any future amount due to the authority from central government.

Underspends

29. If there are funds left over at the end of the financial year they can be carried over into the next financial year. Funds carried over should be accounted for in a ring-fenced public health reserve. All the conditions that apply to the use of the grant will continue to apply to any funds carried over. However, where there are large underspends, the department reserves the right to reduce allocations in future years.

Annex B: public health allocations to unitary and upper tier local authorities in England for 2023 to 2024

ECODE	Class	Local authority	2023 to 2024 (£)
E5030	LB	Barking and Dagenham	18,367,243
E5031	LB	Barnet	18,915,473
E4401	MD	Barnsley	18,399,241
E0101	UA	Bath and North East Somerset	10,004,992
E0202	UA	Bedford	9,457,237
E5032	LB	Bexley	10,605,794
E4601	MD	Birmingham	99,100,191
E2301	UA	Blackburn with Darwen	15,991,284
E2302	UA	Blackpool	19,858,394
E4201	MD	Bolton	23,384,547
E1204	UA	Bournemouth, Christchurch and Poole	21,288,254
E0301	UA	Bracknell Forest	4,533,960
E4701	LB	Bradford	45,324,836
E5033	UA	Brent	23,630,445
E1401	UA	Brighton and Hove	22,367,998
E0102	LB	Bristol, City of	35,864,171
E5034	UA	Bromley	16,120,485
E0402	MD	Buckinghamshire	22,981,153
E4202	MD	Bury	12,659,979
E4702	SC	Calderdale	14,458,573
E0521	LB	Cambridgeshire	29,309,716
E5011	UA	Camden	29,314,348
E0203	UA	Central Bedfordshire	13,548,441
E0603	UA	Cheshire East	17,972,237
E0604	MD	Cheshire West and Chester	17,748,013
E5010	LB	City of London	1,758,476
E0801	UA	Cornwall	27,963,177
E1302	UA	County Durham	52,648,142
E4602	UA	Coventry	23,962,345
E5035	MD	Croydon	23,588,163
E0901	LB	Cumberland Council	12,194,616
E1301	UA	Darlington	9,118,917
E1001	UA	Derby	21,185,206
E1021	UA	Derbyshire	45,232,201
E1121	SC	Devon	30,801,194
E4402	SC	Doncaster	26,125,578
E1203	MD	Dorset	15,090,023
E4603	UA	Dudley	22,733,920
E5036	MD	Ealing	26,778,734
E2001	UA	East Riding of Yorkshire	11,996,867
E1421	LB	East Sussex	29,803,623
E5037	UA	Enfield	18,611,479
E1521	SC	Essex	67,756,283
E4501	LB	Gateshead	17,787,149
E1620	SC	Gloucestershire	26,086,809
E5012	MD	Greenwich	25,492,907
E5013	SC	Hackney	37,041,054
E0601	LB	Halton	11,116,501
E5014	LB	Hammersmith and Fulham	24,016,263
E1721	UA	Hampshire	56,186,775
E5038	LB	Haringey	22,203,099
E5039	SC	Harrow	12,006,594
E0701	LB	Hartlepool	9,665,519
E5040	LB	Havering	12,001,420
E1801	UA	Herefordshire, County of	9,901,329
E1920	LB	Hertfordshire	53,005,878
E5041	SC	Hillingdon	19,143,424
E5042	LB	Hounslow	17,329,269
E2101	LB	Isle of Wight	8,194,235
E4001	UA	Isles of Scilly	139,872
E5015	UA	Islington	29,052,254
E5016	LB	Kensington and Chelsea	22,889,252
E2221	LB	Kent	74,031,059
E2002	SC	Kingston upon Hull, City of	26,197,842
E5043	UA	Kingston upon Thames	11,109,624
E4703	LB	Kirklees	28,027,052
E4301	MD	Knowsley	18,678,653
E5017	MD	Lambeth	35,520,989
E2321	LB	Lancashire	74,839,391
E4704	SC	Leeds	48,663,310
E2401	MD	Leicester	29,169,450
E2421	UA	Leicestershire	27,086,931
E5018	SC	Lewisham	26,914,139
E2520	LB	Lincolnshire	35,983,937
E4302	SC	Liverpool	48,042,414
E0201	MD	Luton	16,699,599
E4203	LB	Manchester	57,047,527
E2201	UA	Medway	18,732,920
E5044	MD	Merton	11,450,918
E0702	UA	Middlesbrough	18,315,737
E0401	LB	Milton Keynes	12,521,740
E4502	UA	Newcastle upon Tyne	25,752,666
E5045	UA	Newham	33,675,740
E2620	MD	Norfolk	43,639,932
E2003	LB	North East Lincolnshire	12,315,639
E2004	SC	North Lincolnshire	10,022,510
E2801	UA	North Northamptonshire	18,659,834
E0104	UA	North Somerset	10,249,714
E4503	UA	North Tyneside	13,393,268
E2721	UA	North Yorkshire	23,721,035
E2901	MD	Northumberland	17,932,041
E3001	UA	Nottingham	36,615,358
E3021	UA	Nottinghamshire	44,567,373
E4204	UA	Oldham	18,283,836
E3120	SC	Oxfordshire	33,631,531
E0501	MD	Peterborough	11,945,954
E1101	SC	Plymouth	16,459,875
E1701	UA	Portsmouth	19,212,342
E0303	UA	Reading	10,652,810
E5046	UA	Redbridge	15,051,584
E0703	UA	Redcar and Cleveland	12,593,108
E5047	LB	Richmond upon Thames	10,195,780
E4205	UA	Rochdale	18,639,119
E4403	MD	Rotherham	17,770,537
E2402	MD	Rutland	1,410,486
E4206	UA	Salford	23,338,580
E4604	MD	Sandwell	26,657,917
E4304	MD	Sefton	23,362,254
E4404	MD	Sheffield	36,381,431
E3202	MD	Shropshire	13,191,829
E0304	UA	Slough	8,106,982
E4605	UA	Solihull	12,214,458
E3320	MD	Somerset	22,595,145
E0103	SC	South Gloucestershire	10,202,611
E4504	UA	South Tyneside	14,656,242
E1702	MD	Southampton	18,459,392
E1501	UA	Southend-on-Sea	10,401,380
E5019	UA	Southwark	30,466,495
E4303	LB	St. Helens	15,556,507
E3421	MD	Staffordshire	42,586,115
E4207	SC	Stockport	17,302,644
E0704	MD	Stockton-on-Tees	15,336,479
E3401	UA	Stoke-on-Trent	24,429,499
E3520	UA	Suffolk	32,703,057
E4505	SC	Sunderland	25,977,652
E3620	MD	Surrey	40,929,876
E5048	SC	Sutton	10,840,677
E3901	LB	Swindon	10,937,489
E4208	UA	Tameside	16,668,142
E3201	MD	Telford and Wrekin	13,597,648
E1502	UA	Thurrock	12,306,369
E1102	UA	Torbay	10,413,410
E5020	UA	Tower Hamlets	38,590,614
E4209	LB	Trafford	13,599,399
E4705	MD	Wakefield	26,333,126
E4606	MD	Walsall	19,317,219
E5049	MD	Waltham Forest	17,556,433
E5021	LB	Wandsworth	30,371,343
E0602	LB	Warrington	13,322,932
E3720	UA	Warwickshire	25,065,856
E0302	SC	West Berkshire	6,343,420
E2802	UA	West Northamptonshire	19,730,445
E3820	UA	West Sussex	37,426,506
E5022	UA	Westminster	34,410,243
E0902	SC	Westmorland & Furness Council	7,995,146
E4210	LB	Wigan	27,993,188
E3902	MD	Wiltshire	18,718,073
E0305	UA	Windsor and Maidenhead	5,128,849
E4305	UA	Wirral	32,014,138
E0306	MD	Wokingham	5,875,229
E4607	UA	Wolverhampton	22,462,940
E1821	MD	Worcestershire	32,236,161
E2701	SC	York	8,644,973

