- The government published the levelling up white paper on 2 February 2022, setting out a broad, missions-led approach to rebalancing the UK economy and addressing significant regional inequalities that hold back people, places and prosperity.
- The white paper recognises the need to focus on both economic and social decision-making and the intrinsic links between health, education and skills and the wider economy. This is a welcome statement for those advocating a health-in-all-policies approach.
- One of the missions explicitly refers to the need to narrow the gap in healthy life expectancy (HLE) between local areas. A white paper on health disparities will be published this year, setting out an ambition for reducing the gap in health outcomes. The government has launched two independent reviews to feed into this.
- More broadly, the levelling up white paper is an important framing document for integrated care system and NHS leaders across the country. Many of the missions will have direct and indirect implications for service demand, population health, workforce supply, innovation and local partnerships. Proposals around devolution could bring significant changes in local decision-making and the UK Shared Prosperity Fund should over time become an important enabler.
- This briefing covers the breadth of the white paper and analyses what it means for the health and care sector. We will remain at the heart of the levelling up agenda, advising members on policy, funding and emerging partnerships.
While much has been spoken about levelling up since the 2019 general election, the white paper is the first time the government has publicly clarified a working definition for it and a formal approach.
In short, levelling up will require the country to:
- boost productivity, pay, jobs and living standards by growing the private sector, especially in those places where they are lagging
- spread opportunities and improve public services, especially in those places where they are weakest
- restore a sense of community, local pride and belonging, especially in those places where they have been lost
- empower local leaders and communities, especially in those places lacking local agency.
The white paper is focused on understanding where public policy can address these four objectives in ways that are feasible and desirable from both an economic and a social perspective. The breadth of the government’s approach reflects the nuanced, complex and multi-layered nature of addressing decades of economic and social divergence across the UK.
The government is taking a missions-based approach to levelling up. The 12 chosen ‘missions’ are medium-term attempts to provide targeted, measurable and time-bound objectives from which a programme of change can be developed. Missions have been used before in national policymaking, including for example the industrial strategy, and are distinct from delivery targets.
The levelling up missions have target dates of 2030 and will serve as the focal point around which the whole of government orientates itself, as well as catalysing new ideas and forging collaboration.
The levelling up missions
Boost productivity, pay, jobs and living standards by growing the private sector, especially in those places where they are lagging
|By 2030, pay, employment and productivity will have risen in every area of the UK, with each containing a globally competitive city, and the gap between the top performing and other areas closing.|
|By 2030, domestic public investment in research and development (R&D) outside the greater south east will increase by at least 40 per cent, and over the Spending Review period by at least one third. This additional government funding will seek to leverage at least twice as much private sector investment over the long term to stimulate innovation and productivity growth.|
|By 2030, local public transport connectivity across the country will be significantly closer to the standards of London, with improved services, simpler fares and integrated ticketing.|
|Digital connectivity||By 2030, the UK will have nationwide gigabit-capable broadband and 4G coverage, with 5G coverage for the majority of the population.|
Spread opportunities and improve public services, especially in those places where they are weakest
|Education||By 2030, the number of primary school children achieving the expected standard in reading, writing and maths will have significantly increased. In England, this will mean 90% of children will achieve the expected standard, and the percentage of children meeting the expected standard in the worst performing areas will have increased by over a third.|
|Skills||By 2030, the number of people successfully completing high-quality skills training will have significantly increased in every area of the UK. In England, this will lead to 200,000 more people successfully completing high-quality skills training annually, driven by 80,000 more people completing courses in the lowest skilled areas.|
|Health||By 2030, the gap in healthy life expectancy (HLE) between local areas where it is highest and lowest will have narrowed, and by 2035 HLE will rise by 5 years.|
|Wellbeing||By 2030, wellbeing will have improved in every area of the UK, with the gap between top performing and other areas closing.|
Restore a sense of community, local pride and belonging, especially in those places where they have been lost
|Pride in place||By 2030, pride in place, such as people’s satisfaction with their town centre and engagement in local culture and community, will have risen in every area of the UK, with the gap between top performing and other areas closing.|
|Housing||By 2030, renters will have a secure path to ownership with the number of first-time buyers increasing in all areas; and the government’s ambition is for the number of non-decent rented homes to have fallen by 50 per cent, with the biggest improvements in the lowest performing areas. [ 1 ]|
|Crime||By 2030, homicide, serious violence and neighbourhood crime will have fallen, focused on the worst affected areas.|
Empower local leaders and communities, especially in those places lacking local agency
|Local leadership||By 2030, every part of England that wants one will have a devolution deal with powers at or approaching the highest level of devolution and a simplified, long-term funding settlement.|
While ‘levelling up’ as a term is indelibly linked with the current government’s post-2019 agenda, the issues behind the white paper, and the subsequent strategies and vehicles designed to address them, have exercised successive government administrations.
