NHS AT 75: THE ROLE OF TOWN CENTRES IN IMPROVING HEALTH DETERMINANTS

In the week that marks the 75^th year since the formation of the National Health Service, we take a closer look at the wider themes underpinning health across the country and how shifts in real estate can support better outcomes.

A baby is delivered every 54 seconds by the NHS. That baby has access to free healthcare at the point of delivery for the rest of their life, with significant resources across a very wide range of areas.

But there are also times when wider choices and circumstances can also affect people’s health outcomes.

Location matters. If the baby is born into one of the most deprived areas in England, it is likely to have a lower life expectancy. King’s Fund research[i] informs us that between 2019 and 2021, the gap in life expectancy grew by 0.7 years for women and by 1.1 years for men, while 2021 data illustrates that between those in most deprived and least deprived areas in England the difference in life expectancy for women and men respectively is 8.6 years and 10.4 years.  

And as the baby reaches older age, it will join a growing cohort of seniors. Census 2021 data demonstrates that the number of people aged 65 years and over increased from 9.2 million in 2022 to over 11 million 2021. The same data informs us that the proportion of people aged 65 years and over rose from 16.40% to 18.60%[ii]. By 2040, nearly one in seven people is projected to be aged over 75 [iii].

Other, wider, determinants of health include:

• Income – research suggests that children from households in the bottom fifth of the income distribution are 4x more likely to experience severe mental issues compared to those in the highest fifth.
• Housing – poor quality housing is linked to a number of health conditions including respiratory diseases and depression.
• Education – amongst OECD members, those with a university degree (or equivalent) at age 30 can expect to live more than five years longer than those with lower levels of education.
• Work – unemployment is linked to lower life expectancy.
• Environment – access to green spaces can improve physical and mental health and lead to lower levels of obesity. Air pollution also cuts lives short and exposure to poor air quality is associated with deprivation and ethnicity.

Our town centres and high streets at the heart of our communities are already diversifying to meet a number of challenges and drive social investment. While doing so, there’s a real opportunity to address these issues in an integrated way that puts people’s wider health needs at their heart.

• Housing – the delivery of high-quality housing, which should meet a diverse set of local needs, most importantly keyworker housing for NHS staff to support the workforce strategy and better retirement living and care to meet the needs of our ageing population. Retirement living schemes often offer health and wellbeing programmes with a proven record of easing the burden on our NHS.
• Access to good quality jobs – a vibrant town centre with a diverse set of uses attracts investment (of all kinds) and creates jobs and prosperity.
• Well-planned public infrastructure – this includes delivery of schools, hospitals, primary care (GPs and pharmacists, for example), social care and council services.

As the NHS model shifts to one of prevention over cure, bringing health and social care into the town centre, will become more prevalent.

We have already seen the delivery of numerous Community Diagnostic Centres, some of which have been opened in town centres, to address the backlog associated with COVID-19 and central Government has committed £2.3billion of funding to deliver 160 CDCs by 2025.

Integrated Care Systems have also evolved to bring together NHS stakeholders and other key public sector stakeholders, including councils, to the table to join up the planning and delivery of health and social care.

There is a role for the private sector, too, in embedding these uses into existing assets, repurposed buildings and new developments. Partnership between public and private sectors can often help unlock challenges around delivery in a sustainable way.

Together, these and other real estate initiatives can play an important role in supporting populations and offering more opportunities for healthier living, as well as helping to bring greater vibrancy and growth to our town centres. It is an area with real potential for improvement.

And finally, in the spirit of NHS at 75, we wanted to include a note on the ‘Windrush Generation’. Many will be aware that the 75^th anniversary of the NHS coincides with the 75^th anniversary of the 22 June 1948 arrival of HMT Empire Windrush in the UK, carrying over 1,000 passengers from the West Indies. With so many of these passengers taking up roles in the new NHS which launched two weeks later, it is well known that the journey of these Black and Global Majority NHS colleagues was not an easy one.

The resilience and community spirit of the Windrush Generation in the face of prejudice, discrimination and racism helped shape the NHS into the world-renowned health service it is today. It now has a workforce representing over 200 nationalities and ethnic minorities making up almost a quarter of all NHS staff, and as part of the NHS at 75 celebrations Amanda Pritchard, Chief Executive of NHS England, has said: “The 75th anniversary of the arrival of the Windrush is a fantastic opportunity to celebrate the work of our Black and other ethnic minority colleagues and their significant contributions to the National Health Service… They were critical to the formation of the NHS, and I am honoured to work alongside their descendants and generations that followed in their footsteps.”

[i] https://www.kingsfund.org.uk/publications/what-are-health-inequalities#:~:text=This%20contributed%20to%20widening%20inequalities,and%2010.4%20years%20for%20men.

[ii]https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ageing/articles/profileoftheolderpopulationlivinginenglandandwalesin2021andchangessince2011/2023-04-03#:~:text=2.,from%2016.4%25%20to%2018.6%25.

[iii]https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/816458/future-of-an-ageing-population.pdf