Questions on public health fund
A £2.7 billion fund to improve public health is not always being spent where it is most needed, according to a watchdog.
Records of how the cash has been allocated by some local authorities are also inaccurate, the National Audit Office found.
During an inquiry into how well money is being used to encourage healthier lifestyles and reduce health inequalities, it highlighted recently published NHS research that showed alcohol-related incidents are costing £3.5 billion a year.
English local authorities, however, spent an average of just 7.6% of public health funding on alcohol-related schemes while 21% went on drug misuse, according to the NAO.
Drink-fuelled admissions to hospital increased by more than 6% in 26 local authorities between 2010/11 and 2012/13 but spending on alcohol services in those areas totalled an average of 6% of health funds, its research found.
It pointed to the 9% spent by the 26 local authorities where alcohol-related admissions reduced the most.
The watchdog also highlighted the continued wide gaps in healthy life expectancy, which for men ranges from 52.5 years in Tower Hamlets to 70 years in Richmond upon Thames.
Its report said: "In parts of the system, local authority spending is not fully aligned to areas of concern."
Margaret Hodge, who chairs the Public Accounts Committee, said: "We all know that prevention is better than cure. Good public health is critical to reducing the burden on local health economies and the wider NHS at a time when the health service is facing unprecedented financial challenges, as well as improving the lives of individuals.
"The NHS spends an extraordinary £3.5 billion a year on treating alcohol-related harm - almost half the £8 billion the chief executive of the NHS says is needed to plug the hole in its finances.
"And there still remain unacceptable health inequalities that must be tackled - it cannot be right that a man living in Tower Hamlets has a healthy life expectancy of just 52.5 years, 17.5 years lower than a man living on the other side of London in Richmond upon Thames."
Public Health England was set up in April last year and gives local authorities cash from a £2.7 billion ring-fenced grant.
The report found that the new agency has made a good start in supporting local authorities but said it is too soon to tell whether value for money is being achieved.
It also found problems with the accuracy of how local authorities register what has been spent on public health, with some failing to record spending in certain categories.
Funding for public health went up by 5.5% in 2013/14 but the Government has not decided how long the ring-fence will remain in place and the NAO warned that contingency plans must be put in place to deal with changes in funding.
Amyas Morse, head of the National Audit Office, said: "Public Health England is accountable for achieving the public health outcomes the Department of Health wants, but it is local authorities who are responsible for delivering improved public health. The agency is developing a good relationship with its local stakeholders to whom it is providing tools, support and advice.
"There is a difficult balance to be struck between localism and the agency's responsibility for improving health. The agency's ability to influence and support public health outcomes will be tested further if the grant paid to local authorities were no longer to be ring-fenced."
Duncan Selbie, chief executive of Public Health England, said: " This is a fair and balanced review by the NAO of our first year. Inevitably, there is more we can do to support the new public health system and we fully support their five recommendations.
"We take confidence from their opening assertion that we have made a good start."