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Inclusive economies and healthy futures: Supporting place-based action to reduce health inequalities

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Councils have an unparalleled understanding of their local area and the key institutions in it. This guide will provide inspiration to everyone seeking to build a more inclusive, healthy and prosperous economy in their local area.


The coronavirus pandemic has demonstrated in the clearest way possible the interconnection between public health and the health of the economy. But local authorities have long been aware of this. They have long understood that poor health is one of the greatest barriers to finding and retaining a satisfying and rewarding job and wider involvement in society. Conversely, having high-quality employment and being socially connected are key factors in a person’s health and wellbeing.

As described in our previous publications, Nobody Left Behind and Health, Work and Health-related Worklessness, councils have developed many innovative interventions over recent years in these areas. Such interventions help their citizens to acquire the skills and opportunities to find work that suits them, overcome barriers to work and engagement in society, and become more healthy, active and resilient.

While the case studies in this collection were largely compiled prior to the COVID related restrictions being imposed, they could not be more timely. As we emerge from over 18 months of heavy restrictions on our society and economy, there is a consensus across the political spectrum to build a more inclusive and sustainable economy, in which no city, town or neighbourhood is left behind.

Life was already changing fast even before the pandemic struck and the United Kingdom left the European Union. These two major events have created an even more complex mix of challenges and opportunities for our nation. Though many businesses and households are struggling to keep going, green and digital technologies and the global marketplace present opportunities for growth.

I hope that this guide will provide inspiration to everyone seeking to build a more inclusive, healthy and prosperous economy in their local area. Councils have an unparalleled understanding of the circumstances and features of their local area and the key institutions and organisations in it, as well as a strategic overview across all policy areas.

All of these are needed to develop the programmes which will enable their places to thrive. But while every neighbourhood has unique challenges, the case studies in this collection are very varied. Whether it is growing food, providing leisure facilities, working with the community and voluntary sector, signposting, working with anchor institutions, providing skills training or support within employment, overcoming transport or childcare barriers, working with schools or a host of other issues, there is something in here for everyone.

Councillor David Fothergill, 


LGA Community Wellbeing Board


Nothing has demonstrated as clearly as COVID-19, the intimate connection between public health and the economy – from macro-economic phenomena right down to the personal and household budgets of each and every one of us. For much of 2020 and 2021, most of the UK economy has been on ice. At the time of writing – a few days before the final stage of lifting restrictions in England, on 19 July 2021 – the economic after-effects of the pandemic are unclear. For example, we simply do not know how close employment levels will return to pre-covid levels. It is apparent that many jobs have been saved by the furlough scheme, support for the self-employed, and other support from the Government, local authorities and others, but also that many jobs have been lost. The invidious effects of long covid may also result in a significant drain on working hours. And the interest payments on the additional debt that the Government has taken on will be with us for decades to come.

However, the relation between public health and the economy goes far beyond COVID-19. High-quality work and affluence are highly correlated with good mental and physical health and wellbeing. Conversely, poor-quality work or unemployment and financial difficulties are highly correlated with poor mental and physical health. This relationship works in both directions. Unemployment, particularly if it is long-term, or poor-quality work can trigger or exacerbate mental and physical health conditions. However, mental and physical health conditions can also become barriers to gaining employment, keeping a job or progressing in a career.

Local authorities have long recognised this interplay. They have developed a wide range of programmes to help their residents move from a downward spiral of poor health, deprivation and exclusion to an upward path of good health, financial stability and career progression.

The programmes developed by local authorities and their partners are so wide-ranging because both public health and inclusive economic growth are so cross-cutting in their nature, intersecting with so many different service areas. Directors of Public Health know this, as their job requires one of the greatest degrees of collaboration of any post in a local authority. This may be witnessed in the case studies in this collection, which involve issues associated with skills/training, community engagement, business support, leisure and green spaces, food and horticulture, primary healthcare, schools, planning, housing, transport, funding and finance, and arts and culture. Indeed, some councils have adopted a Health In All Policies approach, where policy areas across the council are examined for their health implications. The LGA produced a manual in 2016 to help them with this approach and The Health Foundation published a set of international case studies on it in 2019.

Many organisations across the public, private and voluntary and community sectors have a role in these policy areas. Consequently, the development and execution of such programmes requires constant partnership working. Again, this will be familiar to councillors and council officers with roles in public health, economic development and social inclusion.

Any new project involving the public sector needs to take into account the policy context in which it is launched and evolves, and the trends in society which inform this context. Over the last 15 months or so, COVID-19 has dominated this landscape. However, there are other longer-term trends, some of which COVID-19 has accelerated, which are also highly relevant. These include demographic changes, environmental and climate issues, and the effects of living a more digital and interconnected world. Along with COVID-19 and its consequences, these trends have influenced the programme of the Government, in particular the way its ambitions of ‘levelling up’ and ‘building back better’ have developed.

We will look more closely at all of these matters in the following sections. We will start by expanding upon the philosophy and facts behind the interventions described in this document. We will then describe the societal trends and Governmental policy context that need to be considered when developing a programme of action. Finally, we shall draw out some recurring themes from the case studies, point out important considerations for those developing interventions and highlight some useful resources for practitioners.

