Robin Tuddenham is Chief Executive at Calderdale Council and Accountable Officer for NHS Calderdale Clinical Commissioning Group. We spoke to him about the role of local government to reduce inequalities and implement measures to support levelling up, and how opportunities for devolution could help.
What does ‘levelling up’ mean to you and the populations you serve in Calderdale?
‘Levelling up’ may be a new term with a big political context, but it’s by no means a new agenda for us. It’s just describing the need to solve a long-term issue – a level of systemic inequality in terms of investment, opportunity and focus within different communities, neighbourhoods and regions across the country. The core problem is that currently where you live, your ethnicity, and your class is determining your life opportunities. And that shouldn’t be the case.
In West Yorkshire it meant we went into the pandemic with widening gaps between those areas that do well and those that do less well (and that’s evidenced by the most recent Index of Multiple Deprivation from 2019). That’s partly the result of ten years of reduced public sector investment, combined with a reduction in land values and a combination of issues around worklessness, poverty and poor health.
What impact do you hope the government’s focus on levelling up will have in your area?
The government sees levelling up as something important to its political success, particularly in relation to demographic shifts around its voter base. So, it’s an opportunity. It means there’s currently a focus on providing short term capital funding to invest in towns and regions that haven’t had much money spent on them over the last decade.
In Calderdale around five of our towns are seeing some of this investment, including places like Brighouse and Todmorden. That’s not going to level up in a sustainable way, but it is a way to offer some short-term interventions as part of a longer-term plan. I’m hoping some of that investment will be used to improve our civic spaces, to help bring back pride in the local place and create more attractive and healthy environments.
Longer-term I really hope that the focus on education recovery post-pandemic can provide an opportunity for levelling up. If we focused on interventions for those children and young people aged between 0-5 years and 18-24 years with a 10-year proposition to shift poverty and opportunity, we could really make an impact.
Levelling up isn’t about taking some money from one place and giving it to another. It’s just about creating a sustained long-term focus on areas that are disadvantaged, using scalable, evidence-based interventions to make improvements.
In the current funding landscape how possible is it for local authorities to invest in that kind of work to tackle the real causes of inequality?
The problem is that nearly everything that leads to any sustainable impact needs action in the longer term. Whether that’s intervening during the early years or building on education and skills.
In reality we’ve seen a destruction of some of those opportunities in parts of the north. Here in Calderdale we sought to keep our Sure Start centres, handing them over to the voluntary sector, and that’s proved worthwhile. The evidence now around early years intervention is positive in terms of its impact on health and opportunities. But that evidence is only just starting to come through. And that’s the problem. Often to see results now, you need to have been investing 10 years ago. And the Treasury will always want evidence of impact quicker than you can get it.
For example, you can show a business case for the impact of a new road, through reduced traffic, better air quality etc, which enables you to spend £110m on improving that road. But to be able to say that spending £110 million on children under five is going to lead to a better life for them is a lot harder. If we could only look at investment in the first 5 years of life as a similar kind of infrastructure investment, it would change everything.
Like lots of councils, we have elections 3 years out of four here, so it’s always been difficult to prioritise work where you don’t see immediate results. But it’s not an either or, you need to be able to work on short-term quick wins within a longer-term dimension.
How important is place-based leadership and could increased devolution give local areas more flexibility about how they allocate funding and priorities?
Levelling up should be about shifting the dial through an interventionist approach. And this will be what devolution means in practice if there is a commitment to longer-term funding for public sector spend on things like housing and skills. Increased devolution to local areas, whether that is via mayors or local authority leaders, is an opportunity.
Local government has always provided place-based leadership – it’s democratically accountable local people who understand their local places, elected into leadership roles. There is now an opportunity through the devolution deals to collaborate across places at scale, to create a new layer of politically legitimate local leadership. This could be really important for changing key aspects of the wider determinants of health. When you begin to work at a level of 2.3 million people in the sub-region of West Yorkshire, you really have the potential to shift opportunities in a meaningful way.
What collaborations are needed to facilitate changes to health inequalities?
Place-based leadership is important, but it’s not about doing everything at local district level, it is about working with different tiers of government and public services. We need to see ourselves as system leaders. Our role is to convene and create opportunities to collaborate across the public, private and voluntary sectors. That way we can use devolution to intervene on the more entrenched issues like homelessness, severe poverty and disadvantage, and food poverty. We are working on those issues locally and across West Yorkshire. It’s all long-term work and that takes bravery and courage – and we need to show evidence as we go along to make the case for continued investment.
None of this can happen without partnership working, and we’ve got some really strong systems set up to do that now, including the West Yorkshire Integrated Care System, bringing together health, local government and voluntary and community services, and our West Yorkshire Combined Authority which oversees infrastructure projects, transport and skills.
There’s still work to do on pooling the money, but generally we collaborate by default now. Because bringing together our collective resources gives us collaborative advantage. If we are not going to act on this now, as we seek to recover from the impact of the pandemic, then when?
This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.