Key points

  • Education is important for health. It provides the skills and specialist knowledge needed to secure good jobs and participate in society – the basic building blocks of a healthy life.
  • Further education – often perceived as a less valuable route to employment – provides people with the necessary experience and training for the world of work. It lays the foundations for their future and leads to improved health outcomes.
  • It also supports adults who are in poor quality work, or in vulnerable sectors to retrain and enter more secure employment. 
  • But changes to the funding structure are needed. Further education has seen the most severe cuts in the education sector over the past decade, with an 11% real-terms cut in funding between 2010/11 and 2020/21 – it will be a major challenge for the government to reverse its fate.
  • By investing in further education, government can create the conditions for a healthier and more prosperous society.
  • In the UK’s recovery from the COVID-19 pandemic, further education will be a key mechanism to improve labour market outcomes and to fulfil the government’s aims of levelling up the country.
  • A commitment to long-term investment could help to improve outcomes across several areas central to the levelling up agenda – from a more skilled workforce, through to reduced rates of unemployment and better local economic performance.


Education has an important influence on health. It provides the skills, attributes and specialist knowledge needed to secure good jobs and participate in society – building blocks of a healthy life. Investment in further education specifically can contribute to a healthier and more prosperous society.

The academic track has long been thought of as the most common route into high quality employment – working up from GCSEs to A-levels and through to university before securing a graduate job. However, this is not the approach most school leavers take, with only 36% of 18-year-olds studying in a higher education institute last year.

Further education offers an alternative way into employment, but it tends to be perceived as less valuable. Further education encompasses a broad range of providers and courses, from specialist courses through to work-based learning. In essence, it provides people with training, experience and skills needed for the world of work. In turn, this lays the foundations for their future and strengthens their long-term health prospects.

Among many important functions, further education offers an entry route into vocational careers in key industries, such as construction or health care. It also supports adults who are in poor quality work, or in sectors vulnerable to macroeconomic changes (such as automation or decarbonisation), to retrain and enter more secure employment.

The further education sector comprises any institution or organisation (other than schools or universities) that receives government funding to provide education and training to people over the age of 16. Most opportunities are delivered through colleges, but training can also be delivered by employers, local authorities, or independent training providers.

Qualifications might be academic, such as studying for A-levels at a general further education or sixth form college, or taking up a specialist course at an agricultural or arts college.

Further education can also include vocational or technical training, such as an apprenticeship or T-Levels and BTECs. These training courses will typically have a ‘work-based’ learning element to them, where learners are expected to complete a certain number of hours each week in employment, putting their skills into practice.

Some people may also pursue ‘community learning’, which is typically targeted towards adults. These courses are intended to help people develop new skills or prepare for higher level study. They tend to be short term and may be delivered in the evenings to fit around other responsibilities.

As the UK emerges from the pandemic and works through the impact of Brexit on the available workforce, the further education sector will play a key role in developing the labour market skills necessary for economic recovery and delivering the government’s levelling up aspirations.

Improving human capital and educational attainment – and bridging the gap for people in poorer areas – will have benefits for the nation’s long-term health. Among OECD countries, the UK currently spends the fourth highest proportion of its GDP on education. The Education Policy Institute found that in the UK, people who leave school with the lowest education levels have a life expectancy 4 years lower than those educated to the highest levels, by the time they are 30 years old. This analysis will focus on further education as a route into good quality work, which has been previously shown to be a key driver of health.

What’s the current situation with the further education sector?

Over the past decade, further education funding has seen the most severe cuts in the education sector, with an 11% real-terms cut in funding between 2010/11 and 2020/21. The government has committed to launching the £2.5bn National Skills Fund to boost lifelong learning – but this would reverse only about a third of the cuts (according to the Institute for Fiscal Studies).

The tide is turning on further education, with policy decisions for the sector getting more attention. New legislation has the potential to reshape the further education sector and ensure it is more closely aligned with local economic needs. Beyond this, the government has committed to expanding apprenticeship opportunities in the Plan for Jobs through targeted financial incentives for employers.

All aspects of education will need to feature strongly in the government’s levelling up plans, in order to increase prosperity, widen opportunity and ensure that no region is left behind. Only time will tell whether the forthcoming Spending Review will deliver sufficient investment in further education to fully reverse past cuts and address future funding challenges.


A lifetime of good education

Levelling up educational attainment is linked to reduced unemployment

Improved educational attainment leads to people experiencing greater success in the labour market. Longitudinal data published by the Department for Education show that people with higher levels of educational attainment tend to perform better in the labour market over the long term, in respect of both income and career progression. And 15 years after completing GCSEs, those who obtain a level 3 vocational qualification or above earn £3,000 per annum more than non-graduates with a highest qualification at level 2 or below. People with the lowest education levels were also more likely to claim out-of-work benefits than their peers.