This collection of case studies is the third in a series of case studies on public health and inclusive growth, the other two being Health, work and health related worklessness - A guide for local authorities and Nobody left behind - Maximising the health benefits of an inclusive local economy.

The case studies in this collection were largely compiled prior to COVID-19 restrictions being applied across England. Like everything else in our lives, the programmes described in them have been heavily affected by the pandemic. Where possible, the case studies have been updated in recent months to describe the development of them since restrictions were imposed. Programmes such as these are now needed more than ever.

We hope that these will provide inspirational for policy makers across the local government family and beyond. It would be better to be inspired by them than to try to apply a carbon copy of any of them, because every successful programme of action is rooted in the unique local circumstances of the place in which it is executed.

The motivation for interventions: how health and wellbeing relate to inclusive growth

Social inequality kills – and kills in large numbers.

A study published in The Lancet Public Health in January 2020 found that just over one third of premature deaths (those under the age of 75) in England during the period 2003-2018 were attributable to socioeconomic inequality. This equates to 877,082 deaths – approximately the population of Staffordshire.

The biggest contributors were coronary heart disease, respiratory cancers and chronic obstructive pulmonary disease. The most unequal causes of death were tuberculosis, opioid use, HIV, psychoactive drugs use, viral hepatitis, and obesity, each with more than two-thirds attributable to inequality. The proportion of deaths attributable to inequality actually increased during the study period.

This leads to a variation in life expectancy around England. The Prime Minister, Boris Johnson, acknowledged this in a speech in Coventry on 15 July 2021:

“it is an outrage that a man in Glasgow or Blackpool has an average of ten years less on this planet than someone growing up in Hart in Hampshire or in Rutland… A woman from York has on average a decade longer of healthy life expectancy than a woman from Doncaster 30 miles away”.

The social determinants of health have been widely studied. A landmark review in 2010 was Fair Society, Healthy Lives: The Marmot Review. This pointed out that the illnesses associated with health inequalities resulted in “productivity losses, reduced tax revenue, higher welfare payments and increased treatment costs”. It provided charts showing that:

  • limiting illnesses were much more common amongst those with no or low qualifications
  • mortality was much higher for unemployed men than employed men (in 1981), across all social classes.

On the issue of unemployment, it stated (drawing on many previous studies) that

“Unemployed people incur a multiplicity of elevated health risks. They have increased rates of limiting long-term illness, mental illness and cardiovascular disease. The experience of unem­ployment has also been consistently associated with an increase in overall mortality, and in particular with suicide. The unemployed have much higher use of medication and much worse prognosis and recovery rates.

Unemployment has both short- and long-term effects on health. The immediate negative impact of being made redundant on a person’s health outcomes has been frequently reported while other studies emphasise the steady negative effects, proportional to the duration of unemployment, which progressively damage health. Therefore adverse effects on health are greatest among those who experience long-term unemployment.

“There are three core ways in which unemployment affects levels of morbidity and mortality.

“First, financial problems as a consequence of unemployment result in lower living standards, which may in turn reduce social integration and lower self-esteem.

“Second, unemployment can trigger distress, anxiety and depression. Many psychosocial stressors contribute to poor health not only among the unemployed themselves, but also among their partners and children. Loss of work results in the loss of a core role which is linked with one’s sense of identity, as well as the loss of rewards, social participation and support.

“Third, unemployment impacts on health behaviours, being associated with increased smoking and alcohol consumption and decreased physical exercise.”

It also drew attention to the links between health on the one hand and income and wealth on the other. On income, it stated (again drawing on many previous studies) that

“The relationship between low income and poor health is well established. It operates in several ways. People on low incomes refrain from purchasing goods and services that maintain or improve health or are forced to purchase cheaper goods and services that may increase health risks. Being on a low income also prevents people from participating in a social life and can leave them feeling they are less worthy or have a lower status in society than the better-off. The relationship can operate in both directions: low income can lead to poor health and ill health can result in a lower earning capacity...

There is substantial evidence that particular social groups are at higher risk of having a low income. Some groups have significantly reduced employment opportunities; they include disabled adults, people with mental health problems, those with caring responsibilities, lone parents and young people. Many of the social and economic problems that lone mothers are exposed to are made worse by exclusion from paid work and lack of income. An increase in income leads to an increase in psychological well­being and a decrease in anxiety and depression. The more debts people have, the more likely they will have a mental disorder.”

It proposed six policy objectives which would be required to reduce health inequalities:

  • give every child the best start in life
  • enable all children young people and adults to maximise their capabilities and have control over their lives
  • create fair employment and good work for all
  • ensure healthy standard of living for all
  • create and develop healthy and sustainable places and communities
  • strengthen the role and impact of ill health prevention.

It further stated that “Delivering these policy objectives will require action by central and local government, the NHS, the third and private sectors and community groups”.

A follow-up report was published in 2020: Health Equity in England: The Marmot Review 10 Years On. Amongst its findings were that, although life expectancy overall had increased:

  • increases in life expectancy have slowed since 2010
  • life expectancy for women in the most deprived 10 percent of neighbourhoods had decreased in every region except London, the West Midlands and the northwest
  • life expectancy for men in the most deprived 10 percent of neighbourhoods decreased in the northeast, Yorkshire and the Humber and the east of England
  • mortality rates had increased for people aged 45-49
  • those living in the most deprived areas die up to a decade earlier and spend an average of 19 extra years in poor health than those living in the least deprived areas.

