Building for health

Taken as a whole the NHS is one of the largest landowners in England. Through its role as an anchor institution, the NHS has an opportunity to intentionally manage its land and buildings in a way that has a positive social, economic and environmental impact. The effects of good management can improve the health and wellbeing of communities and reduce health inequalities.

We have developed practical information for estates and facilities managers, planning, health inequalities or strategy leads, and anchor or sustainability coordinators in NHS provider organisations and integrated care systems (ICSs).

The role of estates in reducing health inequalities

A well-maintained and well-designed estate is the bedrock on which clinical services are delivered. It is essential they meet current and future service needs, provide a good patient experience, offer a high-quality healing environment, and support the NHS and government’s net zero carbon strategies.

We have summarised the key ways estates and facilities can play their role in reducing health inequalities in our 10 building blocks for building for health.

The building blocks can be applied to all aspects of estates management including in the:

  • delivery of new healthcare buildings, for example through the New Hospital Programme or the development of community diagnostic centres
  • modernisation of NHS facilities
  • prioritisation of investment
  • management of the use of NHS buildings and spaces
  • ‘disposal’ or repurposing of facilities the NHS no longer needs – the NHS Estates and facilities workforce action plan (2022) sets out ways to address estates workforce needs.

The building blocks can be applied to the concept, detailed design and construction and operation stages.

10 key building blocks for health

 

1. Supporting community development

  • use of premises by the community and voluntary, community and social enterprise (VCSE) organisations
  • co-location of community facilities and public services
  • supporting integrated care and partnership working
  • using and supporting community assets.

Example case study

GP practices and wider primary care activities in one location in the form of new integrated health and wellbeing centres are ‘super’ facilities which bring primary care activities in one location – for example dentistry, general practice, community pharmacy and optometry under one roof. Sleaford is one of six pilot sites across England is expected to achieve extensive economic development and wider social outcomes for its community, eg attract business, support regeneration.

Read about the Sleaford Health and Wellbeing Centre.

2. Improving location and access

  • estate located in areas of high deprivation or improving access from those areas (for healthcare and employment)
  • catalysing improvements to transport infrastructure particularly affordable public transport
  • encouraging active travel such as walking or cycling
  • exemplar inclusive physical and cultural design.

Example case study

Transport for Greater Manchester and lead transport officers from the ten Greater Manchester authorities have been working to develop a new people-centred framework for street planning to level up the transport network, support growth and productivity and meet decarbonisation targets. The framework aims to support decision making across Greater Manchester to balance the complex demands of communities.

Read about the people-centred framework for street planning.

3. Supporting healthier communities

  • providing healthy and affordable food options for patients, visitors and NHS staff
  • improving connectivity to wider public services in areas of greatest need
  • enabling social interactions and reducing isolation through volunteering
  • inclusive indoor and outdoor exercise facilities, supporting prevention programmes.

Example case study

The Life Rooms programme introduced by Mersey Care enables the trust to engage with people on local high streets by creating ‘life rooms,’ which provide people with spaces and resources to support learning, social interaction and access services such as social prescribing.

Read about the Life Rooms programme.

4. Facilitating economic development

  • catalysing regeneration of communities in urban or rural areas
  • improving footfall of high streets
  • enhancing civic pride
  • supporting town and spatial planning and improving public realm – attracting investment.

Example case study

Individuals are released on licence from prison to help build affordable, eco-friendly housing pods that will be situated on various ‘meanwhile use sites’ (temporary use sites) across the Southwest, including NHS Trust estates. The modular housing will provide accommodation for vulnerable members of the community.

Read about the Prisoners Building Homes programme.

5. Enabling access to green space

  • use of estates and land for social prescribing and community projects
  • creating new or improving quality of natural environment and green space for people and wildlife
  • use of green space for physical activity, play spaces, socialising and food growing.

Example case study

The Primary Care Lambeth GP Food Co-op build gardens on land occupied by GP practices and NHS hospitals. The project allows for people to learn how to grow healthy food in a safe, secure and supported environment.

Read about the Food Co-op healthy food project.

