Health · United Kingdom · 2011–13 to 2022–24

Britain is losing healthy years.

Healthy life expectancy in the UK in 2022–24 was the lowest since the ONS series began in 2011–13: 60.7 years for men and 60.9 for women, down from 62.7 and 63.7. Life expectancy has risen since 2019–21, back to its pre-pandemic level for women and slightly below it for men; years in self-rated good health have kept falling. This is a population estimate, not a prediction for any one child.

Priority: Increase healthy years and narrow avoidable physical and mental ill-health gaps. What would change it →

Evidence last reviewed 3 October 2026

Overview

The short version

Three key measures

Who feels this most?

Deprivation runs through every health measure on this page. In England’s most deprived tenth of areas, healthy life expectancy at birth is about 49.8 years for men and 48.2 for women, against 69.2 and 68.5 in the least deprived (2022 to 2024). Common mental health conditions follow the same gradient: 26.2% of adults in the most deprived fifth of areas against 16% in the least deprived (2023/4).

The evidence

Longer lives, healthier years and the gaps between people

Longer lives, fewer healthy years

Are people living longer, and how much of that life is healthy?

Lifespans are back where they were; years in good health have fallen

Left: life expectancy at birth. Right: healthy life expectancy at birth (years in “very good” or “good” self-reported health). United Kingdom, by sex, three-year periods 2011–13 to 2022–24. Both axes span ten years so slopes are comparable; neither starts at zero.

United Kingdom (both panels) · 2011–13 to 2022–24

Life expectancy at birth

1996–2026 displayed window · observations only. Shading marks years outside the displayed record.

YearsNo observations shown8085axis does not start at 020002010202083.079.2

Healthy life expectancy at birth

1996–2026 displayed window · observations only. Shading marks years outside the displayed record.

Years in good healthNo observations shown6065axis does not start at 020002010202060.960.7

Both axes span ten years and neither starts at zero. Confidence intervals for the latest period are in the data table.

Life expectancy dipped during the pandemic and in 2022–24 is 79.2 years for men and 83.0 for women — within a few months of 2011–13. Healthy life expectancy did not recover: it fell from 62.7 to 60.7 years for men and from 63.7 to 60.9 for women. The gap between the two lines — years lived in less than good health — has widened to 18.5 (men) and 22.1 (women). Confidence intervals are narrow for life expectancy and wider for healthy life expectancy.

United Kingdom (both panels) · 2011–13 to 2022–24 · Official statistics (life expectancy); official statistics in development (healthy life expectancy)

Sources, definitions and data — Lifespans are back where they were; years in good health have fallen
Geography:
United Kingdom (both panels) — Usual residents; deaths of non-residents excluded
Measure:
Years
Period:
2011–13 to 2022–24
Status:
Official statistics (life expectancy); official statistics in development (healthy life expectancy)
Calculation:
As published. Each point is a three-year average plotted at its middle year. Life expectancy from the ONS local-area series that ONS pairs with healthy life expectancy.
Compare with:
2011–13, the first period of the healthy life expectancy series
Not included / breaks:
Healthy life expectancy rests on people’s own rating of their health in the Annual Population Survey; it is not a clinical diagnosis. ONS re-estimated the whole series with an interim method because the survey’s sample has shrunk, which widens uncertainty. Periods overlap, so consecutive points are not independent.

Source: ONS, Healthy life expectancy, UK: between 2011 to 2013 and 2022 to 2024, Dataset “Healthy life expectancy, UK”, Table 1 (released 19 February 2026). Chart HEALTH-01.

View the data as a table
PeriodLife expectancy, menLife expectancy, womenHealthy life expectancy, menHealthy life expectancy, women
2011–1379.082.862.763.7
2012–1479.182.862.963.7
2013–1579.182.863.063.9
2014–1679.282.963.063.8
2015–1779.282.863.163.8
2016–1879.282.963.063.8
2017–1979.483.062.963.5
2018–2079.082.862.863.7
2019–2178.782.762.463.4
2020–2278.682.662.062.4
2021–2378.882.861.361.6
2022–2479.2 (79.1–79.2)83.0 (83–83.1)60.7 (60.5–60.9)60.9 (60.7–61.2)

Scroll the table sideways to see every column.

Life expectancy is about how long people live; healthy life expectancy is about how many of those years people rate their own health as good. A girl born in the UK today could expect about 22 years in less than good health, and a boy about 19 — both more than in 2011–13. Women live longer than men but spend more of their lives in poorer health.

The fall is real but needs care in reading. ONS rebuilt the healthy-life series with an interim method because its survey sample has shrunk, and the pandemic still weighs on the latest period. The direction is consistent across all four UK nations and in most local areas. Why healthy years fell — more long-term conditions, more mental ill health, or people rating the same health more harshly — is not settled by this measure alone: see why healthy years fell.

Who feels this most?

Does a preventable cause of early death follow deprivation?

Preventable heart and stroke deaths before 75 are nearly 4 times as common in the most deprived areas

Deaths under 75 from cardiovascular disease considered preventable, per 100,000 people aged under 75, directly age-standardised, by neighbourhood deprivation tenth (most deprived at top), England, 2022, persons.

England · 2022
Deaths per 100,000 under-75s, age-standardisedEngland average (30.8)
  • Most deprived tenth61.6
  • 2nd49.5
  • 3rd40.9
  • 4th34.3
  • 5th30.0
  • 6th26.3
  • 7th23.6
  • 8th21.0
  • 9th19.1
  • Least deprived tenth16.2
The rate rises at every step from the least to the most deprived tenth of neighbourhoods, from 16.2 to 61.6 per 100,000. Because the rates are age-standardised, the gap is not explained by poorer areas having older or younger populations. Risk factors such as smoking are more common in deprived areas, but this chart does not measure causes. The confidence intervals for the most and least deprived tenths are far apart.

England · 2022 · Official statistics (OHID, from ONS death registrations)

Sources, definitions and data — Preventable heart and stroke deaths before 75 are nearly 4 times as common in the most deprived areas
Geography:
England — Residents aged under 75, grouped by the deprivation decile of their small area (LSOA 2021)
Measure:
Deaths per 100,000, age-standardised to the 2013 European Standard Population
Period:
2022
Status:
Official statistics (OHID, from ONS death registrations)
Calculation:
As published by OHID. Ratio = most deprived ÷ least deprived (UK Facts calculation).
Compare with:
England average: 30.8 per 100,000
Not included / breaks:
“Preventable” follows the 2019 ONS/OECD definition: deaths that could mainly be avoided by public health and primary prevention; cardiovascular causes count at 50%. OHID says the LSOA decile figures are still to be revised for new population estimates. Area deprivation describes neighbourhoods, not individuals.

Source: OHID, Public health profiles (Fingertips): under-75 mortality rate from cardiovascular disease considered preventable, Indicator 93722 (E04b), LSOA21 deprivation deciles (released checked 3 October 2026). Chart HEALTH-02.

View the data as a table
Deprivation tenthRate per 100,00095% confidence interval
Most deprived tenth61.659.2–64.1
2nd49.547.4–51.7
3rd40.939–42.9
4th34.332.6–36
5th30.028.5–31.5
6th26.324.9–27.7
7th23.622.3–24.9
8th21.019.8–22.3
9th19.118–20.3
Least deprived tenth16.215.2–17.3

These are comparisons between areas, not proof that deprivation alone causes ill health: income, work, housing, smoking and access to care all differ between places, and poor health can also reduce income. The full comparison is on the inequality page.

Go deeper

  • How many years are lived in good health?
    -4.4%2011–2013–2022–2024United Kingdom · years
    No observationsshown0408019962026
    63.7 → 60.92011–2013–2022–2024
    Women, UK: healthy life expectancy at birth. Overlapping three-year periods; the chapter compares men and women.
    Sources and data

    Self-reported general health from the Annual Population Survey combined with ONS life tables by the Sullivan method. Not a clinical diagnosis. 95% confidence intervals are published in the dataset. ONS re-estimated "good" health prevalence for the whole series with an interim logistic-regression method because Annual Population Survey samples have shrunk; the series is labelled official statistics in development.

    Source dataset →
    PeriodyearsStatus
    2011–201363.7Outturn
    2012–201463.7Outturn
    2013–201563.9Outturn
    2014–201663.8Outturn
    2015–201763.8Outturn
    2016–201863.8Outturn
    2017–201963.5Outturn
    2018–202063.7Outturn
    2019–202163.4Outturn
    2020–202262.4Outturn
    2021–202361.6Outturn
    2022–202460.9Outturn
    Life expectancy and healthy life expectancy side by side, with what the measure can and cannot say.Read the chapter → How many years are lived in good health?
  • Which early deaths could be prevented?
    -54.3%2001–2024England · per 100,000 (age-standardised)
    0408019962026
    64.3 → 29.42001–2024
    Preventable cardiovascular deaths before age 75. Age-standardised rate, not a count of deaths or all preventable illness.
    Sources and data

    ICD-10 I10-I13, I15, I20-I25, I60-I70, I71, I73.9, each counted at 50% as preventable under the 2019 ONS/OECD definition. Includes the pandemic years. Mid-2022 and mid-2023 population estimates were revised; OHID says the effect on rates is very small.

    Source dataset →
    Periodper 100,000 (age-standardised)Status
    200164.3Outturn
    200260.8Outturn
    200357.2Outturn
    200452.1Outturn
    200548.4Outturn
    200644.9Outturn
    200742Outturn
    200839.8Outturn
    200936.4Outturn
    201035.4Outturn
    201133.1Outturn
    201231.7Outturn
    201331.1Outturn
    201430.1Outturn
    201529.8Outturn
    201629.2Outturn
    201728.5Outturn
    201828.6Outturn
    201927.4Outturn
    202029.4Outturn
    202130.2Outturn
    202230.8Outturn
    202330.5Outturn
    202429.4Outturn
    A preventable condition by deprivation, and the long-run trend.Read the chapter → Which early deaths could be prevented?

Evidence → choices → outcomes

What could improve it?

More years lived in good health across the UK, and a narrower gap between England’s most and least deprived areas.

These options link to their national assessment, including funding, delivery constraints and remaining uncertainties.

  • Assessed option · provisional

    Introduce minimum unit pricing for alcohol in England

    Use the Scottish evaluation to appraise an English policy.

    9/10 criteria scored

    Coverage of the appraisal, not an impact score.

    Delivery: Amber

    Whole-life costs incomplete

    Evidence and delivery constraints

    Controlled Scottish evaluation supports mortality effects; English transfer and design need assessment. Admission reduction was not statistically significant.

    Choose price/indexation; consult; legislate; arrange enforcement and support for dependent drinkers; predefine evaluation.

    Wellbeing listEvidence and assessment

  • Assessed option · provisional

    Build family hubs around what worked

    Evaluated Sure Start features, weakest-access areas first, and a phased, evaluable roll-out of the family hubs.

    9/10 criteria scored

    Coverage of the appraisal, not an impact score.

    Delivery: Amber

    Whole-life costs incomplete

    Evidence and delivery constraints

    Sure Start evidence supports defined features; it does not validate all current hub models or immediate benefits.

    Specify service intensity and target reach; staff health/family services; measure uptake, fidelity and long-term outcomes.

    Wellbeing listEvidence and assessment

  • Assessed option · provisional

    School mental health: symptoms, functioning, attendance and equitable access

    A comparison-based evaluation and a route for greater needs.

    8/10 criteria scored

    Coverage of the appraisal, not an impact score.

    Delivery: Amber

    Whole-life costs incomplete

    Evidence and delivery constraints

    Artifact describes early implementation evidence without a comparator; universal classroom programmes and targeted treatment differ.

    Specify intervention and referral threshold; secure qualified staff and escalation to specialist care; evaluate outcomes.

    Wellbeing listEvidence and assessment

  • Assessed option · provisional

    Get effective depression treatment to adults missing out

    Close the gap between effective treatment and people receiving it.

    9/10 criteria scored

    Coverage of the appraisal, not an impact score.

    Delivery: Amber

    Whole-life costs incomplete

    Evidence and delivery constraints

    NICE provides treatment evidence and clinical recommendations. They do not establish that a new access pathway reaches additional patients or that sufficient therapists are available.

    Verify unmet clinical need and commissioned care; cost therapists, supervision, triage, follow-up and escalation; monitor symptoms, functioning, deterioration and access. Proposed owners: NHS commissioners and providers; jurisdiction-specific.

    Wellbeing listEvidence and assessment

  • Assessed option · provisional

    Make effective smoking treatment reach more people

    Expand access, measure additional quits and track who is still missing out.

    9/10 criteria scored

    Coverage of the appraisal, not an impact score.

    Delivery: Amber

    Whole-life costs incomplete

    Evidence and delivery constraints

    NICE supports effective treatment combinations. Evidence is stronger for treatment than for this exact outreach/access increment; no national impact total is claimed.

    Verify service gap and current funding; cost adviser time, treatment, referral and follow-up. Measure sustained quits and inequalities, with adverse effects monitored. Proposed owners: public-health commissioners and health providers.

    Wellbeing listEvidence and assessment

  • Assessed option · provisional

    Make heat protection operational in vulnerable settings

    Assess overheating in selected care settings and homes, then commission proportionate cooling, shading and response plans.

    8/10 criteria scored

    Coverage of the appraisal, not an impact score.

    Delivery: Amber

    Whole-life costs incomplete

    Evidence and delivery constraints

    The site records heat risk and options; it does not evaluate this exact package.

    Cost a local risk-led plan before the next warm season, prioritising people unable to protect themselves. Use risk-based standards; a mild summer is not proof the intervention worked.

    Resilience and sustainability appraisal queueEvidence and assessment

This domain in the UK SWOT →UK National Action Plan →

How we assessed these options

What would it take to improve this?

What would move the needle?

The outcome we want: More years lived in good health across the UK, and a narrower gap between England’s most and least deprived areas.

The main constraint: Most levers that add healthy years sit outside the NHS — price rules need UK legislation, and councils fund prevention from a ring-fenced public health grant — while the benefits arrive years later in other budgets; an English alcohol floor price needs a government decision ministers say they have no plans to make.

Constraint type: legislation, money, public consent, evidence.

The options on the table

What is funded now, and the changes assessed against it — the current baseline and the alternatives, before the position today and the actions.

Provisional single-reviewer assessments from the 6 October 2026 review; not approved business cases, and not government policy.

  • Alcohol minimum unit price in EnglandDelivery RAG: Amber

    Funded now
    Not government policy: ministers said in June 2026 that they “do not currently have any plans” to introduce MUP in England, and the 10 Year Health Plan (July 2025) does not include it. England would need legislation, as Scotland and Wales did.
    The change assessed
    An English minimum unit price, by primary legislation.

    Range if completed: 20.0–23.0 out of 30 (equal weights; not yet assessed: incremental affordability (Co))

  • Family hubs built on Sure Start featuresDelivery RAG: Amber

    Funded now
    Best Start Family Hubs are being rolled out to every local authority in England from April 2026, “backed by over £500 million”, with up to 1,000 hubs by the end of 2028 (DfE, July 2025); by March 2026 the stated backing was £900m over three years, including £200m for Healthy Babies services, and on 30 September 2026 the Burnham government said the Healthy Babies programme would reach every hub. They are not automatically equivalent to the 2000s Sure Start centres that were evaluated. The proposal is to hold the hubs to the features that were tested, start where access is weakest, and phase the roll-out so it can be evaluated.
    The change assessed
    Evaluated Sure Start features, weakest-access areas first, and a phased, evaluable roll-out of the family hubs.

    Range if completed: 17.0–20.0 out of 30 (equal weights; not yet assessed: incremental affordability (Co))

  • School mental healthDelivery RAG: Amber

    Funded now
    Teams covered 60% of pupils and learners in 2025–26, and the Spending Review 2025 commits to every school by 2029–30. The proposal is to make the remaining roll-out evaluable and to fill the needs gap, not to start a new service.
    The change assessed
    A comparison-based evaluation and a route for greater needs.

    Range if completed: 15.0–21.0 out of 30 (equal weights; not yet assessed: expected incremental benefit (Bn), incremental affordability (Co))

  • Access to effective adult depression treatmentDelivery RAG: Amber

    Funded now
    Funded baseline: NHS Talking Therapies (1.81m referrals and 674,683 finished courses in England in 2025–26), with ring-fenced funding and a planning target of 805,000 courses by the end of 2026/27 and 915,000 by 2028/29. Targeting extra capacity at the areas with the lowest completion and recovery is a UK Facts proposal, not government policy.
    The change assessed
    Close a verified access gap for clinically appropriate NICE-recommended adult depression treatment, with supervision and an escalation route.

    Range if completed: 19.0–22.0 out of 30 (equal weights; not yet assessed: incremental affordability (Co))

  • Targeted access to smoking treatmentDelivery RAG: Amber

    Funded now
    Funded baseline: the 2026–27 public health grant ring-fences £152.8m for smoking cessation (absorbing the extra £70m a year and Swap to Stop); the generational age-of-sale law starts on 1 January 2027; NHS trusts offer tobacco dependence treatment. Targeted outreach to routine and manual workers is a UK Facts proposal, not government policy.
    The change assessed
    Expand access to established behavioural support plus suitable cessation treatment for a defined underserved adult group; cardiovascular prevention is a separate, unscored option.

    Range if completed: 21.0–24.0 out of 30 (equal weights; not yet assessed: incremental affordability (Co))

Assessed with another page as home

These options also bear on this topic. The full assessment sits on the home page named under each.

  • Make heat protection operational in vulnerable settingsDelivery RAG: Amber

    Home: Social care.

    Funded now
    Baseline: the Adverse Weather and Health Plan (guidance; no statutory duty or indoor-temperature standard for care homes); building regulations on overheating (Approved Document O) for new buildings only; more than £32m for NHS cooling projects (September 2026), nothing yet for social care. Risk assessment and building-specific measures in existing care homes is a UK Facts proposal, not government policy.
    The change assessed
    Assess overheating in selected care settings and homes, then commission proportionate cooling, shading and response plans.

    Range if completed: 17.0–23.0 out of 30 (equal weights; not yet assessed: expected incremental benefit (Bn), incremental affordability (Co))

Alternatives already on record: 34 options listed under the points in the position today (22 without an action record), and 4 earlier options under other options compared. They have not been scored in the review.

The position today

  • What we can build on (2)
  • What is holding us back (6)Healthy life expectancy at birth fell from 62.7 to 60.7 years for men and from 63.7 to 60.9 for women. (2011–13 to 2022–24 · United Kingdom)
  • What could improve things (1)Prevention with tested evidence — a floor price for alcohol, early-years help where access is weakest — could reach deprived areas most: in Scotland the largest estimated falls in alcohol deaths were in the 40% most deprived areas, an exploratory result. Neither has been shown to close the wider gap in early deaths.
  • What could make it worse (3)

Which quadrant a point sits in is our analytical judgement, not a statistical category. Each point says whether it is a measured fact, our synthesis or a risk.

What we can build on Strengths

What is holding us back Weaknesses

What could improve things Opportunities

What could make it worse Threats

  • School mental health teams are being rolled out to every school by 2029–30 without a published measure of what they change for children, so a national service could be complete before anyone knows whether it works.

    Risk, not a certaintyConfidence: Moderate

    Source: NIHR Health and Social Care Delivery Research 11(8), Early evaluation of the Children and Young People’s Mental Health Trailblazer programme: a rapid mixed-methods study (Abstract); HM Treasury, Spending Review 2025 (Paragraph 5.16c, p.59)

    Options assessed against this point: School mental health (Amber delivery RAG)

    What government has committed to

    Target: Mental health support teams to reach 100% of schools in England by 2029–30 (Spending Review 2025); NHS England planning targets 77% coverage in 2026/27 and 94% in 2028/29, reaching 100% by 2029.

