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Build back healthier: the role of NHS estates in population health

The growing interest from NHS leaders in the power of their wider economic and social impact is having profound implications for how the service acts in a range of important areas. Can we recruit not simply to fill vacancies, but to transform lives in some of our most deprived wards? Can we procure in ways that support local businesses to prosper and strengthens our post-Brexit industrial outlook? Can we align our estates development with local infrastructure planning to unlock new opportunities for our communities? After all, population health is about making people both better and better off.

This last question is particularly pertinent for a number of reasons.  This government has announced significant investment in hospital infrastructure throughout the term of the Parliament and beyond, directly aligning it with the politics of their levelling-up agenda. I have seen in my national work how some integrated care systems, understanding this nuance, have started explicitly telling the story of what their hospital plans mean for their place; in terms of employment, investment and opportunity. Surely, this ‘anchoring’ will in time become the rule rather than the exception of NHS capital and estates planning.

The acute picture is important, of course, but given the impacts of COVID-19 on the economic and social fabric of our communities, perhaps more of our interest should be directed on what we can do at the heart of the very areas where people live, work, shop and meet.

As described in a joint NHS Confederation – Power to Change report published in December 2020, the high street fits this brief well. An economic, social and cultural hub that shapes the vibrancy, wellbeing and prosperity of our cities, towns and villages up and down the country. High streets are also in many ways the place where the changing picture of the pandemic’s impact has been most vividly illustrated.

What if, through rethinking our NHS estate, we could:

  • play a leading role in supporting the high street through these challenging times, diversifying the local offer, increasing footfall and putting money in the pockets of both community-owned businesses and the local authority;
  • deliver health and care services in ways which improved their effectiveness and engagement, rather than requiring people to travel for healthcare on the outskirts of towns;
  • embed health in its broadest sense as a more important, explicit part of the future ‘experience’ of our place, particularly if retail is no longer the dominant local theme?

For all the damage that COVID-19 continues to bring, this opportunity does now exist and is starting to permeate our collective thinking.

Rooted at the very heart of place, and with perhaps more to offer and more to gain from taking this approach, primary and community care is an obvious area to start. In line with the remodelled HM Treasury Green Book, our opening thoughts should revolve around how our communities’ needs could be best met by our local developments, rather than simply addressing the needs of the NHS. How can we understand, measure and improve the socio-economic impacts of our planning and who would we partner with to maximise this, often generational, opportunity to regenerate our local area?

More specifically, NHS colleagues have in several places reached out to say they are looking at utilising newly-vacated floorspace in, for example, a local Debenhams. What is particularly interesting is that they don’t want this to be an NHS-only building, rather a multi-purpose community hub in which health and wellbeing plays a vital complementary part but which engages citizens in a much broader sense.  Seen through this prism, the real value of the high street is in the potential for a maturing in the relationship between the NHS and communities, with less of an overtly clinical focus and instead enabling people to come and discuss their own health in their own time and on their own terms – and thus increasing their own responsibility.

Similarly, Mersey Care NHS Foundation Trust operates a range of services in a library in Walton which the local authority was about to close for financial reasons. Maintaining the library use and evolving a wider health and care offering, particularly in areas with widening inequalities, is a central part of their Life Rooms ethos. Conceptually the links between the closure of key community assets such as libraries and the implications for population health and demand for our services should be relatively simple to make, however the short-termism of NHS planning often obstructs those innovative, civic-led solutions that exist in our place.

Lastly, there have been a plethora of place-based funding programmes pushed by central government recently and it is particularly pleasing to see much more direct health input into these, including the Town Deal proposals.

We don’t yet know how quickly and effectively our local place will recover from the broad impact of COVID-19. Nor do we fully understand the nature of what will form its economic, social and cultural future. What we do know is that the NHS is there through thick and thin. It is not a distant shareholder disconnected from, and disinterested in, the success of the area. Our investments are clearly shown in the local bricks and mortar, the local people and the local pound, and our role and purpose will always play a part in local pride. A collaborative, interwoven, locally-owned health and care estates plan is a central part of population health and wealth.

Michael Wood
Michael Wood

Michael Wood is head of health economic partnerships at the NHS Confederation. Follow him on @NHSLocalGrowth

Last Updated on 7 June 2022