6. Access to good inclusive employment and training in estates

  • enhancing access to employment, skills and training programmes for communities that experience inequalities (across planning, construction and facilities management)
  • fair terms and conditions and supporting health and wellbeing of employees and career progression including supply chains
  • provision of space for training, education and upskilling.

Example case study

Whipps Cross Hospital has developed ‘training wards’ to support access into higher education and the levelling up agenda. Barts Health NHS Trust has partnered with a further education provider and is developing its estate to support and roll out a nurse practitioners education programme.

Read about the training wards project.

7. Improved design

  • developing safe, healthy, physically and culturally inclusive spaces
  • embedding community engagement
  • supporting digital inclusion
  • quality public realm.

Example case study

The Healthy Happy Places programme has been introduced to support mental health and wellbeing through the built environment in the Northeast and North Cumbria (NENC). This new programme is intended to test out a concept and explore what impact and innovative practices could be achieved through collaborations between planning, design, health, and public health partners in responding to community health and wellbeing needs through the built environment.

Read about the Healthy Happy Places programme.

8. Access to quality and affordable housing

  • re-using and developing estate for affordable and inclusive key worker accommodation
  • re-using and developing estate into housing to support vulnerable communities.

Example case study

Sandwell and West Birmingham Hospitals NHS Trust (SWBNHST) has partnered with St Basils homelessness charity to transform an empty, unused hospital building into accommodation for homeless youths who then lived and worked on the trust estate. As part of the programme, the trust offers training and follow-on apprenticeships in a wide range of NHS skills.

Read about the partnership work for homeless youths.

9. Reducing negative environmental impact

  • supporting Net Zero carbon targets and sustainable consumption and production
  • reducing air pollution through fleet innovation (eg low emission vehicles)
  • raising awareness of environmental actions staff, patients and visitors can implement at work and home.

Example case study

Eight ambulance trusts are trialling 21 zero-emission vehicles of various types, with six of the new green vehicles dedicated to mental health response in the community – designed to cut emergency response times for people with mental health needs and help reduce demand on traditional double-crewed ambulances.

Read about the electric ambulance project.

10. Social value in procurement

  • supporting local business or VCSE
  • consideration of social, environmental and economic impacts of supply chain
  • embedding at least 10% social value and optimising social, economic and environmental investment
  • sharing investment.

Estates teams can optimise impact by:

Focusing on priorities

Aim to support communities identified in the Core20PLUS5 approach or those that locally experience the most heath inequalities and address social and economic issues identified by Integrated Care Partnerships (ICPs).

Working in partnership with communities and stakeholders

Working in partnership with communities and stakeholders will help identify what is important and of value. It will support innovation and help ensure local assets are used and enhanced where possible. Engagement should be inclusive, meaningful and embedded throughout the design and delivery process. Working with voluntary, community and social enterprise and with partners on the design and delivery of any estates initiative can help ensure this is achieved.

Measuring, evaluating and iterating

To ensure the initiative is making a difference, it is important to evaluate the impact. This can inform next steps including any iterations required. Sharing impacts also supports transparency and accountability and allows successes to be shared and celebrated. Further information on evaluating impact can be found in The Greenbook Guidance, the Comprehensive Investment Appraisal (CIA) Model and guidance and on the HALN measurement page.

Providing training and sharing good practice

Increase awareness of health inequalities and the role of the NHS as an anchor, including how estates can address them through training and development and sharing inspiring good practice examples.

Improving leadership, culture and governance

Embed the role of estates in reducing health inequalities into strategy, decision making, policy and guidance.


Case Studies

Sleaford Health and Wellbeing Centre

Lead organisation: NHS Lincolnshire Integrated Care Board

GP practices and wider primary care activities in one location in the form of new integrated health and wellbeing centres are “super” facilities which bring primary care activities in one location – for example dentistry, general practice, community pharmacy and optometry under one roof. Sleaford is one of six pilot sites across England is expected to achieve extensive economic development and wider social outcomes for its community, eg attract business, support regeneration.

Links to health inequalities outcomes

  • the facility will act as a catalyst for social and economic regeneration in the town
  • enhance socio-economic conditions supporting reduction in health inequalities leading to an enhanced population health profile for Sleaford
  • focus on prevention and creating good health for all
  • access to a full range of services including third sector, closer to home helping to improve accessibility and address the wider determinants of health.