    Who and when:
    Starmer government (to July 2026), 11 June 2025.
    Since 20 July 2026:
    Not confirmed either way since the change of Prime Minister on 20 July 2026. No Burnham-era restatement or change found: the 5 Aug 2026 mental health announcement does not mention school teams; no DfE news on them since 20 Jul 2026.
    Source:
    HM Treasury, Spending Review 2025 (HTML) (Chapter 1 "Mental health and family help" and Chapter 5 DHSC settlement ("expanding mental health support teams to 100% of schools by 2029-30"; 92% within 18 weeks by end of Parliament; adult social care +£4bn in 2028-29 vs 2025-26))

    Checked 4 October 2026. A commitment is not delivery.

    Options (2)

  • Healthy life expectancy rests on a shrinking survey and an interim ONS method, so a real change of a few months may not be detectable for years.

    Risk, not a certaintyConfidence: Moderate

    Source: Office for National Statistics, Healthy life expectancy, UK: between 2011 to 2013 and 2022 to 2024 (Bulletin: measuring the data)

    What government has committed to

    Policy: The 10 Year Health Plan says the government will work with the ONS and other experts to develop a new suite of delivery indicators, alongside a broader measure of the nation's health, recognising the lag between intervention and impact on healthy life expectancy.

    Who and when:
    Starmer government (to July 2026), 3 July 2025.
    Since 20 July 2026:
    Not confirmed either way since the change of Prime Minister on 20 July 2026. No publication of the new indicator suite found on gov.uk since 20 Jul 2026; the halving-the-gap goal itself was re-stated (14 Sep 2026).
    Source:
    DHSC, Fit for the future: 10 Year Health Plan for England (Executive summary and Chapter 4 "From sickness to prevention" (goal to halve the gap in healthy life expectancy; ONS delivery indicators; alcohol labelling; MHSTs to full national coverage by 2029 to 2030); Chapter 2 (neighbourhood health, beginning where healthy life expectancy is lowest); Chapter 5 (Better Care Fund reform from 2026 to 2027 focused on discharge, intermediate care, rehabilitation and reablement))

    Checked 4 October 2026. A commitment is not delivery.

    Options (2)

    • Publish interim delivery indicators alongside healthy life expectancy

      Annual measures that move faster (premature CVD deaths, alcohol-specific deaths, smoking prevalence) show progress while HLE is too noisy to detect small changes.

      Who: DHSC with ONS and OHID · Evidence: Expert or audit recommendation · Status: Announced proposal

      Source: DHSC, Fit for the future: 10 Year Health Plan for England (Executive summary and Chapter 4 "From sickness to prevention" (goal to halve the gap in healthy life expectancy; ONS delivery indicators; alcohol labelling; MHSTs to full national coverage by 2029 to 2030); Chapter 2 (neighbourhood health, beginning where healthy life expectancy is lowest); Chapter 5 (Better Care Fund reform from 2026 to 2027 focused on discharge, intermediate care, rehabilitation and reablement))

    • Track the CVD framework's annual metrics as the main near-term health-gap measure

      The framework sets 3-year and 10-year ambitions with metrics that update annually.

      Who: DHSC and NHS England · Evidence: Untested proposal · Status: Announced proposal

      Source: DHSC, Cardiovascular disease (CVD) modern service framework (MSF): a cardiovascular-kidney-metabolic approach – strategic vision and delivery model (Executive summary and "Our ambition" (reduce premature mortality from heart disease and stroke by 25% within 10 years, to about 49 per 100,000 by 2034; proportionate universalism; smoking standards citing the Tobacco and Vapes Act 2026))

  • Hot summers already cost lives: UKHSA estimated 1,504 heat-associated deaths in England in summer 2025 (677 of them in care homes) and 2,985 in 2022, and an interim 2,877 in the May and June 2026 heatwaves alone; the Climate Change Committee warns heat-related deaths could exceed 10,000 in an average year by 2050 as the population ages.

    Risk, not a certaintyConfidence: Moderate· Summers 2022 to 2025; projection to 2050· England (projection: UK)

    Source: UK Health Security Agency, New UKHSA data shows 1,504 heat-related deaths during summer of 2025 (Heat mortality monitoring report, England: 2025) (News story, opening paragraphs); UK Health Security Agency, Heat mortality monitoring report: England, 2025 (Observed mortality by place of death); UK Health Security Agency, UKHSA report shows 2,877 excess deaths caused by May and June heatwaves (Opening paragraphs (interim, May and June 2026)); Climate Change Committee, Progress in adapting to climate change – 2025 report to Parliament (Executive summary, printed p.12)

    What government has committed to

    Funding: More than £32m for NHS cooling, ventilation and overheating projects, with the NHS instructed to look at heatwaves in the next funding round. Nothing comparable has been announced for care homes; the Adverse Weather and Health Plan (UKHSA) remains guidance.

    Who and when:
    Burnham government (from 20 July 2026), 9 September 2026.
    Since 20 July 2026:
    Made by the current government.
    Source:
    DHSC, Over £1.5 billion to help NHS withstand year-round pressure (Paragraphs on heat (“more than £32 million”))

    Checked 7 October 2026. A commitment is not delivery.

    Options (3)

The actions worth examining

Our shortlist for this page. Research quality, policy status, cost and funding are judged separately; none of these is government policy unless its status says so.Our shortlist. None is government policy unless its status says so.

  1. Set a minimum price per unit of alcohol in England — not a direct public-spending programme
  2. Rebuild integrated early-years help where access is weakest — programme funding exists; project allocation unconfirmed
  3. Measure what school mental health teams achieve as they reach every school, and close the gap for children with greater needs — programme funding exists; project allocation unconfirmed

And 2 more in the full list.

  • Action 1A49Policy status: external proposal

    Set a minimum price per unit of alcohol in England

    A legal minimum price per unit of alcohol raises the price of the cheapest, strongest drinks, so heavy drinkers buy less and deaths from alcohol fall.

    The thread: issue, evidence, action

    1. Issue Weakness: Alcohol-specific deaths in England were 13.8 per 100,000 people in 2024. The rate fell on 2023, but across the UK it was still 14.8 against 11.8 in 2019, and within England it ranged from 10.9 in London to 21.1 in the North East. Also: opportunity, strength
    2. Evidence Alcohol-specific deaths
    3. Action A49, this action

    Assessment (draft, 6 October review)

    Who decides:
    UK government (Home Office and DHSC) and Parliament, with councils enforcing through licensing (England)
    Evidence:
    Experimental or quasi-experimental evaluation. A controlled interrupted time series in Scotland, with England as the comparison, found fewer alcohol deaths; it is a within-UK evaluation, but at a 50p floor and over 32 months.
    Expected effect:
    −13.4% (about 156 deaths a year averted in Scotland): deaths wholly attributable to alcohol (Scotland (England as control)). Measured at a 50p floor in 2018–2020; the effect of 65p, or of a floor in England, is a forecast. Deaths from acute causes rose slightly but not significantly. 1 more result in “What it takes”.
    Cost and funding

    Not yet costed

    Funding: Not a direct public-spending programme

    Why it is shortlisted here: The prevention option on this page with a within-UK evaluation of an effect on deaths: in Scotland, alcohol deaths fell 13.4% relative to England. England has no floor price, so the change would be fully additional — but it needs legislation and a decision ministers have not made.

    What it takes
    The problem

    The cheapest, strongest drinks sold in shops are bought mostly by heavy drinkers, and alcohol harm is concentrated in deprived areas; England has no floor price.

    Who is affected, and where

    Adults in England who drink heavily, and the communities where alcohol harm is concentrated. Territory: England. Scotland has had MUP since May 2018 (65p since 30 September 2024) and Wales since March 2020 (65p since 1 October 2026). Northern Ireland has no MUP; its current position was not confirmed from a primary source.

    Policy status

    Proposed by researchers or others, not government policy. Not government policy: ministers said in June 2026 that they “do not currently have any plans” to introduce MUP in England, and the 10 Year Health Plan (July 2025) does not include it. England would need legislation, as Scotland and Wales did.

    The evidence
    What the research found:
    Deaths wholly attributable to alcohol −13.4% (95% CI −18.4% to −8.3%), about 156 a year; admissions −4.1% (95% CI −8.3% to +0.3%), not significant. Total alcohol sales −3%, all through shops. Largest reductions among men and in the 40% most deprived areas. No consistent evidence of effects on crime or on the drinks industry as a whole.
    Evaluated on:
    Adults aged 16+ in Scotland, compared with England; Scotland, May 2018 to December 2020 (MUP at 50p)
    Transfer to this case:
    England’s drinking patterns, retail market and price levels differ from Scotland’s, and the floor would be set years later than 50p in 2018; the Scottish effect is evidence on the mechanism, not a forecast for England.
    Our recommendation (separate from the research):
    Consult on an English floor price, set at a level justified by modelling of English drinking and prices, legislate with a review clause, and fund treatment for people with alcohol dependence alongside it.
    Strongest counter-evidence:
    There is limited evidence that MUP cut drinking among people with alcohol dependence, and qualitative evidence of financial strain for some on low incomes; one survey-based study found larger consumption falls in less deprived areas; admissions results were not significant.
    Effects on record
    • Deaths wholly attributable to alcohol: −13.4% (about 156 deaths a year averted in Scotland) (England over the same period (controlled interrupted time series); May 2018 to December 2020, at 50p a unit; 95% CI −18.4% to −8.3%). evaluated, moderate confidence; Scotland (England as control). Measured at a 50p floor in 2018–2020; the effect of 65p, or of a floor in England, is a forecast. Deaths from acute causes rose slightly but not significantly.
    • Hospital admissions wholly attributable to alcohol: −4.1% (not statistically significant) (England over the same period; May 2018 to December 2020, at 50p a unit; 95% CI −8.3% to +0.3%; results varied with the control group used). evaluated, limited confidence; Scotland (England as control). The interval includes no effect. Admissions for chronic causes fell; acute-cause admissions rose non-significantly; COVID-19 overlaps the period.
    • Financial strain for some people with alcohol dependence on low incomes: A cost or harm; size not established. evaluated, limited confidence; Scotland. Qualitative evidence: PHS found no evidence that these experiences were prevalent or typical, and limited evidence that MUP cut consumption among people with dependence. Treatment and support services are the mitigation.
    Cost and funding

    Cost completeness: Not yet costed. Funding: Not a direct public-spending programme.

    • Legislation, guidance, licensing enforcement and evaluation of a minimum unit price in England (administration; paid by central government, councils): Not yet costed. Not estimated for England. Scotland did not cost implementation: compliance checks were absorbed into existing licensing enforcement. Higher prices raise what drinkers spend, which PHS treats as a transfer to retailers rather than a public cost; no English estimate is used here.
    Who pays:
    Drinkers, through higher prices for the cheapest drinks (the extra spending goes mainly to retailers); government and councils for legislation, guidance and licensing enforcement.
    Financing proposed:
    None needed beyond administration; no English cost estimate exists. Scotland absorbed compliance checks into licensing enforcement.
    Gap remaining:
    Unknown: the administration and enforcement cost has not been estimated for England. The Home Office or DHSC would need to produce it in an impact assessment.
    What delivery needs
    Skills:
    Price modelling and licensing enforcement.
    Operational capacity:
    Trading standards and licensing teams.
    Infrastructure:
    None.
    Permissions:
    Compatibility with trade and competition law (tested in the Scottish courts).
    Law:
    Primary legislation for England, with a review or sunset clause.
    Public consent:
    Ministers say they have no plans; public and industry views in England were not assessed here.
    First step and stages

    First step: Commission modelling of English drinking and prices to propose a floor price and publish an impact assessment with costs, gainers and losers. (owner: DHSC with the Home Office)

    1. Model the level and consult — DHSC and the Home Office (proposed stage, not an official timetable)
    2. Legislate with a review clause — Parliament (proposed stage, not an official timetable)
    3. Introduce, with treatment support for dependent drinkers — Councils and NHS (proposed stage, not an official timetable)
    4. Evaluate deaths, admissions and sales against a comparison — OHID with independent researchers (proposed stage, not an official timetable)

    Depends on: Alcohol treatment capacity for people with dependence; A legislative slot

    Trade-offs
    Who gains and who loses:
    In Scotland the largest health gains were in the most deprived areas; moderate drinkers on low incomes pay a little more for the cheapest drinks, and some dependent drinkers on low incomes faced financial strain.
    What else the money or effort could do:
    Little public money, but legislative time and enforcement effort that could go to other alcohol or prevention measures; an alcohol duty rise is the main alternative price lever.
    Strongest counterargument:
    A floor price is a blunt tool that also charges moderate drinkers; duty rises raise revenue for the Exchequer instead of retailers; and dependent drinkers may cut spending on essentials rather than drink less.
    Risks:
    Setting the level too low to matter or letting inflation erode it; cross-border or online purchasing; harm to dependent drinkers without treatment support.
    How we would judge it
    Baseline:
    Alcohol-specific deaths in England (ONS annual release), not yet stored on this site; per-adult alcohol sales.
    Leading indicator:
    Off-trade sales per adult and the share of alcohol sold below the floor.
    Outcome:
    Deaths and admissions wholly attributable to alcohol, by deprivation, against a comparison such as Scotland and Wales before their 65p changes.
    Continue, adapt or stop:
    Write the comparison and the review point into the legislation; set any continue or repeal threshold in the impact assessment before introduction, not after.
    Sources

    Source published March 2023 (Lancet); June 2023 (PHS synthesis); June 2026 (government answer); evidence reviewed 2026-10-04. Reconsider if: An evaluation of Scotland’s 65p level; A change in the UK government’s position; New ONS alcohol-specific death figures for England.

  • Action 2A13Policy status: funded programme

    Rebuild integrated early-years help where access is weakest

    Provide accessible, integrated health, parenting and early-education support for young children, with outreach, in areas where access is weakest.

    The thread: issue, evidence, action

    1. Issue Weakness (Inequality): Healthy life expectancy in England’s most deprived areas is 19.4 years lower for men and 20.3 years lower for women than in the least deprived. Also: opportunityHow acting here reaches it: Integrated early-years help (Sure Start) cut hospital admissions by age 15 in the best UK evaluation; better child health where access is weakest is the route by which it acts on the deprivation gap in healthy life expectancy that the inequality page measures.
    2. Evidence Gap in healthy life expectancy, least vs most deprived areas (men)
    3. Action A13, this action

    Assessment (draft, 6 October review)

    Who decides:
    DfE, DHSC and councils (England)
    Evidence:
    Experimental or quasi-experimental evaluation. A strong quasi-experimental evaluation of the 2000s programme; transfer to today’s services is uncertain.
    Expected effect:
    +0.9 percentage points (about 2%): five GCSEs at A*–C (or equivalent) at 16 (England). 2000s Sure Start, not today’s family hubs. 1 more result in “What it takes”.
    Cost and funding

    Not yet costed

    Funding: Programme funding exists; project allocation unconfirmed

    Why it is shortlisted here: Early-years help is the page’s evaluated route to better child health: 2000s Sure Start cut hospital admissions by age 15 by 8.5%. It is the same shared record as on Education and Inequality, so its costs and effects are counted once.

    What it takes
    The problem

    The attainment gap opens before school, and integrated early-years services have thinned out in many areas.

    Who is affected, and where

    Children under five and their families in areas with weak access, in England. Territory: England. Sure Start was an England programme; devolved nations run separate early-years services.

    Policy status

    A funded programme already exists. Best Start Family Hubs are being rolled out to every local authority in England from April 2026, “backed by over £500 million”, with up to 1,000 hubs by the end of 2028 (DfE, July 2025); by March 2026 the stated backing was £900m over three years, including £200m for Healthy Babies services, and on 30 September 2026 the Burnham government said the Healthy Babies programme would reach every hub. They are not automatically equivalent to the 2000s Sure Start centres that were evaluated. The proposal is to hold the hubs to the features that were tested, start where access is weakest, and phase the roll-out so it can be evaluated.

    The evidence
    What the research found:
    Five A*–C GCSEs up 0.9 percentage points; hospital admissions down 8.5% by age 15 (up 10% at age 1); no significant effect on EHC plans; more cautions by 16. Central appraisal: £2.7bn cost per cohort against £5.5bn discounted benefits (£2.4bn to government), 2023–24 prices.
    Evaluated on:
    Children in England with access to a Sure Start centre, cohorts born around 1990–2007; England, 1999–2010 roll-out
    Transfer to this case:
    Today’s family hubs differ in services, funding and staffing from 2000s Sure Start.
    Our recommendation (separate from the research):
    Specify the service mix and outreach first, then fund it where access is weakest, and evaluate cohorts rather than claiming the old results.
    Strongest counter-evidence:
    Updated methods removed an earlier fall in EHC plans; crime results are mixed (more cautions); benefits are largely modelled lifetime earnings. Wales’s Flying Start raised service contact but found no measurable difference in child development by about age three.
    Effects on record
    • Five GCSEs at A*–C (or equivalent) at 16: +0.9 percentage points (about 2%) (children without access, before and after centres opened; cohorts born around 1990–2003; quasi-experimental; method update changed some earlier findings). evaluated, moderate confidence; England. 2000s Sure Start, not today’s family hubs.
    • Hospital admissions by age 15: −8.5% by age 15 (areas with fewer centres per child; cohorts born 1990s–2000s; admissions rose 10% at age 1 before falling). evaluated, moderate confidence; England. Not a cashable NHS saving.
    • Criminal record by age 16: A mixed effect; size not established. evaluated, moderate confidence; England. More young people had a criminal record by 16, driven by an 11% rise in cautions; a fall in convictions was not significant. A trade-off to watch, not a benefit.
    Cost and funding

    Cost completeness: Published programme envelope; project costs still needed. Funding: Programme funding exists; project allocation unconfirmed.

    • Integrated early-years service package and workforce (recurring spending; paid by central government, councils, NHS): Not yet costed. The IFS appraisal of 2000s Sure Start is a benchmark, not today’s rollout price; see the separate appraisal chart.
    • Best Start Family Hubs roll-out (programme envelope) (recurring spending; paid by central government): at least £500m in total, Announced 6 July 2025 (“over £500 million”), hubs in every local authority from April 2026 to the end of 2028; fiscal years and price basis not stated in the announcement., price basis not stated by the source. A programme envelope for the hubs, not a costed package of the Sure Start features the evaluation tested; an individual area’s offer is funded only once its allocation and specification are confirmed.
    • Best Start Family Hubs: “over £500 million” to the end of 2028: amount not established — not committed (programme envelope, not a project award). Recorded as “at least £500m” in the cost record; the amount is not repeated here to avoid implying a precise figure.
    Who pays:
    Central government and councils; the NHS for health visiting.
    Financing proposed:
    Best Start Family Hubs allocations (a programme envelope of over £500m) and public-health and health-visiting budgets; extra coverage or staffing beyond the hubs needs a new allocation or explicit displacement.
    Gap remaining:
    Unknown until the service package is specified and costed. Lifetime benefits cannot fund upfront delivery.
    What delivery needs
    Skills:
    Early-years practitioners, health visitors, outreach workers.
    Operational capacity:
    Local commissioning.
    Infrastructure:
    Accessible buildings.
    Permissions:
    None.
    Law:
    None.
    Public consent:
    Families’ trust and use of services.
    First step and stages

    First step: Map service access and specify the offer before choosing buildings or branding. (owner: Councils with DfE)

    1. Map access and specify services — Councils (proposed stage, not an official timetable)
    2. Build provision and track reach — Councils and NHS (proposed stage, not an official timetable)
    3. Evaluate cohorts over years — DfE with researchers (proposed stage, not an official timetable)

    Depends on: Early-years workforce

    Trade-offs
    Who gains and who loses:
    Largest gains for disadvantaged children; costs fall now, benefits mostly later and partly to other budgets.
    What else the money or effort could do:
    Funds and staff are not available for childcare places or other services.
    Strongest counterargument:
    Effects are modest per child and arrive slowly; diluted provision may not reproduce them.
    Risks:
    Workforce shortages and attributing every childhood outcome to one programme.
    How we would judge it
    Baseline:
    Good level of development at age five (DfE EYFS profile).
    Leading indicator:
    Reach among families in target areas.
    Outcome:
    Child development, later attainment and admissions, kept separate from projections.
    Continue, adapt or stop:
    Expand where reach and early outcomes improve; review where reach is low.
    Earlier option on this page

    This card replaces the option “Early years support in disadvantaged areas” (operating: Family hubs operate in some council areas.). Its evidence: IFS evaluations of Sure Start found fewer hospital admissions among children aged 11–15 in areas with centres, with the biggest benefits in the most disadvantaged areas. Adult health effects are not yet observable. IFS, The health impacts of Sure Start (2021)

    Sources

    Source published 22 May 2025 (IFS); December 2020 (Marmot); evidence reviewed 2026-10-04. Reconsider if: An evaluation of family hubs or Best Start services; A change in early-years funding.