Some of these issues raised in the Marmot reviews are worth drawing out further.

Firstly, while the effects of unemployment and low incomes on health are explained in the above extracts, it also points out that this relationship operates in both directions. The result of health issues for employment is that there is an ‘employment gap’ between the healthy population and those with various conditions. In 2016, Public Health England pointed out that the employment rate for people without disabilities was 80 per cent. But for those with musculoskeletal impairment it was 58 per cent, for those with mental health issues it was 42 per cent and for those with learning difficulties it was just 28 per cent.

Similarly, the 2018 Annual Report of the Chief Medical Officer stated that “Among healthy men only six  per cent are out of work at all, and just two  per cent have been out of work for three years. Yet a quarter of men with a longstanding illness are out of work, and one in six has not worked in the last three years.”

The same report found that 28 per cent of those with a long-standing illness were in poverty (a household income less than 60 per cent of the median) and that “those in ill health who are poor are also much more likely to be persistently poor”.

Secondly, just having a job is no guarantee of work-related wellbeing. The quality of the work also matters greatly. Analysis by the Health Foundation considered the health impacts of five measures of job quality:

  • low pay
  • job autonomy
  • job wellbeing
  • job security
  • job satisfaction.

They found that whenever the job quality was poor according to any of these measures, employees aged 18-55 were more likely to rate their health as ‘poor’ or ‘fair’ (as opposed to ‘good’, ‘very good’ or ‘excellent’) than employees across all work. The more of these factors that people experience in their work, the more likely they are to have worse health; ‘poor’ or ‘fair’ health occurred at more than twice the rate with two factors than with none.

Certain groups were more likely to be in low-quality work: “younger adults, people in more routine occupations, and members of black and minority ethnic groups generally, but particularly those of mixed ethnicity, Pakistani, Bangladeshi and African Caribbean heritage”. Some regions of the UK had higher levels of low-quality work than others.

These five measures were based on those used by a previous study in the International Journal of Epidemiology. This looked at biomarkers, such as blood pressure, of people who were unemployed at the outset and then either remained unemployed or made a transition into work. It found that while the greatest adverse levels of these biomarkers were seen in those who remained unemployed, there were also higher levels in those who moved into poor quality work than those who moved into good quality work.

It is worth noting that the Health Foundation analysis, published in February 2020, was showing that while unemployment was reaching the lowest level since at least 2001, underemployment was still above the levels seen in the period 2001-2007 (that is, pre-credit crunch).

Thirdly, ill health can impact on job retention and earning prospects. This can also vary by region. A report by the Northern Health Science Alliance (nhsa) in 2018 found that workers with ill health in the North are 39 per cent more likely to lose their job than a similar individual in the rest of England. And if these workers with ill health do return to work, their wages are 66 per cent  lower than a similar individual in the rest of England.

This report also put economic figures on the benefits of tackling ill health and mortality:

  • tackling the North’s health could generate an additional £13.2bn a year
  • relatively small decreases in the rates of ill health and mortality could reduce the gap in Gross Value Added (GVA) per-head between the North and the rest of England by 10 per cent.

This understanding of the impact of ill-health on the economy and public finances is growing. For example, the Liverpool City Region Wealth and Wellbeing Programme found that 33 per cent of the productivity gap between the city region and the rest of England could be attributed to ill-health. This equates to £3.2bn in lost GVA or about 10 per cent of the region’s annual economic output.

It also applies to the value of investing in public health measures to prevent a costly decline in people’s health. It should be borne in mind that if someone’s health declines for a preventable reason, the NHS is likely to treat them at a considerable cost to the public purse. A recent article in the British Medical Journal (BMJ) uses the concept of a Quality-Adjusted Life Year (QALY) to compare the value obtained from local public health expenditure with NHS expenditure.

It finds that each additional QALY costs about £3,800 from the local public health budget, compared with £13,500 from the NHS budget. Another BMJ article looked at studies that had calculated a Return On Investment (ROI) figure for public health interventions in high-income countries with universal healthcare. Unsurprisingly, these values varied widely (covering a wide range of different interventions), but the median ROI was 14.3, that is, the median value achieved from these interventions was 14.3 times the initial investment.

This issue of investing in public health is one we will return to in the sections below. 

What local councils and their partners can do

We have looked at the interrelation between health and inclusive growth and why local councils and their partners might want to plan interventions to address these issues together. We have also looked at the policy context within which such interventions would be planned. Now we want to consider what such interventions might look like – the concepts and considerations involved in planning a project or programme of action. This section runs through a selection of these, drawing on the case studies in this collection and other sources. It also highlights some resources that local councils and their partners might find helpful.