At the heart lies the continuing need to rebalance the UK economy and address significant regional inequalities. Productivity, routinely measured by the amount of work produced per working hour, is seen as the main driver of long-term growth and living standards. Not only has UK productivity nationally lagged behind that of many Organisation for Economic Cooperation and Development (OECD) countries since the 2008 financial crash, but there remain significant regional disparities today. Put simply, many parts of the Midlands and the North of England are now among the poorest in Europe. This low productivity routinely manifests itself in poor physical and social infrastructure, health and educational standards, as well as other indicators of social cohesion, such as increased child poverty, reducing life expectancy and rising crime rates.
Particularly over the last decade, governments have responded to this stagnant economic performance with an acceptance that the UK is overly centralised, and that decentralisation, through various forms, can breathe new life into local economies. The vehicles for this transition of powers and resource away from Westminster, and the overarching strategy narrative, represent a journey in itself. The levelling up white paper should be seen as the latest in a long line of attempts to resolve this patchwork policy approach to our stubborn spatial inequalities.
Addressing the levelling up objectives
Taking the four key objectives in turn, we have highlighted the most relevant provisions for those responsible for strategic health and care planning, focusing where possible on what is new rather than pre-existing commitments.
1. Boost productivity, pay, jobs and living standards by growing the private sector, especially in those places where they are lagging
Keywords: investment, R&D, transport, digital
As with many national initiatives to grow and rebalance the economy, the private sector draws a special focus. To help drive improvements in productivity, pay, jobs and living standards, the UK Government is setting four core missions, spanning living standards, research and development, transport infrastructure, and digital connectivity.
‘By 2030, pay, employment and productivity will have risen in every area of the UK, with each containing a globally competitive city, and the gap between the top performing and other areas closing’
- UK Government is asking Local Government Pension Scheme funds to publish plans for increasing local investment, including setting an ambition of up to 5 per cent of assets invested in projects which support local areas.
‘By 2030, domestic public investment in R&D outside the Greater South East will increase by at least 40 per cent, and over the Spending Review period by at least one third. This additional government funding will seek to leverage at least twice as much private sector investment over the long term to stimulate innovation and productivity growth.’
- The Department for Business, Energy and Industrial Strategy (BEIS) will aim to invest at least 55 per cent of its research and development (R&D) funding outside the Greater South East by 2024/25. This covers domestic R&D funding, including UK Research and Innovation (UKRI) funding, other BEIS R&D funding competitions, industry R&D programmes and R&D infrastructure expenditure.
- BEIS will also factor levelling up into investment decisions for R&D infrastructure and facilities and give UKRI a new organisational objective to ‘Deliver economic, social, and cultural benefits from research and innovation to all of our citizens, including by developing research and innovation strengths across the UK in support of levelling up’.
- BEIS will invest £100 million to pilot three new innovation accelerators, centred on Greater Manchester, the West Midlands and Glasgow City-Region. Each accelerator will see local consortia identifying transformational projects to grow their innovation ecosystem.
- The Department for Health and Social Care (DHSC) will commit that new contractual periods for NIHR Biomedical Research Centres and NIHR Clinical Research Facilities see increased levels of investment outside London, Oxford and Cambridge.