    Also on: Education, Inequality — one shared record, so its cost is counted once.

  • Action 3A50Policy status: funded programme

    Measure what school mental health teams achieve as they reach every school, and close the gap for children with greater needs

    Phase the remaining roll-out so schools joining later act as a comparison, measure children’s outcomes and waits, and route children whose needs exceed the teams’ remit to specialist help.

    The thread: issue, evidence, action

    1. Issue Weakness: 25.8% of 16–24-year-olds had a common mental health condition in 2023/4, against 17.5% in 2007. Also: threat
    2. Evidence 16–24-year-olds with a common mental health condition
    3. Action A50, this action

    Assessment (draft, 6 October review)

    • This action: School mental health

      Delivery RAG: AmberGate: pending

      Range if completed: 15.0–21.0 out of 30 (equal weights; not yet assessed: expected incremental benefit (Bn), incremental affordability (Co))

      National plan: Wellbeing list

    Who decides:
    NHS England and integrated care boards with DfE, schools and colleges (England)
    Evidence:
    Observational analysis. An early evaluation without a comparison group reported only perceived benefits; no study has yet measured children’s outcomes, and trials of classroom-wide lessons (a different intervention) mostly found no benefit.
    Expected effect:
    Direction plausible; size not established.
    Cost and funding

    Not yet costed

    Funding: Programme funding exists; project allocation unconfirmed

    Why it is shortlisted here: Mental ill health among young adults has risen sharply, and the national answer — teams in every school — is funded but unmeasured. The action makes the remaining roll-out evaluable and closes the gap for children with greater needs.

    What it takes
    The problem

    One in four 16–24-year-olds in England has a common mental health condition, and school-based teams are being rolled out to every school without any published measure of what they change for children.

    Who is affected, and where

    Children and young people in schools and colleges in England, especially those not yet covered and those whose needs are more than mild to moderate. Territory: England. Mental Health Support Teams are an England programme; Scotland, Wales and Northern Ireland run their own school counselling and wellbeing services, not assessed here.

    Policy status

    A funded programme already exists. Teams covered 60% of pupils and learners in 2025–26, and the Spending Review 2025 commits to every school by 2029–30. The proposal is to make the remaining roll-out evaluable and to fill the needs gap, not to start a new service.

    The evidence
    What the research found:
    Schools reported positive early outcomes such as staff confidence and quicker access to advice — perceived, not measured — alongside staff retention problems and a gap for children whose needs were “more serious than ‘mild to moderate’”. The study was not designed to assess impact.
    Evaluated on:
    The first 25 Trailblazer sites (school staff, team members and commissioners); England, November 2020 to February 2022
    Transfer to this case:
    Evidence from whole-class mindfulness or literacy lessons (MYRIAD, INSPIRE) does not test targeted support teams; neither a null nor a positive result transfers between them.
    Our recommendation (separate from the research):
    Use the 40% of pupils still to be covered as a phased comparison, publish outcome and waiting-time results before full coverage, and fund a clear route to specialist care for children the teams cannot help.
    Strongest counter-evidence:
    Large UK trials of school-based lessons found no benefit for emotional difficulties, and some subgroups did worse; the teams have not been tested against a comparison, so their benefit is unproven rather than disproven.
    Effects on record
    • Children’s mental health and timely access to support: Direction plausible; size not established. plausible spillover, limited confidence; England. Only perceived benefits and school satisfaction have been reported; the NIHR-funded follow-on evaluation that began in 2023 had not published child outcome results by 4 October 2026 (its project page gives a final report in May 2027).
    Cost and funding

    Cost completeness: Not yet costed. Funding: Programme funding exists; project allocation unconfirmed.

    • Mental Health Support Teams: roll-out to every school and college in England by 2029–30 (recurring spending; paid by central government, NHS): Not yet costed. The Spending Review commits to full coverage but no separate amount for the teams is published; the £680m quoted in a May 2025 announcement covers wider children’s mental health services and is not used here.
    • Comparison-based outcome evaluation of the remaining roll-out, and specialist support for needs beyond “mild to moderate” (administration; paid by central government, NHS): Not yet costed. Not costed. A phased roll-out can provide the comparison group at little extra cost; the clinical capacity for children whose needs exceed the teams’ remit is the larger, unestimated cost.
    • Spending Review 2025 commitment to full Mental Health Support Team coverage (no amount published): amount not established, 2025–26 to 2029–30 — not committed (programme envelope, not a project award). Funds the teams, not a comparison-based evaluation or support for needs beyond the teams’ remit.
    Who pays:
    NHS England and integrated care boards for the teams and specialist care; DfE for schools’ time.
    Financing proposed:
    The roll-out is committed in the Spending Review without a published amount; the evaluation can use the phased roll-out, and the specialist route needs a decision within NHS children’s mental health budgets.
    Gap remaining:
    Unknown: the cost of the teams, the evaluation and the specialist route is not published.
    What delivery needs
    Skills:
    Education mental health practitioners, supervisors and specialist clinicians.
    Operational capacity:
    Specialist children’s services to take referrals (360,640 children and young people were waiting at the end of July 2026).
    Infrastructure:
    Linked health and pupil records for the evaluation.
    Permissions:
    Data-sharing agreements for record linkage.
    Law:
    No new law.
    Public consent:
    Schools, families and young people.
    First step and stages

    First step: Publish the order in which remaining schools will join and the outcome and waiting measures that will be compared, before the next wave starts. (owner: NHS England with DfE)

    1. Fix the roll-out order and outcome measures — NHS England and DfE (proposed stage, not an official timetable)
    2. Roll out in phases with a specialist referral route — Integrated care boards and schools (proposed stage, not an official timetable)
    3. Publish outcome and waiting-time results before full coverage — Independent evaluators (proposed stage, not an official timetable)

    Depends on: Workforce training places; Specialist children’s mental health capacity

    Trade-offs
    Who gains and who loses:
    Children in schools covered late wait longer for the service; children with complex needs gain only if the specialist route exists.
    What else the money or effort could do:
    Clinician time spent in schools is not available in specialist services, where waits are longest.
    Strongest counterargument:
    Phasing for evaluation delays coverage for some schools, and the commitment is already funded, so evaluation may not change the decision.
    Risks:
    Measuring contacts instead of outcomes; teams absorbing cases beyond their training; staff turnover.
    How we would judge it
    Baseline:
    60% of pupils covered (2025–26); 893,219 under-18s with at least one NHS mental health contact in the 12 months to July 2026.
    Leading indicator:
    Time from referral to first support, and onward referrals accepted by specialist services.
    Outcome:
    Children’s symptoms and functioning, school attendance and specialist waits, compared between early and later schools.
    Continue, adapt or stop:
    Publish the comparison design before the next wave; adapt the model if outcomes do not differ from later-joining schools.
    Sources

    Source published June 2023 (NIHR); June 2025 (Spending Review); June 2026 (DfE coverage); September 2026 (NHS statistics); evidence reviewed 2026-10-04. Reconsider if: Publication of child outcome results from the NIHR-funded follow-on evaluation; A change to the 2029–30 coverage commitment; New waiting-time statistics.

  • Action 4A70Policy status: external proposal

    Close the gap in effective depression treatment where completion and recovery are lowest

    Extra NICE-recommended courses, faster second appointments and active follow-up in the areas with the lowest completion and recovery, delivered under supervision with a step-up route, raise the number of people who finish treatment and reliably recover.

    The thread: issue, evidence, action

    1. Issue Weakness: About half of adults with symptoms of a common mental health condition were receiving any treatment in 2023/4 (47.7% of 16–74-year-olds; 17.9% psychological therapy). In NHS Talking Therapies, 40.7% of people finishing treatment in the most deprived tenth of areas reliably recovered in 2025–26, against 52.7% in the least deprived.
    2. Evidence Reliable recovery in Talking Therapies, most deprived tenth of areas; NHS Talking Therapies courses finished
    3. Action A70, this action

    Assessment (draft, 6 October review)

    Who decides:
    NHS England and integrated care boards, with NHS Talking Therapies providers (England)
    Evidence:
    Experimental or quasi-experimental evaluation. NICE recommends the treatments; one randomised trial of the service model (in Norway) found a large effect on recovery; English service data are uncontrolled before-and-after results that overstate effects; no study tests targeting extra capacity at deprived areas.
    Expected effect:
    Direction plausible; size not established.
    Cost and funding

    Not yet costed

    Funding: Not yet costed / funding not identified

    Why it is shortlisted here: The national adult depression option (standalone addition, 7 October 2026): treatment reaches about half of adults with symptoms, and recovery in Talking Therapies is lowest in the most deprived areas; targeting extra courses there is the bounded change.

    What it takes
    The problem

    About half of adults with common mental health symptoms receive any treatment, and people in the most deprived areas generate twice the referrals to NHS Talking Therapies but are less likely to finish treatment or recover.

    Who is affected, and where

    Adults in England with depression for whom NICE recommends psychological therapy, starting with integrated care boards covering the most deprived tenth of areas, where reliable recovery is lowest. Territory: England. Scotland reports psychological therapies against an 18-week standard (80.7% started within 18 weeks, quarter ending June 2026, against 90%); Wales provides primary-care mental health services under the Mental Health (Wales) Measure 2010; Northern Ireland was not checked. Not comparable with NHS Talking Therapies.

    Policy status

    Proposed by researchers or others, not government policy. Funded baseline: NHS Talking Therapies (1.81m referrals and 674,683 finished courses in England in 2025–26), with ring-fenced funding and a planning target of 805,000 courses by the end of 2026/27 and 915,000 by 2028/29. Targeting extra capacity at the areas with the lowest completion and recovery is a UK Facts proposal, not government policy.

    The evidence
    What the research found:
    Reliable recovery at six months was 58.5% with the Norwegian adaptation against 31.9% with usual care, with no effect on work participation. In England, service features such as the number of sessions, waiting time and the share of referrals treated predicted outcomes, and deprivation was associated with worse outcomes.
    Evaluated on:
    Adults with anxiety or mild-to-moderate depression (Norway trial, 681 adults); people treated in English IAPT services (service data); Norway, 2016–2017 (trial); England, 2014–2016 (service analysis)
    Transfer to this case:
    The trial is Norwegian and the English evidence uncontrolled; the effect of extra courses in deprived areas is not established.
    Our recommendation (separate from the research):
    Fund extra courses and completion support in the integrated care boards with the lowest completion and reliable recovery, with supervision and step-up as NICE and the service manual require, and report reliable recovery by deprivation decile.
    Strongest counter-evidence:
    Recovery rates in English service data have no control group, and the trial found no effect on work; more courses could also lengthen waits between sessions if therapists are not added.
    Cost and funding

    Cost completeness: Not yet costed. Funding: Not yet costed / funding not identified.

      Who pays:
      The NHS (integrated care boards within the Mental Health Investment Standard).
      Financing proposed:
      None identified for the targeted increment; the planning framework’s ring-fenced funding pays for the national trajectory.
      Gap remaining:
      Unknown: no national Talking Therapies budget line, cost per course or cost of the 805,000 and 915,000 trajectories has been published.
      What delivery needs
      Skills:
      Psychological wellbeing practitioners and high-intensity therapists with weekly supervision.
      Operational capacity:
      Trainee places and retention (practitioner leaver rate 21%).
      Infrastructure:
      Digital and in-person delivery.
      Permissions:
      None.
      Law:
      None.
      Public consent:
      Voluntary treatment.
      First step and stages

      First step: NHS England publishes completion and reliable recovery by integrated care board and deprivation decile, and selects boards with the lowest values for funded extra capacity, with comparison boards named in advance. (owner: NHS England)

      1. Publish completion and recovery by board and deprivation — NHS England (proposed stage, not an official timetable)
      2. Fund extra courses and follow-up in selected boards — Integrated care boards (proposed stage, not an official timetable)
      3. Compare reliable recovery with comparison boards — NHS England (evaluation) (proposed stage, not an official timetable)

      Depends on: Therapist training and retention; The forthcoming mental health strategy

      Trade-offs
      Who gains and who loses:
      Aimed at people in the most deprived areas, where reliable recovery was 40.7% against 52.7% in the least deprived in 2025–26.
      What else the money or effort could do:
      Therapist time spent on extra courses is not available to cut waits elsewhere in the service.
      Strongest counterargument:
      Improving service quality everywhere (sessions, waits, follow-up) may lift recovery more than adding courses in selected areas.
      Risks:
      Longer waits between first and second sessions; treating people outside the service’s scope (psychosis, bipolar disorder) without referral; therapist burnout.
      How we would judge it
      Baseline:
      2025–26: 674,683 finished courses; reliable recovery 47.3% (most deprived decile 40.7%, least deprived 52.7%).
      Leading indicator:
      Waits between first and second treatment; referrals ending before treatment.
      Outcome:
      Reliable recovery and reliable improvement by deprivation decile in selected boards against comparison boards.
      Continue, adapt or stop:
      Continue where completion and reliable recovery rise in selected boards relative to comparisons; stop where waits lengthen without recovery rising.
      Sources

      Source published 24 September 2026 (annual report); 2020 (Knapstad trial); 2022 (NICE NG222); evidence reviewed 2026-10-07. Reconsider if: The forthcoming mental health strategy; NHS Talking Therapies annual report 2026–27; The Budget on 28 October 2026.

    • Action 5A72Policy status: external proposal

      Bring effective stop-smoking treatment to routine and manual workers

      Outreach through employers, primary care and community settings offers behavioural support with the more effective medicines or a nicotine vape to routine and manual workers who smoke, raising quit attempts and carbon monoxide-validated quits in that group.

      The thread: issue, evidence, action

      1. Issue Weakness: Smoking is concentrated in routine and manual work: 16.6% of adults aged 18–64 in routine and manual occupations smoked in 2025, against 5.9% in managerial and professional jobs. Stop smoking services recorded 265,502 quit dates in 2025–26, below the around 360,000 a year the 2023 plan expected.
      2. Evidence Quit dates set with local stop smoking services; Adults aged 18–64 in routine and manual occupations who smoke
      3. Action A72, this action

      Assessment (draft, 6 October review)

      Who decides:
      Councils (public health duty, Health and Social Care Act 2012 s.12) with integrated care boards and the Department of Health and Social Care (England)
      Evidence:
      Synthesis of robust evaluations. High-certainty Cochrane evidence shows behavioural support with medication, varenicline and nicotine vapes help people quit; NICE found no evidence on tailoring interventions for under-served groups, so the outreach step itself is untested.
      Expected effect:
      Direction plausible; size not established.
      Cost and funding

      Not yet costed

      Funding: Not yet costed / funding not identified

      Why it is shortlisted here: The national smoking option (standalone addition, 7 October 2026): smoking is concentrated in routine and manual work and services set fewer quit dates than planned; it builds on the smoking option card, which stays.

      Builds on the option Help smokers quit, and stop young people starting compared below.

      What it takes
      The problem

      Smoking is now concentrated among people in routine and manual work, and stop smoking services set far fewer quit dates than the 2023 plan expected.

      Who is affected, and where

      Adults aged 18–64 in routine and manual occupations in England who smoke (16.6% smoked in 2025; about 1.2 million people on ONS weighted counts). Territory: England. Stop smoking services are devolved: Quit Your Way Scotland, Help Me Quit (Wales) and Stop Smoking NI. The Tobacco and Vapes Act 2026 applies UK-wide.

      Policy status

      Proposed by researchers or others, not government policy. Funded baseline: the 2026–27 public health grant ring-fences £152.8m for smoking cessation (absorbing the extra £70m a year and Swap to Stop); the generational age-of-sale law starts on 1 January 2027; NHS trusts offer tobacco dependence treatment. Targeted outreach to routine and manual workers is a UK Facts proposal, not government policy.

      The evidence
      What the research found:
      More behavioural support with medication raised quitting at six months or more (RR 1.15, 1.08–1.22); nicotine vapes against nicotine replacement RR 1.55 (1.28–1.88). In 2025–26 routine and manual workers set 52,653 quit dates in English services and 56.6% reported quitting at four weeks.
      Evaluated on:
      Adult smokers in randomised trials (tens of thousands of participants across reviews); International trials; NICE guidance for England
      Transfer to this case:
      Trial effects are for people who enrolled; the effect of outreach on how many routine and manual smokers try to quit is not established.
      Our recommendation (separate from the research):
      Offer behavioural support with the most effective medicines or a vape to routine and manual smokers through workplaces and primary care in councils with the highest prevalence, and count carbon monoxide-validated quits for that group against comparison councils.
      Strongest counter-evidence:
      Self-reported four-week quits overstate lasting quits (only 12% of quit attempts were carbon monoxide-validated quits in 2025–26), and outreach may mainly reach smokers who would have sought help anyway.
      Cost and funding

      Cost completeness: Not yet costed. Funding: Not yet costed / funding not identified.

        Who pays:
        Councils from the ring-fenced public health grant; the NHS for prescribing and hospital treatment.
        Financing proposed:
        Within the ring-fenced £152.8m if councils choose; any extra would need a grant decision.
        Gap remaining:
        Unknown: the cost of targeted outreach and its cost per extra quitter have not been estimated.
        What delivery needs
        Skills:
        Trained stop smoking advisers.
        Operational capacity:
        Service capacity in high-prevalence councils.
        Infrastructure:
        Workplace and community access points.
        Permissions:
        Employer cooperation.
        Law:
        None new.
        Public consent:
        Voluntary support.
        First step and stages

        First step: DHSC and councils with the highest routine and manual smoking prevalence agree a defined outreach offer and comparison councils, reporting quit dates and carbon monoxide-validated quits by occupation. (owner: DHSC with councils)

        1. Agree the outreach offer and comparison councils — DHSC and councils (proposed stage, not an official timetable)
        2. Deliver through workplaces and primary care — Councils and providers (proposed stage, not an official timetable)
        3. Report validated quits by occupation — NHS England statistics; councils (proposed stage, not an official timetable)

        Depends on: The ring-fenced grant continuing beyond 2026–27; Employer participation

        Trade-offs
        Who gains and who loses:
        Aimed at the occupational group with the highest smoking rate, where smoking-related illness is concentrated.
        What else the money or effort could do:
        Outreach money competes with other uses of the ring-fenced grant, such as pregnancy and mental health pathways.
        Strongest counterargument:
        Population measures — the age-of-sale law and the vaping duty — may reduce smoking more than one-to-one outreach.
        Risks:
        Counting self-reported rather than validated quits; outreach reaching mainly motivated smokers.
        How we would judge it
        Baseline:
        2025: 16.6% of routine and manual workers smoked in England; 2025–26: 265,502 quit dates, of which 52,653 by routine and manual workers.
        Leading indicator:
        Quit dates set by routine and manual workers per 100,000 smokers.
        Outcome:
        Carbon monoxide-validated quits and routine and manual smoking prevalence against comparison councils.
        Continue, adapt or stop:
        Continue where validated quits in the group rise faster than in comparison councils; stop where only self-reported quits rise.
        Sources

        Source published 6 October 2026 (ONS); 23 July 2026 (NHS England); 2019–2025 (Cochrane); evidence reviewed 2026-10-07. Reconsider if: NHS England stop smoking statistics, Q1 2026–27 (22 October 2026); Public health grant allocations for 2027–28; The Budget on 28 October 2026.