Getting an overview

PHE’s report Inclusive and sustainable economies: leaving no-one behind looks at a holistic and place-based approach to reducing health inequalities and promoting inclusive growth. It proposes that action is required across three “domains of an inclusive and sustainable economy”: social, economic and environmental. It identifies 12 sub-domains of these. It then recommends six steps to use its resources to identify shared priority areas for local action:

  1. Establish place-based inclusive and sustainable economy networks – Building inclusive and sustainable economies requires coordinated and collaborative action across a broad range of cross-cutting sectors.
  2. Set a holistic vision – use the inclusive and sustainable economy network to set a local vision which looks beyond gross domestic product (GDP) as a measure of economic success.
  3. Measure and benchmark - use the inclusive and sustainable economy framework and data catalogue to consider each of the 12 building blocks, identify areas of need and benchmark local performance.
  4. Consider the local context – reflect on local economic, environmental and social conditions, strengths and assets, and political factors that may constrain or support the development of inclusive and sustainable economies.
  5. Consult with citizens and communities – adopt a participatory approach through capturing local citizen and community insights.
  6. Prioritise areas for action – prioritise areas for action based on the above considerations ensuring that effort is targeted towards the areas of greatest need. 

These will be considered in the sections below. Appendix three of the report contains links to further useful guidance and commentary from PHE:

  • The Place-Based Approaches (PBA) for reducing health inequalities
  • The Community-Centred Public Health guidance and resources
  • The What Good Looks Like (WGLL) series of publications.

Learning from others

In such planning, it is always best to start from a detailed knowledge of what has gone from what has gone before – to learn from what other areas have done and from what they recommend others to do. Case studies, such as those presented in this document, are particularly helpful in this. Other sources of such case studies include:

  • the predecessors to this one, Health, work and health related worklessness - A guide for local councils and Nobody left behind - Maximising the health benefits of an inclusive local economy
  • other reports and collections of case studies from the LGA, such as Building more inclusive economies
  • Health Equity in England: The Marmot Review 10 Years On
  • Inclusive and sustainable economies: leaving no-one behind
  • Co-operative Councils case studies
  • winners of awards, such as the Institute of Economic Development (IED) Annual Awards, the LGIU & CCLA Cllr Awards, the APSE Annual Service Awards and The MJ Achievement Awards
  • Articles in trade journals/media/websites such as the LGC, the MJ, Public Finance, New Start and Room 151.

The Government also invites local councils to trial new approaches, so it can be informative to research the outcomes of these trials. Our case study on Sheffield City Region is an example of this – a trial into whether the Individual Placement and Support (IPS) model can be adapted for people with mild to moderate mental and/or physical health issues and for those in work struggling with health issues. Another example is the Childhood Obesity Trailblazer Programme, funded by the Government but run by the LGA. In this programme, interventions to tackle childhood obesity in five councils are being funded for three years. The LGA is keen to share learning from these five ‘trailblazers’ and have information and a contact email address on their website.

Even better is to interact directly with other local councils. This could be a standing arrangement between two councils, such as that between Manchester City Council and Islington. This arrangement has involved members and officers from Manchester peer reviewing Islington’s approach to securing social value through public procurement, and Manchester learning from Islington on using planning powers to provide affordable housing and workplaces. Or it could be through a wider network, such as the Inclusive and Sustainable Communities Knowledge Hub.

Working in partnership

An understanding of what others are doing in other parts of the country will be very useful to local councils and their partners, as they seek to identify barriers to health and inclusive growth in their area, and develop interventions to tackle these.

Just as important is a thorough understanding of what the key players in this area are already doing in this space.

It is therefore vital to identify potential partners, reach out to them and engage with them in planning programmes of action. If there was one thing that our interviewees were most keen to impress on us, it was the importance of partnership working.

Many studies on this focus on ‘anchor institutions’. These are large organisations which are ‘anchored’ in a particular location and make a significant contribution to the local economy, through their spending and employment and services they provide. As well as local councils, they include universities and colleges, hospitals, housing organisations, airports, football clubs, religious institutions, power stations and factories. Two different approaches to identifying these were used by Birmingham and Leeds: Birmingham mapped them by identifying the organisations which exceeded particular thresholds on expenditure on good and services, number of employees and ownership of land and key assets. Leeds, on the other hand, set up the Leeds Anchors Network, initially made up predominantly of public sector bodies and Yorkshire Water, and then used a prospectus-style document as a tool to grow the network.

The resulting partnerships can result in a range of different projects. A famous example is Preston, where the council’s work with anchor institutions has, firstly, resulted in much more of their expenditure being retained locally and, secondly, helped its programme of support to worker-owned co-operatives (see below).

There are examples of such collaboration in our Oldham case study: Well North, Well Oldham and the Oldham Partnership. The Oldham Partnership is a striking example of a collaboration run according to the Co-operative Councils ethos: the Partnership has set out its shared vision for the area in the Oldham Plan; the council’s Corporate Plan then “outlines how the council contributes to the Oldham Plan”.

However, it must also be remembered that there are many teams working in a large local council. Some of them may already be running programmes which have health and/or inclusive economy dimensions. It is helpful to look for synergies between different programmes and ensure that they are coordinated. An example of this can be seen in our Wakefield case study, in the coordination and signposting between the Live Well Wakefield and STEP UP programmes. A Health In All Policies approach can help with this (see above).