- DHSC will also review the NIHR Clinical Research Network funding formula to enhance levels of funding outside the Greater South East, supporting more studies and a greater percentage of patient recruitment in underserved communities across the UK.
‘By 2030, local public transport connectivity across the country will be significantly closer to the standards of London, with improved services, simpler fares and integrated ticketing.’
- The government will support city regions to transform local transport networks through London-style integrated settlements, creating a more devolved model of local transport funding, and explore devolving more transport powers and responsibilities in England.
‘By 2030, the UK will have nationwide gigabit-capable broadband and 4G coverage, with 5G coverage for the majority of the population.’
- In 2022, the UK Government will publish the Wireless Infrastructure Strategy, determining how the UK Government can tackle market failures in places that need to be addressed.
2. Spread opportunities and improve public services, especially in those places where they are weakest
Keywords – health, education, skills, training, employment
The white paper stresses the links between people’s health, education, skills and employment prospects and focuses on policies that can ensure that everyone, wherever they live, has the opportunity to live fulfilling, healthy and productive lives. Here, the government sets out three core missions, spanning education, skills and health, as well as an overarching mission on wellbeing.
‘By 2030, the number of primary school children achieving the expected standard in reading, writing and maths will have significantly increased. In England, this will mean 90 per cent of children will achieve the expected standard, and the percentage of children meeting the expected standard in the worst performing areas will have increased by over a third.’
- Education Investment Areas (EIAs) will be introduced, covering local authorities in England where attainment is currently weakest.
- A UK National Academy to support the work of schools will be created allowing students to acquire additional advanced knowledge and skills on a flexible timetable.
- £500 million will be invested to build the network of Family Hubs and transform Start for Life services for parents and babies, carers and children and to expand the Supporting Families programme in England.
‘By 2030, the number of people successfully completing high-quality skills training will have significantly increased in every area of the UK. In England, this will lead to 200,000 more people successfully completing high-quality skills training annually, driven by 80,000 more people completing courses in the lowest skilled areas.’
- Local skills improvement plans (LSIPs) will be placed on a statutory footing and rolled out across England, prioritising areas with the most pressing skills needs.
- Higher technical qualifications (HTQs), level 4 and 5 qualifications approved against employer-led standards, will be rolled out in England from September 2022.
- Pathfinder areas will be introduced, bringing together employers and agencies to respond to intelligence about local employers’ skills needs, supporting people into work and identifying progression opportunities for people in part-time work.
- The Department for Education (DfE) will establish a Unit for Future Skills, working with BEIS and the Department for Work and Pensions (DWP) to produce information on local skills demand and the pathways between training and good jobs.
- Nine new Institutes of Technology (IoTs) will be established, delivering higher technical education in areas across England.
- Universities’ access and participation plans will be refocused to ensure closer working with schools and colleges to raise standards and support students from disadvantaged backgrounds in their communities, and to emphasise social mobility.
- A Lifelong Loan Entitlement, part of the Lifetime Skills Guarantee, will provide individuals in England with a loan entitlement equivalent to four years’ worth of fees for post-18 education.
- From 2025, the DfE will transform the student finance system, helping to achieve greater parity between higher and further education.
- Progression Champions will be appointed across Britain to make connections between employers, local authorities and skills providers.
- From April 2022 the National Living Wage (NLW) will be increased by 6.6 per cent to £9.50 an hour for those 23 years plus; the National Minimum Wage for people aged 21-22 will increase to £9.18 an hour; and the Apprenticeship Rate will be increased to £4.81 an hour.
- From April 2022, the Free Courses for Jobs programme offering free level 3 qualifications to adults without an A Level or advanced technical diploma equivalent will expand to include a trial enabling any adult with a level 3 qualification or higher who earns below the National Living Wage or who is unemployed to access a further high-value level 3 qualification for free, regardless of their prior qualifications.
- Quadrupling of places in England on Skills Bootcamps, which provide short intensive training in shortage areas, will ensure that acute national and local skill shortages can be addressed at speed.