      Considered but not shortlisted here: A05 — A framework rather than an intervention. On this page it is replaced by specific prevention actions with their own evidence (A49, A13, A50); the draft stays a candidate in the national review.

      How the options are assessed

      One shared record per option — the same one the national plan reads. Delivery RAG, gate and list membership are separate judgements.

      • Alcohol minimum unit price in England — Amber delivery RAG; gate pending
      • Family hubs built on Sure Start features — Amber delivery RAG; gate pending
      • School mental health — Amber delivery RAG; gate pending
      • Access to effective adult depression treatment — Amber delivery RAG; gate pending
      • Targeted access to smoking treatment — Amber delivery RAG; gate pending

      Provisional single-reviewer assessments from the 6 October 2026 review; not approved business cases, and not government policy.

      • A49Delivery RAG: AmberGate: pending

        Alcohol minimum unit price in England

        Existing action A49, assessed at the same scope.

        Provisional single-reviewer assessment; not an approved business case.

        Who and where
        Adults in England who drink heavily, and the communities where alcohol harm is concentrated. (from the action record) Jurisdiction: England.
        Result so far
        Range if completed: 20.0–23.0 out of 30 (equal weights; not yet assessed: incremental affordability (Co))
        Funded now (baseline)
        Not government policy: ministers said in June 2026 that they “do not currently have any plans” to introduce MUP in England, and the 10 Year Health Plan (July 2025) does not include it. England would need legislation, as Scotland and Wales did. (from the action record)
        The change assessed (marginal)
        An English minimum unit price, by primary legislation. (from the superseded 4 October selection table)
        What the evidence supports—and the next decision

        Scottish evaluation supports examining alcohol pricing; an English design still needs its own price, population and distributional appraisal.

        Codex — AI-assisted analytical follow-up · 8 October 2026. Proposed appraisal design; the attributed scores below are unchanged. No funding or delivery agreement is implied.

        Define the change
        Specify an English minimum price and uprating rule, with treatment access and a pre-specified evaluation against suitable comparison trends.
        Test whether it works
        Alcohol-specific deaths, admissions, purchasing and hardship, including heavy drinkers and low-income households. Report uncertainty and concurrent policy changes.
        Establish the cost
        Enforcement, evaluation and treatment capacity plus consumer and retailer effects. A price transfer to retailers is not government revenue.
        Protect against harm
        Monitor substitution and hardship among dependent drinkers; do not treat Scotland’s estimated percentage change as a guaranteed English result.

        Read with the outcome evidence and sources in the full assessment. Monitoring proposals are not existing baseline measurements. A numerical benefit or cost score needs evidence for the defined increment, not just the scale of the problem.

        Full assessment of Alcohol minimum unit price in England: ten criteria, scenarios, delivery, costs and monitoring
        The ten criteria (0–3)

        Each criterion is scored 0 to 3 by the reviewer. “Not yet assessed” means unknown: it is never counted as zero.

        1. Scale and severity (Sc)3 of 3 — Severe harm across a broad population

          Reviewer’s reason: Provisional problem-importance judgement from linked site pages; not the scale of achievable benefit.

        2. Increment beyond baseline (Ad)3 of 3 — Substantial clearly distinct increment; not novelty alone

          Reviewer’s reason: Choose price/indexation; consult; legislate; arrange enforcement and support for dependent drinkers; predefine evaluation. A missing rating requires a defined marginal change.

        3. Confidence in the proposed action (Ev)2 of 3 — Relevant evaluated evidence with limitations

          Reviewer’s reason: Controlled Scottish evaluation supports mortality effects; English transfer and design need assessment. Admission reduction was not statistically significant.

        4. Expected incremental benefit (Bn)3 of 3 — Large for the target population; no multi-domain bonus

          Reviewer’s reason: Unknown unless a reasonably defined target-population benefit can be judged; no bonus merely for spanning domains.

          Reason and score disagree — under review

        5. Residual harms (Hm)1 of 3 — Material harm/unresolved mitigation

          Reviewer’s reason: Dependence-related hardship; distribution of increased retail receipts.

        6. Incremental affordability (Co)Not yet assessed

          Reviewer’s reason: Enforcement, treatment support and evaluation plus household burdens and retailer effects; low fiscal cost is not full costing.

        7. Delivery capacity (Ca)3 of 3 — Little scarce capacity required

          Reviewer’s reason: Choose price/indexation; consult; legislate; arrange enforcement and support for dependent drinkers; predefine evaluation.

        8. Distribution (Fa)2 of 3 — Mixed or broadly neutral with safeguards

          Reviewer’s reason: Provisional distribution judgement for the stated target; verify who pays, who gains and excluded groups.

        9. Meaningful first outcome (Ti)2 of 3 — More than one and up to three years

          Reviewer’s reason: First meaningful outcome, not announcement: Alcohol-attributable deaths and harm, consumption and household hardship.

        10. Readiness (Rd)1 of 3 — Legislation/external agreement or major enabling work

          Reviewer’s reason: DHSC, Parliament, public health and enforcement bodies; Legislative and distributional appraisal

        Four weightings

        Normalised as 10 × weighted sum ÷ sum of weights, on a 0–30 scale. Where a criterion is not yet assessed, the range is the lowest and highest result if it were later scored 0 or 3 — not a score, a confidence interval or a rank.

        • Equal weights: Range if completed: 20.0–23.0 out of 30. Not yet assessed: incremental affordability (Co). Funding gate: not passed.
        • Evidence doubled: Range if completed: 20.0–22.7 out of 30. Not yet assessed: incremental affordability (Co). Funding gate: not passed.
        • Scale doubled: Range if completed: 20.9–23.6 out of 30. Not yet assessed: incremental affordability (Co). Funding gate: not passed.
        • Cost ignored (the funding gate still applies): Range if completed: 22.2–22.2 out of 30. Not yet assessed: incremental affordability (Co). The missing criteria carry no weight here, so the ends meet; the record is still incomplete. Funding gate: not passed.

        Funding gate: Not passed — the cost is not yet assessed or no allocation is committed for this scope. Ignoring cost in a weighting never removes the gate.

        Delivery RAG and gate

        Delivery RAG shown: AmberReview’s claim: Amber. Best the recorded evidence allows: Amber.

        Review’s reason: Enforcement, treatment support and evaluation plus household burdens and retailer effects; low fiscal cost is not full costing.

        Why it is not Green yet

        • Scope (population, place and increment) not verified against the delivery baseline.
        • No verified owner with the powers in place.
        • Delivery capacity not verified.
        • Lifetime incremental costs not complete.
        • No credible funding (a committed allocation for the scope).
        • Safeguards not specified.
        • Monitoring lacks a metric, a data source or a baseline.

        Green needs verified scope, a verified owner with the powers, verified capacity, complete lifetime costs with credible funding, specified safeguards and monitoring with a metric, source and baseline. Amber means appraisal gaps remain; Red means a material delivery obstacle. Red does not mean unimportant.

        Gate: Pending — appraisal incomplete (review label: “Pending: incomplete appraisal”).

        Why: Scores incomplete; Funding gate not passed (cost unknown or no credible funding).

        The gate is separate from national list membership: being listed does not make an option eligible, and an eligible option need not be listed.

        Cost and funding

        Lifetime costing: Not established. Review: “Full incremental costing not established in reviewed material”.

        • Legislation, guidance, licensing enforcement and evaluation of a minimum unit price in England (not costed; C-A49-ADMIN)

        Still to cost: Enforcement, treatment support and evaluation plus household burdens and retailer effects; low fiscal cost is not full costing.

        Funding status: not a spending proposal.

        Owner, powers and capacity

        Proposed owner: DHSC, Parliament, public health and enforcement bodies (proposed, unverified).

        Powers: needs legislation or external agreement. Capacity: unverified.

        Powers and capacity read from the review’s Rd and Ca anchors; no proposed owner has agreed to act (the review: “Proposed owners have not agreed to act”).

        England:
        UK government (Home Office and DHSC) and Parliament, with councils enforcing through licensing (action record)
        Scotland:
        not assessed
        Wales:
        not assessed
        Northern Ireland:
        not assessed

        Scotland has had MUP since May 2018 (65p since 30 September 2024) and Wales since March 2020 (65p since 1 October 2026). Northern Ireland has no MUP; its current position was not confirmed from a primary source.

        Dependencies, safeguards and risks

        Depends on: None recorded.

        Safeguards

        None specified yet.

        Risks and residual harms: Dependence-related hardship; distribution of increased retail receipts.

        Monitoring and measured results

        Metric: Alcohol-attributable deaths and harm, consumption and household hardship.

        Data source: Not yet named. Baseline: Not yet established.

        Measures already on the domain page

        A page measure is not necessarily the review’s metric; linking the two is an editorial decision still to be made.

        Evidence for the outcome

        Outcome: Alcohol-attributable deaths and harm, consumption and household hardship.

        Controlled Scottish evaluation supports mortality effects; English transfer and design need assessment. Admission reduction was not statistically significant.

        Sources: publichealthscotland.scot (not yet in the source register)

        Effect records for this action

        • Deaths wholly attributable to alcohol: −13.4% (about 156 deaths a year averted in Scotland) (evaluated, moderate confidence; Scotland (England as control))
        • Hospital admissions wholly attributable to alcohol: −4.1% (not statistically significant) (evaluated, limited confidence; Scotland (England as control))
        • Financial strain for some people with alcohol dependence on low incomes: size not established (evaluated, limited confidence; Scotland)
        Review record

        Assessment version: working-review-2026-10-06 (A49@working-review-2026-10-06).

        Reviewer: Author of the review blueprint (single reviewer, not named in uk-facts-complete-plan.json). Reviewed: 6 October 2026.

        Scored in the working review of 6 October 2026 on the shared ten-criterion scale (one reviewer); not independently calibrated.

        First 90 days (review): Produce a signed scope and current-delivery baseline; Choose price/indexation; consult; legislate; arrange enforcement and support for dependent drinkers; predefine evaluation. Obtain incremental costs and an accountable decision before expansion.

        Decision route: Legislative and distributional appraisal

        An earlier assessment exists on the 4 October 2026 selection table (nine H/M/L bands; superseded 7 October 2026). Its bands are kept, not converted into these scores.

        An editorial screening framework by one reviewer, not a formal appraisal or business case. Proposed owners have not agreed to act.

      • A13Delivery RAG: AmberGate: pending

        Family hubs built on Sure Start features

        Existing action A13, assessed at the same scope.

        Provisional single-reviewer assessment; not an approved business case.

        Who and where
        Children under five and their families in areas with weak access, in England. (from the action record) Jurisdiction: England.
        Result so far
        Range if completed: 17.0–20.0 out of 30 (equal weights; not yet assessed: incremental affordability (Co))
        Funded now (baseline)
        Best Start Family Hubs are being rolled out to every local authority in England from April 2026, “backed by over £500 million”, with up to 1,000 hubs by the end of 2028 (DfE, July 2025); by March 2026 the stated backing was £900m over three years, including £200m for Healthy Babies services, and on 30 September 2026 the Burnham government said the Healthy Babies programme would reach every hub. They are not automatically equivalent to the 2000s Sure Start centres that were evaluated. The proposal is to hold the hubs to the features that were tested, start where access is weakest, and phase the roll-out so it can be evaluated. (from the action record)
        The change assessed (marginal)
        Evaluated Sure Start features, weakest-access areas first, and a phased, evaluable roll-out of the family hubs. (from the superseded 4 October selection table)
        What the evidence supports—and the next decision

        Sure Start findings do not automatically transfer to every family-hub model. Process evaluation establishes implementation, not an effect size.

        Codex — AI-assisted analytical follow-up · 8 October 2026. Proposed appraisal design; the attributed scores below are unchanged. No funding or delivery agreement is implied.

        Define the change
        Specify the services, intensity and outreach features to reproduce in low-access areas, net of current family-hub funding.
        Test whether it works
        Reach among eligible families, child and parent outcomes and later service use through a phased comparison design.
        Establish the cost
        Premises, trained staff, outreach, supervision and recurring services; analyse per eligible family and per participant separately.
        Protect against harm
        Avoid judging hubs solely on attendance; test whether families facing the greatest barriers actually benefit.

        Read with the outcome evidence and sources in the full assessment. Monitoring proposals are not existing baseline measurements. A numerical benefit or cost score needs evidence for the defined increment, not just the scale of the problem.

        Full assessment of Family hubs built on Sure Start features: ten criteria, scenarios, delivery, costs and monitoring
        The ten criteria (0–3)

        Each criterion is scored 0 to 3 by the reviewer. “Not yet assessed” means unknown: it is never counted as zero.

        1. Scale and severity (Sc)2 of 3 — Serious harm to a defined group or widespread moderate harm

          Reviewer’s reason: Provisional problem-importance judgement from linked site pages; not the scale of achievable benefit.

        2. Increment beyond baseline (Ad)2 of 3 — Specific material change to existing delivery

          Reviewer’s reason: Specify service intensity and target reach; staff health/family services; measure uptake, fidelity and long-term outcomes. A missing rating requires a defined marginal change.

        3. Confidence in the proposed action (Ev)2 of 3 — Relevant evaluated evidence with limitations

          Reviewer’s reason: Sure Start evidence supports defined features; it does not validate all current hub models or immediate benefits.

        4. Expected incremental benefit (Bn)2 of 3 — Material for the target population

          Reviewer’s reason: Unknown unless a reasonably defined target-population benefit can be judged; no bonus merely for spanning domains.

          Reason and score disagree — under review

        5. Residual harms (Hm)2 of 3 — Manageable harm with specified safeguards

          Reviewer’s reason: Thin provision; failure to reach families most in need; long benefit horizon.

        6. Incremental affordability (Co)Not yet assessed

          Reviewer’s reason: Premises, staffing, outreach, recurring services and evaluation beyond existing allocations.

        7. Delivery capacity (Ca)1 of 3 — Binding scarce resource

          Reviewer’s reason: Specify service intensity and target reach; staff health/family services; measure uptake, fidelity and long-term outcomes.

        8. Distribution (Fa)3 of 3 — Benefits concentrated on disadvantaged people with assessed burdens

          Reviewer’s reason: Provisional distribution judgement for the stated target; verify who pays, who gains and excluded groups.

        9. Meaningful first outcome (Ti)1 of 3 — More than three but less than ten years

          Reviewer’s reason: First meaningful outcome, not announcement: Child development, family outcomes and later health/attainment.

        10. Readiness (Rd)2 of 3 — Named commissioning/allocation/coordination step

          Reviewer’s reason: DfE, councils and health partners in England; Phased implementation with transfer evaluation

        Four weightings

        Normalised as 10 × weighted sum ÷ sum of weights, on a 0–30 scale. Where a criterion is not yet assessed, the range is the lowest and highest result if it were later scored 0 or 3 — not a score, a confidence interval or a rank.

        • Equal weights: Range if completed: 17.0–20.0 out of 30. Not yet assessed: incremental affordability (Co). Funding gate: not passed.
        • Evidence doubled: Range if completed: 17.3–20.0 out of 30. Not yet assessed: incremental affordability (Co). Funding gate: not passed.
        • Scale doubled: Range if completed: 17.3–20.0 out of 30. Not yet assessed: incremental affordability (Co). Funding gate: not passed.
        • Cost ignored (the funding gate still applies): Range if completed: 18.9–18.9 out of 30. Not yet assessed: incremental affordability (Co). The missing criteria carry no weight here, so the ends meet; the record is still incomplete. Funding gate: not passed.

        Funding gate: Not passed — the cost is not yet assessed or no allocation is committed for this scope. Ignoring cost in a weighting never removes the gate.

        Delivery RAG and gate

        Delivery RAG shown: AmberReview’s claim: Amber. Best the recorded evidence allows: Amber.

        Review’s reason: Premises, staffing, outreach, recurring services and evaluation beyond existing allocations.

        Why it is not Green yet

        • Scope (population, place and increment) not verified against the delivery baseline.
        • No verified owner with the powers in place.
        • Delivery capacity not verified.
        • Lifetime incremental costs not complete.
        • No credible funding (a committed allocation for the scope).
        • Safeguards not specified.
        • Monitoring lacks a metric, a data source or a baseline.

        Green needs verified scope, a verified owner with the powers, verified capacity, complete lifetime costs with credible funding, specified safeguards and monitoring with a metric, source and baseline. Amber means appraisal gaps remain; Red means a material delivery obstacle. Red does not mean unimportant.

        Gate: Pending — appraisal incomplete (review label: “Pending: incomplete appraisal”).

        Why: Scores incomplete; Funding gate not passed (cost unknown or no credible funding).

        The gate is separate from national list membership: being listed does not make an option eligible, and an eligible option need not be listed.

        Cost and funding

        Lifetime costing: Partial — some lines costed, no whole-life total. Review: “Full incremental costing not established in reviewed material”.

        • Best Start Family Hubs roll-out (programme envelope) (published programme envelope; C-BSFH-2025)
        • Integrated early-years service package and workforce (not costed; C-A13-SERVICE)

        Still to cost: Premises, staffing, outreach, recurring services and evaluation beyond existing allocations.

        Funding status: programme route, not allocated.

        Owner, powers and capacity

        Proposed owner: DfE, councils and health partners in England (proposed, unverified).

        Powers: needs a decision or allocation. Capacity: binding constraint.

        Powers and capacity read from the review’s Rd and Ca anchors; no proposed owner has agreed to act (the review: “Proposed owners have not agreed to act”).

        England:
        DfE, DHSC and councils (action record)
        Scotland:
        not assessed
        Wales:
        not assessed
        Northern Ireland:
        not assessed

        Sure Start was an England programme; devolved nations run separate early-years services.

        Dependencies, safeguards and risks

        Depends on: None recorded.

        Safeguards

        None specified yet.

        Risks and residual harms: Thin provision; failure to reach families most in need; long benefit horizon.

        Monitoring and measured results

        Metric: Child development, family outcomes and later health/attainment.

        Data source: Not yet named. Baseline: Not yet established.

        Measures already on the domain page

        A page measure is not necessarily the review’s metric; linking the two is an editorial decision still to be made.

        Evidence for the outcome

        Outcome: Child development, family outcomes and later health/attainment.

        Sure Start evidence supports defined features; it does not validate all current hub models or immediate benefits.

        Effect records for this action

        • Five GCSEs at A*–C (or equivalent) at 16: +0.9 percentage points (about 2%) (evaluated, moderate confidence; England)
        • Hospital admissions by age 15: −8.5% by age 15 (evaluated, moderate confidence; England)
        • Criminal record by age 16: size not established (evaluated, moderate confidence; England)
        Review record

        Assessment version: working-review-2026-10-06 (A13@working-review-2026-10-06).

        Reviewer: Author of the review blueprint (single reviewer, not named in uk-facts-complete-plan.json). Reviewed: 6 October 2026.