Figure 1 shows that, on average, a greater share of people whose highest qualification is level 2 (or below) are unemployed than people with qualifications of above level 2. For example, 3.7% of all 30 to 39-year-olds with a highest qualification of level two or below were unemployed, compared with only 1.8% of those with a highest qualification above level 2.

Figure 1

Modelling by the Centre for Progressive Policy suggests that increasing the proportion of people in a local area with a formal qualification is associated with an increase in the employment rate. In the most deprived areas, a 1% decrease in the percentage of people without a formal qualification can mean a 0.33 percentage point increase in employment rates. This suggests that targeted investment in adult skills can help meet the government’s ambition of levelling up through boosting employment of deprived areas, which can in turn improve population health.

Individuals need to be supported to access new learning opportunities – simply creating such opportunities is not enough. Tackling barriers such as time constraints due to employment patterns, potential cuts to benefit entitlements, and a lack of information about funding opportunities, can ensure equitable access to learning opportunities.

But reducing unemployment rates cannot be delivered through reskilling alone. Improving access to labour market requires a whole-system approach, including increasing job supply. This can also be addressed by creating better links between skills provision and local labour market demand, which was a key recommendation of the Augar Review, and has since been adopted as a cornerstone of the Skills and Post-16 Education Bill (with new forms of local skills planning to be trialled in pilot areas). Further education providers, businesses and other stakeholders will work together to define areas of growth, local needs and how best to meet them. Local public health teams and NHS providers should be included in these plans.


Individual health and wellbeing

Further education supports people to develop specialist knowledge and skills which they can use to secure better quality work and improve their health, with wider benefits for society and the economy. Previous Health Foundation analysis has shown that the presence, adequacy and quality of work has a direct bearing on health, as well as underpinning other determinants of health such as income or social networks. Unemployment can harm mental health, result in unhealthy coping behaviours and exposure to poverty, which is in itself damaging to health. Unemployment can also have a ‘scarring effect’, where pay prospects are affected and future work opportunities are harder to obtain.

Low quality work – low job satisfaction, low job autonomy, job insecurity and low pay – can be harmful to health. Health Foundation analysis shows that the prevalence of less than good health is twice as high for those with two or more negative job aspects (15%) than for those with no negative job aspects (7%).

Figure 2 shows how low pay, an indicator of low-quality work, is much more widespread among people with lower level qualifications and this places them at increased risk of poor health. Conversely, low pay is far less common for individuals whose highest qualification is a degree or equivalent. For people aged between 26 and 35 years old, 23% of those holding only a GCSE qualification (or equivalent) or below are on low pay, compared with just 9% of those with a degree (or equivalent).

Figure 2

While education is typically seen as an early intervention for long-term health, there is emerging evidence suggesting that pursuing education later in the life-course can have positive health effects. Chandola et al suggest that those who leave school without qualifications see a small reduction in their risk of developing coronary heart disease if they go on to obtain some qualifications later in life, although further research is needed to understand this relationship. Targeting lifelong learning opportunities, as well as information and financial support to access these opportunities, at adults with little to no educational attainment therefore has the potential to improve health and reduce health inequalities within the population.

Bradley lives in Chesterfield and started working as a customer service apprentice in April 2021. As part of his apprenticeship, he spends the equivalent of one day a week studying, which he fits around his work schedule. His recent modules have helped him with skills he needs for work, such as managing business and customer expectations, and using customer feedback efficiently:

‘I chose to go there [to college] because even though it’s not my end goal, doing administration helps me to build my goals and the transferable skills that helps work towards the future. Even though it’s not what I want to do in the long run, it will help me with my career.

Alongside his studies, Bradley gives motivational talks about mental health, speaking about his experiences of mental health and how he learned to embrace it. He had particularly struggled managing his mental health when he was unemployed. His apprenticeship provided a lifeline:

This job is very much where I can take my mind off myself for a bit and work on this. It can be very technical sometimes; it can be very hardworking and that’s what I sort of need.’

Bradley found that he gets lots of support from his manager and his college tutor, who help him push himself to go further and get the skills he needs. His apprenticeship makes him hopeful for the future:

’I definitely have a vision. I always say to myself if I don’t like the position, I’m in now, if I’m not going to like the position I’m in now in 10 years’ time, why should I suffer with it now? So, I’m hopeful that I’m improving myself. I’m comparing myself to who I was yesterday in order to learn today to be a better person tomorrow.’


Apprenticeships as the pathway into better health

Apprenticeships are one aspect of further education and one of the most well-known forms of vocational training.

