Virgin Care: Levelling Up through a Civic Health Model - Opportunity Action Plan

Levelling Up through a Civic Health Model A new approach to achieving equality of opportunity in health and wellbeing

00 Forewords

00 Forewords Growing up in Rotherham in the 1970s and 80s, and educated at my local comprehensive school, I didn’t have my future career mapped out for me, or my path smoothed by privilege and connection.

My family experienced unemployment when my father lost his job at the local steelworks. I saw first-hand the impact of job losses on an already disadvantaged community, especially when the opportunities to successfully retrain were almost non-existent.

As Secretary of State for Education, I put social mobility at the heart of our education policy because those gaps in access to opportunity that I experienced growing up in Rotherham, in many ways have become wider over the years. Disadvantage and a lack of opportunity still shape the life chances of many children and young people growing up in many communities, irrespective of their talent.

From my own lived experience, but also from my time spent in Government, it’s clear to me that fixing social mobility is a complex, long term challenge to solve. One complexity is that different communities might have the same challenge of weak social mobility, but for different reasons.

So in 2017, whilst at the Department for Education, I set up Opportunity Areas which were education social mobility 02

strategies tailored to the needs of the community they were in, rather than a one-size-fits-all approach.

They brought people together in improving education outcomes locally with a sense of common purpose and objectives that everyone felt they had a stake in. This meant people were working alongside, rather than against one another, and were able to focus on more systemic priorities to achieve in both the short and the long term, rather than a piecemeal set of results.

Fundamental to the approach of Opportunity Areas was a belief that empowered communities were an intrinsic part of bringing about sustained, long term change themselves.

But one barrier to social mobility we couldn’t address at the Department for Education, and most businesses within the Social Mobility Pledge would find difficult to address, is the growing gap of health inequality in the UK. Poor health can prevent people accessing opportunities, and statistically, you’re more likely to have worse health outcomes in the UK if you’re from a less privileged background.

Rt Hon Justine Greening Founder of the Social Mobility Pledge & Former Education Secretary

So while health was one area that Opportunity Areas could never really reach even in a localised model, I was impressed by Virgin Care’s new model of community-led, or ‘Civic Health’ approach, of working upstream to promote positive health outcomes in the communities that would have the largest health inequalities otherwise.

It is this same Civic Health approach which Virgin Care has championed and has been able to bring to Essex, working with children’s charity Barnardo’s and Essex County Council, through the Essex Child and Family Wellbeing Service.

It has used a partnership model with a more innovative type of healthcare that priorities a proactive approach and moves away from commissioning a specific activity to one which targets collective outcomes, and measures what has actually been achieved.

That has delivered real results for the community in Harlow, changing things on the ground by empowering the community around a common set of goals, in part delivered through the community itself with the capacity and framework provided by Virgin Care.

More broadly, Department for Education’s Opportunity Areas has shown a localised approach works in education; and Virgin Care’s work in Essex has demonstrated that this Civic Health Model can work in the

public health sector too, with a completely new approach.

Because of its local tailoring, the approach necessarily can work in very different places with different challenges, whether rural, urban or seaside settings, so it has the capability to be applied much more broadly across the country and across public service delivery. Allowing people to jointly own decisions locally about how services are organised and delivered in their area, whilst making sure there is a collective ownership of the results through strong partnership working and not just a ‘devolve and forget’ mentality, is key to tackling long-term inequalities.

In light of the challenges that the country will face during the difficult recovery period following coronavirus, Virgin Care should continue to share its working model with other parts of its own business, with other parts of Essex County Council and with other councils and businesses across the country more widely.

I launched the Social Mobility Pledge to ensure that those who do not have as many advantages as some still can progress in their lives and Virgin Care, with its partners, has shown that its Civic Health solution is one that works.

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00 Forewords

00 Forewords

We started Virgin Care more than a decade ago with a simple purpose: to make a difference to people’s lives.

Health and social care services are crucial to us all. They not only keep us fit and well throughout our lives, but early years services make a huge difference to how we go on to live our lives.

But the barriers to improving life chances are complex and the solutions require collaboration across organisations, across sectors and between services and the communities they serve and bravery to focus on long term aims with careful investment of resources and a shared vision of the journey, not just the destination.

Through our services across the country, we pledge to do all that we can to encourage and improve social mobility. Through investing in our people, through investing in our services and through partnering with communities to invest in themselves.

Never more than now, following the huge disruption brought about by COVID-19, has increasing social mobility, improving life chances and making a difference been more important.

I feel overwhelmed with pride that Essex Child and Family Wellbeing Service is one of Virgin Care’s many services able to showcase how we’re working towards socio-economic equality of opportunity for our service users, staff and the wider public.

The ways in which we are supporting social mobility in the community truly transcends ‘work’ and feels much more purposeful.

It is truly satisfying knowing we are making a monumental difference to people’s lives by creating educational and employment opportunities and investing in personal development to enable them to achieve their dreams and aspirations.

Richard Comerford Managing Director, Essex Child and Family Wellbeing Service

This report is all about the progress we’ve made in just one small part of our service to do just that. It looks at what we’ve done, in partnership with the county council and Barnardo’s, to make a difference.

We pledge to continue to work to support those who face barriers to social mobility to achieve their full potential – through our services, through employment and through education.

Dr Vivienne McVey Chief Executive Officer

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Health inequality in the United Kingdom is not just a medical issue; it’s a socioeconomic one too.

01 Introduction There is a growing body of evidence that indicates there is a large difference in health outcomes between the least and most privileged groups in society, despite living in a country where healthcare is free at the point of use.

This is because the health inequalities often occur not during the point of treatment, nor inside hospitals or GPs’ practices, but throughout communities, due to a complex series of interrelated factors.

For example, a child born into a low-income background or into poverty in the UK, is more likely to have a low birth weight, shorter life expectancy and a higher risk of death in the first year of life.

Children living in low-income households or poverty are more likely to suffer from chronic diseases and diet-related problems.

Children living in the most deprived areas in the UK are twice as likely to be obese than children born into the least deprived areas.

Being born into poverty and low-income backgrounds has a significant impact on cognitive development and children born in these circumstances are three-times as likely to suffer from mental health problems. Most individual chronic and long-term conditions are more than twice as common in adults from lower socio-economic groups too.

The COVID-19 pandemic has exposed the true scale of health inequality in the UK.

The most deprived areas of England and Wales have 55.1 deaths per 100,000 people, compared with 25.3 in affluent areas. As with most examples of health outcomes in the UK, COVID-19 is affecting those in deprived areas.

In turn, statistics also show the more affluent an area, the lower the impact of COVID-19 is1.

This requires a different approach to traditional health care and public health policy. It requires an approach that doesn’t just focus on treatment, but working with communities before treatment is needed to proactively promote more positive health outcomes.

The COVID-19 pandemic should be the ‘wake-up’ moment which exposes the harrowing scale of the relationship between deprivation and poor health outcomes; and the need for a new approach to addressing the immediate public health risks associated with deprivation.

To this end, Virgin Care has demonstrated a new way of working in Essex, to help make a difference on the stark reality of health inequality, and break the barrier it presents to social mobility and opportunity.

