As part of our Creating healthy Places programme, NHS England's Strategy Programme Manager, Danny McDonnell, updates us on the progress being made in providing modern health services and a healthy physical environment on sites across England where new housing is being delivered.

The built environment is not routine territory for the NHS but with increasing numbers of people living longer and potentially in poorer health (PHE 2016), we recognise an opportunity to ensure that homes and neighbourhoods promote wellbeing and enable independence. Planning and urban design can play a crucial role in achieving this.

Across the country, local authorities and providers and commissioners of health and social care are planning how they will deliver joined up services for the future and putting together ‘Sustainability and Transformation Plans’ (STPs). At the heart of STPs are the communities in which services are delivered.

NHS England’s Five Year Forward View identified new housing developments as an opportunity to rethink how health and social care services are provided to those communities.

New housing also offers the opportunity to encourage healthier behaviours through the built environment and urban design, preventing ill health and encouraging greater independence and self-care.

New housing also offers the opportunity to encourage healthier behaviours through the built environment and urban design, preventing ill health and encouraging greater independence and self-care (NHS England 2014). From this starting point, the Healthy New Towns programme emerged in 2015.

The Healthy New Towns programme

The key question often asked of the programme is “what does a healthy new town look like?” The programme is currently exploring and testing the answer. Through the Healthy New Towns programme, ten demonstrator sites were selected from 114 expressions of interest and announced in March 2016, representing a diverse cross-section of housing developments across England.

A range of developers are involved, from high volume builders to housing associations. The size of the developments ranges from 15,000 to fewer than 1,000 homes. The sites also vary significantly in terms of land values, socio-economic profiles - and crucially from an NHS perspective - population demographics and health needs.

This myriad of local circumstances means that the sites have differing lists of priorities for service delivery and for the most suitable interventions. The demonstrator sites’ delivery plans reflect this contextual diversity although there are common themes relating to new care models, active travel, community activation and digital technology.

NHS England has provided funding and expertise from a range of sources to assist sites put together ambitious delivery plans ensure that health and wellbeing is at the heart of the new neighbourhoods.

Bicester: 'a walk-able and cycle-able community' 

Bicester is a market town whose population is set to double over the next 20-30 years with the construction of 13,000 new homes. Bicester’s Elmsbrook site is an Eco Town as well as a Healthy New Town – the only site in the UK being developed to PPS1 Eco Town standards of environmental sustainability.

The Partnership is using physical connectivity, green corridors and community assets and to build a ‘walkable and cycleable community’ that links the new areas of housing with the existing market town.

Overseeing the planning and delivery of housing development is the Bicester Healthy New Towns Partnership, whose core members are Cherwell District Council, Oxfordshire Clinical Commissioning Group, Oxford Academic Health Science Network and A2 Dominion Housing Group.

One key aim for Bicester is to increase physical activity amongst residents. The Partnership is using physical connectivity, green corridors and community assets and to build a ‘walkable and cycleable community’ that links the new areas of housing with the existing market town.

A central green corridor into the town centre will improve air quality, provide cycle and walk ways and reduce reliance on the car. Active travel and green infrastructure will be complemented by community activation activities. In primary and nursery schools this will take the form of a parental involvement strategy, bringing children and parents together to eat healthily and be more active. In workplaces, support will be offered to employees to switch journeys by car to walking or cycling.

The Partnership is also working closely with Sport England encourage physical activity in residents’ daily lives.

Joining up healthcare services

The NHS has major programmes underway to make healthcare provision more efficient and to improve the experience of patients by re-designing and joining up healthcare services – such as through Multi-Speciality Community Providers (MCPs) and Primary and Acute Care Systems (PACS) models (NHS England 2016).

An example of re-designed service provision is a diabetes clinic running alongside occupational therapy, dietetics and diabetes support services to enable diabetic patients to receive much of the treatment and support they need in one place on the same day.

As part of the Healthy New Towns programme, several demonstrators of new, joined-up models of care are being developed in the form of health and wellbeing centres, where several health services will be co-located. Whitehill and Bordon, Halton, Cranbrook and Barton are all exploring this approach.

In Halton in the North West of England, an old hospital site close to the town centre will be redeveloped to provide housing and a health and wellbeing centre.

In Halton in the North West of England, an old hospital site close to the town centre will be redeveloped to provide housing and a health and wellbeing centre. While still at an early stage of planning, Halton is set to show how healthcare services can be delivered as part of wider commercial development on NHS or government land.

Barton Healthy New Town 

Barton is a neighbourhood on the north-east side of the city of Oxford. The new Barton Park housing development of 893 homes is being used as a driver to regenerate the existing neighbourhood and to connect with the existing community.

One of Barton’s propositions is the conversion of an existing neighbourhood centre into a Healthy Living Centre, as part of the development’s Section 106 agreement. The Centre will provide sports facilities, units for community organisations, a GP practice and other primary care facilities.

Nearby, the Oxford’s John Radcliffe Hospital offers the ideal opportunity to bring services from the hospital and embed them within the community, integrating GP, primary and acute data systems to provide seamless care - a key component of wider plans to transform healthcare in Oxfordshire.

What it takes to create a Healthy New Town

To deliver new models of care services in a physical environment that is conducive to good health, a large number of organisations and professional disciplines have to be involved from both the public and private sector.

There isn’t a single answer to describing what a healthy new town looks like; it’s a combination of a huge range of components, including service redesign and integration, active travel infrastructure, behaviour change, healthy food options and many more.

We also need to look at prevention of ill health and treatment of ill health together. This reflects what has been termed a ‘whole systems approach’ (TCPA, PHE 2013): service design, public health and prevention being developed together to achieve holistic change.

There isn’t a single answer to describing what a healthy new town looks like; it’s a combination of a huge range of components, including service redesign and integration, active travel infrastructure, behaviour change, healthy food options and many more.

The examples from Bicester, Halton and Barton are a just a handful of the planned activities Healthy New Towns are undertaking. Wider application In parallel to the on-the-ground work with the demonstrator sites, we’re engaging with home builders, developers and Government to see where else NHS England can connect health, service design and house-building.

The Healthy New Towns programme is mentioned in the government’s Housing White Paper of February 2017 (UK Government 2017) and we hope to influence government policy in the future. Plans are ambitious but also relate to the current planning system and in the fiscal landscape of house-building, local authority budgets and the local health economy.

A focus for the Healthy New Towns programme is therefore to support the creation of healthy neighbourhoods in this political and economic context, across the country.

A Healthy New Towns guidelines and a dossier of best practice is planned to support the wider adoption of the programme’s successes, bringing together evidence with real life examples of best practice. 

Going back to ‘what does a healthy new town look like?’ perhaps the question should instead be ‘how do we ensure everyone can live a healthy life no matter where they live?’

Bicester is a town that is growing and Cherwell District Council has been working with developers on a number of large scale new developments, as well as delivering projects within the existing town. The Eco Town development by A2Dominion at NW Bicester helped us to think creatively about how challenges around sustainable living could be met.

Feedback from planners, urban designers and others involved in the demonstrator sites has consistently referred to the value of bringing different disciplines together to focus on health and well-being. Many of the built environment propositions planned are not revolutionary, but the health and wellbeing driver of this programme helps ensure that good planning and place making are not pushed aside by other concerns.

Going back to ‘what does a healthy new town look like?’ perhaps the question should instead be ‘how do we ensure everyone can live a healthy life no matter where they live?’ The Healthy New Towns programme is beginning to answer this complex question, with cross-sector working as the foundation.

References 

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Feature — 16/11/2017