BLOG: Levelling up? Just give the North a break

NHSA Chief Executive blogs in advance of the long-awaited Levelling Up White Paper

1st February 2022

In advance of the long-awaited Levelling Up White Paper, NHSA Chief Executive Dr Séamus O’Neill explores the scale of health inequalities in the North and what needs to be done to tackle the problem.   


Levelling up captures the very strongly felt need for fairness, from people in the North of England, in terms of opportunity and investment.  Over decades Government investment in transport, R&D, health, education, and housing has heavily favoured the South East, hard-wiring unfairness and inequality across the UK.  

We must make 2022 the year we finally break this cycle of under-investment. It has driven the economic malaise, poorer life chances and the ill-health we are seeing in many UK regions, especially in the North.  

There has been enough rhetoric on levelling up. We need to see action, at scale, that is cross-party and that is sustained over multiple parliaments. 

As we await publication of the Government’s highly anticipated Levelling Up white paper, it is timely to remind ourselves of the issues it is seeking to address. It is imperative that we act and acknowledge the scale of the challenge that faces us. We must also understand that the root causes of the health inequalities we witness are primarily economic. While increased investment in health and care is needed, only a long-term improvement in the economy of the North and, by extension, the wider determinants of health can address the unfairness and injustice experienced.

What is the impact in the North of UK health inequalities?   

In collaboration with our members, the Northern Health Science Alliance (NHSA) has played a key role over the past decade in highlighting the health inequalities that exist between the North and more affluent areas of the UK. 

We kicked off 2022 with the launch of a joint report between the NHSA and All-Party Parliamentary Group for ‘left behind’ neighbourhoods. These communities are predominately, but not exclusively, in the North. They are common in post-industrial towns and in coastal areas. The findings of the report were stark and showed the devastating impact of poor health for people living in the most deprived areas of the country. People in these ‘left behind’ communities: 

  • Are working longer hours but living shorter lives, with more ill-health. This burden of relative ill health has a staggering cost to the economy – around £30bn annually in lost productivity. 
  • Suffer a higher prevalence of 15 of the most common 21 health conditions compared to other deprived areas and England as a whole. They include high blood pressure, obesity and chronic lung conditions such as COPD.  
  • Bore the brunt of the pandemic as they were 46% more likely to die from COVID-19 than in the rest of England.  

These findings add to the mountain of evidence that tackling economic imbalances across the UK, and the health inequality that results, should be central to the Government’s levelling up aspirations. A child growing up in the North post-pandemic, shouldn’t be at greater risk than their peers in the South East from: death in childhood; living in poverty; or suffering from a mental health condition, loneliness or obesity – as highlighted in our recent Child of the North report 

Change the Government policies that currently reinforce economic inequality 

The scale and resilience of the economy in the North must be prioritised immediately. Successful modern economies are based on innovation and the research that underpins it. The North has excellence at scale in sectors that will be crucial for growth in the 21st Century: notably in life sciences and net zero. UK research in these fields and the development and adoption of the discoveries for societal benefit and economic growth should be prioritised in the North where we have a critical mass of research expertise and companies that can create the jobs that are needed.  

However, government investment in northern R&D infrastructure has been woefully inadequate for a long time. From the work of Professor Richard Jones, we know that we miss out on £4bn every year in government R&D funding. As a direct result, more high-tech companies and jobs are established in, or attracted to, other parts of the country. NHSA analysis of the UK Health Research Analysis Report 2020 showed that in the North £21 was spent per person on health research, compared to £62 per person in the South East. Over time this has a marked effect on capacity, skills, life-chances, migration and ultimately on health and wellbeing. It is no wonder that we have ended up with an unbalanced economy and unequal life-chances: it is an injustice and it must be addressed. 

As things stand, we don’t receive anything like the investment in the South in R&D or transport or education – all the things that build a strong economy. This becomes self-perpetuating as fewer jobs and lower levels of skills reduce resilience in communities and diminish life chances, health suffers as a consequence. This in turn acts as a drag on the economy with shorter productive working lives and lower output because of a skills deficit, inefficient and expensive transport and time off work through sickness. Work done by the NHSA in 2018 demonstrated5 that a third of the productivity gap between the North and the rest of England is due to ill health at a cost of £13.2bn to the UK economy each year. 

Urgent action is required and a long-term commitment 

The answers will not be quick, or easy, but we must start to break into the cycle: the impact is real, the gap is widening, and awareness of the injustice is growing. There are common themes across R&D, transport, housing, education and pretty much everything else in levelling up. These are that we need a commitment to the North having: 

  • a fair share of government investment from now on 
  • the autonomy to shape how that investment is used, in partnership with the people of the North 
  • time to make the recovery happen. 

With these three principles in mind, below are four priorities the Government needs to deliver: 

  1. There have been encouraging signs recently from Government on increasing public spending on R&D to the OECD average of 2.4%. Government must now take steps to ensure that the increase required to reach that figure is spent outside of the South East.  
  1. Double the size of the Strength in Places Fund, as it is the sort of targeted, place-based and industry-led initiative that will work quickly. In 2019, the £236 million Strength in Places Fund was created to support innovation-led regional growth with consortiums bidding on funds made up of research bodies and business.  
  1. Invest in a Supercluster in Life Sciences across the North as a UK growth opportunity. From Silicon Valley to Israel, the most successful superclusters have a locally-led cluster development organisation to foster the partnerships needed, provide coordination and to act as a “front door” for domestic and international investors. Government, and in particular Minister for Science, Research and Innovation George Freeman, seem to have grasped this and we look forward to seeing how this connectivity across the complex life sciences ecosystem is supported. 
  1. Set targets for Government departments on addressing the historic imbalance in funding to regions other than the Greater South East. For example, mandate that all of the increase in National Institute of Health Research budget be deployed outside of the South East. This is particularly important as the NIHR funds research that “leads to improved outcomes for patients and the public”. Given the health discrepancies between the North and South this increase in funding can be targeted at improving regional health outcomes as well as driving innovation and economic growth.  

Concerted action on these fronts will deliver growth and jobs in the life science sector. It could also solve lots of the complex skills and on-shoring issues that were highlighted during the pandemic. Government needs to invest in deficiencies highlighted during COVID-19, in diagnostics, therapeutics and manufacturing. In doing so, it should look at every opportunity to develop infrastructure in the North to meet that need. The excellence is here, and the economic case is writ large; and double-sided.

A new paradigm and some honesty 

We need to move away from the convenient fallacies that the status quo is due to deficiencies of the North and that poverty is the fault of the poor. As our reports identify, people in some of the hardest hit areas are working longer hours than elsewhere. The problem isn’t that people aren’t working hard, or that there are not assets in the North that will make it competitive. The problem is that there has been a sustained lack of opportunity and investment through choices made by successive governments. That’s what needs to be addressed and over a sufficiently long period of time to recover the ground that has been lost. 

The life sciences sector has a key role to play and excellent opportunities for growth and job creation in the North. The NHSA and the NP11 LEPs will play their part in that and colleagues in the N8 northern universities and NPP are championing Net Zero North in a similar vein. These locally-led initiatives represent our future economic prosperity, and, on this, we are hearing the North speaking with one voice.  

If the Government is serious about building back better, levelling up and making the UK a global scientific superpower, we need action. Our left-behind neighbourhoods and regions cannot recover on rhetoric. So, let’s make 2022 the year where real investment and commitment to change happen and then look to sustain that. I’m optimistic it can be done, based on the world-leading research, industry and clinical assets we have in life sciences and other high-value sectors across the North and the desire of industry to work with us. The simple message…give the people of the North of England an even break and let them get on with it.  

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