While the immediate health consequences of the impact of poverty are clear, what is less discussed is the impact of opportunity and social mobility within these groups with lower health outcomes, and how it manifests as a barrier to opportunities.

Being born into low-income backgrounds, and the health consequences strongly associated with this, has long term implications on children’s ‘life chances,’ as well as health, in adulthood.

This relationship between deprivation and health inequality must be broken in order to tackle wider socioeconomic inequalities.

It is clear that while individuals from lower income families are facing additional health problems, this further removes them from opportunity, and acts as yet another barrier to social mobility.

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Virgin Care’s Civic Health Model, which it launched in its delivery of services in Essex, having been commissioned by Essex County Council and West Essex CCG, has adopted a proactive (rather than reactive) approach to promoting better health outcomes, by working with communities. It has demonstrated how health care can be more than treatment - and working upstream to help those furthest away from privilege to make the right choices everyday in regards to their own health.

The Social Mobility Pledge has recognised this approach as a unique contribution to boosting social mobility in the UK, addressing a much overlooked barrier to social mobility and opportunity: the health gap.

This report will highlight Virgin Care’s approach, how it has made an impact in Essex, and recommend an action plan to

scale-up the benefits throughout other communities across the country where Virgin Care operates, where it could operate in the future, and recommend that other providers of health care services should follow Virgin Care’s lead.

Virgin Care’s experience in Essex, detailed in this report, demonstrates that it is possible to improve these outcomes with a collaborative community approach.

With local communities at the heart of its services, it has shown it understands that high quality care is not just best delivered inside hospitals and medical practices but by helping people to lead healthier and, therefore, longer and more fulfilled lives.

This report shows how Virgin Care has successfully addressed social mobility issues in Essex. It contains insights into best practices which have worked well and which have had a positive outcome on the community. It features case studies which illustrate the impact that its approach has had on individuals and analysis focusing on the community in which it operates.

The Action Plan also considers how Virgin Care might continue to work with Essex County Council to extend this best practice to other parts of the council and also how other local authorities could replicate it in other parts of the country to empower other local communities. It also suggests possible next steps and recommendations for further action.

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1. ONS (2020). ‘Deaths involving COVID-19 by local area and socioeconomic deprivation’

02 Best Practice

if the population is to be engaged in its own wellbeing, a professionally driven, service type approach will not work. There are people who need a more specialist level of service but that should not be uncritically commissioned as a default.

There is a need to embrace the creativity and diversity of everybody2.

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There are a number of key pillars to Virgin Care’s community-led approach across Essex. In addition to clinical services, they include building relationships with schools and colleges, providing financial investment, establishing volunteering programmes and bringing together strategic partnerships with delivery partners to facilitate these aims, such as with Barnardo’s.

A new model for tackling inequality

2.1 A Civic Health Approach: Essex Child and Family Wellbeing Service

Since it was created over a decade ago, Virgin Care has sought to focus on the areas where it could make a difference through health and social care services. This has meant that its focus has not been on hospitals, but on community services for the vulnerable in our society – and in particular those looking after children and families.

The services delivered by Virgin Care’s Essex Child and Family Wellbeing Service embodies this new Civic Health Model. In working on behalf of Essex County Council and NHS West Essex Clinical Commissioning Group, the Service provides health visiting, school nursing, family health education and support, and specialist children’s community health services across the County.

Virgin Care has recognised that in its role as a healthcare provider, there is a great responsibility and a great opportunity to empower local communities to lead more fulfilled lives. In the spirit of that, they have taken the opportunity to work with forwardthinking local councils with a bold vision for their citizens.

As part of its provision of community health and care services in Essex, a service it has run alongside children’s charity Barnardo’s and on behalf of Essex County Council since 2017, it empowers the local community to take measures and adopt lifestyles to look after its own health.

The model, which also provides direct interventions where they are needed, helps to avoid service users becoming just passive recipients of healthcare services, but to use the services provided – and the facilities offered – to continually improve their own skills and resources as well. We call this new model for tackling inequality “a Civic Health approach.”

The primary objective of the Essex model is to empower local communities to take responsibility for their own health and wellbeing and, by focusing on highly effective parenting in order to give children the best start in life, introducing behaviour change that leads to life-long healthy decision-making, emotional resilience and a sense of belonging and purpose.

The Civic Health approach is communityled, putting civic society at its heart and its values are embodied by the Derek Wanless Report, Securing Good Health for the Whole Population (2004). The report concludes that,

service is measured on metrics such as school readiness and health factors which can affect life chances and social mobility – such as prevalence of unhealthy lifestyles, emotional resilience and developmental delay.

Their work in Essex ranges from parenting support, support for young people with special educational needs and disabilities, providing information for children, parents and school staff on health issues and support for physical, emotional and developmental issues.

The service has 29 multidisciplinary Healthy Family Teams that work from district-based Family Hubs and Delivery Sites across the county. They provide pre-birth to 19 services centred around GP practices and clusters of secondary schools, feeder primary schools, nurseries and their communities.

Through the integration of skills from Virgin Care and Barnardo’s colleagues, specialist support is also offered to parents, children and families alongside medical services; meaning together the two organisations provide services that were previously delivered by twelve different medical providers in total.

These are services which exist across the country, commissioned by local authorities, but in Essex the County Council, Virgin Care and Barnardo’s have changed their focus to the impacts of what they do – and the approach is reflected first in the way that the service was commissioned, and then in how it is operated.

With a long-term aim of improving health outcomes, rather than on delivering individual pieces of activity, the service – and the dedicated colleagues who work within it - can go beyond traditional preventative or medical interventions. For example, the

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09 2. https://esrc.ukri.org/files/news-events-and-publications/evidence-briefings/health-inequalities-continue-to-undermine-social-mobility-pdf/

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2.2 Community Participation Virgin Care’s approach involves more than just the provision of services to ‘service users,’ but centres around community participation and engaging people in local communities with the promotion of positive health habits.

It emphasises building trust and integrity in local communities, in a largely new approach to boosting health outcomes and tackling health inequality.

Virgin Care actively seeks to understand volunteers’ aims, and supports them to develop – even into paid employment within the service, thus promoting the pursuit of personal ambition as well as social mobility.

Virgin Care, in partnership with Essex County Council, believe that the future of public health lies in reaching a greater proportion of the Essex population, and by using the skills, knowledge and experience of the people in the community alongside commissioned services.

It has proven itself to be a company that looks as its community’s priorities, and makes those its own priorities. For Example, Virgin Care and its partners worked with community volunteers in Essex to set up a “Supergirls” support group for parents of young children with autism. The group gives parents an opportunity to meet and support one another and to share parenting experiences and techniques.

This approach supports social mobility through empowering families to take a lead themselves, with professional support where and when they need it; through Virgin Care’s investment in volunteers, as well as its apprenticeship and career education development schemes.

These examples epitomise not only the effectiveness of the community-led approach used in Essex in creating truly meaningful relationships and delivering longer-term outcomes but also in creating opportunities for those in the community who might not otherwise have had them.

This delivery model isn’t just about provision of services to individuals, but involvement with the services.

It’s about creating and fostering a culture of inclusion to ensure those who want to do more in local communities are empowered to do so, and are able to learn skills and develop in the process.

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Virgin Care and Barnardo’s support volunteers to develop skills which can then allow them to ‘put back’ into the service, either through employment or further volunteering opportunities.