        Scored in the working review of 6 October 2026 on the shared ten-criterion scale (one reviewer); not independently calibrated.

        First 90 days (review): Produce a signed scope and current-delivery baseline; Specify service intensity and target reach; staff health/family services; measure uptake, fidelity and long-term outcomes. Obtain incremental costs and an accountable decision before expansion.

        Decision route: Phased implementation with transfer evaluation

        An earlier assessment exists on the 4 October 2026 selection table (nine H/M/L bands; superseded 7 October 2026). Its bands are kept, not converted into these scores.

        An editorial screening framework by one reviewer, not a formal appraisal or business case. Proposed owners have not agreed to act.

      • A50Delivery RAG: AmberGate: pending

        School mental health

        Existing action A50, assessed at the same scope.

        Provisional single-reviewer assessment; not an approved business case.

        Who and where
        Children and young people in schools and colleges in England, especially those not yet covered and those whose needs are more than mild to moderate. (from the action record) Jurisdiction: England.
        Result so far
        Range if completed: 15.0–21.0 out of 30 (equal weights; not yet assessed: expected incremental benefit (Bn), incremental affordability (Co))
        Funded now (baseline)
        Teams covered 60% of pupils and learners in 2025–26, and the Spending Review 2025 commits to every school by 2029–30. The proposal is to make the remaining roll-out evaluable and to fill the needs gap, not to start a new service. (from the action record)
        The change assessed (marginal)
        A comparison-based evaluation and a route for greater needs. (from the superseded 4 October selection table)
        What the evidence supports—and the next decision

        More school mental-health coverage is not itself evidence of improved health or timely specialist care.

        Codex — AI-assisted analytical follow-up · 8 October 2026. Proposed appraisal design; the attributed scores below are unchanged. No funding or delivery agreement is implied.

        Define the change
        Specify the practitioner offer, schools and referral gap beyond commissioned provision; establish an escalation agreement before expanding access.
        Test whether it works
        Validated symptom and functioning measures, waiting time, deterioration and referral completion against comparison schools or phased rollout.
        Establish the cost
        Practitioner time, clinical supervision, teacher time, referral capacity and follow-up. Cost displaced specialist activity.
        Protect against harm
        Safeguarding, consent and specialist escalation must remain available; screen for unequal access and unmet severe need.

        Read with the outcome evidence and sources in the full assessment. Monitoring proposals are not existing baseline measurements. A numerical benefit or cost score needs evidence for the defined increment, not just the scale of the problem.

        Full assessment of School mental health: ten criteria, scenarios, delivery, costs and monitoring
        The ten criteria (0–3)

        Each criterion is scored 0 to 3 by the reviewer. “Not yet assessed” means unknown: it is never counted as zero.

        1. Scale and severity (Sc)2 of 3 — Serious harm to a defined group or widespread moderate harm

          Reviewer’s reason: Provisional problem-importance judgement from linked site pages; not the scale of achievable benefit.

        2. Increment beyond baseline (Ad)2 of 3 — Specific material change to existing delivery

          Reviewer’s reason: Specify intervention and referral threshold; secure qualified staff and escalation to specialist care; evaluate outcomes. A missing rating requires a defined marginal change.

        3. Confidence in the proposed action (Ev)1 of 3 — Indirect, mixed, modelled or weak causal support

          Reviewer’s reason: Artifact describes early implementation evidence without a comparator; universal classroom programmes and targeted treatment differ.

        4. Expected incremental benefit (Bn)Not yet assessed

          Reviewer’s reason: Unknown unless a reasonably defined target-population benefit can be judged; no bonus merely for spanning domains.

        5. Residual harms (Hm)2 of 3 — Manageable harm with specified safeguards

          Reviewer’s reason: Over-referral, unmet specialist demand and inappropriate intervention.

        6. Incremental affordability (Co)Not yet assessed

          Reviewer’s reason: Practitioner time, supervision, specialist referrals, school time and follow-up.

        7. Delivery capacity (Ca)1 of 3 — Binding scarce resource

          Reviewer’s reason: Specify intervention and referral threshold; secure qualified staff and escalation to specialist care; evaluate outcomes.

        8. Distribution (Fa)3 of 3 — Benefits concentrated on disadvantaged people with assessed burdens

          Reviewer’s reason: Provisional distribution judgement for the stated target; verify who pays, who gains and excluded groups.

        9. Meaningful first outcome (Ti)2 of 3 — More than one and up to three years

          Reviewer’s reason: First meaningful outcome, not announcement: Symptoms, functioning, attendance and equitable access; unmet severe need.

        10. Readiness (Rd)2 of 3 — Named commissioning/allocation/coordination step

          Reviewer’s reason: Education and health commissioners, schools and providers; Evaluate defined care pathway

        Four weightings

        Normalised as 10 × weighted sum ÷ sum of weights, on a 0–30 scale. Where a criterion is not yet assessed, the range is the lowest and highest result if it were later scored 0 or 3 — not a score, a confidence interval or a rank.

        • Equal weights: Range if completed: 15.0–21.0 out of 30. Not yet assessed: expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
        • Evidence doubled: Range if completed: 14.5–20.0 out of 30. Not yet assessed: expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
        • Scale doubled: Range if completed: 15.5–20.9 out of 30. Not yet assessed: expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.
        • Cost ignored (the funding gate still applies): Range if completed: 16.7–20.0 out of 30. Not yet assessed: expected incremental benefit (Bn), incremental affordability (Co). Funding gate: not passed.

        Funding gate: Not passed — the cost is not yet assessed or no allocation is committed for this scope. Ignoring cost in a weighting never removes the gate.

        Delivery RAG and gate

        Delivery RAG shown: AmberReview’s claim: Amber. Best the recorded evidence allows: Amber.

        Review’s reason: Practitioner time, supervision, specialist referrals, school time and follow-up.

        Why it is not Green yet

        • Scope (population, place and increment) not verified against the delivery baseline.
        • No verified owner with the powers in place.
        • Delivery capacity not verified.
        • Lifetime incremental costs not complete.
        • No credible funding (a committed allocation for the scope).
        • Safeguards not specified.
        • Monitoring lacks a metric, a data source or a baseline.

        Green needs verified scope, a verified owner with the powers, verified capacity, complete lifetime costs with credible funding, specified safeguards and monitoring with a metric, source and baseline. Amber means appraisal gaps remain; Red means a material delivery obstacle. Red does not mean unimportant.

        Gate: Pending — appraisal incomplete (review label: “Pending: incomplete appraisal”).

        Why: Scores incomplete; Funding gate not passed (cost unknown or no credible funding).

        The gate is separate from national list membership: being listed does not make an option eligible, and an eligible option need not be listed.

        Cost and funding

        Lifetime costing: Not established. Review: “Full incremental costing not established in reviewed material”.

        • Mental Health Support Teams: roll-out to every school and college in England by 2029–30 (not costed; C-MHST-ROLLOUT)
        • Comparison-based outcome evaluation of the remaining roll-out, and specialist support for needs beyond “mild to moderate” (not costed; C-A50-EVAL)

        Still to cost: Practitioner time, supervision, specialist referrals, school time and follow-up.

        Funding status: programme route, not allocated.

        Owner, powers and capacity

        Proposed owner: Education and health commissioners, schools and providers (proposed, unverified).

        Powers: needs a decision or allocation. Capacity: binding constraint.

        Powers and capacity read from the review’s Rd and Ca anchors; no proposed owner has agreed to act (the review: “Proposed owners have not agreed to act”).

        England:
        NHS England and integrated care boards with DfE, schools and colleges (action record)
        Scotland:
        not assessed
        Wales:
        not assessed
        Northern Ireland:
        not assessed

        Mental Health Support Teams are an England programme; Scotland, Wales and Northern Ireland run their own school counselling and wellbeing services, not assessed here.

        Dependencies, safeguards and risks

        Depends on: None recorded.

        Safeguards

        None specified yet.

        Risks and residual harms: Over-referral, unmet specialist demand and inappropriate intervention.

        Monitoring and measured results

        Metric: Symptoms, functioning, attendance and equitable access; unmet severe need.

        Data source: Not yet named. Baseline: Not yet established.

        Measures already on the domain page

        A page measure is not necessarily the review’s metric; linking the two is an editorial decision still to be made.

        Evidence for the outcome

        Outcome: Symptoms, functioning, attendance and equitable access; unmet severe need.

        Artifact describes early implementation evidence without a comparator; universal classroom programmes and targeted treatment differ.

        Effect records for this action

        • Children’s mental health and timely access to support: size not established (plausible spillover, limited confidence; England)
        Review record

        Assessment version: working-review-2026-10-06 (A50@working-review-2026-10-06).

        Reviewer: Author of the review blueprint (single reviewer, not named in uk-facts-complete-plan.json). Reviewed: 6 October 2026.

        Scored in the working review of 6 October 2026 on the shared ten-criterion scale (one reviewer); not independently calibrated.

        First 90 days (review): Produce a signed scope and current-delivery baseline; Specify intervention and referral threshold; secure qualified staff and escalation to specialist care; evaluate outcomes. Obtain incremental costs and an accountable decision before expansion.

        Decision route: Evaluate defined care pathway

        An earlier assessment exists on the 4 October 2026 selection table (nine H/M/L bands; superseded 7 October 2026). Its bands are kept, not converted into these scores.

        An editorial screening framework by one reviewer, not a formal appraisal or business case. Proposed owners have not agreed to act.

      • A70Delivery RAG: AmberGate: pending

        Access to effective adult depression treatment

        Existing action A70, assessed at the same scope.

        Not stated in the review record; treated as a provisional single-reviewer assessment, not an approved business case.

        Who and where
        Adults in England with depression for whom NICE recommends psychological therapy, starting with integrated care boards covering the most deprived tenth of areas, where reliable recovery is lowest. (from the action record) Jurisdiction: England.
        Result so far
        Range if completed: 19.0–22.0 out of 30 (equal weights; not yet assessed: incremental affordability (Co))
        Funded now (baseline)
        Funded baseline: NHS Talking Therapies (1.81m referrals and 674,683 finished courses in England in 2025–26), with ring-fenced funding and a planning target of 805,000 courses by the end of 2026/27 and 915,000 by 2028/29. Targeting extra capacity at the areas with the lowest completion and recovery is a UK Facts proposal, not government policy. (from the action record)
        The change assessed (marginal)
        Close a verified access gap for clinically appropriate NICE-recommended adult depression treatment, with supervision and an escalation route. (from the 6 October review)
        What the evidence supports—and the next decision

        NICE supports clinically appropriate treatments; that evidence does not quantify the effect or budget of expanding a particular local service.

        Codex — AI-assisted analytical follow-up · 8 October 2026. Proposed appraisal design; the attributed scores below are unchanged. No funding or delivery agreement is implied.

        Define the change
        Identify an underserved adult depression cohort and a specified NICE-consistent treatment pathway with supervision and escalation.
        Test whether it works
        Symptoms, functioning, recovery, deterioration and access against commissioned care, with follow-up and appropriate clinical oversight.
        Establish the cost
        Triage, treatment sessions, supervision, follow-up and escalation × realistic caseloads; cost-effectiveness is distinct from the available budget.
        Protect against harm
        Use shared decisions, safeguard patients and protect provision for severe or complex needs.

        Read with the outcome evidence and sources in the full assessment. Monitoring proposals are not existing baseline measurements. A numerical benefit or cost score needs evidence for the defined increment, not just the scale of the problem.

        Full assessment of Access to effective adult depression treatment: ten criteria, scenarios, delivery, costs and monitoring
        The ten criteria (0–3)

        Each criterion is scored 0 to 3 by the reviewer. “Not yet assessed” means unknown: it is never counted as zero.

        1. Scale and severity (Sc)3 of 3 — Severe harm across a broad population

        2. Increment beyond baseline (Ad)2 of 3 — Specific material change to existing delivery

        3. Confidence in the proposed action (Ev)2 of 3 — Relevant evaluated evidence with limitations

        4. Expected incremental benefit (Bn)2 of 3 — Material for the target population

        5. Residual harms (Hm)2 of 3 — Manageable harm with specified safeguards

        6. Incremental affordability (Co)Not yet assessed

        7. Delivery capacity (Ca)1 of 3 — Binding scarce resource

        8. Distribution (Fa)3 of 3 — Benefits concentrated on disadvantaged people with assessed burdens

        9. Meaningful first outcome (Ti)2 of 3 — More than one and up to three years

        10. Readiness (Rd)2 of 3 — Named commissioning/allocation/coordination step

        Four weightings

        Normalised as 10 × weighted sum ÷ sum of weights, on a 0–30 scale. Where a criterion is not yet assessed, the range is the lowest and highest result if it were later scored 0 or 3 — not a score, a confidence interval or a rank.

        • Equal weights: Range if completed: 19.0–22.0 out of 30. Not yet assessed: incremental affordability (Co). Funding gate: not passed.
        • Evidence doubled: Range if completed: 19.1–21.8 out of 30. Not yet assessed: incremental affordability (Co). Funding gate: not passed.
        • Scale doubled: Range if completed: 20.0–22.7 out of 30. Not yet assessed: incremental affordability (Co). Funding gate: not passed.
        • Cost ignored (the funding gate still applies): Range if completed: 21.1–21.1 out of 30. Not yet assessed: incremental affordability (Co). The missing criteria carry no weight here, so the ends meet; the record is still incomplete. Funding gate: not passed.

        Funding gate: Not passed — the cost is not yet assessed or no allocation is committed for this scope. Ignoring cost in a weighting never removes the gate.

        Delivery RAG and gate

        Delivery RAG shown: AmberReview’s claim: Amber. Best the recorded evidence allows: Amber.

        Review’s reason: Verify unmet clinical need and commissioned care; cost therapists, supervision, triage, follow-up and escalation; monitor symptoms, functioning, deterioration and access. Proposed owners: NHS commissioners and providers; jurisdiction-specific.

        Why it is not Green yet

        • Scope (population, place and increment) not verified against the delivery baseline.
        • No verified owner with the powers in place.
        • Delivery capacity not verified.
        • Lifetime incremental costs not complete.
        • No credible funding (a committed allocation for the scope).
        • Safeguards not specified.
        • Monitoring lacks a metric, a data source or a baseline.

        Green needs verified scope, a verified owner with the powers, verified capacity, complete lifetime costs with credible funding, specified safeguards and monitoring with a metric, source and baseline. Amber means appraisal gaps remain; Red means a material delivery obstacle. Red does not mean unimportant.

        Gate: Pending — appraisal incomplete (review label: “Pending baseline verification, incremental costing and funding; not a rollout approval”).

        Why: Scores incomplete; Funding gate not passed (cost unknown or no credible funding).

        The gate is separate from national list membership: being listed does not make an option eligible, and an eligible option need not be listed.

        Cost and funding

        Lifetime costing: Not established. Review: “Not fully costed in this review”.

        Still to cost: Verify unmet clinical need and commissioned care; cost therapists, supervision, triage, follow-up and escalation; monitor symptoms, functioning, deterioration and access. Proposed owners: NHS commissioners and providers; jurisdiction-specific.

        Funding status: not identified.

        Owner, powers and capacity

        Proposed owner: NHS commissioners and providers; jurisdiction-specific (proposed, unverified).

        Powers: needs a decision or allocation. Capacity: binding constraint.

        Powers and capacity read from the review’s Rd and Ca anchors; no proposed owner has agreed to act (the review: “Proposed owners have not agreed to act”).

        England:
        NHS England and integrated care boards, with NHS Talking Therapies providers (action record)
        Scotland:
        not assessed
        Wales:
        not assessed
        Northern Ireland:
        not assessed

        Scotland reports psychological therapies against an 18-week standard (80.7% started within 18 weeks, quarter ending June 2026, against 90%); Wales provides primary-care mental health services under the Mental Health (Wales) Measure 2010; Northern Ireland was not checked. Not comparable with NHS Talking Therapies.

        Dependencies, safeguards and risks

        Depends on: None recorded.

        Safeguards

        None specified yet.

        Monitoring and measured results

        Metric: Define and baseline the outcome described in delivery requirements before approval.

        Data source: Not yet named. Baseline: Not yet established.

        Measures already on the domain page

        A page measure is not necessarily the review’s metric; linking the two is an editorial decision still to be made.

        Evidence for the outcome

        Outcome: Define and baseline the outcome described in delivery requirements before approval.

        NICE provides treatment evidence and clinical recommendations. They do not establish that a new access pathway reaches additional patients or that sufficient therapists are available.

        Sources: nice.org.uk (P-GC-NICE-NG222)

        Review record

        Assessment version: working-review-2026-10-06 (A70@working-review-2026-10-06).

        Reviewer: Author of the review blueprint (single reviewer, not named in uk-facts-complete-plan.json). Reviewed: 6 October 2026.

        Scored in the working review of 6 October 2026 on the shared ten-criterion scale (one reviewer); not independently calibrated.

        An editorial screening framework by one reviewer, not a formal appraisal or business case. Proposed owners have not agreed to act.

      • A72Delivery RAG: AmberGate: pending

        Targeted access to smoking treatment

        Existing action A72, assessed at the same scope.

        Not stated in the review record; treated as a provisional single-reviewer assessment, not an approved business case.

        Who and where
        Adults aged 18–64 in routine and manual occupations in England who smoke (16.6% smoked in 2025; about 1.2 million people on ONS weighted counts). (from the action record) Jurisdiction: England.
        Result so far
        Range if completed: 21.0–24.0 out of 30 (equal weights; not yet assessed: incremental affordability (Co))
        Funded now (baseline)
        Funded baseline: the 2026–27 public health grant ring-fences £152.8m for smoking cessation (absorbing the extra £70m a year and Swap to Stop); the generational age-of-sale law starts on 1 January 2027; NHS trusts offer tobacco dependence treatment. Targeted outreach to routine and manual workers is a UK Facts proposal, not government policy. (from the action record)
        The change assessed (marginal)
        Expand access to established behavioural support plus suitable cessation treatment for a defined underserved adult group; cardiovascular prevention is a separate, unscored option. (from the 6 October review)
        What the evidence supports—and the next decision

        Established cessation treatment provides a stronger basis than a generic prevention promise; reach and sustained quits still determine additional benefit.

        Codex — AI-assisted analytical follow-up · 8 October 2026. Proposed appraisal design; the attributed scores below are unchanged. No funding or delivery agreement is implied.

        Define the change
        Expand access for a defined underserved adult group using suitable NICE-recommended support and treatment beyond current provision.
        Test whether it works
        Sustained quits, relapse and adverse effects by deprivation and other relevant groups; distinguish quit attempts from lasting outcomes.
        Establish the cost
        Adviser time, treatment, referral and follow-up; estimate health gains separately from cashable NHS savings.
        Protect against harm
        Use clinically appropriate choices and informed consent; this assessment does not include an uncosted cardiovascular-prevention package.

        Read with the outcome evidence and sources in the full assessment. Monitoring proposals are not existing baseline measurements. A numerical benefit or cost score needs evidence for the defined increment, not just the scale of the problem.

        Full assessment of Targeted access to smoking treatment: ten criteria, scenarios, delivery, costs and monitoring
        The ten criteria (0–3)

        Each criterion is scored 0 to 3 by the reviewer. “Not yet assessed” means unknown: it is never counted as zero.