Outputs and outcomes   

A wide range of socio-economic benefits are proposed including reduction of long-term conditions, carbon reduction and creation of over 100 additional job opportunities; estimating a potential social return on investment of £4.72 for each £1 spent.

Back to the 10 building blocks for building for health

Manchester Streets for All

Lead organisations: Transport for Greater Manchester and Greater Manchester Combined Authority

Transport for Greater Manchester and lead transport officers from the 10 Greater Manchester authorities have been working to develop a new framework for street planning to level up the transport network, support growth and productivity and meet decarbonisation targets, The framework aims to support decision making across Greater Manchester to balance the complex demands of communities. The programme is a people-centred approach to street planning, design and network management which is needed to level up the transport network, support growth and productivity and meet decarbonisation targets.

Links to health inequalities outcomes

Most of the issues that Streets for All seeks to address are directly or indirectly related to health inequalities:

  • poor air quality and high carbon emissions from road transport
  • congested roads as use of private vehicles has increased
  • low levels of physical activity as people make fewer journeys on foot or by bike
  • too many road traffic injuries and deaths
  • communities divided by major roads
  • declining use of buses
  • fewer children playing in the streets
  • increased isolation, particularly for older or mobility impaired people, and those without access to a car.

Outputs and outcomes

The programme aims to:

  • improve quality of life
  • protect the environment
  • support sustainable economic growth.

Further information 

  • Read this report by the Greater Manchester Local Government on their ‘Streets for All’ strategy to ensure streets are accessible for all and support green methods of transport.

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Health on the High Street – The Life Rooms

Lead organisation: Mersey Care NHS Foundation Trust and the Life Rooms

The Health on the High Street programme has been introduced to integrate health services into local high streets. High streets tend to be at the centre of public transport networks, making health and care services more accessible to people and increase their engagement and effectiveness. Integrating healthcare into the high street has numerous benefits including addressing health inequalities, improved capacity for health service delivery and attracting more people into their local high street, while encouraging healthier lifestyles.

A key example of this is the Life Rooms Programme introduced by Mersey Care. The programme enables the trust to engage with people on local high streets by creating ‘life rooms,’ which provide people with spaces and resources to support learning, social interaction and access services such as social prescribing. They are designed to help members of communities feel better about themselves and their lives in a non-medical manner. The services are delivered in accessible spaces at the heart of the community and have been designed and operated with service users and stakeholders. Volunteers are closely involved and many of them have experience of accessing Mersey Care’s services.

The focus is on prevention and enabling the whole community, to bring about positive change. This model aims to improves the health of the population and reduce pressure on clinical services.

Links to health inequalities outcomes:

  • Courses are provided to support mental and physical health as well as cultural and creative opportunities
  • Support is offered in areas such as employment, housing and debt

Outputs and outcomes       

The life rooms have demonstrated improvements to mental health wellbeing and a reduction of the burden of mental illness.

Further information 

  • read the NHS Confederation report on the recovery of local services and communities in the light of COVID-19
  • visit The Life Rooms webpage
  • read this report by The Life Rooms in partnership with Mersey Care NHS Foundation Trust on the community healthcare.

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Prisoners Building Homes Programme

Lead organisation: Avon & Somerset Police

Individuals are released on licence from prison to help build affordable, eco-friendly housing pods that will be situated on various ‘meanwhile use sites’ (temporary use sites) across the Southwest, including NHS Trust estate. The modular housing will provide accommodation for vulnerable members of the community.

Links to health inequalities outcomes:

  • Builds communities for vulnerable groups
  • Provides prisoners with transferable construction skills to improve employability upon release from prison
  • Provides affordable housing on under-used sites.

Outputs and outcomes       

Provision of suitable accommodation on release from prison can reduce reoffending by up to 50%.

Further information

  • visit the Avon & Somerset Police & Crime Commissioner webpage on the Prisoners Building Homes programme being undertaken in Hardwicke, Gloucester
  • watch this video documenting the Prisoners Building Homes programme in the South West.