Through this work, Virgin Care and Barnardo’s harness the power of volunteering and social action to help improve community health outcomes in Essex. Virgin Care and its partners have mobilised a team of over 100 volunteers in Essex, in various roles to supports families and communities.

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2.3 Establishing Pathways to Employment As part of Virgin Care’s aim to empower service-users by helping them make a difference, there are also opportunities to progress onto become service-providers themselves.

This is naturally connected to the employment opportunities available within Virgin Care. This is a testament to the success of the community engagement model, and in effect, demonstrates a pathway to employment that underpins the entire notion of social mobility in action.

For those who might not have had opportunities in the past, Virgin Care’s Essex-based community-led service enables clear pathways to volunteering and employment at a local level.

One example of Virgin Care’s outcomes in this includes a mother who progressed from being a service-user to becoming a volunteer, and then into paid employment as a healthcare support assistant, helping others by sharing her knowledge and experience with her newly acquired training and skills.

There are pathways of progression beyond this too. Virgin Care also has its own training department, in the form of The Learning Enterprise, which works in close partnership 12

with a number of universities, including two universities in Essex - Anglia Ruskin and University of Essex.

Virgin Care’s local Practice Education Team generates income from agencies such as Health Education England to enable the service to fully sponsor student placements.

They facilitate the recruitment of students from local parts of Essex and support their practice placements within Essex Child and Family Wellbeing Service by allocating them a mentor.

The Practice Education Team works hand-inhand with university lecturers and academics so that the curriculum is adjusted to the requirements of the service delivery model.

It has created pathways into apprenticeships, enabling service users to progress into opportunities to earn and learn. Company wide, Virgin Care has increased its focus on developing talent through apprenticeships as a means of creating opportunities with wide access.

There are now 153 colleagues within Virgin Care currently on apprenticeships; with 126 of these being delivered by TLE, and 27 through external training providers.

they can get more money and how they can get decent jobs, which will impact upon their resilience to achieve some of the desired outcomes.

There are also opportunities for higher study, with opportunities to undertake foundation degrees supported by Virgin Care, with progression opportunities beyond that into full university degrees in nursing.

Prior to the start of this contract, Essex County Council had never employed anyone that had been a child in care. Virgin Care seeks to ensure that it creates career opportunities for young people who have been in care. The Council now employs a number of them and has supported others to find paid employment elsewhere.

Once qualified as nurses, they have the option within Virgin Care to participate in the organisation’s Health Visitor Course and become team leaders.

And involvement with the service can also lead to people finding jobs with other organisations too. In another case study, Virgin Care was contacted by an organisation who knew of someone suffering from anxiety and depression who was struggling to get back into employment.

Virgin Care interviewed him and he became an administrative support volunteer within the organisation.

He was able to build up his confidence and increase his understanding of the barriers to getting into paid employment. Now, he has a qualification and a paid job with another part of the NHS.

This is another example of a business which seeks not to take the easy route that requires the least effort or resources, but a business that has set out to address the widest gaps in society, not just in terms of public health, but providing opportunities for groups in society that are the furthest away from opportunity.

Together with Essex County Council and Barnardo’s, Virgin Care’s Civic Health Approach has ultimately created an environment where the community can come together with professionals and tackle the issues that matter most to them, including inequality.

Virgin Care is looking at how it can support some of the more vulnerable families, how 13

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2.4 Empowered through Partnership Virgin Care has established key strategic partnerships in its community-led approach.

It recognises that by establishing effective partnerships, the whole model will be greater and have more impact than the sum of its parts.

While Virgin Care has clinical expertise and knowledge in some fields, it understands that to have an effective impact in communities, it must partner with those that are experts in fields that it is not.

This is why it is working with Barnardo’s on its community engagement and volunteering delivery; and has established strong working relationships with universities in the local communities where it is delivering key services, including University of Essex and Anglia Ruskin University.

Barnardo’s Barnardo’s is a children’s charity that protects and supports the UK’s most vulnerable children and young people across the UK, running approximately 900 services in total.

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Virgin Care’s partnership with Barnardo’s aligns the skills and expertise of both organisations into a single service in Essex.

The partnership is so well integrated in Essex that the staff effectively act as a single body, with line management aligned to service need rather than to organisational boundaries.

Universities Through its training arm The Learning Enterprise, Virgin Care develops relationships with local universities to support training programmes which allow it to develop its staff and services.

In Essex, Virgin Care partners with Anglia Ruskin University and the University of Essex to support student nurses and provide them with practical on-the-job experience.

During COVID-19, this support was made possible virtually so 21 third year students were still able to obtain the required hours of experience to qualify the course.

Seventeen students started the foundation programme which specifically targets local students from socially and educationally challenged backgrounds who gained entry on a lower A-level grade offer.

2.5 Investing in the community As a private sector provider of public services, Virgin Care is not subject to the same restrictions of annual accounting which means it can take a more long-term view to investing in local communities and providing financial support to help address some of the widest gaps.

Since it was created, Virgin Care has not generated a profit and Sir Richard Branson, founder of Virgin Care, has committed to re-investing any future profits (over and above his original investments) back into frontline services, as advised by staff and the service users who use them.

It is these two factors combined which allow Virgin Care to take a communityled approach, developing services for the longer term and creating – essentially – a virtuous circle, with an aim to generate a very small surplus from each contract so it can be re-invested in future improvements.

Virgin Care prides itself on being characterised as free from unnecessary management hierarchies, bureaucracy and waste and being innovative, well governed and safe.

This is something the Care Quality Commission says Virgin Care does well. In the most recent report on the Essex service (December 2019), inspectors rated the service ‘Good’ in all five domains - Safe, Caring, Responsive, Effective and Well-led.

It encourages a culture of opportunity in which staff who demonstrate the right behaviours and attitude, invest the right time and effort can progress as far as they want.

It seeks a combination of making sure there is structure and the necessary professional qualifications, while also ensuring that a lack of qualifications is not an obstacle in getting the opportunity to work for Virgin Care.

Virgin Care has set out to be an organisation which has a welcoming and friendly atmosphere and which supports people – an important component of social mobility.

Chief Executive, Dr Vivienne McVey, summarised this strategy as

“we want to be a place where people want to work”.

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2.6 Response to the COVID-19 Pandemic

2.6.2 Supporting its colleagues

As the pandemic continues to affect people across the United Kingdom, Virgin Care has been playing a frontline role in the delivery of crucial services as part of the NHS family. It has been doing this for patients and communities; as well as for its 7,000 valued colleagues and their families.

Virgin Care’s colleagues are the some of the heroes delivering the national health effort on the front line every day, whether they work in NHS services, local authority services or social care. It is a priority for Virgin Care to keep them and their families safe; and supporting them to continue to be part of the national response to this pandemic.

Additionally, its online platform, ‘MyWellness’, is helping its colleagues to stay on top of their wellbeing, diet and fitness; • In working with NHS partners it has made sure its colleagues can access Coronavirus tests when they need them, just like their colleagues across the NHS family;

Virgin Care is: • Ensuring its colleagues have what they need to be able to work safely during this outbreak – whether that’s Personal Protective Equipment (PPE) or a laptop.