        1. Scale and severity (Sc)3 of 3 — Severe harm across a broad population

        2. Increment beyond baseline (Ad)2 of 3 — Specific material change to existing delivery

        3. Confidence in the proposed action (Ev)2 of 3 — Relevant evaluated evidence with limitations

        4. Expected incremental benefit (Bn)2 of 3 — Material for the target population

        5. Residual harms (Hm)2 of 3 — Manageable harm with specified safeguards

        6. Incremental affordability (Co)Not yet assessed

        7. Delivery capacity (Ca)2 of 3 — Stretched but plausibly obtainable

        8. Distribution (Fa)3 of 3 — Benefits concentrated on disadvantaged people with assessed burdens

        9. Meaningful first outcome (Ti)3 of 3 — Within one year

        10. Readiness (Rd)2 of 3 — Named commissioning/allocation/coordination step

        Four weightings

        Normalised as 10 × weighted sum ÷ sum of weights, on a 0–30 scale. Where a criterion is not yet assessed, the range is the lowest and highest result if it were later scored 0 or 3 — not a score, a confidence interval or a rank.

        • Equal weights: Range if completed: 21.0–24.0 out of 30. Not yet assessed: incremental affordability (Co). Funding gate: not passed.
        • Evidence doubled: Range if completed: 20.9–23.6 out of 30. Not yet assessed: incremental affordability (Co). Funding gate: not passed.
        • Scale doubled: Range if completed: 21.8–24.5 out of 30. Not yet assessed: incremental affordability (Co). Funding gate: not passed.
        • Cost ignored (the funding gate still applies): Range if completed: 23.3–23.3 out of 30. Not yet assessed: incremental affordability (Co). The missing criteria carry no weight here, so the ends meet; the record is still incomplete. Funding gate: not passed.

        Funding gate: Not passed — the cost is not yet assessed or no allocation is committed for this scope. Ignoring cost in a weighting never removes the gate.

        Delivery RAG and gate

        Delivery RAG shown: AmberReview’s claim: Amber. Best the recorded evidence allows: Amber.

        Review’s reason: Verify service gap and current funding; cost adviser time, treatment, referral and follow-up. Measure sustained quits and inequalities, with adverse effects monitored. Proposed owners: public-health commissioners and health providers.

        Why it is not Green yet

        • Scope (population, place and increment) not verified against the delivery baseline.
        • No verified owner with the powers in place.
        • Delivery capacity not verified.
        • Lifetime incremental costs not complete.
        • No credible funding (a committed allocation for the scope).
        • Safeguards not specified.
        • Monitoring lacks a metric, a data source or a baseline.

        Green needs verified scope, a verified owner with the powers, verified capacity, complete lifetime costs with credible funding, specified safeguards and monitoring with a metric, source and baseline. Amber means appraisal gaps remain; Red means a material delivery obstacle. Red does not mean unimportant.

        Gate: Pending — appraisal incomplete (review label: “Pending baseline verification, incremental costing and funding; not a rollout approval”).

        Why: Scores incomplete; Funding gate not passed (cost unknown or no credible funding).

        The gate is separate from national list membership: being listed does not make an option eligible, and an eligible option need not be listed.

        Cost and funding

        Lifetime costing: Not established. Review: “Not fully costed in this review”.

        Still to cost: Verify service gap and current funding; cost adviser time, treatment, referral and follow-up. Measure sustained quits and inequalities, with adverse effects monitored. Proposed owners: public-health commissioners and health providers.

        Funding status: not identified.

        Owner, powers and capacity

        Proposed owner: public-health commissioners and health providers (proposed, unverified).

        Powers: needs a decision or allocation. Capacity: unverified.

        Powers and capacity read from the review’s Rd and Ca anchors; no proposed owner has agreed to act (the review: “Proposed owners have not agreed to act”).

        England:
        Councils (public health duty, Health and Social Care Act 2012 s.12) with integrated care boards and the Department of Health and Social Care (action record)
        Scotland:
        not assessed
        Wales:
        not assessed
        Northern Ireland:
        not assessed

        Stop smoking services are devolved: Quit Your Way Scotland, Help Me Quit (Wales) and Stop Smoking NI. The Tobacco and Vapes Act 2026 applies UK-wide.

        Dependencies, safeguards and risks

        Depends on: None recorded.

        Safeguards

        None specified yet.

        Monitoring and measured results

        Metric: Define and baseline the outcome described in delivery requirements before approval.

        Data source: Not yet named. Baseline: Not yet established.

        Measures already on the domain page

        A page measure is not necessarily the review’s metric; linking the two is an editorial decision still to be made.

        Evidence for the outcome

        Outcome: Define and baseline the outcome described in delivery requirements before approval.

        NICE supports effective treatment combinations. Evidence is stronger for treatment than for this exact outreach/access increment; no national impact total is claimed.

        Sources: nice.org.uk (P-GC-NICE-NG209-TREAT)

        Review record

        Assessment version: working-review-2026-10-06 (A72@working-review-2026-10-06).

        Reviewer: Author of the review blueprint (single reviewer, not named in uk-facts-complete-plan.json). Reviewed: 6 October 2026.

        Scored in the working review of 6 October 2026 on the shared ten-criterion scale (one reviewer); not independently calibrated.

        An editorial screening framework by one reviewer, not a formal appraisal or business case. Proposed owners have not agreed to act.

      Decision briefs

      • Set a minimum price for each unit of alcohol sold in England
      • Finish the school mental health team roll-out in a way that shows what it achieves, with a route for children who need more

      The leading option set out as a decision someone could take: who decides, who benefits, the best evidence, cost and funding, and the main trade-off. The full research record is one click away.

      Decision briefPublic-policy proposalReviewed 2026-10-04

      Set a minimum price for each unit of alcohol sold in England

      The thread: issue, evidence, action

      1. Issue Weakness: Alcohol-specific deaths in England were 13.8 per 100,000 people in 2024. The rate fell on 2023, but across the UK it was still 14.8 against 11.8 in 2019, and within England it ranged from 10.9 in London to 21.1 in the North East. Also: opportunity, strength
      2. Evidence Alcohol-specific deaths
      3. Action Set a minimum price per unit of alcohol in England
      Decision required
      Whether DHSC and the Home Office commission an English impact assessment of a minimum unit price and, if it supports it, legislate with a review clause.
      Who and where
      All alcohol sold in England; the intended effect is on heavier drinkers who buy the cheapest, strongest drinks. Applies in: England.
      Accountable body
      Department of Health and Social Care, with the Home Office (alcohol licensing)
      Intervention
      Set a legal minimum price per unit of alcohol, enforced through licensing.
      Best evidence, and where it applies
      Scotland’s 50p floor cut deaths wholly caused by alcohol by 13.4% against England (95% CI −18.4% to −8.3%) in its first 32 months; admissions fell 4.1%, not significantly.Studied in: Adults in Scotland, with England as the comparison (MUP from 1 May 2018; health outcomes to December 2020; sales to three years after).How closely the comparison transfers to this decision: Scotland — partial.
      Extra cost of this change
      Capital: none identified in the brief.Recurring: none identified in the brief.One-off or mixed: Legislation, guidance, licensing enforcement and evaluation — Not yet costed.
      Funding
      Mainly a legal or regulatory change: administration costs still need a budget.Committed to this change: none.Possible source, not an award: none identified.Unfunded: Administration and evaluation costs are not established; no public programme budget is needed.
      Savings and wider benefits
      Not yet specified: no cashable saving or avoided cost has been costed for this change. Expected outcomes are listed one by one in the research appendix and are never added together or counted as money available.
      First 90-day step
      An English impact assessment published, with modelled effects by income and drinking level.The proposed first milestone; a 90-day date is not yet specified. Owner: DHSC with the Home Office. Proposed by UK Facts, not an official deadline.
      Twelve-month milestone
      Not yet specified.Time to a first useful result: The assessment within months of commissioning; measured health effects two to three years after a floor takes effect (Scotland’s evaluation covered 32 months).
      Outcome, and when to scale or stop
      Measure: Off-trade sales per adult and the price distribution of cheap drinks.Scale if: Deaths wholly attributable to alcohol fall relative to the comparison.Stop if: No change against the comparison at the statutory review.
      Main trade-off
      Prices rise for moderate drinkers on low incomes and some dependent drinkers face strain, while the extra money goes to retailers, not the Exchequer.
      Source and review date
      Evaluating the impact of minimum unit pricing for alcohol in Scotland: Final report. A synthesis of the evidence (June 2023); Evaluating the impact of alcohol minimum unit pricing on deaths and hospitalisations in Scotland: a controlled interrupted time series study (March 2023). Reviewed 2026-10-04.

      An editorial proposal by UK Facts for discussion, not government policy. Records: A49 · effects E-A49-DEATHS, E-A49-ADMISSIONS, E-A49-DEPENDENT · costs C-A49-ADMIN

      Research appendix: study design, effect sizes and limits, alternatives, full costing, international comparisons and how we would know

      1.The change, in plain words

      Set a minimum price for each unit of alcohol sold in England

      2.The decision requested

      Decision
      Commission and publish an English impact assessment of a minimum unit price (levels, effects by income and drinking level, effects on dependent drinkers), then decide whether to bring forward primary legislation with a review clause and an uprating rule.
      Accountable institution
      Department of Health and Social Care, with the Home Office (alcohol licensing)
      Geography
      England
      Powers
      New primary legislation needed (Scotland and Wales legislated for theirs); enforcement through existing licensing.
      Delivery partners
      Parliament; Councils (licensing and trading standards); Alcohol treatment services; Retailers

      3.Who it is for, and what changes beyond today

      Target population
      All alcohol sold in England; the intended effect is on heavier drinkers who buy the cheapest, strongest drinks.
      Eligibility
      Universal: a price floor applies to every sale.
      Scale
      National once in force; the level is a choice for the impact assessment (Scotland moved from 50p to 65p in September 2024).
      Baseline
      Alcohol-specific deaths in England were 13.8 per 100,000 in 2024 (age-standardised), against 20.9 in Scotland and 16.8 in Wales. England has no floor price.

      Source: Office for National Statistics, Alcohol-specific deaths in the UK: registered in 2024 (Section 3); UK Parliament, Written answer: minimum unit pricing for alcohol in England (HL972) (Answer text)

      Change beyond existing law or funding
      The whole change is additional: ministers said in June 2026 they “do not currently have any plans” for a floor in England.

      4.How it would work

      Do: Set a legal minimum price per unit of alcohol, enforced through licensing. Changing: The price of the cheapest, strongest drinks rises; heavier drinkers buy them most, so consumption falls where harm is concentrated (total sales fell 3% in Scotland, all in shops).

      • Deaths wholly attributable to alcohol

        Measured for this interventionEffect record E-A49-DEATHS

        Measured in Scotland at 50p (−13.4%). An English effect, at any level, is a forecast, not this result.

      • Hospital admissions wholly attributable to alcohol

        Measured for this interventionEffect record E-A49-ADMISSIONS

        Fell 4.1% in Scotland, but the interval includes no effect.

      • Financial strain for some people with alcohol dependence on low incomes

        Measured for this interventionEffect record E-A49-DEPENDENT

        A harm found in qualitative research in Scotland; not shown to be typical. Treatment services are the mitigation.

      Outcomes are kept separate and never added into one impact figure.

      5.Best evidence

      • Evaluating the impact of minimum unit pricing for alcohol in Scotland: Final report. A synthesis of the evidence

        Author or institution:
        Public Health Scotland
        Published:
        June 2023
        Evaluation period:
        MUP from 1 May 2018; health outcomes to December 2020; sales to three years after
        Design:
        Synthesis of commissioned studies, each quality-appraised, with alternative explanations tested against causal criteria
        Sample or population:
        Adults in Scotland, with England as the comparison
        Effect and uncertainty:
        Deaths −13.4% (95% CI −18.4% to −8.3%), about 156 a year averted (69 to 243); admissions −4.1% (−8.3% to +0.3%)
        Limits:
        Short period; COVID-19 overlaps; 50p only; no full economic evaluation

        Where: Key messages printed pp.11–14; section 3.3 printed p.32; Table 5 p.90. Affiliation is provenance, not proof of quality.

      • Evaluating the impact of alcohol minimum unit pricing on deaths and hospitalisations in Scotland: a controlled interrupted time series study

        Author or institution:
        Wyper GMA et al. (Public Health Scotland and University of Glasgow)
        Published:
        March 2023
        Evaluation period:
        January 2012 to April 2018 before; May 2018 to December 2020 after
        Design:
        Controlled interrupted time series, Scotland against England
        Sample or population:
        Adults aged 16+; deaths and admissions wholly attributable to alcohol
        Effect and uncertainty:
        As above; exploratory subgroup reductions largest in the four most deprived deciles
        Limits:
        Results for admissions varied with the control group used

        Where: Table 1; Table 2. Affiliation is provenance, not proof of quality.

      6.Alternatives, counter-evidence and who loses

      Closest feasible alternative
      Raising alcohol duty on the cheapest strong products: the money goes to the Exchequer, but retailers can choose not to pass rises through on cheap drinks; no evaluation of its effect on deaths was reviewed here.
      Strongest counter-evidence
      Admissions did not fall significantly, acute-cause deaths and admissions rose slightly (not significantly), and there was limited evidence that people with dependence cut their drinking.

      Source: The Lancet, Evaluating the impact of alcohol minimum unit pricing on deaths and hospitalisations in Scotland: a controlled interrupted time series study (Table 1); Public Health Scotland, Evaluating the impact of minimum unit pricing for alcohol in Scotland: Final report. A synthesis of the evidence (Printed pp.13, 55, 80)

      Distributional effects
      The largest estimated health gains were among men and in the 40% most deprived areas; the price rise falls hardest on low-income drinkers of cheap, strong drinks.
      Main downside
      A regressive price rise whose extra revenue goes to retailers, with financial strain for some dependent drinkers.

      The options compared, including current policy

      • The proposal

        Legislate for an English minimum unit price

        Who is reached
        All drinkers; heaviest effect on heavy drinkers of cheap alcohol
        Evidence
        Within-UK controlled evaluation (Scotland)
        Likely outcome and timing
        Fewer alcohol deaths; measurable in two to three years (size in England a forecast)
        Cost and funding
        Not a spending proposal; admin not costed
        Main trade-off
        Regressive price rise; revenue to retailers

      • Current policy

        Current policy: no floor price

        Who is reached
        —
        Evidence
        —
        Likely outcome and timing
        English death rate 13.8 per 100,000 (2024) on its current trend
        Cost and funding
        None
        Main trade-off
        Forgoes the evaluated reduction in deaths

      • Alternative

        Raise duty on the cheapest strong products

        Who is reached
        Drinkers of the taxed products
        Evidence
        Not reviewed here for deaths
        Likely outcome and timing
        Depends on pass-through to shelf prices
        Cost and funding
        Raises Exchequer revenue
        Main trade-off
        Retailers may absorb rises on cheap drinks

      7.What other countries or the devolved nations show

      Country lesson · Scotland, From May 2018 (50p); 65p from September 2024

      A minimum price per unit of alcohol in Scotland

      Evidence: Experimental or quasi-experimental evaluationPartial match: some conditions differ

      What was changed
      A legal floor price for every unit of alcohol sold, enforced through licensing; set at 50p from 1 May 2018 and raised to 65p from 30 September 2024 after Parliament renewed it.
      Study design and population
      A synthesis by Public Health Scotland of the commissioned evaluation studies, led by a controlled interrupted time series comparing Scotland with England. Adults in Scotland; outcomes are deaths and hospital admissions wholly attributable to alcohol, May 2018 to December 2020.
      Measured outcome there
      Deaths wholly attributable to alcohol −13.4% (95% CI −18.4% to −8.3%), about 156 a year averted; admissions −4.1% (95% CI −8.3% to +0.3%), not significant. Total sales −3%, all in shops. Largest reductions among men and in the 40% most deprived areas.
      Cost status
      No full economic evaluation and no published implementation cost: compliance checks were absorbed into existing licensing enforcement. Drinkers pay more, mostly to retailers.
      What failed or remains uncertain
      Admissions did not fall significantly; some economically vulnerable people with alcohol dependence reported financial strain; no consistent effect on crime; COVID-19 overlaps the period; the effect of 65p is not yet evaluated, and a fixed floor erodes with inflation.
      Why the UK differs
      England’s alcohol-specific death rate is lower than Scotland’s (13.8 against 20.9 per 100,000 in 2024), drinking patterns and prices differ, and the English level would be a new choice — so the Scottish percentage is not a forecast for England. Wales has had a floor since 2020, so England would be the outlier in Great Britain.
      First change required here
      DHSC and the Home Office model an English floor price, publish an impact assessment that includes low-income dependent drinkers, and legislate with a review clause and treatment-service mitigation.

      Not a UK forecast: the effect above was measured in that place and population. Source: Public Health Scotland, Evaluating the impact of minimum unit pricing for alcohol in Scotland: Final report. A synthesis of the evidence (Key messages printed pp.11–14; section 3.3 printed p.32; Table 5 p.90); The Lancet, Evaluating the impact of alcohol minimum unit pricing on deaths and hospitalisations in Scotland: a controlled interrupted time series study (Table 1); legislation.gov.uk, The Alcohol (Minimum Price per Unit) (Scotland) Amendment Order 2024 (SSI 2024/128) (Article 2); Office for National Statistics, Alcohol-specific deaths in the UK: registered in 2024 (Section 3). Reviewed 2026-10-04.

      8.What delivery needs first

      • law — Primary legislation and parliamentary time. (Genuine veto: nothing proceeds without it; owner: DHSC, Home Office and Parliament)
      • data — An English impact assessment modelling price levels and effects on low-income dependent drinkers. (Requirement; owner: DHSC)
      • staff — Alcohol treatment capacity for people with dependence who face strain. (Requirement; owner: Councils’ public health teams)

      9.What it would cost

      How the cost is built up: Impact assessment + legislation and guidance + enforcement through licensing + evaluation. Drinkers pay the higher prices; this is not public spending.

      • Legislation, guidance, licensing enforcement and evaluation

        England

        Not yet costed (ledger C-A49-ADMIN)

        one-off revenue; price year not stated; From commencement; Not yet established

        Scotland absorbed compliance checks into existing licensing enforcement and published no implementation cost.

      10.Who pays, and what is missing

      Programme envelope (a possible route, not an award)
      None identified
      Allocation committed to this change
      None
      Remaining gap
      Administration and evaluation costs are not established; no public programme budget is needed.
      Proposed financing
      DHSC and Home Office running costs for the impact assessment; councils’ licensing budgets for enforcement.
      Responsible payer
      central government, councils, households
      Budget displaced
      Departmental analytical time and parliamentary time.

      11.First milestone and time to a useful result

      An English impact assessment published, with modelled effects by income and drinking level. (Owner: DHSC with the Home Office. Proposed by UK Facts, not an official deadline.)

      Time to first useful result: The assessment within months of commissioning; measured health effects two to three years after a floor takes effect (Scotland’s evaluation covered 32 months).

      What could delay it: Parliamentary time is found. Retail and trade objections are settled without lengthy litigation (Scotland’s scheme was delayed by a legal challenge before it began).

      12.How we would know

      Baseline
      Alcohol-specific and wholly attributable deaths in England, and off-trade sales per adult, before commencement.
      Comparison
      Pre-commencement trends and a comparison series (as Scotland used England), chosen in the evaluation design.
      Leading indicator
      Off-trade sales per adult and the price distribution of cheap drinks.
      Follow-up
      A statutory review three to five years after commencement.
      Continue if
      Deaths wholly attributable to alcohol fall relative to the comparison.
      Adapt if
      The floor has eroded with inflation, or dependent drinkers’ hardship rises without access to treatment.
      Stop if
      No change against the comparison at the statutory review.
      Thresholds
      Not yet set: Set in the impact assessment and evaluation design, using the English baseline and a power calculation; the Scottish percentage is not a target.