Notes

1. The 10 Greater Manchester local authorities (Bolton, Bury, Manchester, Oldham, Rochdale, Salford, Stockport, Tameside, Trafford and Wigan) are piloting business rate retention for public health and no longer receive a grant. The funding values quoted for these areas are notional allocations only.

2. The Cumbria (Structural Changes) Order 2022 establishes a single tier of local government in Cumbria from 1 April 2023. Two new councils will be created:

• Cumberland Council, comprising the existing districts of Allerdale, Carlisle and Copeland

• Westmorland and Furness Council, comprising the existing districts of Barrow-in-Furness, Eden and South Lakeland

The funding values quoted for the new local authorities (E0901) Cumberland Council and (E0902) Westmorland and Furness Council are based on locally determined splits. We have not included an allocation for the previous UA Cumbria County Council as this would not be appropriate.

3. The Somerset (Structural Changes) Order 2022 establishes a single unitary authority Somerset Council (E3301) from 1 April 2023, being conterminous with the previous Somerset County Council (E3320).

4. The North Yorkshire (Structural Changes) Order 2022 establishes a single unitary authority North Yorkshire (E2702) from 1 April 2023, being conterminous with the previous North Yorkshire County Council (E2721).

Annex C: categories

Categories for reporting local authority public health spend from 2023 - that is, Revenue Account Budget (RA) 2023 to 2024 and Revenue Outturn (RO) 2023 to 2024.

Prescribed functions

1) Sexual health services - STI testing and treatment

2) Sexual health services - contraception

3) NHS Health Check programme

4) Local authority role in health protection

5) Public health advice to NHS Commissioners

6) National Child Measurement programme

7) Prescribed children’s 0 to 5 services

Non-prescribed functions

8) Sexual health services - advice, prevention and promotion

9) Obesity - adults

10) Obesity - children

11) Physical activity - adults

12) Physical activity - children

13) Treatment for drug misuse in adults

14) Treatment for alcohol misuse in adults

15) Preventing and reducing harm from drug misuse in adults

16) Preventing and reducing harm from alcohol misuse in adults

17) Specialist drugs and alcohol misuse services for children and young people

18) Stop smoking services and interventions

19) Wider tobacco control

20) Children 5 to 19 public health programmes

21) Other Children’s 0 to 5 services non-prescribed

22) Health at work

23) Public mental health

24) Miscellaneous, can include, but is not exclusive to:

• nutrition initiatives
• accidents prevention
• general prevention
• community safety, violence prevention and social exclusion
• dental public health
• infectious disease surveillance and control
• environmental hazards protection
• seasonal death reduction initiatives
• birth defect preventions

25) Test, track and trace and outbreak planning

26) Other public health spend relating to COVID-19