Furthermore, in most parts of the country, there is more than one tier of local government. There may be upper-tier councils, district councils, city regions/combined councils and town/parish councils. Again, it is worth understanding what all of these are doing; partnership working between these authorities can result in imaginative new ventures. 

In any matters to do with the local economy, the Local Enterprise Partnership (LEP) has an important role to play. Outside Mayoral Combined Authorities, they are leading on the development of Local Industrial Strategies (LIS). Close links with the LEP and the content or development of the LIS could improve the effectiveness of any programme relating to economic inclusion. An example of a programme emerging from such a partnership is Digital Enterprise, a business support programme in the Leeds City Region. This is funded by a combination of the region’s LEP, nine local councils and the European Union. It provides small to medium size businesses with a range of support: free workshops, masterclasses, digital conferences and mentoring support and vouchers for connectivity and digital technology.

A particularly extensive example of partnership working is the targeted NEET prevention service in Northamptonshire, run by Prospects. This tracks the progress of young people after year 11 and works with them to reduce the number not in education, employment or training (NEET). This work is carried out on a very collaborative basis, involving:

  • close working between Prospects and the county council’s social care team, leaving care team, virtual schooling team and Special Educational Needs and Disabilities (SEND) team
  • data sharing arrangements with schools, colleges and job centres
  • community drop-in sessions with advisors in job centres and leisure centres (which are run by the district councils)
  • close working between Prospects and the district councils, including the skills forum in East Northamptonshire (which has, among its members, representatives of the district’s economic development team and local employers), youth training in Kettering and a sports project in Northampton
  • involvement in the Community Initiative to Reduce Violence (CIRV), led by ‘navigators’ in the police force, and using housing, employment and so forth to divert young people from crime
  • a scheme set up with local taxi companies to help young people get to places of work (such as industrial estates).

Use of evidence and data

Another key learning point from our case studies is the importance of using evidence to determine the most effective intervention. Perhaps the best example of this is Wakefield, where a close scrutiny of employment statistics revealed specific labour market issues. The authority designed the STEP pilot to tackle these, as explained in the case study.

Another take on this is that used by Suffolk. Here, Public Health Suffolk has contributed to Suffolk County Council’s policies and embedded a consideration of health and wellbeing into the council’s approach to inclusive growth. Evidence is collected on this and key data is presented in the ‘State of Suffolk Report’. This helps to engage partners and align interests across the health and economic development sectors.

Probably the most important source of evidence is the council’s partners themselves. This is good, local intelligence. This was used very successfully in our Basildon case study, where a combination of the Pathway Panel, local employers and local providers of skills training and similar support managed to identify a specific problem. A very specific solution was developed to tackle it, a town centre Advice Store.

For statistical comparisons with other parts of the country, there is a vast amount of data available, both commercially and for free. A particularly useful source of data in a public health context is PHE’s Fingertips database (with a helpful API tool for customised data retrieval). A digest of the data in this and many other sources is contained in the ‘data catalogue’ issued alongside PHE’s report Inclusive and sustainable economies: leaving no-one behind. Just to name a few others, the LGA’s LG Inform service provides a range of data and benchmarking information for local councils. Many other networks and membership organisations do likewise. Besides the well-known Indices of Multiple Deprivation, other indices on deprivation and prosperity are available – for example, the London Prosperity Board has created a five-part Prosperity Index, while Grant Thornton has developed a Vibrant Economy index. There are also commercial analyses of economic data available, such as the tools on sectoral strength and labour market information created by EMSI.

Similarly, when it comes to assessing the expected impact of various measures, there are many tools available. The movement towards seeking social value from services and procurement (enshrined in law since 2012 – see above) has led to a growth in determining the cost-benefit ratios and returns on investment from policy measures. Two particularly noteworthy examples of this are the Cost Benefit Analysis (CBA) model developed by the Greater Manchester Combined Authority (GMCA) and the Social Value Engine developed by Rose Regeneration. Social Value UK has played a key role in supporting the development of such analysis, and in supporting social value more widely.

While these tools contain analysis of the impact of health policies, there are also many tools that relate purely to the impact of health interventions. Many of these are listed in Appendix three of Inclusive and sustainable economies: leaving no-one behind, including:

  • Health Equity Assessment Tool (HEAT)
  • Spend and Outcome Tool (SPOT);
  • Health Economics Evidence Resources (HEER)
  • Cost-effectiveness resources and ROI tools
  • The World Health Organisation (WHO)’s Health Impact Assessment (HIA);
  • The THRIVES Framework, designed by the Institute for Environmental Design and Engineering of University College London – this provides a structure for understanding healthy urban environments and helps key decision-makers from different sectors to reach a shared understand and make informed decisions.

Research into such interventions is funded by the National Institute for Health Research (NIHR).

Routes by which councils can create more inclusive local economies

Once a specific local need or barrier has been identified, it is important to remember that a local councils has many levers it can pull to achieve its aims. These include:

  • the direct delivery of services
  • the way in which services and goods are commissioned and procured
  • its role as an employer
  • setting up a local authority trading company
  • its ownership of land or buildings
  • its investment policies
  • its planning and development policies
  • its role in existing partnerships and in convening new ones.