Apprentices are expected to work a minimum of 30 hours per week while undertaking formal ‘off-the-job’ training, which makes up around 20% of their time. Their formal learning may take place at a college or other further education institution, but some apprenticeship providers will deliver learning in-house.

Apprenticeships are offered at different levels depending on prior attainment:

  • Level 2 (intermediate level) – equivalent to five GCSE passes at grades A* to C. This is the lowest level of apprenticeship available and with basic levels of maths and English as the only eligibility criteria for application.
  • Level 3 (advanced level) – equivalent to two passes at A-level. This tends to be the next step for those who have completed a level 2 apprenticeship or who have already achieved five passes at GCSE.
  • Level 4 and above (higher levels) – equivalent to foundation degree and above. Apprentices at this level will be expected to already have a level 3 qualification as well as five passes at GCSE at grade A* to C (grade 9–4 on the new scale).

These qualifications give students the opportunity to gain the skills required for professional trades, and higher-level apprenticeships can rival the earnings potential of higher education qualifications.

Barriers to accessing apprenticeships

Apprenticeships are intended to offer pathways into work for young people with few or no prior qualifications, as well as pathways into specialist vocations at higher levels. However, the Young people’s future health inquiry found that careers advice in school didn’t provide enough information on the further education opportunities available. Wider analysis highlights further barriers, such as regional disparities in opportunities and unequal access to opportunities for certain groups.

The availability of apprenticeship opportunities varies across the country. As shown in Figure 3, the South West has the most people (relative to population) beginning apprenticeships, with 31.7 starts per 1,000 people aged 16–24, closely followed by Yorkshire and the Humber (30.6 starts). However, London has a disproportionate number of higher level starts compared with the rest of the country, at 26.4% compared with a national average of 14.8%.

Figure 3

The National Foundation for Education Research found that there was a 30% decline in apprenticeship starts between 2015/16 and 2018/19 among the most disadvantaged apprentices (where disadvantage is identified using local Index of Multiple Deprivation scores), compared with 3% among the least disadvantaged apprentices. This was driven by a rapid decline in intermediate and advanced apprenticeships offered by small and medium-sized employers.

Young people without GCSEs can apply for level 2 apprenticeships if they can demonstrate an ability to complete the programme. However, a sustained growth in higher level apprenticeships over recent years, in part due to the introduction of the apprenticeship levy, has made it increasingly difficult for learners with no qualifications to access apprenticeship opportunities. In 2020, only 31% of all apprenticeship starts were at level 2, which is down from 65% in 2013/14.

The Department for Education recently announced that they had met diversity and inclusion targets set for apprenticeships. However, our analysis suggests that people with a learning difficulty, disability or long-term health condition, and those from less affluent communities, are less likely to access higher levels of apprenticeships than their peers.

Department for Education data show that only 9% of apprentices with a learning difficulty, disability or health problem started a higher level apprenticeship between August 2019 and April 2020, compared with 16% of learners without a learning difficulty, disability or health problem. This may also be influenced by other factors such as prior educational attainment.

Similarly, government data show that learners eligible for free school meals were more likely to enter a lower level apprenticeship after completing 16–18 studies compared with those not eligible for free school meals, at 58% of apprenticeship starts compared with 44%.

Beyond issues of access, there have been concerns in recent years that apprentice opportunities have not been of consistently good quality. The last Ofsted annual report found that apprenticeships were the weakest area of further education provision, with one in ten judged to be inadequate in 2019/20.

Poor quality apprenticeships can also lead to increased drop-out rates, with recent data showing that only 60.2% of apprentices stayed on their programme until the end in 2019/20. Social Mobility Commission analysis shows that this is an issue particularly affecting disadvantaged learners (identified using local Index of Multiple Deprivation scores), who are up to 4 percentage points less likely to finish their training than their non-disadvantaged peers.

Ensuring that apprenticeship opportunities are of a high quality, and that learners are supported to complete their studies, is as important as increasing the actual number of apprenticeships available. Engaging with employers to develop high-quality apprenticeship opportunities and training will further ensure that learners can achieve the best possible outcomes.

How has COVID-19 affected apprenticeships?

As the recent COVID-19 impact inquiry has shown, the effects of the pandemic have fallen unequally across society. For young people this has meant significant disruptions to their education as well as disproportionate rates of furlough and job loss.

Further education providers were encouraged to continue supporting apprenticeships, utilising digital or distance-learning tools to minimise disruption. However, the number of apprenticeship opportunities fell sharply at the start of the pandemic – apprenticeship vacancies were 81% below their long run average in May 2020. Analysis from the Sutton Trust shows that only 39% of apprenticeships continued as normal during the pandemic, with 36% furloughed and 8% made redundant. 17% of apprentices had their off-the-job learning suspended. Younger apprentices, particularly those from lower socioeconomic backgrounds, were more likely to have been working in sectors vulnerable to the crisis, such as hospitality.