‘By 2030, the gap in healthy life expectancy (HLE) between local areas where it is highest and lowest will have narrowed, and by 2035 HLE will rise by five years’
- NHS England is taking forward the Core20PLUS5 initiative to level up healthcare, focusing on improving cardiovascular disease, cancer, respiratory, maternity and mental health outcomes in the poorest 20 per cent of the population, along with ethnic minorities and inclusion health groups.
- A white paper on health disparities in England will be published in 2022 that will:
- set out a strategy to tackle the core drivers of inequalities in health outcomes, with a strong focus on prevention and disparities by ethnicity, socioeconomic background and geography.
- learn from experiences during the pandemic response about how best to mobilise communities and a range of partners to address shared health challenges, including new ways to ensure that business plays a part in improving health and proposals for place-based solutions.
- the government has launched two independent reviews to feed into the forthcoming white paper.
- DHSC will work with the whole of government to consider health disparities at each stage at which they arise, with plans to look in more detail at what can be done in communities with higher than average rates of early death.
- A Tobacco Control Plan for England will be published in 2022, setting out how the ambition for England to be smokefree by 2030 will be met.
- A Better Health: Rewards scheme will be launched and tested in Wolverhampton in 2022, incentivising and rewarding participants for improving physical activity and diet.
- To aid prevention, work to improve participation in screening programmes by under-served groups will be taken forward, targeting health information and improvement tools and campaigns where they can have the greatest impact, whilst the future of the NHS Health Check programme is being considered.
- The forthcoming food strategy white paper will take forward recommendations from Henry Dimbleby’s independent review of the food system.
- At least 100 community diagnostic centres will be established in England by 2025, the majority of which will be based outside of London and the South East.
‘By 2030, wellbeing will have improved in every area of the UK, with the gap between top performing and other areas closing.’
- In addition, an overarching mission on wellbeing has been set, reflecting the bearing wellbeing has on all four of the UK Government’s objectives for levelling up.
3. Restore a sense of community, local pride and belonging
Keywords – regeneration, housing, communities
Recognising that people’s lives are shaped by the social and physical fabric of their communities, the white paper sets out three missions focused on how to strengthen the civic institutions, assets and relationships within communities that anchor local pride in place.
‘By 2030, pride in place, such as people’s satisfaction with their town centre and engagement in local culture and community, will have risen in every area of the UK, with the gap between top performing and other areas closing.’
- New transformational regeneration projects will start in 20 places in England, including initially Sheffield and Wolverhampton, bringing together locally-led funding with private investment to deliver brownfield regeneration.
- The High Streets Taskforce will be extended to a further 68 local authorities.
- A new National Youth Guarantee will invest £560 million over the next three years, focusing in areas of high child income deprivation.
- There will be a new strategy for community spaces and relationships, a review of neighbourhood governance and a pilot of new models for community partnership, including community covenants. These are agreements between councils, public bodies and communities, seeking to harness local energy, know-how and assets and set out how social capital and infrastructure can be built and sustained.
- To tackle disparities in access to culture, the government will increase cultural investment outside of London. This begins with 100 per cent of the additional Arts Council Funding agreed at the last Spending Review being spent outside of London.
- In sport, the government will work at pace to determine the most effective way to deliver an independent regulator of English football and any powers that might be needed, and UK sport has been commissioned to lead feasibility work on the prospect of bringing major sporting events to the UK, focusing on opportunities outside of London.
‘By 2030, renters will have a secure path to ownership with the number of first-time buyers increasing in all areas; and the government’s ambition is for the number of non-decent rented homes to have fallen by 50 per cent, with the biggest improvements in the lowest performing areas.’
- Homes England will be asked to support mayors and local authorities to regenerate brownfield sites.
- To improve housing quality, a white paper will be published in spring 2022, setting out proposals to end Section 21 ‘no fault’ evictions and introducing a National Landlord Register. The Decent Homes Standard will also be reviewed.
- Vulnerable population cohorts will be supported through the launch of a task force looking at how better choice, quality and security of housing for older people can be provided.
- A social housing regulation bill will be introduced, giving residents key performance information regarding landlords and the ability for the regulator to issue unlimited fines to landlords.