      What is not yet known, and how to find out

      • What would an English floor at 65p (or another level) do to deaths? (effect)Next step: Model levels in the English impact assessment; evaluate against a comparison after commencement.Defensible route: legal or accountability reform
      • What would enforcement and evaluation cost? (cost)Next step: Cost enforcement through licensing and a statutory evaluation in the impact assessment.Scope: Licensing enforcement and evaluation in England · Data or quotes needed: Councils’ licensing workload estimates; evaluation design and data costs · Who can estimate it: DHSC with the Home Office and the Local Government Association
      • What is Northern Ireland’s current position? (legal)Next step: Obtain a Department of Health (NI) statement or Assembly record (held claim on this page).

      Sources last checked 4 October 2026 · Owner: Evidence editor (James Harris) · Next check: OHID Local Alcohol Profiles for England: 2026 update (1 December 2026, provisional) or the first trigger: ONS alcohol-specific deaths in the UK, next annual release (date not announced when reviewed).

      Decision briefExisting programmeReviewed 2026-10-04

      Finish the school mental health team roll-out in a way that shows what it achieves, with a route for children who need more

      The thread: issue, evidence, action

      1. Issue Weakness: 25.8% of 16–24-year-olds had a common mental health condition in 2023/4, against 17.5% in 2007. Also: threat
      2. Evidence 16–24-year-olds with a common mental health condition
      3. Action Measure what school mental health teams achieve as they reach every school, and close the gap for children with greater needs
      Decision required
      NHS England and DfE publish the order in which the remaining schools will join Mental Health Support Teams and the outcomes that will be compared, so later-joining schools act as a comparison, and each integrated care board names a referral route for children whose needs are beyond the teams’ remit.
      Who and where
      Children and young people aged 5–18 in schools and colleges in England not yet covered by a Mental Health Support Team, and children in covered schools whose needs are more than mild to moderate. Applies in: England.
      Accountable body
      NHS England (commissioning of the teams and of specialist children’s mental health services) with the Department for Education
      Intervention
      Phase the remaining roll-out in a published order, measure children’s symptoms, functioning, attendance and waits in early and later schools, and commission a route to specialist help for children with greater needs.
      Best evidence, and where it applies
      The first evaluation (NIHR, 25 Trailblazer sites, 2020–22) reported perceived benefits and a gap for children with more serious needs; it was not designed to measure impact. No published study comparing children’s outcomes with and without a team was found by 4 October 2026.Studied in: School staff, team members and commissioners in the first 25 Trailblazer sites, with focus groups of children and young people (November 2020 to February 2022).How closely the comparison transfers to this decision: Australia (headspace centres, all states) — low.
      Extra cost of this change
      Capital: none identified in the brief.Recurring: Teams for the remaining schools (the committed roll-out) — Not yet costed.One-off or mixed: Comparison-based evaluation and a specialist route for needs beyond the teams’ remit — Not yet costed.
      Funding
      Not funded yet: a possible funding route exists, but nothing is allocated to this change.Committed to this change: none.Possible source, not an award: Spending Review 2025 commitment to full Mental Health Support Team coverage (no amount published).Unfunded: Unknown: no amount is published for the teams, the evaluation or the specialist route; nothing is allocated to the increment.
      Savings and wider benefits
      Not yet specified: no cashable saving or avoided cost has been costed for this change. Expected outcomes are listed one by one in the research appendix and are never added together or counted as money available.
      First 90-day step
      NHS England and DfE publish the order of joining for the remaining waves and the outcome and waiting measures to be compared, before the next wave’s schools are chosen.The proposed first milestone; a 90-day date is not yet specified. Owner: NHS England with DfE. Proposed by UK Facts, not an official deadline.
      Twelve-month milestone
      Not yet specified.Time to a first useful result: About two years: a wave needs around 12 months of practitioner training before it starts, then at least a school year of follow-up.
      Outcome, and when to scale or stop
      Measure: Time from referral to first support, and onward referrals accepted by specialist services.Scale if: Children in schools with a team do better on symptoms, functioning or attendance than comparable later-joining schools, and referred children reach specialist help sooner.Stop if: Children supported by the teams do worse than comparable children without a team, as some subgroups did in the INSPIRE trial of classroom lessons.
      Main trade-off
      Fixing a phased order means some schools wait for a service ministers have committed to every school; without it, a national service will be complete before anyone knows what it changes.
      Source and review date
      Early evaluation of the Children and Young People’s Mental Health Trailblazer programme: a rapid mixed-methods study (June 2023); Mental Health Support Teams: coverage and school and college experiences (data release) (June 2026). Reviewed 2026-10-04.

      An editorial proposal by UK Facts for discussion, not government policy. Records: A50 · effects E-A50-MH · costs C-MHST-ROLLOUT, C-A50-EVAL

      Research appendix: study design, effect sizes and limits, alternatives, full costing, international comparisons and how we would know

      1.The change, in plain words

      Finish the school mental health team roll-out in a way that shows what it achieves, with a route for children who need more

      2.The decision requested

      Decision
      Before the next training wave starts, NHS England and DfE publish (1) the order in which the remaining schools and colleges will join, chosen so that later-joining schools are comparable with earlier ones, (2) the child outcome and waiting measures to be compared, and (3) a requirement that every integrated care board names the specialist route for children the teams cannot help. An independent evaluator reports before full coverage.
      Accountable institution
      NHS England (commissioning of the teams and of specialist children’s mental health services) with the Department for Education
      Geography
      England
      Powers
      Existing NHS commissioning powers and the Spending Review 2025 commitment to full coverage by 2029–30; DfE’s grant and data powers for schools. No new law; data linkage needs data-sharing agreements.
      Delivery partners
      Integrated care boards; Schools and colleges (senior mental health leads); Specialist children and young people’s mental health services; Universities training Education Mental Health Practitioners; An independent evaluation team (for example NIHR-funded)

      3.Who it is for, and what changes beyond today

      Target population
      Children and young people aged 5–18 in schools and colleges in England not yet covered by a Mental Health Support Team, and children in covered schools whose needs are more than mild to moderate.
      Eligibility
      Teams offer early support for mild to moderate problems such as anxiety and low mood; children with more serious needs are referred on. The comparison covers schools joining from the next wave; the specialist route covers all covered schools.
      Scale
      The remaining 40% of pupils and learners, in the waves already planned to 2029–30. On current averages a team covers about 8,200 pupils in 17 schools and colleges; the number of new teams per wave is set by NHS England’s training places, not by this brief.
      Baseline
      Teams covered 5.8 million pupils and learners (60%) and 48% of schools and colleges in 2025–26, with about 785 teams expected by March 2027. In the 12 months to July 2026, 893,219 under-18s had at least one NHS-funded mental health contact, 172,068 of them with a school-based team; 360,640 children and young people were waiting for treatment at the end of July 2026 (a new measure). For context, 25.8% of 16–24-year-olds in England had a common mental health condition in 2023/4, against 17.5% in 2007.

      Source: Department for Education, Mental Health Support Teams: coverage and school and college experiences (data release) (Summary p.5; Overview pp.6–8 (Table 1)); NHS England, Mental Health Services Monthly Statistics, Performance July 2026 (England rows, measures MHS95, MHS159, MHTT02); NHS England, Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/4 (Chapter 1: Common mental health conditions)

      Change beyond existing law or funding
      The roll-out is already committed and continues regardless. The change is (a) the order of joining and the outcome measures are published in advance so the remaining waves provide a comparison, (b) outcomes are reported before full coverage, and (c) a named specialist route is commissioned for children whose needs exceed the teams’ remit. No new teams beyond the committed plan.

      4.How it would work

      Do: Phase the remaining roll-out in a published order, measure children’s symptoms, functioning, attendance and waits in early and later schools, and commission a route to specialist help for children with greater needs Changing: so that whether the teams improve children’s mental health is measured rather than assumed, and children the teams cannot help are not left waiting without a route

      • Children’s mental health and timely access to support in schools with a team

        Hypothesis to testEffect record E-A50-MH

        The effect record is a plausible spillover: only perceived benefits and school satisfaction have been reported, and the NIHR-funded follow-on evaluation that began in 2023 had not published child outcome results by 4 October 2026. This is the outcome the comparison is designed to measure.

      • Waits and onward referral for children whose needs are beyond the teams’ remit

        Hypothesis to test

        The early evaluation found a gap for these children; no study measures whether a named route shortens their waits. To be measured from referral and waiting records in the evaluation.

      • Specialist clinician time available outside schools

        Hypothesis to test

        A possible cost: clinicians placed in schools are not available to specialist services where waits are longest. Not measured; to be tracked through workforce returns.

      Outcomes are kept separate and never added into one impact figure.

      5.Best evidence

      • Early evaluation of the Children and Young People’s Mental Health Trailblazer programme: a rapid mixed-methods study

        Author or institution:
        Ellins J et al. (NIHR-funded evaluation, published in NIHR Health and Social Care Delivery Research)
        Published:
        June 2023
        Evaluation period:
        November 2020 to February 2022
        Design:
        Rapid mixed-methods evaluation: surveys of all 25 Trailblazer sites and case studies in five; no comparison group.
        Sample or population:
        School staff, team members and commissioners in the first 25 Trailblazer sites, with focus groups of children and young people
        Effect and uncertainty:
        Schools reported positive early outcomes such as staff confidence and quicker access to advice — perceived, not measured — with staff retention problems and a gap for children whose needs were “more serious than ‘mild to moderate’”. The study “was not designed to assess the impact” of the programme.
        Limits:
        Low survey response; no child outcome measures; funding was committed before evaluation, which weakened the case for a counterfactual impact evaluation.

        Where: Abstract; Chapter 11 (impact-evaluation scoping); Chapter 12 (discussion and conclusions). Affiliation is provenance, not proof of quality.

      • Mental Health Support Teams: coverage and school and college experiences (data release)

        Author or institution:
        Department for Education
        Published:
        June 2026
        Evaluation period:
        Coverage 2025–26; school and college survey 9 May to 27 June 2025
        Design:
        Management information on coverage, and an online survey of schools and colleges with a team.
        Sample or population:
        9,308 schools and colleges surveyed; 2,421 responses (26%)
        Effect and uncertainty:
        92% of respondents agreed their team had provided beneficial support; staff availability (in the team and in the school) and parents’ engagement were the barriers most often named. These are school views, not children’s outcomes.
        Limits:
        Satisfaction from a self-selected quarter of schools; no comparison and no child-level data.

        Where: Summary p.5; survey pp.16–23 (Figure 12). Affiliation is provenance, not proof of quality.

      6.Alternatives, counter-evidence and who loses

      Closest feasible alternative
      Carry on the committed roll-out to every school by 2029–30 as now, and rely on the NIHR-funded follow-on evaluation when it reports, without fixing a comparison in the remaining waves.
      Strongest counter-evidence
      Large UK trials of school-based mental health lessons found no benefit: universal mindfulness training (MYRIAD, 84 schools) showed no effect on depression risk at one year, and INSPIRE (213 schools) found no effect on emotional difficulties with some subgroups doing worse. These test classroom lessons, not targeted teams, so they show that plausible school interventions can fail — not that the teams do.

      Source: Evidence-Based Mental Health 25(3):99–109, Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision (MYRIAD) (Abstract); Department for Education, Effectiveness of school mental health and wellbeing promotion (INSPIRE trial) (Summary pp.3–5)

      Distributional effects
      Children in schools placed later in the order wait longer for a team; children with complex needs gain only if the specialist route is funded. Coverage is already higher in secondary schools (79% of pupils) than overall (60%), so the order also decides how quickly primary schools are reached.
      Main downside
      Phasing for evaluation delays a committed service for some schools, and if the specialist route is not funded the teams may absorb cases beyond their training.

      The options compared, including current policy

      • The proposal

        Phased, measured roll-out with a named specialist route (this brief)

        Who is reached
        Pupils in the remaining 40% of schools and colleges, and children in covered schools whose needs exceed the teams’ remit.
        Evidence
        No outcome evidence yet; the early NIHR evaluation found perceived benefits and a gap for more serious needs.
        Likely outcome and timing
        First comparison results about two years after the order is fixed; coverage still complete by 2029–30.
        Cost and funding
        Teams paid from the Spending Review commitment (amount not published); evaluation and specialist route not costed or allocated.
        Main trade-off
        Some schools wait in a fixed order; in return the service is judged on children’s outcomes before it is complete.

      • Current policy

        Committed roll-out as now

        Who is reached
        All schools by 2029–30 (60% of pupils covered in 2025–26).
        Evidence
        School satisfaction surveys and the early NIHR evaluation; the NIHR-funded follow-on evaluation has not yet reported children’s outcomes.
        Likely outcome and timing
        Full coverage by 2029–30; whether children benefit may not be known by then.
        Cost and funding
        Committed in the Spending Review; no separate amount published.
        Main trade-off
        No school waits for an evaluation, but no comparison remains once coverage is complete.

      • Alternative

        Put the same clinician time into specialist children’s services instead

        Who is reached
        Children already referred to specialist services (360,640 waiting at the end of July 2026).
        Evidence
        No evaluation found comparing the two uses of clinician time.
        Likely outcome and timing
        Could shorten specialist waits within months if staff were available; does not offer early help in school.
        Cost and funding
        Integrated care board budgets; would mean scaling back a committed programme.
        Main trade-off
        Help for the most unwell sooner, against early support for many more children with milder needs.

      • Alternative

        A minimum price per unit of alcohol in England (see the national decision brief)

        Who is reached
        Adults who drink heavily, mostly in deprived areas.
        Evidence
        A within-UK evaluation: alcohol deaths fell 13.4% in Scotland relative to England at a 50p floor.
        Likely outcome and timing
        Needs new legislation; effects on deaths measured within about three years in Scotland.
        Cost and funding
        Mainly administration; not costed for England. Decided in the national brief.
        Main trade-off
        A different prevention target (adult alcohol harm), with financial strain for some low-income dependent drinkers.

      • Alternative

        Early-years help where access is weakest (see the national decision brief)

        Who is reached
        Young children and families in areas with the weakest access to early-years services.
        Evidence
        2000s Sure Start reduced hospital admissions by age 15.
        Likely outcome and timing
        Health effects emerge over years to adolescence.
        Cost and funding
        Decided in the national brief.
        Main trade-off
        Acts much earlier in life and more slowly than school-age support.

      7.What other countries or the devolved nations show

      Country lesson · Australia (headspace centres, all states), Service from 2006; independent evaluation of 2013–14 data, reported October 2015

      A national youth mental health service in Australia, evaluated after it had spread

      Evidence: Observational analysisWeak match: context only, not a model to copy

      What was changed
      Free or low-cost, youth-friendly centres for 12–25-year-olds working across four areas in one place — mental health, physical health, drug and alcohol use, and social and vocational participation —, funded by a national grant plus Medicare. Centre-based, not a team working inside schools.
      Study design and population
      Government-commissioned evaluation: administrative records of over 45,000 clients (change in psychological distress against clinical benchmarks), plus surveys of 1,515 clients and 4,774 young people not attending, compared by difference-in-differences with matched “other treatment” and “no treatment” groups. Not randomised. 45,195 young people who received 194,968 occasions of service at 67 centres in 2013–14; 74.2% had high or very high psychological distress at first assessment.
      Measured outcome there
      A small programme effect: against matched groups, the difference-in-differences effect size on psychological distress was −0.11 (against no treatment) and −0.16 (against other treatment), both statistically significant. Average distress fell 2.3 points on the K10 scale (28.8 to 26.55); 22.7% of clients improved reliably or clinically.
      Cost status
      Historic only: an average government cost of A$339 per occasion of service in 2013–14, ranging from A$136 to over A$1,000 between centres (grant only). Not a guide to English costs.
      What failed or remains uncertain
      Distress rose for 24.3% of clients and did not change for almost 29%; over a quarter of clients attended only once, and clients with two or three visits were over-represented among those whose distress did not change; centres reported staff vacancies (14 of 29 managers surveyed) and family therapy as the main gap. The comparison groups were matched, not randomised, so selection may remain. The service had expanded nationally before this evaluation reported.
      Why the UK differs
      Mental Health Support Teams work inside schools with children aged 5–18 and are meant for mild to moderate needs; headspace is a walk-in centre for 12–25-year-olds, many with high distress. The lesson that transfers is about timing and measurement — a national service built before its effect was measured, then found to have a small one — not the effect size.
      First change required here
      NHS England and DfE fix the order in which the remaining schools join, so later schools act as a comparison, and record a validated symptom and functioning measure at first contact and follow-up before coverage is complete.

      Not a UK forecast: the effect above was measured in that place and population. Source: Social Policy Research Centre, UNSW Australia, for the Australian Government Department of Health, Is headspace making a difference to young people’s lives? Final report of the independent evaluation of the headspace program (SPRC Report 08/2015) (Executive summary, printed pp.1–5; section 1.1 (background); Appendix C, printed p.172 (service use)). Reviewed 2026-10-04.

      8.What delivery needs first

      • staff — Education Mental Health Practitioners for each new team; training takes around 12 months, so the order of joining must match the training waves already under way. (Scarce resource shared with other priorities; owner: NHS England with training universities)
      • staff — Specialist children’s mental health clinicians to take referrals for needs beyond the teams’ remit, in services where 360,640 children and young people were already waiting. (Scarce resource shared with other priorities; owner: Integrated care boards)
      • data — Linked school (pupil records, attendance) and NHS mental health records, with data-sharing agreements, so outcomes can be compared between early and later schools. (Requirement; owner: DfE and NHS England)
      • dependency — The order of joining must be fixed before the next wave is chosen; once every school is covered, no comparison is possible. (Genuine veto: nothing proceeds without it; owner: NHS England with DfE)
      • public consent — Schools, families and young people agree to outcome measurement; schools placed later accept the wait. (Requirement; owner: Schools and integrated care boards)

      9.What it would cost

      How the cost is built up: Increment = evaluation (design, data linkage, analysis and reporting) + specialist referral capacity (children referred on × treatment cost). The teams themselves are current policy and are not added to the increment.

      • Teams for the remaining schools (the committed roll-out)

        England: schools and colleges not yet covered

        Not yet costed (ledger C-MHST-ROLLOUT)

        recurring; price year not stated; 2026–27 to 2029–30; Not yet established

        Committed in the Spending Review without a published amount; part of current policy, not of this brief’s increment.

      • Comparison-based evaluation and a specialist route for needs beyond the teams’ remit

        England: schools joining from 2026–27; specialist referrals from all covered schools

        Not yet costed (ledger C-A50-EVAL)

        mixed; price year not stated; 2026–27 to 2029–30; Not yet established

        The increment. A phased order adds little cost; the specialist clinical capacity is the larger, unestimated part.

      10.Who pays, and what is missing

      Programme envelope (a possible route, not an award)
      Spending Review 2025 commitment to full Mental Health Support Team coverage (no amount published), 2025–26 to 2029–30
      Allocation committed to this change
      None
      Remaining gap
      Unknown: no amount is published for the teams, the evaluation or the specialist route; nothing is allocated to the increment.
      Proposed financing
      The evaluation from NHS England and DfE research budgets (or an NIHR commission); the specialist route from integrated care boards’ children’s mental health budgets. The Spending Review commitment pays for the teams, not for either increment.
      Responsible payer
      NHS, central government
      Budget displaced
      Specialist capacity for referred children competes with other children’s mental health services in the same integrated care board budgets.

      11.First milestone and time to a useful result

      NHS England and DfE publish the order of joining for the remaining waves and the outcome and waiting measures to be compared, before the next wave’s schools are chosen. (Owner: NHS England with DfE. Proposed by UK Facts, not an official deadline.)

      Time to first useful result: About two years: a wave needs around 12 months of practitioner training before it starts, then at least a school year of follow-up.