For apprentices who were able to continue their studies, providers struggled to meet their needs. The Association of Colleges found that 77% of college leaders reported that 16–18-year-olds, including apprentices, were performing below expectations as a result of the pandemic. Ambiguity remains in the Education Recovery Plan as to how apprenticeships can return to and exceed their pre-pandemic performance, in terms of both quantity and quality.


Future opportunities

Opportunities for the NHS and local health systems

The NHS has a significant role to play in shaping local skills planning through its role as an anchor institution. As large public sector organisations, NHS providers have considerable influence over local labour markets and can in turn create high quality employment opportunities for local communities.

Barts Health NHS Trust employs more than 17,000 staff, with around 300 entry-level vacancies created every year that are accessible to the local east London community. Through their Community Works for Health programme, entry-level vacancies (such as health care support worker and medical laboratory assistant roles) are offered to a talent pool of local candidates. Where candidates do not have functional skills in English and maths, they are given pre-employment advice and work placements, as well as adult learning support. The scheme has provided 1,000 NHS roles for local people.

The Barts Health team have also worked closely with local further education providers to offer work experience opportunities for young people interested in a health care career. For example, they have supported students of health and social care in Tower Hamlets to take up 8-week hospital placements. Their Healthcare Horizons programme, which offers careers guidance to young people, has advised more than 1,000 young people on different roles they can undertake in the NHS, including apprenticeship pathways.

In order to better support vocational education and apprenticeships in its local area, the NHS should be included in the new Local Skills Improvement Plans, as part of the upcoming further education reforms. While public sector organisations in England with more than 250 staff are required to recruit at least 2.3% of new staff as apprentices, further action is needed to ensure that NHS Trusts can access the full apprenticeship levy available to them to help meet this requirement.


Policy implications

Further education as a cornerstone of the levelling up agenda

The government has set out its ambitions to level up the country by increasing prosperity, widening opportunity and ensuring that no region is left behind. The term ‘levelling up’ is opaque, with the government’s plans still under construction, but it is positive that there is acknowledgement that skills development falls into these plans. Further detail will be needed in the forthcoming white paper. Areas with a ‘need for economic recovery and growth’, such as having a high proportion of the working age population without qualifications, are higher priority targets for the Levelling Up Fund.

Figure 4 (and the table above) shows that 16 of the 30 local authorities with the highest proportion of students without a sustained education, apprenticeship or employment destination in 2018/19 have not been included in the priority 1 category of the Levelling Up Fund. Once they have completed their 16–18 studies, between 24% and 31% of students in these areas end up in neither study nor employment. Additional targeted investment in further education in these areas as part of the wider levelling up agenda – and designing proposals for the Levelling Up Fund to create opportunities such as apprenticeships – could help to reduce the percentage of young people not in education, employment or training.

Reforming the sector: challenges and opportunities

Alongside the Levelling Up Fund, the government has also created the new National Skills Fund, which will deliver £2.5bn in funding for adult skills over 4 years, including the introduction of the Lifelong Loan Entitlement to provide funding for 4 years of post-18 education to adults without an existing level 3 qualification. There are still many questions about how these changes will be delivered in practice and the long-term implications for the further education sector, with no firm commitments to changing the funding structure.

As highlighted by the Institute for Fiscal Studies, spending on apprenticeships and adult education has seen a real-terms combined cut of 35% over the past decade. Modelling by the Institute for Public Policy Research suggests that for the sector to keep up with pressures, it would need an additional £4.8bn in investment per year (on top of the already pledged National Skills Fund), rising to £6bn per year by the end of this parliament. The sector more broadly faces an ever-changing policy landscape, with the introduction of new qualifications (such as T-levels) and reforms to skills planning processes. With constant reform, it is challenging for the sector to achieve and sustain meaningful changes.

Now is the time to recognise the vital role of further education in recovery and for the nation's future health. Long-term investment in the further education sector could lead to improved outcomes across several areas central to the levelling up agenda – from a more skilled workforce, through to reduced rates of unemployment and better local economic performance. These developments will in turn improve health and reduce health inequalities, making such investment not just sensible but imperative for a more prosperous future.

Further reading

Long read

What the quality of work means for our health

4 February 2020

About 13 mins to read

Long read

Read about how the quantity and quality of employment has changed over the last 10 years, and the...


The government’s levelling up agenda

July 2021

What does ‘levelling up’ mean, and why should health be centre stage in plans to do so?

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