- Planning will be used as levelling-up tool, with models developed for a new infrastructure levy enabling local authorities to capture value from development more efficiently, and enhancing compulsory purchase powers to support town centre regeneration.
‘By 2030, homicide, serious violence and neighbourhood crime will have fallen, focused on the worst-affected areas’
- The Safer Streets Fund will be rationalised into a single stream of funding, with civil society organisations bidding, to be matched by PCCs and local authorities.
- The government will work with partners across the youth justice system to ramp up the use of unpaid work undertaken by 16- and 17-year olds as part of youth rehabilitation orders and other existing powers.
- Plans for a ‘national spring clean will use community payback to help clean up neighbourhoods and government will publish a new plan for anti-social behaviour and quality of life issues.
4. Empower local leaders and communities
Keywords – devolution, funding, local growth
The white paper recognises that achieving the levelling up missions relies on local leaders being empowered to develop local solutions to local problems. At the heart of this objective lies a renewed mission to extend, deepen and simplify devolution in England.
‘By 2030, every part of England that wants one will have a devolution deal with powers at or approaching the highest level of devolution and a simplified, long-term funding settlement’
- Extending devolution in England through:
- inviting Cornwall; Derbyshire and Derby; Devon, Plymouth and Torbay; Durham; Hull and East Yorkshire; Leicestershire; Norfolk; Nottinghamshire and Nottingham; and Suffolk to start formal negotiations to agree new County Deals, with the aim of agreeing a number of these deals by autumn 2022
- taking forward negotiations to agree a Mayoral Combined Authority (MCA) deal with York and North Yorkshire and an expanded MCA deal for the North East
- confirming that other areas, particularly those with broadly similar circumstances to North Yorkshire and York, such as Cumbria, have the opportunity to consider their interest in an MCA devolution deal.
- Deepening devolution in England through:
- opening negotiations immediately on trailblazer deals with the West Midlands and Greater Manchester, which will act as the blueprint for other MCAs to follow
- working with MCAs to explore options to streamline their funding landscape
- inviting other MCAs and the Greater London Authority to bid for further powers.
- Simplifying devolution through:
- setting out the UK Government’s new devolution framework to provide greater clarity on the devolution offer across England
- seeking to legislate to establish a new form of combined authority model to be made up of upper-tier local authorities only, providing a single, accountable institution across a functional economic area or whole county geography.
- The UK Shared Prosperity Fund (UKSPF) will be formally launched, worth £2.6 billion initially, with funding increasing to £1.5 billion a year by 2024/25. This replacement for European Structural and Investment Funding (ESIF) will focus on communities and place, people and skills, and local business.
- Communities and place: This could include community-led projects such as local support groups and sport in the community; making high streets clean, safe and prosperous; and providing support for projects to renew community infrastructure and improve access to green space and to strengthen social, physical and cultural ties
- People and skills: Multiply, the £560 million adult numeracy programme, will be the first priority, offering local support for people to gain or improve their skills. From 2024/25, further emphasis will be placed on investment to support life chances and skills, including for those furthest from the labour market.
- Local business: This could include a range of activities, from investment in pedestrianisation and new outdoor markets to increasing high street footfall; to supporting business networks and programmes to adopt energy-efficient or low carbon technologies; to support for the local visitor economy.
- In England, this funding will be allocated to, and invested by, MCAs where they exist, and the GLA. Elsewhere, most funding will be allocated to, and invested by, lower-tier local authorities. Local areas will also have the option to come together to deliver the UKSPF.
- Opportunities will be explored for MCAs to take on a duty to improve the health of their residents, concurrent with the existing duty of their constituent upper-tier councils. This duty will complement the health improvement role of local authorities and their directors of public health, making it easier for MCAs to participate alongside local authorities in initiatives that can improve health and proactively consider health as part of key strategies and investment decisions. The forthcoming integration white paper will set out plans for health and social care integration in early 2022.
- The government is encouraging the integration of local enterprise partnerships (LEPs) and their business boards into MCAs, the GLA and County Deals, where these exist. Where a devolution deal does not yet exist, LEPs will continue to play their role in supporting local businesses and the local economy.