The second of these is subject to the requirements of the Public Services Social Value Act 2012 (see above). However, social value can be applied more widely than to just the services commissioned by the council. For example, GMCA has developed a Social Value Framework for the use of organisations across the region, supported by a Social Value Network. This has an aim to “encourage organisations in every sector to seek relevant social, environmental and economic value from everything they do, including service delivery, commissioning and procurement”.

Preston has taken a similar approach. Its own spend as a district council is relatively small compared to other anchor institutions in the area. It therefore worked with them to identify their top 300 suppliers and shift their processes and practices around procurement. Consequently, in the four years from 2012/13 to 2016/17, they went from a position where only five per cent  of this spend was retained in Preston and 39 per cent in Lancashire as a whole, to one where 18.2 per cent was spent in Preston and 79.2 per cent in Lancashire. This last figure equated to £489m. It was estimated that the increase in local spend supported 1,648 jobs in Preston and 4,500 around Lancashire.

Employment practices is another area where the Greater Manchester Combined Authority has identified a need for improvement and has driven change across the city region. Its Good Employment Charter was co-designed on tripartite basis – that is, working in partnership with businesses and trade unions. The Combined Authority and its constituent councils are now exploring embedding its principles in their procurement and investment policies.

Councils can use their investments to support local businesses and can even provide financial and related services themselves. An example of the former is Liverpool City Region’s Strategic Investment Fund (SIF). It is to be invested in projects such as ultra-fast broadband across the region, a smart ticketing system for public transport, a Town Centre Fund and a new generation of Mersey Ferries. Numerous authorities are now supporting local businesses through investing in peer-to-peer lenders and other crowdfunding. LGiU and Spacehive have produced a guide for local authorities on this. But perhaps one of the greatest range of innovations in this sphere is in Cambridgeshire. Here, the County Council’s pension fund invested £15m into shares in a local building society in 2017. Together with the University of Cambridge’s Trinity Hall College, it launched its own bank, the Cambridge and Counties Bank, in 2012, to provide banking services, including deposit accounts and loans, to small to medium sized enterprises (SMEs). And Cambridge City Council has created its own lettings agency, Townhall Lettings. Preston has also made some progress in providing financial services, as explained below.

Buildings owned by a council can be used in a variety of ways to support the prosperity and wellbeing of the local population. International House in Lambeth is a former council office which the council has repurposed as an affordable co-working space for new and growing businesses, social enterprises and charities.

One floor of the block is dedicated to not-for-profit and community organisations who are not charged rent. It was the first building in the UK to be recognised as a Living Wage Building, meaning that all tenants are obliged to pay their tenants at least the London Living Wage. It was also the sixth affordable workspace for small and growing businesses to be opened as part of a council programme called Lambeth Works, which was highly commended in the Enterprising Britain Awards 2018. Another of them is the Health Foundry, which is located opposite St Thomas’ Hospital and was set up by Guy’s and St. Thomas’ Foundation. This provides a supportive environment for digital health start-ups.

Other levers can be used by local councils for similar purposes. Islington uses the Section 106 process and its planning powers to provide affordable workspaces and associated social value, while Manchester uses Local Labour Agreements in its planning processes to help connect local workers to employment opportunities in construction.

Designing interventions

Once a council and its partners have an idea for improving health and economic inclusion, there are many issues that need to be considered in planning a programme of action. We now consider some of these.

Financing the programme

A programme of interventions will need to be financed. Given the tight constraints on most local councils budgets, this will often mean a need for external funding. Three grants specifically intended for economic development are the Levelling Up Fund described above, the Towns Fund and the Community Renewal Fund. However, it is worth local councils being imaginative, looking for funding that is specific to the intervention and discussing funding with their partner organisations – both current and potential. It is also worth monitoring funding pilots, as discussed above, and funding announced in the main fiscal events (Budgets and Spending Reviews).

For example, Birmingham City Council’s successful bid for the Childhood Obesity Trailblazer Programme contained a scheme for deprived areas of the city, where obesity rates are highest, to offer young people apprenticeships focused on health, food, nutrition and physical activity. It was also to create a local metric for consumer habits called the ‘Birmingham Basket’ to measure impact and inform policymaking.

These principles can also be seen in our Bicester case study – the town became the UK’s first Garden Town and also one of the demonstrator sites for the NHS’s Healthy New Towns (HNT) programme.

Once one source of funding is secured, it can sometimes be used to lever in further funding.

It is also worth looking for funding that does not come from grants or public expenditure, especially in the long-term. This includes crowdfunding/community funding and also looking for the commercial potential in projects. Our Oldham case study contains both of these. Community crowdfunding was used by the Oldham Food Network. Commercial income is or could be derived from a range of sources, including a green energy company, the sale of produce from several of the outputs and toolkits developed for the Northern Roots project. Indeed, the council is determined that in the long term the Northern Roots project will be commercially self-sustaining. Commercial funding also plays a role in our Basildon case study, from advertising and from payments by providers in the Advice Store.

Evaluation, learning and data sharing

It is important to plan the evaluation process out thoroughly before the programme commences. To quote from the LGA’s recent report Building more inclusive economies, “The inclusive growth agenda is a long-term effort – and strategies will have multiple iterations. Interventions and policies need to be effectively evaluated so that they can be improved, with lessons learnt from what was successful and what was less successful”.