It has delivered more than 2 million items of PPE to keep its colleagues safe while they deliver NHS and social care services with more arriving every day, and more than 150 new laptops into its services since January 2020 when it started its response, helping keep colleagues safe, and able to work to support the NHS and the people who rely on the services;

2.6.1 Supporting the NHS, patients and service users As the UK’s hospitals and wider health services, private and public, come together as one to support the increased number of people who may require treatment for COVID-19, Virgin Care has ramped up its community services. These allow people to return home from hospital – increasing hospital capacity.

Virgin Care has: • Implemented NHS England’s Community Services Prioritisation Plan, freeing up its colleagues to work on priority and critical services and to ramp up its capacity for patients to be discharged into the community; • Created additional capacity in its community and district nursing services, meaning more people can be cared for 16

at home – reducing pressure on hospitals – and supporting terminally ill patients with end of life care and ensuring their dignity is maintained; • Opened its community hospital wards for ‘step down’ care, supporting its local acute hospitals to free up bed space for COVID-19 patients; • Redesigned many of its services and back office functions so they can keep operating while following the Government’s guidance, including launching its first entirely virtual Single Point of Access in Lancashire; • Launched video consultations and virtual support in its Primary Care, School Nursing and Health Visiting Services; and • Begun redeploying its colleagues into other critical local NHS services, ensuring they can keep operating where sickness absence might otherwise mean services would have to close.

• Ensuring all of its colleagues can follow the Government’s guidance and continue to support the response – it is supporting colleagues with working from home and it has implemented strict social distancing where roles can’t be done from home; • Reviewing and expanding its policies, enabling its colleagues to take additional leave where they need to as a result of the pandemic and empowering its colleagues to take decisions which keep services running and safe. Virgin Care has given colleagues who need it access to additional paid leave for dependents, in addition to its existing policies; • Adding additional wellbeing support to help support its colleagues through these difficult times. Virgin Care’s Occupational Health Employee Assistance Programme has expanded, and it has partnered with Cruse, the bereavement support charity, to provide additional support for those whose families are affected;

• Keeping in touch with colleagues regularly so they have the latest information on the outbreak, and how we are responding to it – and importantly, saying thank you; • Learning and development has been made available through new online and virtual classrooms resources.

For apprentices, it has adapted its approach to secure learning, providing continual support to all apprentices and workplace facilitators to make the best use of the exceptional learning experiences due to Covid -19; • And finally, through Virgin Tribe, its colleagues, like those across the Virgin Group are able to access exclusive discounts – including on practical items like supermarket shopping.

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Sylvia’s Story Sylvia had worked as a teaching assistant for about nine years while her children were young. She was well into her 30s when she qualified as an adult nurse, spending time with health visitors and school nurses, and ‘something clicked’. She was able to mesh her experience in schools and nursing together and became a school nurse.

03 Case Studies No story is better told than by people who’ve experienced the benefits of the programmes for themselves.

This is why we have highlighted case studies to bring these outcomes to life in a more engaging way - to show the really positive social impact that Virgin Care’s Civic Health Model has had on people in Essex. *Some names have been changed for anonymity.

She was one of the first to undertake the specialist community public health nursing degree with Virgin Care.

Previously a lack of funding had meant that nurses couldn’t progress, but investment has since led to in-house training of health visitors and school nurses, thereby ‘growing their own talent’.

“It doesn’t matter where you fit in, there is opportunity there. I know there’s a career path for me.”

She feels that Virgin Care truly invested in her and, with her university fees and salary paid, she didn’t have to worry about anything financially but could concentrate on her studies and her job.

Julie’s Story Julie was 17 when she left home and started working for the NHS. She wanted to prove to her family that she could aspire to something.

A previous manager had encouraged her to move up in her job in small steps. When her current role was advertised, she felt ready to take the step but it meant jumping up two pay bands which wasn’t normally done. She took a leap of faith, despite feelings of imposter syndrome, and got the job as a result of her enthusiasm and drive.

Julie thinks she has had opportunities that she would never have got in the NHS and cites an example of a colleague there in administration who had always wanted to work in IT but had been told that it was not his field. He moved to Virgin Care, got an apprenticeship and is now working in the IT department.

“The difference for me is that Virgin Care recognises potential and allows development rather than just looking at qualifications and experience. They take a chance on people and think about who could fill your shoes if you move on tomorrow.”

Charlie’s Story Charlie is 19. Having grown up in care, he felt confused and lacked purpose. He’d dropped out of school with no qualifications and was working as a forklift driver when he realised that he really wanted to work in healthcare, looking after people. He tried to get a job in nursing but didn’t have the confidence to go to college as he felt that he would not be able to cope in the classroom environment.

His social worker, who’d known him for years, told him about a nursing course with Virgin Care’s Essex Child and Family Wellbeing Service, and which provided him with the opportunity to study online - his preferred pathway.

All the learning was done online, including a maths GCSE equivalent which he’d previously failed. A mentoring system was in place where he was given small tasks to achieve which were then checked by his ‘buddy’.

He’s now two months into an apprenticeship and is learning on the job, doing health visits and shadowing health professionals. “Virgin Care looks after me really well and it’s getting me to where I want to be” he says.

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Dawn’s Story Six years ago, Dawn worked as a dinner lady while her own children were at school. As they got older she began to consider what future work options could lie ahead of her.

She looked at the sort of skills she already had and felt that in a childcare role she would thrive. When Virgin Care joined with Barnardo’s at the Essex Family & Wellbeing Centre, she saw an opportunity to work for the unique partnership, and subsequently got a job with Barnardo’s as a family support worker.

Charlie found that this system really suited him:

“No one has ever said you can’t do this, or you’re not at that level yet.

It’s always been a more try it and see approach.”

“There’s so many different people around to help you out and there’s never a dull day. I love my job.”

At first Dawn wasn’t ready to leave support work as she enjoyed being on the front line but eventually she did a leadership and management apprenticeship which was paid for and she also received a salary throughout. She was always allowed to go to college and given study time when she needed it.

He is on his way to getting into adult nursing as his final goal. He recognises that his teenage years were difficult and he failed in school as a result, so he’d also like to help other children facing similar challenges growing up in care.

She attributes her recent role as hub coordinator to the support she’s received from the service which she sees as nurturing and “a family within a family”.

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Virgin Care has delivered a purposeful collaborative community approach to the delivery of healthcare services in Essex, focussed on outcomes which enable it to tailor the business to maximise its effectiveness and bringing together the skills of the organisations involved with, through volunteering, the community’s own skills.

04 Insights and Assessment We have called this new model “a Civic Health approach”. It is about service providers using their skills not only to deliver services, but empowering local communities, working with civil society and supporting local people to tackle both health inequalities and, in doing so, boosting social mobility by focusing on long term outcomes which are proven to make a difference over short term activity targets.

This Civic Health approach has meant that local programmes have been more successful and developed long term value because they are based on what local people and communities want and need and build skills rather than solve immediate problems.

Involving local communities in developing and delivering these programmes has also brought greater diversity of thought and innovation, helping to produce bottom up creative solutions and more inclusive approaches.

Through strong leadership, the Essex Child and Family Wellbeing Service is a fantastic example of successful partnership in action.