The devolution framework
Level 3: A single institution or county council with a directly elected mayor (DEM), across a functional economic area (FEA) or whole county area
Level 2: A single institution or county council without a DEM, across an FEA or whole county area
Level 1: Local authorities working together across a FEA or whole county area, for example through a joint committee
|Strategic role in delivering services||Host for Government functions best delivered at a strategic level involving more than one local authority e.g. Local Nature Recovery Strategies||x||x||x|
|Opportunity to pool services at a strategic level||x||x||x|
|Opportunity to adopt innovative local proposals to deliver action on climate change and the UK’s Net Zero targets||x||x||x|
|Supporting local businesses||LEP functions including hosting strategic business voice||x||x|
|Local control of sustainable transport||Control of appropriate local transport functions e.g. local transport plans*||x||x|
|Defined key route network*||x|
|Priority for new rail partnerships with Great British Railways – influencing local rail offer, e.g. services and stations||x|
|Ability to introduce bus franchising||x||x|
|Consolidation of existing core local transport funding for local road maintenance and smaller upgrades into a multi-year integrated settlement||x|
|Investment spending||UKSPF planning and delivery at a strategic level||x||x|
|Long-term investment fund, with an agreed annual allocation||x|
|Giving adults the skills for the labour market||Devolution of Adult Education functions and the core Adult Education Budget||x||x|
|Providing input into Local Skills Improvement Plans||x||x|
|Role in designing and delivering future contracted employment programmes||x|
|Local control of infrastructure decisions||Ability to establish Mayoral Development Corporations (with consent of host local planning authority||x|
|Devolution of locally-led brownfield funding||x|
|Strategic partnerships with Homes England across the Affordable Housing Programme and brownfield funding||x|
|Homes England compulsory purchase powers (held concurrently)||x||x|
|Keeping the public safe and healthy||Mayoral control of Police and Crime Commissioner (PCC) functions where boundaries align^||x|
|Clear defined role in local resilience*||x||x|
|Where desired offer MCAs a duty for improving the public’s health (concurrently with local authorities)||x|
|Financing local initiatives for residents and business||Ability to introduce mayoral precepting on council tax*||x|
|Ability to introduce supplement on business rates (increases subject to ballot)||x|
* refers to functions which are only applicable to combined authorities
^ refers to functions which are currently only applicable to mayoral combined authorities
The changing role of government
The white paper recognises that central government decision-making itself is often a barrier to levelling up. By reviewing the information, incentives and institutions which underpin spatial decision-making, the government is committing to:
- improving transparency about place‑based spending
- hardwiring spatial considerations into decision‑making and evaluation
- improving coordination of central government policies at the local level
- having a greater focus on local place.
Supportive changes to the national architecture including streamlining the funding landscape; establishing the Leadership College for Government, incorporating the Civil Service Leadership Academy and the National Leadership Centre; and setting up a new independent body in England focused on data, transparency and robust evidence.
To support this new way of working, a Levelling Up Cabinet Committee has been established which will embed levelling up across central government policy design and delivery. There will also be a new cohort of levelling up directors appointed to act as a single point of contact for local leaders and a first port of call for local policy proposals, and a Levelling Up Advisory Council created to provide independent advice. Finally, in terms of transparency, a statutory obligation will ensure annual reporting on progress towards meeting the levelling up missions.
A serious, collective attempt at understanding and responding to decades of growing regional inequality
The levelling up white paper is certainly ambitious. With missions that straddle the full breadth of Whitehall and local policymaking, as well as a timescale that covers at least UK two general elections, this is a serious, collective attempt at understanding and responding to decades of growing regional inequality. The government finally has a framework for assessing and understanding regional disparities, the benefits of addressing them and how public policy might most effectively do so.
What is noticeable is the acceptance that this is a social and moral purpose, not just an economic one. Past attempts at rebalancing the economy have been accused of placing too much emphasis on investing in narrow centres of excellence at the expense of raising opportunity everywhere. The impact of the pandemic, and the nature of the local cross-sectoral response, has shown the intrinsic value of health, education and skills to communities and to the wider economy.