      What could delay it: Waves already in training have fixed their schools, so the first comparable wave may be later than the next one. Data-sharing agreements to link school and NHS records take longer than a school year to agree. Staff availability in teams and schools — among the barriers schools most often name — weakens delivery in the comparison period.

      12.How we would know

      Baseline
      Symptoms and functioning on a validated measure at first contact; attendance; time from referral to first support; specialist waits — in schools before their team starts.
      Comparison
      Schools joining in later waves, compared with similar schools that joined earlier, using the published order (a phased or stepped design).
      Leading indicator
      Time from referral to first support, and onward referrals accepted by specialist services.
      Follow-up
      Each school year until full coverage, with a published report before the last wave.
      Continue if
      Children in schools with a team do better on symptoms, functioning or attendance than comparable later-joining schools, and referred children reach specialist help sooner.
      Adapt if
      Outcomes do not differ from later-joining schools, or referrals beyond the teams’ remit go unanswered: change the model (for example, more supervision or a different mix of support) before the remaining waves.
      Stop if
      Children supported by the teams do worse than comparable children without a team, as some subgroups did in the INSPIRE trial of classroom lessons.
      Thresholds
      Not yet set: Thresholds should be set in the published evaluation design, from baseline outcomes, the number of schools per wave and statistical power; none has been published.

      What is not yet known, and how to find out

      • Do Mental Health Support Teams improve children’s symptoms, functioning or attendance? (effect)Next step: Publish the phased order and measures now; ask the NIHR-funded evaluation team when child outcome results will be published and align their measures with the comparison.Defensible route: evaluation of existing delivery
      • What would the evaluation and the specialist route for children with greater needs cost? (cost)Next step: NHS England estimates the referral volume from team activity records and prices the route in the next planning round.Scope: Evaluation of the waves from 2026–27; specialist assessment and treatment for children referred on from covered schools · Data or quotes needed: Numbers referred on by covered teams, current specialist treatment costs per child, and evaluation tender quotes · Who can estimate it: NHS England with integrated care boards (specialist route) and DfE or NIHR (evaluation)
      • How much is spent on the teams each year? (cost)Next step: Request the annual team budget through a written parliamentary question or the next NHS England mental health investment publication.Scope: Mental Health Support Teams in England, 2025–26 to 2029–30 · Data or quotes needed: The NHS England and DfE budget lines for the teams (no amount was published in the Spending Review) · Who can estimate it: NHS England and DfE
      • Can the order of joining still be changed for the waves already in training? (delivery)Next step: NHS England confirms which waves have fixed school lists and names the first wave that can follow a published order.

      Sources last checked 4 October 2026 · Owner: Evidence editor (James Harris) · Next check: NHS England Mental Health Services Monthly Statistics, performance August 2026 (8 October 2026) or the first trigger: Publication of the Mental Health Support Teams impact study.

      More decision briefs on other pages

      What it would take

      The order things have to happen in, who pays, and the effects and appraisals on record.

      The order things have to happen in

      1. First, the prerequisite

        Model an English floor price and publish an impact assessment

        Owner: DHSC with the Home Office

        No date: the timing depends on the steps before it.

      2. First, the prerequisite

        Fix the order of the remaining school roll-out and the outcome measures to compare

        Owner: NHS England with DfE

        No date: the timing depends on the steps before it.

      3. Then, the decision

        Legislate for a minimum unit price with a review clause

        Owner: Parliament

        No date: the timing depends on the steps before it.

      4. Then, delivery

        Specify and fund early-years services where access is weakest

        Owner: Councils with DfE and DHSC

        No date: the timing depends on the steps before it.

      5. Finally, the measured outcome

        Mental Health Support Teams in every school

        Owner: NHS England and DfE

        By 2029–30 (Spending Review 2025) — source

      6. First, the prerequisite

        Publish Talking Therapies completion and recovery by board and deprivation decile

        Owner: NHS England

        No date: the timing depends on the steps before it.

      7. Then, delivery

        Outreach with effective stop-smoking treatment for routine and manual workers, with comparison councils

        Owner: Councils with DHSC

        No date: the timing depends on the steps before it.

      Who pays, and what is still missing

      Cost, committed funding and the remaining gap for the same scope and years. A programme envelope is not an award to a project; a proposal is not committed money. None of these costs has been established yet, so no total is shown.

      Cost and funding ledger

      • Legislation, guidance, licensing enforcement and evaluation of a minimum unit price in England

        A49 · administration · not costed

        Amount
        Not yet costed
        Who pays
        central government, councils
        Committed
        None identified
        Proposed, not committed
        —
        Gap
        Not established

      • Best Start Family Hubs roll-out (programme envelope)

        A13 · recurring spending · published programme envelope

        Amount
        at least £500m in total, Announced 6 July 2025 (“over £500 million”), hubs in every local authority from April 2026 to the end of 2028; fiscal years and price basis not stated in the announcement., price basis not stated by the source
        Who pays
        central government
        Committed
        None identified
        Proposed, not committed
        Best Start Family Hubs: “over £500 million” to the end of 2028
        Gap
        Not established

      • Integrated early-years service package and workforce

        A13 · recurring spending · not costed

        Amount
        Not yet costed
        Who pays
        central government, councils, NHS
        Committed
        None identified
        Proposed, not committed
        —
        Gap
        Not established

      • Mental Health Support Teams: roll-out to every school and college in England by 2029–30

        A50 · recurring spending · not costed

        Amount
        Not yet costed
        Who pays
        central government, NHS
        Committed
        None identified
        Proposed, not committed
        Spending Review 2025 commitment to full Mental Health Support Team coverage (no amount published)
        Gap
        Not established

      • Comparison-based outcome evaluation of the remaining roll-out, and specialist support for needs beyond “mild to moderate”

        A50 · administration · not costed

        Amount
        Not yet costed
        Who pays
        central government, NHS
        Committed
        None identified
        Proposed, not committed
        —
        Gap
        Not established

      “Not yet costed” means no defensible cost has been found — not that the action is free. Lifetime benefits, benefit-cost ratios and forecast savings are never shown here as money available to spend.

      Effects on record, with evidence ratings (7 records)

      What the evidence says each action changes

      Effects on record — these measure different outcomes, so they are not drawn on one scale
      ActionOutcome and areaEffectCompared withEvidence
      Rebuild integrated early-years help where access is weakestFive GCSEs at A*–C (or equivalent) at 16 Education and children+0.9 percentage points (about 2%)quasi-experimental; method update changed some earlier findingschildren without access, before and after centres opened; cohorts born around 1990–2003evaluated; moderate confidence; England2000s Sure Start, not today’s family hubs.
      Rebuild integrated early-years help where access is weakestHospital admissions by age 15 Health and care−8.5% by age 15admissions rose 10% at age 1 before fallingareas with fewer centres per child; cohorts born 1990s–2000sevaluated; moderate confidence; EnglandNot a cashable NHS saving.
      Rebuild integrated early-years help where access is weakestCriminal record by age 16 Crime and justice · mixedSize not established—evaluated; moderate confidence; EnglandMore young people had a criminal record by 16, driven by an 11% rise in cautions; a fall in convictions was not significant. A trade-off to watch, not a benefit.
      Set a minimum price per unit of alcohol in EnglandDeaths wholly attributable to alcohol Health and care−13.4% (about 156 deaths a year averted in Scotland)95% CI −18.4% to −8.3%England over the same period (controlled interrupted time series); May 2018 to December 2020, at 50p a unitevaluated; moderate confidence; Scotland (England as control)Measured at a 50p floor in 2018–2020; the effect of 65p, or of a floor in England, is a forecast. Deaths from acute causes rose slightly but not significantly.
      Set a minimum price per unit of alcohol in EnglandHospital admissions wholly attributable to alcohol Health and care−4.1% (not statistically significant)95% CI −8.3% to +0.3%; results varied with the control group usedEngland over the same period; May 2018 to December 2020, at 50p a unitevaluated; limited confidence; Scotland (England as control)The interval includes no effect. Admissions for chronic causes fell; acute-cause admissions rose non-significantly; COVID-19 overlaps the period.
      Set a minimum price per unit of alcohol in EnglandFinancial strain for some people with alcohol dependence on low incomes Poverty and inequality · harmSize not established—evaluated; limited confidence; ScotlandQualitative evidence: PHS found no evidence that these experiences were prevalent or typical, and limited evidence that MUP cut consumption among people with dependence. Treatment and support services are the mitigation.
      Measure what school mental health teams achieve as they reach every school, and close the gap for children with greater needsChildren’s mental health and timely access to support Health and careDirection plausible; size not established—plausible spillover; limited confidence; EnglandOnly perceived benefits and school satisfaction have been reported; the NIHR-funded follow-on evaluation that began in 2023 had not published child outcome results by 4 October 2026 (its project page gives a final report in May 2027).
      Past appraisals, kept apart from funding (1)
      What 2000s Sure Start cost and what the IFS estimates it returned, per cohort

      Children with access to a Sure Start centre in England, cohorts born around 1990–2007. Horizon: lifetime of each cohort (benefits discounted at 3.5%). 2023-24 prices, discounted. A historical appraisal — not a budget for a new programme and not cash savings.

      • Upfront cost: £2.7bn

      • Estimated benefits: £5.5bn in total — to government (lower spending and extra tax) £2.4bn; to individuals (higher earnings) £3.1bn

      The cost is peak 2010 annual spending used as a stand-in for one cohort. Benefits rest on modelled lifetime earnings. None of this is money available to fund a new service today, and today’s family hubs are not the same programme.

      Source: Institute for Fiscal Studies, The short- and medium-term effects of Sure Start on children’s outcomes, Table ES.1, printed p.11

      How we would know

      Healthy life expectancy at birth, women; Healthy life expectancy at birth, men; Preventable cardiovascular deaths under 75; and 6 more.

      The outcome measures to watch. A baseline is where we start, not a target; where there is no official target we say so.

      Measured results

      What each option would be judged on, and the latest value of the measures already on this page. A measure moving is not proof that an option caused it.

      Where the ideas come from

      Research, counter-evidence and methods (31 sources; 3 claims held back)

      Counter-evidence and criticism

      • Set a minimum price per unit of alcohol in England: There is limited evidence that MUP cut drinking among people with alcohol dependence, and qualitative evidence of financial strain for some on low incomes; one survey-based study found larger consumption falls in less deprived areas; admissions results were not significant. (Public Health Scotland)
      • Rebuild integrated early-years help where access is weakest: Updated methods removed an earlier fall in EHC plans; crime results are mixed (more cautions); benefits are largely modelled lifetime earnings. Wales’s Flying Start raised service contact but found no measurable difference in child development by about age three. (Institute for Fiscal Studies; Welsh Government (Ipsos MORI and SQW))
      • Measure what school mental health teams achieve as they reach every school, and close the gap for children with greater needs: Large UK trials of school-based lessons found no benefit for emotional difficulties, and some subgroups did worse; the teams have not been tested against a comparison, so their benefit is unproven rather than disproven. (Evidence-Based Mental Health 25(3):99–109; Department for Education)
      • Close the gap in effective depression treatment where completion and recovery are lowest: Recovery rates in English service data have no control group, and the trial found no effect on work; more courses could also lengthen waits between sessions if therapists are not added. (Psychotherapy and Psychosomatics 89(2):90–105)
      • Bring effective stop-smoking treatment to routine and manual workers: Self-reported four-week quits overstate lasting quits (only 12% of quit attempts were carbon monoxide-validated quits in 2025–26), and outreach may mainly reach smokers who would have sought help anyway. (NICE)

      Claims held back

      • Northern Ireland has dropped minimum unit pricing for this Assembly mandate — Found only in a news report quoting the Health Minister; no Assembly or Department of Health record was found. Needed: A Department of Health (NI) statement or Assembly record.
      • A £49m budget for the 2025–26 Mental Health Support Team expansion — Seen only in secondary reporting, not in a government document. Needed: A DfE or NHS England funding document.
      • Mental Health Support Teams improve children’s mental health — Only perceived benefits and satisfaction have been reported; the NIHR-funded follow-on evaluation that began in 2023 had not published child outcome results by 4 October 2026. Needed: The NIHR impact evaluation, or another comparison-based study.

      “Full text checked” means we read the report itself; “relevant passages” means the sections behind each figure; “summary or abstract only” means we could not read the full study, so no number from it is published here without another source.

      Other options compared — not on the shortlist (4)

      Other options compared

      Options from earlier work on this page that are not on the shortlist. They remain valid choices; their evidence is shown as before.

      • preventionStatus: operating

        Help smokers quit, and stop young people starting

        Aims to:
        Fewer smokers, especially in deprived areas where smoking rates are highest; fewer heart, lung and cancer deaths later.
        How:
        Local stop-smoking services combine behavioural support with medication or vapes; age-of-sale rules reduce uptake.
        Who decides:
        Councils (local stop-smoking services); DHSC and Parliament (age-of-sale law); NHS trusts (treating tobacco dependence in hospital).
        Main constraint:
        Public health grant budgets; reaching smokers who do not seek help.
        Evidence:
        Strong evidence — evaluated, and transferable to this case
        See the trade-offs and evidence
        What the evidence shows
        NICE finds behavioural support combined with stop-smoking medicines among the most effective and cost-effective public health interventions. Effects on mortality accrue over years after quitting.
        Policy status
        Stop-smoking services operate locally, with £152.8m ring-fenced for smoking cessation in the 2026–27 public health grant. The Tobacco and Vapes Act 2026 (Royal Assent 29 April 2026) makes it an offence to sell tobacco to anyone born on or after 1 January 2009, from 1 January 2027.
        Resources
        Public health grant; trained advisers; NHS prescribing.
        Consent and decisions needed
        Age-of-sale rules restrict a legal product; support for them is not measured here.
        Time
        Quit rates within a year; lower mortality over a decade or more.
        Cost and yield
        No single current costing is cited here.
        Trade-offs and who pays
        Lost tobacco duty; enforcement costs; questions about personal liberty.
        How we would know it worked
        Leading indicator: Four-week quit rates in stop-smoking services. Outcome: Adult smoking prevalence by deprivation; preventable cardiovascular and cancer deaths. It would not be working if: Service quits rise but smoking prevalence in deprived areas does not fall.
      • preventionStatus: operating

        Change the food environment

        Aims to:
        Less obesity and type 2 diabetes, starting with children.
        How:
        Levies and advertising rules push manufacturers to reformulate and shift what people buy.
        Who decides:
        HM Treasury (levies); DHSC; Ofcom and the Advertising Standards Authority (advertising rules).
        Main constraint:
        Industry reformulation choices; substitution to untaxed products.
        Evidence:
        Moderate evidence — evaluated, with limits on scope or transfer
        See the trade-offs and evidence
        What the evidence shows
        An interrupted time-series evaluation linked the Soft Drinks Industry Levy (2018) to an 8% relative reduction in obesity among Year 6 girls, largest in deprived areas, with no clear effect for boys or younger children. Evidence for other food rules is earlier-stage.
        Policy status
        Soft Drinks Industry Levy in force since April 2018.
        Resources
        Mainly regulatory; HMRC collection; monitoring of product sales.
        Consent and decisions needed
        New levies need Treasury and parliamentary approval; public support not measured here.
        Time
        Product changes within two years; health outcomes over many years.
        Cost and yield
        Levies raise revenue rather than cost money; administration costs not separately cited.
        Trade-offs and who pays
        Higher prices fall proportionately harder on low-income households.
        How we would know it worked
        Leading indicator: Sugar sold per person in levied products. Outcome: Child obesity at Reception and Year 6 by deprivation. It would not be working if: Sales fall but child obesity does not change.
      • preventionStatus: operating

        Find high blood pressure and diabetes earlier

        Aims to:
        Fewer heart attacks and strokes through earlier treatment of risk factors.
        How:
        Checks in GP surgeries and pharmacies identify people at risk, who then receive treatment or advice.
        Who decides:
        Councils (NHS Health Check commissioning); NHS England and integrated care boards (GP and pharmacy services).
        Main constraint:
        Primary care capacity; reaching people who do not attend.
        Evidence:
        Limited evidence — plausible mechanism, little direct evaluation
        See the trade-offs and evidence
        What the evidence shows
        Reviews of the NHS Health Check find it increases the detection of high blood pressure, diabetes and kidney disease, but measured reductions in cardiovascular risk are modest and take-up is lowest among those at highest risk.
        Resources
        GP and pharmacy time; follow-up treatment capacity.
        Consent and decisions needed
        Largely uncontested; competes with other uses of GP time.
        Time
        Detection within a year; outcome effects over five to ten years.
        Cost and yield
        No single current costing is cited here.
        Trade-offs and who pays
        Checking people at low risk uses scarce appointments; more diagnoses add to treatment demand.
        How we would know it worked
        Leading indicator: Share of eligible adults checked, by deprivation. Outcome: Preventable cardiovascular deaths before 75 in the most deprived tenth. It would not be working if: Checks rise mostly among low-risk groups and the deprivation gap does not narrow.
      • preventionStatus: operating

        Warmer, drier homes

        Aims to:
        Better respiratory and general health for people in cold, damp housing.
        How:
        Insulation, heating and damp repairs reduce exposure to cold and mould.
        Who decides:
        DESNZ and MHCLG (energy efficiency and housing standards); councils and landlords.
        Main constraint:
        Installer capacity; landlord compliance; enforcement by councils.
        Evidence:
        Moderate evidence — evaluated, with limits on scope or transfer
        See the trade-offs and evidence
        What the evidence shows
        A Cochrane review found that warmth improvements, especially for people with chronic respiratory disease or in inadequately heated homes, improved health; effects of general housing improvement were less clear.
        Policy status
        Energy efficiency schemes and housing standards operate; details are on the Energy and Housing pages.
        Resources
        Capital grants; installers and building trades.
        Consent and decisions needed
        Standards for private landlords are contested on cost.
        Time
        Health effects within a few winters for those most exposed.
        Cost and yield
        Depends on scheme; see the Energy page.
        Trade-offs and who pays
        Costs passed to tenants or bill payers; competes with other housing priorities.
        How we would know it worked
        Leading indicator: Homes in the lowest energy-efficiency bands. Outcome: Winter respiratory admissions in targeted areas. It would not be working if: Homes are upgraded but admissions among residents do not change.
      The options side by side
      OptionResourcesTimeEvidenceOutcome to watch
      Help smokers quit, and stop young people startingPublic health grant; trained advisers; NHS prescribing.Quit rates within a year; lower mortality over a decade or more.strongAdult smoking prevalence by deprivation; preventable cardiovascular and cancer deaths.
      Change the food environmentMainly regulatory; HMRC collection; monitoring of product sales.Product changes within two years; health outcomes over many years.moderateChild obesity at Reception and Year 6 by deprivation.
      Find high blood pressure and diabetes earlierGP and pharmacy time; follow-up treatment capacity.Detection within a year; outcome effects over five to ten years.limitedPreventable cardiovascular deaths before 75 in the most deprived tenth.
      Warmer, drier homesCapital grants; installers and building trades.Health effects within a few winters for those most exposed.moderateWinter respiratory admissions in targeted areas.

      Plan reviewed 2026-10-07. How we judge evidence.

      How this connects

      Sources and methods (5)

      Method notes

      • Life expectancy and healthy life expectancy are period measures: they apply current death rates and health reports to a hypothetical newborn. They are not forecasts of how long anyone will live.
      • Healthy life expectancy uses self-reported general health. ONS designates the latest release official statistics in development because Annual Population Survey samples have fallen.
      • Life expectancy here comes from ONS’s local-area tables (five-year age bands), which ONS pairs with healthy life expectancy. The National life tables use single years of age and can differ by about 0.1 year.
      • UK figures are used for the headline; deprivation and mental health figures cover England only. Each chart states its geography.