No hospital is an island… or at least it shouldn’t be.
In this final article from our Town Centre series, we explore how health services have the potential to expand their influence beyond the confines of a single site, to deliver transformative change to the social, economic and environmental conditions of communities.
An anchor to weather the storm
Anchor institutions, like universities and government departments, can be the economic linchpins of an area, providing thousands of job and training opportunities to local people. However, it would be hard to pinpoint any other organisation that matches the clout and contribution of the NHS to local communities. A contribution that has been elevated as a result of the COVID-19 pandemic — raising the profile and value of health services both nationally and within the communities they serve.
As an employer of more than 1.3 million people across the UK, the NHS plays a significant role in not only the health of the nation but in shaping the wealth of it too. In addition to supporting the livelihoods of the people who work there, the economic footprint of the NHS spans well beyond this. From procurement and supply chains to investment in infrastructure and land, the strategic spending power of the NHS reaches all corners of communities and can invigorate the fortunes of local economies.
“NHS organisations are rooted in their communities and local economies. Often the largest employer in any given place, as well as a significant land-owner, driver of new innovations and a procurer, its influence flows through local households, businesses, charities and education providers. Supporting NHS organisations to unlock this economic value and to directly play a role in local regeneration can have multiple benefits.”
Michael Wood, Head of Economic Partnerships, NHS Confederation
The opportunity of Integrated Care Systems
With health services evolving towards Integrated Care Systems (ICS) to better address the health and wellbeing needs of communities as a collective, the NHS can expand its influence, and leverage power beyond its primary calling. As well as improved integration and engagement between health organisations, ICS provide the opportunity for stronger links with the community-focused initiatives and civic services that understand the specific characteristics and challenges of towns and cities.
The collaboration between the NHS, local government and wider partners will generate opportunities for wider regeneration on a scale that until this point hasn’t been possible. From key worker housing to space for social enterprises to flourish, greater financial freedoms and collective spending are key to tackling communities’ complex health and social problems. Exploring possibilities beyond the boundaries of existing NHS infrastructure is a major step towards tackling the deepening health inequalities caused by the varying social and economic conditions across the UK.
But where to drop the anchor?
Reimagining town centre spaces
Ease of access to services is a key priority for the NHS when it comes to reducing inequalities, and with so many town centres calling out for regeneration, high streets offer the perfect nucleus from which to increase accessibility. Designing purpose-built spaces within town centres for GP surgeries, routine diagnostic or therapy centres could replace visits to acute hospital sites. While freeing up much-needed space within hospital estates, it would also increase the visibility and accessibility of vital health and care services.
As a catalyst for wider regeneration, town centre health and care services are the anchor institutions communities need. Redesigning high streets with these functions as integral elements enables these spaces to empower the communities they are built to serve.
“The nature of the pandemic can act as a timely opportunity to radically rethink which NHS services could be more effectively and appropriately delivered in communities, and in ways that make our high streets more economically and socially sustainable, and the services themselves more accessible.”
Michael Wood, Head of Economic Partnerships, NHS Confederation
The correlation between health and wealth
Where the expectations on the NHS once revolved around the provision of care and cure, policy planning has created a long-term commitment to the prevention of ill health and the promotion of wellbeing — supporting people to live longer, healthier lives. As insights develop into the links between the health of the community and the social, economic and environmental factors that influence good health, the remit of the NHS is greater than it has ever been. To meet these growing expectations, the role of the NHS must continue to expand beyond the boundaries of health care properties and into collective community initiatives that positively influence the wellbeing of the nation.
The detrimental impacts of poverty on health are stark — with those in the most deprived area of the UK expected to live 19 years less than those in the least deprived. Likewise, poor health also significantly increases the risk of poverty, and with 1 in 5 people in the UK classified as living in poverty, these statistics have serious implications for the NHS. Strong economies rely on the health and wellbeing of the population, leaving health and wealth inextricably linked.
Ripple effect
The benefit of town centre spaces is that they already come with much of the infrastructure health and care services need. With strong transport links, car parking and connected facilities such as pharmacies, town centres provide the foundations on which to build a balanced social and economic ecosystem. Placing health and care services at the heart of economic development strategies can create a ripple effect that brings wider benefits to the whole community.