It clearly demonstrates how Virgin Care,

in partnership with Barnardo’s and Essex County Council, has facilitated more effective health services in the community which improve health outcomes. This in turn boosts life chances, social mobility and opportunity for the community it serves.

The “Civic Health” model used in Essex is similar to the model Justine Greening introduced for Opportunity Areas at the Department for Education where local communities and businesses work together on key local priorities to lift outcomes for young people in the area. That collaborative approach was shown to have “helped to create a step change in the level of enthusiasm and support for our shared mission - by drawing on and empowering local educators and local talent3.”

Virgin Care has shown how this can also succeed in the health and care sector, provided the right conditions are created.

Both Essex County Council and Virgin Care were keen to highlight that the delivery of the service in this way was only possible due to the approach to commissioning and managing the service towards a common, longer term aim.

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21 3. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/667690/Social_Mobility_Action_Plan_-_for_printing.pdf

04 Insights and Assessment

The Essex experience also shows that, while investment is important, it is possible to achieve a greater impact by working with, and seeking to understand, local communities and their needs – and at the same time, by recognising that all local communities are different.

The way in which social mobility is improved in Darlington or Oldham is likely to be different from the way it is approached in Harlow, but there are common approaches which can be taken to identifying these solutions – and these are captured within the Civic Health Approach. Solutions need to be more responsive to local needs than the more centrally controlled approaches we are used to.

It is a genuinely different working model and contrasts markedly with the more cumbersome models where accounting rules can inhibit long term investment and activity monitoring can take precedence over longer term achievements. The more responsive and nimble system in Essex makes for a much more effective strategic approach to dealing with social problems.

04 Insights and Assessment

It is important, however, that there is a way of evaluating social mobility outcomes in this context. Virgin Care has 27 outcomes specified in its formal contract with the County Council, but that contract is a ten year one. Although this enables progress to be made and shown achieving social mobility, and therefore being able to measure it, can be a 20 or 30-year process.

Virgin Care is an organisation which nurtures its employees and it works hard to recruit from within the community, both to paid employment and through empowering volunteering. Its use of systematic career pathways means that people who join the organisation can, with support, work their way through to qualifications in administrative, healthcare and leadership fields and to the associated jobs, with Virgin Care or elsewhere.

Virgin Care works towards creating opportunities for people at all stages of their careers.

It has shown how volunteering can not only be part of community health provision but also part of a wider mechanism as a pathway into employment. The Civic Health Model it has adopted also shows that successful community engagement can boost social mobility, offering new opportunities and improving access to services for marginalised and vulnerable people at the same time.

In Essex, as in many models that tackle social mobility, one entry point is schools.

Virgin Care acknowledges that early years intervention is crucial in ensuring that a child’s education outcomes are as positive as possible. The way in which the work internally and with schools is connected with other stakeholders in the community may vary. Different communities may choose to put together different core priorities and these should be supported.

Virgin Care’s approach has enabled it to build effective and meaningful local partnerships. It has facilitated the community to look after itself and has changed the emphasis from one which purely commissions services. It demonstrates the synergy between treatment and health prevention at its most preliminary and shows that, to be most effective, you should go to the source – the community itself.

• Two years ago there were four volunteers, now there are 40 • Three years ago there were 35 unfilled nursing vacancies, by 2021 there will be none • Essex Council had previously employed no care leavers, now it employs many The innovative cross-organisational approach has brought benefits to all parties.

Local, smaller scale solutions are supported by a local community which is fully engaged and the business has credibility and accountability as a result.

Health outcomes and social mobility are inextricably linked and it is well known that

22

the least advantaged in society generally have access to the least high-quality health services, relative to their needs, compared to higher income groups.

That inequality means that, amongst other poor outcomes, there is a 19-year gap in average life expectancy between the least and most deprived areas of the UK. Those living in the most deprived areas spend nearly a third of their lives in poor health, compared with only a sixth for those in the least deprived areas. Health outcomes, whether at early years, schools or young adult stages are huge barriers to positive social mobility.

The success of the collaborative community approach we have looked at in this report in Essex demonstrates that its bottom-up approach, its adaptability to local conditions and its willingness to invest up front for the long term is a model that other areas with an opportunity gap should replicate.

It provides real value to that community by helping to address their own health inequalities and boost social mobility as a result.

This Opportunity Action Plan will also outline examples of where Virgin Care’s Civic Health Model could be expanded, but holds a fundamental view that this proactive approach to improving health outcomes, and thus removing an additional barrier to social mobility, should become the norm, not the exception in health care.

23

05 Data Analysis: Community Context

When developing an action plan to boost social mobility and opportunities, it’s important to thoroughly understand the context of place, and the particular challenges certain communities face.

Here the Social Mobility Pledge has analysed the data collected in Harlow, Essex – where this report has been focused - and in Lancashire, where Virgin Care is earlier on in its journey to develop a similar service with the County Council there.

Furthermore, we have analysed the social mobility data in Chippenham, where Virgin Care has been delivering broader range of services under a more traditional contract for the past 4 years, and where it could look to scale its successful community-led model alongside commissioners; as well as West Lancashire, where Virgin Care’s Edge Hill division is based.

The idea is to provide an example of other areas where Virgin Care could expand its Civic Health Model to have a positive impact on those communities too. This has taken into account two studies of data.

Firstly, it considers data produced in the most recent House of Commons Library Social Mobility Index, made up of four key life stages, and here considering 14 key data-sets, from which the HC Library generated rankings of constituency—level social mobility across the UK. This uses the relative social mobility performance of the most the least privileged groups, such as those entitled to free school meals, across the life stages. This Index, albeit the most 24

recent full Index, was produced in October 2018, and is the same type of methodology that informed the Government’s Opportunity Areas programme. The life stages considered are early years, school years, youth and adulthood; with key datasets for assessment for each.

Secondly, it considers additional context from the Social Mobility Commission’s data that specifically considers life outcomes in relation to male median earnings by age 28.

Thirdly, it will provide some context as to the impact of the COVID-19 on the economies of Harlow, Chippenham and West Lancashire.

The complexities within the datasets themselves, and different outcomes between life stages, highlight that social mobility cannot be tackled with a one-sizefits-all approach. Therefore, a thorough understanding of the challenges those individual communities face is vital and we assess social mobility through those life stages. Nevertheless, this data helps to identify where particular challenges are in certain areas, and tailor strategies that will be effective for those communities.

For Virgin Care, it has been used as an example in the context of places where its Civic Health Model could be scaled and applied to, and can outline the type of considerations the company can take into account when looking to scale this best practice.