We await to see how government will embed the wellbeing mission throughout its agenda
This is particularly the case when considering the growing role of the health sector. In general terms, the level of interaction between the NHS and those responsible for local strategic economic planning since 2010 has been extremely limited. This will change. As the white paper makes clear, some of the most striking spatial disparities in the UK are in health, with previously disparate groups now finding common cause in making a clearer alignment between population health and population wealth.
However, if the need to focus more on social development and wellbeing is borne out by the depth of the analysis that underpins the white paper (including a bewildering amount of graphs and charts), it doesn’t immediately follow through into policy and actions. We await to see how government will embed the wellbeing mission throughout its agenda and the full potential of investing in public services. The relationship between health and productivity is not close to being realised, despite the evidence.
For the health sector, the focus will turn to the new white paper on health disparities, to be published this year and which, we are told, will set out an ambition for reducing the gap in health outcomes. With a policy programme focused on improving public health, supporting people to change their food and diet, and tackling diagnostic backlogs, many of the levelling up references to health link to previously announced commitments, which while positive that they are included, do not easily relate to a renewed sense of achieving the healthy life expectancy mission within eight years.
Devolution in England finally has a framework
Of course, we should look beyond simply this mission to understand the broader health connections.
Devolution in England finally has a framework. It should be a priority for NHS and ICS leaders to understand the local implications of this new transition of powers. Over what footprint, and with which priorities in mind, will local powers be sought? How will the broader health of the population form an explicit part of new and existing deals? Relationships matter, and this includes reaching out positively to the new levelling up regional directors.
The overly complex funding landscape will have a welcome spring clean, though concerns remain over the government’s preference for an episodic, centralised and competitive approach. The NHS was an active partner in many European Structural and Investment Funding projects and should be enthusiastic about engaging with its replacement, the UK Shared Prosperity Fund, as it develops and in supporting local partners to strengthen and secure their applications.
ICSs should be leading new conversations with schools, colleges and universities to understand the forthcoming changes
Skills and education will remain a focal point for many. As the largest employer in every local economy, the NHS has more to gain than most in understanding the wider skills landscape and the local labour markets in which systems and organisations operate. ICSs should be leading new conversations with schools, colleges and universities to understand the forthcoming changes and their role in education investment areas and bodies such as the local skills improvement plans.
Although being clear that levelling up is not a ‘North vs South’ battle, there will be some shifting of resource away from the Greater South East, and particularly in relation to R&D. This presents a very tangible opportunity for ICS and NHS leaders in these areas to develop new clusters and align innovation priorities with MCAs and industry in ways which enrich our populations and services.
The breadth of the white paper is in many ways its greatest strength and its main weakness
Finally, the focus on community is essential. One of the interesting aspects of levelling up is the meeting of both macro and micro policy. For many citizens, the safety and appearance of the high street will be their test of success. For an NHS becoming more interested in community engagement there are welcome signs of engaging civic society in local decision-making – our goal should be to support this and to help unlock our local assets. Many have already started this journey, looking at health on the high street, for example.
The breadth of the white paper is in many ways its greatest strength and its main weakness. A relentless, long-term cross-government focus on addressing spatial inequalities is needed to have any chance of being successful, yet this requires the continued focus and priority of several departments and in particular the muscular support of the Treasury. Regarding the latter, too much of the white paper looks back at past announcements rather than unleashing new solutions. Early tests of their support will come in the plethora of white papers due to be published in the coming months and the next time the Chancellor sets out his fiscal policy.
Our Health Economic Partnerships work programme supports the NHS to understand its growing role in the local economy, to develop anchor strategies at institutional, place and system level and to facilitate new local partnerships. We will remain at the heart of the levelling up agenda as the government engages; advising members on policy, helping them access funding and facilitating new partnerships with the key players.
- 1. Government will consult on the impact on the private rented market and particularly those on the lowest incomes. Further detail will be set out once the review of the Decent Homes Standard has concluded. ↑