Levelling up: bricks and mortar were never going to be enough

blog | 24 Feb 2022

There is a lot to welcome in the government’s Levelling Up White Paper. We support the recognition that tackling entrenched regional inequality will not be a quick fix and the commitment to a long-term agenda of systems change, innovation and devolution.

We’re also pleased to see the government recognises that bricks and mortar projects are not going to be enough – and that the White Paper’s 12 missions combine economy and infrastructure with more human, social, cultural and place-based outcomes.

Innovation Unit has worked in place-based transformation for 15 years. Our programmes lead to better outcomes for communities and we know this because we use person-centred, strengths-based metrics which demonstrate impact in the areas that matter most to people.

Our approach has taught us many valuable lessons about achieving outcomes for people, communities and local systems, chiming with the White Paper’s ambitions:

Lesson 1: liberate local leadership, put local people in control

The White Paper promises increased devolution and recognises that existing centralision “fails to cultivate local leadership and has often meant anchor institutions in local government have lacked powers, capacity and capability.”

Our work in Greater Manchester has taught us that successful devolution requires a shift away from polarising party politics, toward a place-based approach that embeds true coproduction; that liberates local leaders to make change happen; and where multi-disciplinary teams on the ground break down siloed ways of working to deliver better outcomes for people.

Lesson 2: mobilise local anchor organisations

The White Paper recognises that “the private sector, civil society and government must work in partnership” and that the collaboration of anchor institutions – place-based organisations such as hospitals, universities, councils with large workforces and significant spending power – is core to the success of the levelling up missions.

Through our work in the Health Anchors Learning Network, we have seen how the work of anchor organisations –  particularly around employment, procurement and the environment –  can improve population health, reduce poverty, address inequalities, and remove ineffective or unjust ways of working.

Through the network we support anchor organisations with tools and learning opportunities to better collaborate with local partners, embed a whole-systems approach into their work and to measure their success in new ways like population outcome measures (e.g healthy life expectancy or child poverty) and soft person-centred outcomes (e.g.choice and control) as well as more traditional hard metrics (e.g. recovery from cancer).

Lesson 3: address our weaknesses at scaling innovation

As a country we have a proud history of creativity, invention and breakthrough ideas. But our track record at scaling, spreading and exploiting those ideas is poor. This is as true in the private sector, where few of our start ups go on to become huge global companies; as it is in education, health, justice and regeneration where high impact innovations spread very slowly to neighbouring institutions or places, if at all.

To overcome this collective blindspot, we need to develop and innovate with scale in mind from the very outset. Our work with Ministry of Justice reducing reoffending of care leavers in the prison, and our work with the Department for Education on the Strengthening Families Protecting Children programme are good examples where promising innovations are supported to spread with fidelity.

Government and charitable grants should be designed to build in the four key features of scale: spreading to new places, sustainability over time, continual improvement, and transfer of ownership from innovators to adopters. Our own methodology for adopting and adapting innovations to new and different local contexts, developed through partnerships with innovators like No Wrong Door and the establishment of four healthcare Innovation Hubs, provides lessons for how to intentionally plan for scaling.

Lesson 4: prevention is better than cure

We look to the 2022 White Paper on Health Disparities to see a focus on prevention, looking especially for an understanding of broader community networks, for instance around mental health and childcare, which are missing from the levelling up paper. Central to our own work in mental health and violence reduction is listening carefully to communities and co-producing holistic support approaches based on what we hear.

We hope that the White Paper grasps the opportunity to invest in research, development and innovation that tackles the wider determinants of health – an investment in social, place-based and community solutions to health inequalities that are designed, developed and tested by local communities far from the reach of Whitehall, and then supported to spread and scale nationally and internationally.

Lesson 5: impactful collaboration materialises when leaders work at relationships, not structures and bureaucracy

The Levelling Up missions will require greater collaboration and partnership working between health, housing, education and employment, as well as between the statutory sector, private sector, voluntary sector and communities. The particularly ambitious ‘Healthy Life Expectancy’ mission makes pledges that go beyond the scope of the NHS, so more work is needed to explain how changing ICS structures and a new Office for Health Improvement and Disparities will enable the NHS to look outwards.

In our work on health inequalities, we are supporting 14 voluntary sector grantees to improve health and wellbeing in their localities through establishing sustainable place-based partnerships – the power of focusing influencing strategies on building equitable, empathetic, trusting relationships with statutory partners has emerged as a key learning.

In our mental health transformation work, we are intentional about addressing the power dynamics that currently exist within local systems. We work hard to establish more equal power relationships between hospitals, primary care, social care and voluntary organisations, and we especially seek to give greater power and voice to people with lived experience who have been excluded from decision making for too long.

We welcome the government’s renewed commitment to innovation as a driver of economic growth and social growth. But the ambition must be matched with more resources and more developed policies, if it is to succeed. We want to see the same level of attention and priority given to innovation that narrows the gap in healthy life expectancy, wellbeing or violence reduction, as we see in innovation in life sciences, artificial intelligence or robotics.

We know how to make system change a reality through stronger local partnerships and collaboration, empowering local leaders, mobilising the resources of local anchor organisations, careful implementation of proven innovations developed elsewhere, and an unwavering belief in the power and capabilities of local people and local communities. Through our work across the UK, we are ready to contribute to the realisation of these bold national missions.