25

05 Data Analysis

05 Data Analysis

5.1 Part A: Social Mobility by Life Stage Life Stage National Rank/533

Early Years

124

Schools

315

Youth

241

Harlow Percentage of Nursery providers rated outstanding or good by Ofsted

94

Percentage of children eligible for free school meals achieving a good level of development

56

Percentage of children eligible for FSM attending a primary school rated outstanding or good by Ofsted

67

Percentage of children eligible for FSM achieving at least the expected level in reading, writing and maths at the end of Key Stage 2

44

Percentage of children eligible for FSM attending a secondary school rated outstanding or good by Ofsted

93

Average Attainment 8 score for pupils eligible for FSM

36

Percentage of young people eligible for FSM that are not in education, employment or training (positive destination) after completing KS4

90

Average points score per entry for young people eligible for FSM at age 15 taking A-level or equivalent qualification

26

Percentage of young people eligible for FSM at age 15 achieving two or more A-Levels or equivalent by the age of 19

Adulthood

328

Harlow Analysis

31

Median weekly salary of all employees who live in the local area

434

Average house prices compared to median annual salary of employees who live in the local area

9

Percentage of people that live in the local area who are in managerial and professional occupations

23

Percentage of jobs that are paid less than the applicable Living Wage Foundation living wage

18

Percentage of families with children who own their home

58

Essex Child & Family Wellbeing Service is in the district and constituency of Harlow, located close to both Hertfordshire and London. When all life stages are viewed together, Harlow is a fairly average constituency, ranked at 232 out of the 533 constituencies in England. However, a more detailed analysis shows that the area is much better in some areas and much worse in others.

Early Years

Youth

At the early years life stage, Harlow performs moderately well: it is just outside of the top quarter of constituencies. 94% of nurseries in the constituency are rated as good or outstanding by Ofsted, slightly beating the national average of 93%. In the other measure, the percentage of children eligible for free school meals achieving a ‘good level of development’, Harlow is ranked 140 out of 533; 56% of those children achieve a good level compared to a national average of 53%.

Harlow slightly improves its position in the Social Mobility Index at the Youth life stage indicators. 90% of young people who were eligible for free school meals find themselves in a positive destination (defined as being in education, employment, or training) after having completed Key Stage 3. This is, however, the only measure by which it beats the national average: young people eligible for FSM achieve 26 A level or equivalent points, which matches the national average, and a lesser percentage of FSM-eligible young people achieve 2 or more A Levels or equivalent at 31% in Harlow compared to 34% as a national average.

School Harlow slips to being in the bottom half of constituencies at the school stage, ranked at 315 out of 533. A dramatically lower percentage (67%) of people eligible for free school meals attend good or outstanding primary schools compared to the national average of 83%. This is Harlow’s single worst indicator across all stages: it is ranked at 485 out of 533 constituencies. This poor performance in this area does not translate into poorer results. 44% of children who are FSM eligible attend the expected level in reading, writing and maths at the end of Key Stage 2, slightly better than the national average of 39%.

Adulthood At the adulthood life stage, Harlow shows its worst performance, being in the bottom 40% of constituencies at 328 out of 533.

However, the picture is still quite complex: in this stage, Harlow also shows its best performance in the living wage indicators, with 82% of jobs paying at or above the real living wage, higher than the national average of 75%. In this metric, Harlow is ranked in the top 100 of all constituencies.

However, weekly earnings are still less than the national average and houses that are nine times the average salary result in just 57% of people owning their own home compared to 65% nationally.

*Data reflecting most recent HC Library Social Mobility Index (Oct, 2018) 26

27 21

05 Data Analysis

Life Stage National Rank/533

Early Years

289

Schools

139

Youth

177

Adulthood

183

West Lancashire

West Lancashire Analysis

Percentage of Nursery providers rated outstanding or good by Ofsted

94

Percentage of children eligible for free school meals achieving a good level of development

50

Virgin Care partners with Edge Hill University to provide placement opportunities for its medical students through Virgin Care. The students receive placements in the towns of Ormskirk and Skelmersdale, also within the West Lancashire constituency. West Lancashire is a relatively good area for social mobility, ranked at 163 out of 533 overall.

Early Years

Percentage of children eligible for FSM attending a primary school rated outstanding or good by Ofsted

96

Percentage of children eligible for FSM achieving at least the expected level in reading, writing and maths at the end of Key Stage 2

46

Percentage of children eligible for FSM attending a secondary school rated outstanding or good by Ofsted

60

Average Attainment 8 score for pupils eligible for FSM

37

Percentage of young people eligible for FSM that are not in education, employment or training (positive destination) after completing KS4

87

Average points score per entry for young people eligible for FSM at age 15 taking A-level or equivalent qualification

31

Percentage of young people eligible for FSM at age 15 achieving two or more A-Levels or equivalent by the age of 19

32

Median weekly salary of all employees who live in the local area

414

Average house prices compared to median annual salary of employees who live in the local area

6

Percentage of people that live in the local area who are in managerial and professional occupations

26

Percentage of jobs that are paid less than the applicable Living Wage Foundation living wage

20

Percentage of families with children who own their home

73

*Data reflecting most recent HC Library Social Mobility Index (Oct, 2018) 28

05 Data Analysis

At the early years life stage, West Lancashire receives its worst ranking: it is firmly in the bottom half of constituencies. 94% of nurseries in the constituency are rated as good or outstanding by Ofsted, slightly beating the national average of 93%.

In the other measure, the percentage of children eligible for free school meals achieving a ‘good level of development’, West Lancashire is ranked 383 out of 533; 50% of those children achieve a good level compared to a national average of 53%.

School The school life stage is West Lancashire’s best area where on two metrics it is within the top 100 constituencies. It is ranked at 139 out of 533 overall. A significantly higher percentage (96%) of people eligible for free school meals attend good or outstanding primary schools compared to the national average of 83%.

This is West Lancashire’s best indicator across all stages: it is ranked at 32 out of 533 constituencies. Strong performance in the quality of schools results in strong attainment levels at primary level: 46% of children who are FSM eligible attend the expected level in reading, writing and maths at the end of Key Stage 2, slightly better than the national average of 39%, again placing West Lancashire in the top 100 of constituencies at 88/533.

Unfortunately, only 60% of FSM eligible children go to a good or outstanding secondary school compared to the average of 72%.

This is West Lancashire’s worst result, placing it at 380 out of 533, and the worse attendance results in worse attainment as the average attainment 8 score for FSM children is 37 compared to 39 nationally.

Youth West Lancashire slips slightly in its position in Youth life stage indicators. 87% of young people who were eligible for free school meals find themselves in a positive destination (defined as being in education, employment, or training) after having completed Key Stage 3. This is slightly worse than the national average of 88%. While a lesser percentage of young people eligible for FSM achieve 2 or more A Levels or equivalent by 19 (32% in West Lancashire vs 34% nationally), those that do have a much higher than average point score per entry at 31 in West Lancashire compared to 26 nationally. This is another top 100 ranking for West Lancashire, where it ranks at 57/533.

Adulthood At the adulthood life stage, West Lancashire ranks at 183 out of 533. While some measures are very positive - 80% of jobs pay at or above the real living wage, nationally it is 75%; home ownership is at 73% compared to 65% nationally - other areas are quite poor. In particular, just 26% of jobs in the area are managerial and professional when in England as a whole that percentage is 30%. That measure is the worst at this life stage and is a poor score overall, at 374/533.

Another poor ranking is the average weekly earnings, which at £414 are much worse than the £433 across England as a whole.