Back to the 10 building blocks for building for health

Primary Care Lambeth GP Food Co-operative

Lead organisation: Lambeth GP Food Co-op

The Primary Care Lambeth GP Food Co-op build gardens on land occupied by GP practices and NHS hospitals. The project helps people learn how to grow healthy food in a safe, secure and supported environment. The gardens provide a space for people to connect and learn together. Patients with long-term health conditions are given opportunities to join gardening groups at their local practice where they are supported by an experienced gardener.

Links to health inequalities outcomes:

  • addresses isolation issues
  • supports self-care and community resilience
  • involvement has supported better mental health and management of long term conditions
  • promotes physical activity
  • provision of environmental functions, such as reducing flood risk and moderating climate and pollution.

Outputs and outcomes       

Number of GP appointments in the area were shown to decrease.

Further information

  • visit the GP Food Co-op webpage to find out more
  • watch this video documenting the patient experience of working together to grow food at the Lambeth GP Food Co-op.
  • view this recorded event by the Health Anchors Learning Network on how the NHS and estates can work together to combat inequality featuring this example
  • read this report by The Kings Fund on the beneficial link between gardening and population health and wellbeing.

Back to the 10 building blocks for building for health

Whipps Cross Barts Health Futures Hub, Hospital Practice Ward

Lead Organisation: Barts Health NHS Trust

Development of ‘practice’ ward (training wards) at Whipps Cross Hospital to support access into higher education and the levelling up agenda. Barts Health NHS Trust has partnered with a further education provider, Newham College, and is developing its estate to support and roll out a nurse practitioners education programme.
Links to health inequalities outcomes

Links to health inequalities outcomes:

• creating fair employment and good work for all
• creating and developing healthy and sustainable places and communities
• investment in workforce – with more people and new ways of working
• supports the economy through financial and social return on investment.

Outputs and outcomes

• Aim to reduce nursing vacancies and improve staff retention.

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Healthy Happy Places

Lead organisation: Northeast and North Cumbria (NENC) ICS Academic Health Science Network

The Healthy Happy Places programme has been introduced to support mental health and wellbeing through the built environment in the Northeast and North Cumbria (NENC). This new programme is intended to test out a concept and explore what impact and innovative practices could be achieved through collaborations between planning, design, health, and public health partners in responding to community health and wellbeing needs through the built environment.

The programme will develop a conceptual design for a sustainable innovation hub in the NENC for healthy, happy environments. It will explore models that can catalyse investment through innovative financing mechanisms and multi-sector engagement, eg for housing and the public realm. Sites within the region will be identified and options to place mental health and wellbeing at the heart of urban planning will be considered.

Links to health inequalities outcomes:

  • Improvement in mental health services and services for people with a learning disability and/or autistic people.

Outputs and outcomes       

Several outputs are expected including:

  • A baseline understanding of the gaps and barriers experienced in the NENC for the role of the built environment on health outcomes.
  • Evaluation framework in place for assessing impact on wellbeing as part of the identified proof of concept project(s).

Further information 

  • Visit the Academic Health Science Network webpage on the ‘Healthy Happy Places’ programme.

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St Basils live and work scheme

Lead organisation: Sandwell and West Birmingham Hospitals NHS Trust (SWBNHST)

The trust partnered with St Basils, a homelessness charity, to transform an empty and unused hospital building into accommodation for homeless youths who then lived and worked on the trust estate. As part of the programme, the trust offers training and follow-on apprenticeships in a wide range of NHS skills.

Links to health inequalities outcomes:

  • supports vulnerable communities
  • brings homeless young people into safe and secure accommodation and provides a pathway to employment work
  • supports the economy through financial and social return on investment (£14 gained from every £1 spent)
  • creates fair employment and a good working environment.

Outputs and outcomes

94% of the people who lived in the block went into education and employment.

Further information 

  • Watch this recorded event by the Health Anchors Learning Network on how the NHS and Estates can work together to combat inequality featuring this example.
  • Read this report from The Centre of Community Research on the live and work scheme carried out at St Basils and Sandwell and West Birmingham Hospital NHS Trust.

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