If there are metrics for evaluating success (and Building more inclusive economies notes that it is usually best to include quantitative analysis as well as qualitative evidence such as case studies), then it is important to establish a baseline. This can only be measured before the project or programme commences – one of the reasons that careful planning is needed.

Another issue that needs to be planned out at the start is data sharing between organisations. Appropriate data sharing can improve evaluation, but this requires the necessary data protection arrangements to be in place. Indeed, this point goes wider than evaluation, as data sharing can hugely improve the overall effectiveness of the project.

There is often a role for local universities in evaluation and related planning. In Bicester, several universities were involved in the overall evaluation. In Oldham, evaluation of the Northern Roots project is done in partnership with Salford University. And Sheffield City Region worked with a researcher from Sheffield University on designing the Working Win project.

As noted in the Bicester case study, it can be helpful to incorporate some form of ‘rapid cycle’ approach into the evaluation (alongside an evaluation across the lifetime of the project), so that adjustments can be made to the project as it proceeds.

Finally, it’s worth remarking that for some projects, data can be provided digitally by the programme’s participants, as is the case for mountain bikers in Oldham’s Northern Roots project.

Other considerations

As these programmes are often so cross-cutting, involving teams from across the authority (and beyond), it is important to get buy-in from the whole organisation. Enthusiastic support and preferably leadership from the most senior leaders and officers can help considerably. Equally, it can help to have the programme, or at least the principles underlying it, written into corporate strategies.

It is just as important to get buy-in from the public, particularly the participants in the programme – and where possible, their active engagement and contribution. While it may be obvious that good consultation is not just about telling the public about what is planned, the best consultation is not simply a matter of asking the public’s opinion, then going away and putting it into practice. It involves engaging in dialogue with citizens and providing meaningful feedback at each stage. This means, for example, reporting back with a checklist of what the public asked for and showing how the council or partnership has fulfilled this.

When someone has participated in a programme, they can be invited to pass on that experience to others. An example of this can be seen in our Kent case study, where many participants in Live Well Kent went on to run groups themselves or take up mentoring or caring roles.

Given the Government’s renewal of the Devolution Deal programme (as flagged up in the Prime Minister’s levelling up speech – see above), this could potentially be used to devolve new powers and funding to local councils. This could help with particular interventions, in keeping with the LGA’s message of Build Back Local.

Finally, it is important for those planning interventions to consider holistically all the possible barriers to engagement. One common issue is lack of transport, particularly in rural areas, which can prevent people accessing services and social relationships and taking up employment that is attached to a particular location. As mentioned above, in Northamptonshire, there is a scheme which provides taxis to help young people get to places of work, such as industrial estates, for which there are no public transport links.

There are also ‘wheels to work’ schemes in several parts of the country, offering those who do not have other transport options the option of hiring a moped, bicycle or electric bike. Something similar can be seen in our Wakefield case study. Digital exclusion can be a similar barrier. There are many schemes across the country to help people learn digital skills and understand the benefits of digital technologies, including the award-winning 100 per cent Digital Leeds.

Common themes and concepts

We close the introduction by running through some common themes and phrases from our case studies and highlighting relevant examples of these from across England.

Helping people into work

Most inclusive economy projects involve this in some way or another, but the variation in these projects is vast.

Some are services which match job seekers with employer’s vacancies. Perhaps an archetypal example of this is Hackney Works. This in-house service links connects residents who are unemployed, underemployed, or in low paid employment, and 16-24 year olds not in education, employment or training, with employment opportunities provided by local businesses. These include work experience, training and pre-employment schemes, as well as full-time jobs, including in the creative sector. Between 2016 and 2019, it provided employment support to more than 4,500 residents, with 2,275 supported into jobs and over 1,132 into training.

Such an idea is far from new. These principles lay behind the system of Labour Exchanges introduced by the Labour Exchanges Act 1909, which was in turn significantly influenced by William Beveridge’s studies of their operation in Germany. However, local councils are able to use their local knowledge and smaller geographical coverage to provide services which are much more creative, supportive and tailored to the specific needs of their local labour market.

Such a service is also at the core of STEP UP, as described in our Wakefield case study. Wakefield provides a truly bespoke service, looking very carefully into the barriers to work for each participant.

This focus on the needs of an individual lies at the heart of the Individual Placement and Support (IPS) model. This might sound like a buzz phrase, but it will only work if careful attention is paid to each of the three words in this acronym: it is about placing individuals – usually with severe mental health issues – into work, treating them as individuals and giving them all the support they need to make this transition. This requires intensive work and consequently support workers’ caseloads are usually very low. Our case study on Sheffield City Region covers a trial of this model for a different cohort.

Another way of promoting inclusive economic growth is by supporting small businesses and a culture of entrepreneurialism.

There are many ways in which this can be done.

For example, the South and Vale Business Support team at the South Oxfordshire and Vale of White Horse District Councils provides support to those who wish to start up a business or improve their business’s productivity. Its series of week-long, free, pop-up business schools to support start-ups in four towns resulted in more than a third of participants starting a business at the end of each week and won the team the IED Impact Award in 2019.