29 21

05 Data Analysis

Life Stage National Rank/533

Early Years

455

Schools

400

Youth

82

Adulthood

178

Chippenham

Chippenham Analysis

Percentage of Nursery providers rated outstanding or good by Ofsted

93

Percentage of children eligible for free school meals achieving a good level of development

44

Percentage of children eligible for FSM attending a primary school rated outstanding or good by Ofsted

83

Percentage of children eligible for FSM achieving at least the expected level in reading, writing and maths at the end of Key Stage 2

28

Percentage of children eligible for FSM attending a secondary school rated outstanding or good by Ofsted

83

Average Attainment 8 score for pupils eligible for FSM

35

Percentage of young people eligible for FSM that are not in education, employment or training (positive destination) after completing KS4

92

Average points score per entry for young people eligible for FSM at age 15 taking A-level or equivalent qualification

30

Percentage of young people eligible for FSM at age 15 achieving two or more A-Levels or equivalent by the age of 19

30

Median weekly salary of all employees who live in the local area

404

Average house prices compared to median annual salary of employees who live in the local area

8

Percentage of people that live in the local area who are in managerial and professional occupations

35

Percentage of jobs that are paid less than the applicable Living Wage Foundation living wage

21

Percentage of families with children who own their home

70

*Data reflecting most recent HC Library Social Mobility Index (Oct, 2018) 30

05 Data Analysis

Virgin Care provides children and young people’s health services on behalf of Wiltshire council. There is significant potential to leverage Virgin Care’s position as a provider of those services as although Chippenham overall is a fairly average area overall for social mobility, ranking at 277/533, this is mostly because a strong performance at the youth stage offsets some exceptionally poor results at the early years and school stages.

Early Years

Youth

At the early years life stage, Chippenham is firmly in the bottom 100 of constituencies at 455/533. 93% of nurseries in the constituency are rated as good or outstanding by Ofsted, which matches the national average of 93%. In the other measure, the percentage of children eligible for free school meals achieving a ‘good level of development’, Chippenham scores at just 44% compared to a national average of 53%, making it the 32nd worst area in England for this metric.

Chippenham makes a strong recovery at the Youth stage, where it ranks at 82 out of 533, making it a hotspot at this life stage. 92% of young people who were eligible for free school meals find themselves in a positive destination (defined as being in education, employment, or training) after having completed Key Stage 3.

School The school life stage continues to be a poor area for Chippenham; it is ranked at 400 out of 533 overall. 83% of children eligible for free school meals in Chippenham attend a good or outstanding school, the same as across England. However, despite the same attendance levels, just 28% of FSM eligible children achieve the expected level in reading, writing, and maths at the end of Key Stage 2, much worse than the average of 39%.

At 496/533 constituencies, Chippenham scores firmly in the bottom 40 of areas for this measure. A similar story is repeated at secondary school, where although a higher percentage (83%) of FSM eligible children attend a good or outstanding school than the average (72%), attainment is much lower, with an average attainment 8 score of just 35 compared to 39 nationally.

This is better than the national average of 88%, and Chippenham ranks at 35 out of 533. While a lesser percentage of young people eligible for FSM achieve 2 or more A Levels or equivalent by 19 (30% in West Lancashire vs 34% nationally), those that do have a much higher than average point score per entry at 30 in Chippenham compared to 26 nationally. On this metric, Chippenham ranks at 71/533.

Adulthood At the adulthood life stage, Chippenham falls to 178 out of 533. Although more jobs pay at or above the real living wage in Chippenham compared to England as a whole, at 79% of jobs vs 75%, average weekly earnings are lower in Chippenham, at £404, than in England, where they are £443.

More jobs are managerial and professional, at 35% compared to 30%, and despite housing affordability being the same in Chippenham as across England as a whole, at eight times the annualised salary, 70% of families own their own home, higher than 65% across England.

21 31

05 Data Analysis

05 Data Analysis

5.2 Part B: Covid-19 Impact As well as considering the social mobility baseline for a community, our analysis also reflects the developing impact of Coronavirus on opportunity. The Office for Budget Responsibility’s Covid Reference Scenario predicts that the economy of the United Kingdom will contract by 35%, with unemployment potentially peaking at 10million4.

But just like the issue of social immobility, the impact of the coronavirus pandemic is varied across the UK. While the 35% national average figure is high in itself, it is the case that some areas – predominantly in the North West and Midlands – will see their economic growth reduce by almost 50%.

Only one of the twenty hardest hit areas are in the South East or London.

In addition to the significant diversity of geographic impact estimated by the Centre for Progressive Policy5, the Resolution Foundation6 point to previous data suggesting that there is likely to be a large impact on those leaving full time education and graduating into an economy in the midst of turmoil. In the 2008 Recession, the unemployment rate across the whole population rose from 5.2% in 2007 to 8.5% in 2011; for those with GCSE equivalent qualifications the unemployment figures were 22% in 2007 and 32% in 2011.

An exacerbating factor for those leaving full time education without a degree is the varied impact of the virus on different sectors of the economy. While sectors such as financial sectors will emerge from the coronavirus pandemic relatively unscathed, with a contraction of just -5%, sectors like retail and hospitality, which have a higher proportion of workers who haven’t completed higher 32

education, will contract by -50% and 85% respectively.

So the data suggests a varied and profound impact across locations, ages, and education levels. This has a worrying impact for social mobility in the United Kingdom, as we predict that 8 out of 14 measures used to calculate social mobility will be impacted.

We have combined existing place based social mobility analysis with the predicted impact of coronavirus to estimate the size of a communities developing “Opportunity Gap” and ranked these throughout England.

From our analysis we believe that there are 16 areas in England at risk of a ‘double opportunity hit’: already amongst the worst areas for social mobility, they are going to be particularly badly hit by coronavirus. These areas are Babergh, Bolsover, Broxtowe, Cannock Chase, Corby, Crawley, East Cambridgeshire, East Northamptonshire, Erewash, Melton, North Warwickshire, Norwich, Rutland, South Derbyshire, Tamworth and Wellingborough.

4. Office for Budget Responsibility. Coronavirus analysis. Office for Budget Responsibility. [Online] April 14, 2020. [Cited: April 15, 2020.] https://cdn.obr.uk/Coronavirus_reference_scenario_commentary.pdf.

5. Centre for Progressive Policy. Which local authorities face the biggest immediate economic hit? Centre for Progressive Policy. [Online] April 16, 2020. [Cited: April 16, 2020.] https:// www.progressive-policy.net/publications/which-local-authorities-face-biggest-immediate-economic-hit.

6. Henehan, Kathleen. Class of 2020. Resolution Foundation.

[Online] May 6, 2020. [Cited: May 14, 2020.] https://www.resolutionfoundation.org/app/uploads/2020/05/Class-of-2020.pdf.

Local Authority

Opportunity Gap

Ranking

Corby 318 1 South Derbyshire 310

2

Wellingborough 308

3

Melton 306 4 North Warwickshire 296

5

Wiltshire 223.5 56 West Lancashire 140.5

188

Harlow 87.5 266

Our analysis shows that Harlow is the 266th most impacted area in England, out of 310.

It’s slightly better than average position on the social mobility index, as well as an economy that will shrink much less than the UK average (Harlow’s economy will contract by 29% compared to 35%) insulates Harlow somewhat from Covid induced shocks.

West Lancashire, the location of Virgin Care’s Children Centre, has an economy that is

more impacted than average - it’s economy will contract by 40%, but a strong ranking on the Social Mobility Index prevents further opportunity gaps developing.

The worst impacted of the Virgin Care locations we have examined is Wiltshire, which has pre-existing vulnerabilities as a social mobility coldspot and an economy more impacted than the rest of the UK’s, contracting by 39%.