A new hospital, medical research centre or equipment manufacturing business creates economic opportunities that can attract fresh investment, supply chains and talent to an area. While on the high street, an increase in vacant spaces and reduction in land values is opening up opportunities for the development of town centre health and care facilities. As well as enabling the delivery of services in the place they are going to have the greatest impact, the provision of health facilities on our high streets would create increased footfall and spending for retail, leisure and other businesses; creating a symbiotic relationship that is a catalyst for sustainable and viable change to local economies.
“The provision of health and care services is changing, with an increasing need to support people to live long, healthy lives in their communities. How and where these primary and community services should be located is sometimes a decision taken from a clinical or cost perspective, yet there remains the opportunity for NHS revenue and covenant strength to also help stabilise high street locations, albeit on shorter leases. Opportunities to co-host these services with other public, leisure and/or commercial services should play more of a part in decision-making.”
Michael Wood, Head of Economic Partnerships, NHS Confederation
Why housing is an NHS issue too
However, for our town centres to really provide transformative change, it’s important to look even further than the functions of retail and health we’ve discussed already. While these changes can positively improve the health and economy of a place, to create truly holistic spaces it’s important to consider housing as a critical factor too. As well as adding to the vitality and economic viability of an area, town centre housing can address wider social challenges. In fact, affordable housing is becoming one of the greatest threats to stability for the NHS. In 2019, a PwC analysis flagged affordability as an acute challenge that was driving key workers to have to commute from ever-further distances, and despite being two years further on, calls to increase council support for affordable housing to address this challenge are still ongoing. This lack of key worker housing could impact many trusts’ ability to recruit and retain vital staff.
Add to this the ticking time bomb of an ageing population, and a lack of appropriate housing stock that meets their needs. As our colleague Bob Smaylen discussed in the first article of this series, without the creation of specialist housing for older people, many will end up occupying much-needed bed space in acute settings.
Housing is therefore an issue that will increasingly impact the NHS and one that can be collectively addressed with creative and collaborative solutions. Some hospitals have already realised the potential of town centres in addressing this issue and have taken action. Yeovil Hospital’s new key worker accommodation will not only breathe new life into a derelict town centre site, but will help improve the lives and livelihoods of hardworking NHS staff and students. Affordable housing can provide a significant boost in income for NHS workers when compared with capped pay-rises that may amount to a real-terms cut.
Investments like this help trusts to recruit and retain staff, while also adding to the vibrancy of an urban area. Likewise, collaborative investment in projects such as urban health and care villages can also provide solutions that benefit the community; from affordable, high-quality living for key workers and the elderly, to investment in facilities and spaces that enhance the health, wellbeing and quality of life for communities.
“Creating spaces where people can pause to chat, to drink coffee away from traffic noise and pollution is hugely beneficial to mental and physical health and means people are more likely to shop locally. If we can add to this with better and more accessible healthcare and housing options for our under-provided-for older generation our town centres will stay bustling and vibrant.”
Anne-Marie Nicholson, Principal, Marchese Partners
Commonality and creativity
A recent report suggests that when it comes to considering its functions as an anchor institution the NHS needs to focus on five key areas: employment, procurement and commissioning, capital and estates, environmental sustainability and localised partnership working. It’s in these areas that the NHS can help, as part of a collaborative effort, to reduce the inequalities and deprivation that undermine economic stability, and create the conditions in which healthy and secure populations can thrive.
As we said at the very start of this article, no hospital is an island. The health impacts felt inside our health institutions are often born out of the conditions of the area surrounding it. Therefore, it’s only by embracing an outward approach and recognising the opportunity that the NHS has to positively impact those conditions that long-term change can be achieved.
As we begin to move forward from a difficult year and learn the true social and economic consequences of the pandemic, it’s more important than ever that the NHS and local community partners identify common goals. In using their collective creativity, funding, scalability and energy they can bring about the long-term economic stability that communities need to support good health and sufficient wealth.
And here at Prime, we believe so many of the solutions to those challenges can be unlocked in the reimaging of our town centres.