Leeds Digital Enterprise provides a range of business support around digital technology as described above, while Wandsworth provides start-up loans, supported by 12 months of free one-to-one mentoring from experienced business professionals. Between 2012 and 2019, £468 million was provided in nearly 61,000 loans, helping to back 28 businesses per day.

We have already described how Lambeth and Islington provide business support through providing workspaces. Lambeth also provides signposting to business support organisations, such as Tree Shepherd and Business Launchpad.

Fostering entrepreneurialism is part of another Lambeth programme called Lambeth Made. This programme is described by Co-operative Councils as “a shared commitment to make Lambeth one of the best places in the world for children and young people to grow up. It seeks to put Lambeth children at the heart of collective thinking, planning and action in the borough, with the aim of improving the lives and futures of all children and young people”. It is partly based on the concept in Leeds of a Child-Friendly City, but it is given a Lambeth flavour – a focus on a symbiotic relationship between local businesses and young people, leading to them growing their talents and fulfilling their potential and to greater community cohesion. It aims to improve outcomes in four areas:

  • confidence, self-esteem, mental well-being and ‘pride’ in young people
  • community and business-led activities providing a positive impact for children and young people
  • employment, education and training opportunities for young people
  • resilient communities working to reduce serious youth violence.

Measures to promote the first of these include, for example, free boxing and basketball sessions for young people at risk.

Recently there has been a particular focus on the work with businesses. For example, twelve schools have been given the opportunity for their students to run micro-social enterprises, and a partnership with LDN Apprenticeships will see 100 apprenticeships offered to young people. There is also a set of annual awards to recognise the achievements of apprentices and the contribution of employers and organisations to young people in the borough.

Lambeth Council is focusing on how to measure outcomes and on fitting the system to the participants, taking into account their personal perspectives (for example, considering the perspectives of children from particular ethnic and cultural backgrounds).

We have also already seen how Preston City Council has worked with anchor institutions to ensure their procurement supports local businesses. Another part of this ‘Preston Model’ is the creation of the Preston Co-operative Development Network (PCDN). This Community Benefit Society provides funding and support for the development of worker-owned co-operatives in the city and surrounding areas. This support includes advice, consultancy and training for those interested in starting a co-operative business or converting an existing business to a co-operative model and help to access financing, suppliers, markets and customers. The Council has also set up a credit union and is exploring the creation of a community bank with neighbouring councils, with a particular focus on lending to small businesses.

'No Wrong Door' and 'Make Every Contact Count'

Again, these sound like buzz phrases, but if diligently applied, these closely related concepts can make a huge difference. They both relate to situations where an organisation or partnership has many points of contact with the public. No Wrong Door means that if a member of the public requires a particular service, they are referred smooth and efficiently to that service, regardless of which point of contact they use. Make Every Contact Count (MECC) is about giving staff the training and resources needed to engage in conversation with service users about the full range of their needs and make appropriate referrals.

Public Health England, NHS England and Health Education England have an agreed definition of MECC in relation to conversations and referrals regarding healthy behaviours and helping people to look after their physical and mental health and wellbeing. These concepts are applied in our Bicester, Kent and Wakefield case studies.

Social prescribing

Another commonly used phrase in services to improve health is social prescribing. The Social Prescribing Network defines it as follows:

“Social Prescribing is a means of enabling GPs and other frontline healthcare professionals to refer patients to a link worker - to provide them with a face to face conversation during which they can learn about the possibilities and design their own personalised solutions, i.e. ‘co-produce’ their ‘social prescription’- so that people with social, emotional or practical needs are empowered to find solutions which will improve their health and wellbeing, often using services provided by the voluntary and community sector. It is an innovative and growing movement, with the potential to reduce the financial burden on the NHS and particularly on primary care.”

Social prescription differs from traditional prescription in terms of what is prescribed: activities, lifestyle changes and support, rather than medication. However, to operate most effectively, it is also important that practitioners consider the way in which this prescription is done. All parties involved in the process need to work together cooperatively and efficiently, to engage with patients empathetically and co-design solutions with them. It must be remembered that taking up a new activity or making a lifestyle change may seem daunting. The traditional doctor-patient relationship, in which the practitioner tells the patient authoritatively what the patient needs to do, is unlikely to be the most effective approach; the patient being diplomatically and supportively invited to consider a change is more likely to result in positive engagement.

Live Well Wakefield is based on social prescribing principles and has won a Social Prescribing Network Award, as described in our Wakefield case study. Social prescribing also forms part of Bicester’s Health New Towns programme and is provided in the Basildon Advice Store by Essex County Council’s Essex Lifestyle Service. Further case studies can be found in the LGA’s case studies Just What The Doctor Ordered.


Locating related services in the same building or complex can help to provide a more seamless set of services to the public. It can make the service user’s journey through them much smoother and can help the providers to work more collaboratively and in a more interconnected way. This is the principle behind the success of the Basildon Advice Store. One example of this is that in some areas JobCentre Plus has relocated into a local council-run building such as a library or civic centre. While co-location will not automatically join up the services, it can be very helpful in facilitating this.

Case studies