21 33

05 Data Analysis

05 Data Analysis

Harlow’s Economy Sector

1

2

3

4

5

6

West Lancashire’s Economy 7

8

9

10 11

12 13 14 15

Sector

1

2

3

4

5

6

7

8

9

10 11

12 13 14 15

GVA (£m)

27 120 16 159 96 21 424 80 291 208 48 205 57 382 57

GVA (£m)

78

79 109 165 175 125 160 44 442 156 48 306 142 404 48

GVA (&)

1.2 5.5 0.7 7.3 4.4 1.0 19.4 3.7 13.3 9.5 2.2 9.4 2.6 17.4 2.6

GVA (&)

3.1

3.2 4.4 6.7

Decline (%)

-85 -40

-17 -70 -90

-5

50

-45 -55 -40 -20 -20 -35 -50

-60

Decline (%)

-85 -40

7.1

-17 -70 -90

5.0 6.4

1.8 17.8 6.3

-5

-45 -55 -40 -20 -20 -35 -50

50

1.9 12.3 5.7 16.3 1.9

-60

Harlow’s Largest Sectors West Lancashire’s Largest Sectors Sector

Wholesale Professional Human Health and Retail Manufacturing Activities Real Estate Sector

GVA (£m)

424

383

291

208

Wholesale Manufacturing and Retail Real Estate Education Construction

205 GVA (£m)

442

404

306

175

165

Biggest Impacted Sectors Sector Predicted Decline

-90% -85% -70% -60% -55%

The top five sectors in Harlow’s economy are human health, wholesale and retail, manufacturing, professional activities, and real estate. The largest of these, human health, buffers Harlow from taking a larger hit to its economy as this sector is predicted to grow by 50% due to the coronavirus pandemic. This offsets to some extent the fact that one of Harlow’s largest sectors, manufacturing, is also one of the hardest hit sectors, with a predicted loss of -55%.

Sector Key: 1 accommodation and food services; 2 administrative and support services; 3 agriculture, mining, electricity, gas, water, and waste; 4 construction; 5 education; 6 financial and insurance activities; 7 human health and social work activities; 8 information and communication; 9 manufacturing; 10 professional, scientific, and technical activities; 11 public administration and defence; 12 real estate activities; 13 transportation and storage; 14 wholesale and retail (including repair of motor vehicles); 15 other.

34

Biggest Impacted Sectors

Accommodation Education and Food Construction Other Services Manufacturing Sector Predicted Decline

Accommodation Education and Food Construction Other Services Manufacturing

-90% -85% -70% -60% -55%

West Lancashire’s is the most vulnerable to Covid shocks, predicted to decline by 40%. The biggest sectors in West Lancashire are manufacturing, wholesale and retail, real estate, education, and construction - with manufacturing, education, and construction predicted to be some of the worst impacted sectors. Wholesale and retail is also a sector that is predicted to decrease a significant amount, by 50%. A strong ranking on the social mobility index, where it is nearly a hotspot, prevents significant opportunity gaps developing in West Lancashire, although it does still take a large blow from the coronavirus pandemic.

35

05 Data Analysis

05 Data Analysis

Wiltshire’s Economy Sector

1

2

3

4

5

6

7

5.3 Part C: Adulthood Outcomes by Earnings

8

9

10 11

12 13 14 15

GVA (£m)

411 344 448 696 734 119 761 494 1704 1228 686 1892 275 1225 344

GVA (&)

3.6 3.0 3.9 6.1 6.5 1.0 6.7 4.3 15.0 10.8 6.0 16.7 2.4 10.8 3.0

Decline (%)

GVA (£m)

-85 -40

-17 -70 -90

-5

50

-45 -55 -40 -20 -20 -35 -50

Real Estate

Manufacturing

Professional Activities

Wholesale and Retail

Human Health

1892

1704

1228

1225

761

Predicted Decline

Accommodation Education and Food Construction Other Services Manufacturing

-90% -85% -70% -60% -55%

Wiltshire’s economy is slightly better insulated than West Lancashire’s, with only one sector being in the top five most impacted sectors. However, the fact that this sector is substantially larger than many other sectors; a human health sector that, while large, is under 7% of GVA; and its existing status as a social mobility coldspot mean that West Lancashire is particularly vulnerable to widening opportunity gaps as a result of covid.

36

Quintile pay gap conditional on education

Median age 28 earnings FSM son (£)

Quintile pay gap

East of England 17,900

4

5

1

1,418

159

2

2

5

6,964

345

Region

South West

16,300

Quintile education gap

No. of sons in sample

No. of FSM sons in sample

West North Lancashire West 14,600 2 3 1 2,022 263

-60

Biggest Impacted Sectors Sector

Harlow Wiltshire

Wiltshire’s Largest Sectors Sector

Local Authority

Methodology: this data takes into account administrative education data (National Pupil Database and Higher Education Statistics Authority) and earnings and benefits records (HM Revenue and Customs and the Department for Work and Pensions)

in the Longitudinal Education Outcomes (LEO) dataset. These data, which have never previously been used to study how opportunities are passed across generations, allow us to link all state-educated sons, born between 1986 and 1988, who attended school in England, to the area where they grew up, and to track their educational and labour market experiences. The above data used by the Social Mobility Commission only takes into account the outcomes of sons, due to a data limitation for women, making the data non-comparable. The Social Mobility Commission has outlined that despite this gender constraint we believe that the main findings within the report are not gender specific. In short: this is a story illustrated by men, but its message is about all those who grow up disadvantaged, and how that disadvantage varies by place.

Analysis The above data has been highlighted to provide background context to Virgin Care’s key sites that emphasise community support where the Civic Health Model could be replicated, in the Wiltshire and West Lancashire local authorities - as well as Harlow, where the current Model has been successfully implemented.

37

06 Next Steps & Recommendation

06 Next Steps and Recommendation

The Social Mobility Pledge recognises this model as one that should be scaled for the benefit of other communities.

Given the complex relationship and high correlation between the least privileged groups and the lowest health outcomes, it’s time to adopt a more nuanced approach to delivering health care.

This need is one that goes beyond reactive delivery of treatment, but a more proactive approach of promoting positive health choices in communities.

The objective being to break the link between socioeconomic status and low health outcomes, because inequality can not be tackled without tackling health inequality.

Expanding the Civic Health Model The Civic Health Model in Essex has exemplified a different way of delivering health care services.

It has fostered an approach which looks to tackle many of the complex interrelated social factors that underpin poor health outcomes, particularly within societal groups that are the furthest away from privilege and opportunity.

It has demonstrated a successful model which has a proactive approach to health care, promoting positive health habits, while also promoting opportunities and development for individuals in those communities, and service-users.

38

This is crucial in order to fully deliver the ‘levelling up’ agenda in the UK. To this end, the approach delivered in Virgin Care’s Civic Health Model in Essex, should increasingly become the norm.

The Social Mobility Pledge concludes that the Essex Model should become the standard across the health sector.

A more sophisticated and holistic approach to health care, by promoting positive health habits and engaging with communities, is an effective method to tackling health inequalities, which is fundamental to tackling wider social inequalities. This is key to Levelling Up Health.