The government’s current approach to levelling up

While many existing government policies target the broad issues outlined in Box 2, we examine policies that have recently been linked to the levelling up agenda: the government’s paper Build Back Better: Our Plan for Growth; and the programme for the next parliament outlined in the Queen’s Speech. Here, we assess the extent to which these reference the goal of improving health.

Build Back Better: Our plan for growth

The government’s plan for growth was published alongside the 2021 Budget, superseding the 2017 Industrial Strategy developed under Prime Minister Theresa May. While the plan for growth is an aspirational document without much detail on implementation, it comes with significant public investment over the next 5 years – at a time when public funds for other activities are likely to be constrained.

Levelling up is highlighted as a key cross-cutting objective and as the government’s ‘most important mission’. Three core ‘pillars’ of investment are set out: infrastructure (£600bn over the next 5 years); skills (in particular technical and basic adult skills); and innovation (R&D). A total of 17 new and existing funds are detailed, with the Levelling Up Fund, Towns Fund, UK Community Renewal Fund and the UK Shared Prosperity Fund specifically focused on levelling up. These funds are summarised in Box 3.

Box 3: Funds focused on levelling up

The Levelling Up Fund

An initial £4bn for England over the next 4 years has been committed as part of a new ‘Levelling Up Fund’, with at least £800m set aside for Scotland, Wales and Northern Ireland. The fund focuses on three themes: town centre and high street regeneration; improving local transport connectivity and infrastructure; and maintaining and regenerating cultural, heritage and civic assets. It is especially intended to ‘support investment in places where it can make the biggest difference to everyday life, including ex-industrial areas, deprived towns and coastal communities’. Local authorities are categorised into one of three priority groups, with those deemed to be in greatest need receiving funding to help in preparing bids. The criteria used were: need for economic recovery and growth; need for improved transport connectivity; and need for regeneration. The resulting categorisation makes no reference to health and bears little relation to markers of socioeconomic deprivation. Research by the Financial Times showed that 14 areas in England considered more prosperous than the national average were placed in the highest priority group for the Fund.

The Towns Fund

In July 2019, the Prime Minister announced that 101 towns across England would be supported with funding through ‘Town Deals’, with 86 areas selected for funding so far following announcements at the March 2021 Budget and more recently in June 2021.,, Composed of various strands including the High Streets Fund, the Towns Fund provides £3.6bn overall to ‘drive the economic regeneration of deprived towns and deliver long-term economic and productivity growth’. Investment is similarly focused on urban regeneration, planning and land use; skills and enterprise infrastructure; and connectivity.

541 towns in England have been designated by MHCLG as potentially eligible for ‘Town Deals’, with the bidding process again run competitively. In the selection process areas were ranked on seven criteria: income deprivation; skills deprivation (proportion of working-age population with no qualifications at NVQ level); productivity; EU exit exposure; exposure to economic shocks; investment opportunity; and alignment to wider government intervention. While it includes brief references to ‘natural capital’ (creating quality green space that can improve health and wellbeing) and aims to encourage active travel, the Towns Fund Prospectus again includes little mention of health, and no direct account is taken of an area’s healthy life expectancy or other indicators of population health.

UK Community Renewal Fund (2021) and UK Shared Prosperity Fund (from 2022)

The UK Community Renewal Fund (UKCRF) was also launched with the March 2021 Budget, providing local areas with access to £220m funding in preparation for the soon to be established UK Shared Prosperity Fund (UKSPF). 100 priority geographical areas for investment have been identified based on an index of ‘economic resilience’ (productivity, household income, unemployment, skills and population density). While there is reference to how the UKCRF will contribute to ‘natural capital’ (net zero and environmental objectives), again there is no mention of measures to improve health and wellbeing in the terms set out.

The UKSPF will replace EU structural funding from 2022, which has historically been spent on areas including inclusive labour markets, skills for growth, promoting social inclusion and combatting poverty. The government has committed to ensuring total domestic UK-wide funding at least matches EU receipts to reach an average of around £1.5bn a year. One element will target places most in need across the UK, such as ex-industrial areas, deprived towns and rural and coastal communities to ‘spur regeneration and innovation’ as well as ‘enabling joined-up, holistic investment to support local communities and people’. A second portion of the UKSPF will focus on employment and skills programmes for those most in need of support. While the precise focus of the UKSPF is still to be developed, so far there has again been no mention of programmes designed to support better health.

The programme set out in the Queen’s Speech

Levelling up was the central theme of the 2021 Queen’s Speech, setting out the government programme over the next parliamentary session. The priority is ‘to deliver a national recovery from the pandemic that makes the United Kingdom stronger, healthier and more prosperous than before’ and to achieve this the government has promised to ‘level up opportunities’. In the background briefing note accompanying the Queen’s Speech, there was a welcome acknowledgement that ‘our health is our most important asset’, shaped by multiple factors that are influenced by a range of central government departments.

The programme laid out a mixture of legislation and initiatives. Centre stage is investment to ‘beat COVID and back the NHS’, with funding for the vaccines programme and a recovery plan for the NHS to tackle the backlog of care. On legislation, 30 bills were promised on a wide range of topics.

The government also confirmed it will publish a white paper on levelling up, ‘setting out bold new interventions to improve livelihoods and opportunities throughout the UK’. Much in the briefing note reaffirms the approach outlined in the plan for growth. This includes funds to regenerate local places; enterprise and jobs measures (eg setting up at least eight freeports); plans to ‘level up public services’ (focused on new hospitals and additional nurses and police officers); skills and education policies (eg a new Lifetime Skills Guarantee); as well as infrastructure and connectivity. The government also promised to ‘bring forward proposals that address racial disparities, support disabled people and help eradicate barriers facing different groups’.

On the Health and Social Care Bill, the Queen’s Speech briefing states that the NHS and local authorities will be given the ‘tools to level up health and care across England so people can live healthier, longer and more independent lives’. There is a separate section on the prevention of ill health, outlining plans to tackle the key risk factors of obesity, air quality, smoking and drug misuse. The role of the new Office for Health Promotion is also mentioned, which the government intends to ‘lead national efforts to improve and level up the public’s health’.

A Town Deal is an ‘agreement in principle between government, the lead council and the Town Deal Board. They are aimed at setting out a ‘vision and strategy for the town, and what each party agrees to do to achieve this vision.’ Town deals are supported via the government’s Towns Fund. (

Following an announcement about the abolition of Public Health England in September 2020, a new Office for Health Promotion was announced by the government in March 2021, to be overseen by the Chief Medical Officer, Chris Whitty. The Office will sit within DHSC and ‘lead work across government to promote good health and prevent illness’ (

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