How a prestigious health research charity is influencing how we Build for Health

What’s the largest charitable organisaton in the UK? Measured by assets, it’s the Wellcome Trust, whose mission is to “bring together expertise from across science, innovation and society to generate new knowledge and find equitable solutions to improve life, health and wellbeing”

The Wellcome Trust is funded by the returns from its massive, diverse investment portfolio, which originated from a gift in the will of pharmaceutical entrepreneur Sir Henry Wellcome, making it an independent charitable foundation not reliant on pharmaceutical profits today. Its investments span stocks, private equity, property, and other assets, generating billions annually to fund global health research, including mental health, infectious diseases, and climate and health. 

Its commitment to generating knowledge on climate and health is considerable, and growing. The built environment features prominently:

“The Wellcome Trust addresses the built environment primarily through the lens of human health, focusing on sustainable, low-carbon, and health-promoting urban design. Key initiatives include funding research on climate-resilient cities and improving their own infrastructure to be net-zero by 2030.” 

One of these initiatives is CUSSH - Complex Urban Systems for Sustainability and Health – which ran from 2018-2023. This was a collaborative programme to deliver global research on the systems that connect urban development and population health. It focused on five global cities, including London, where the Bartlett Faculty of the Built Environment at UCL played a significant role in “learning how policy decisions to achieve health and sustainability goals can be improved and accelerated. To do this, our process includes steps that we hope will provide evidence essential to achieving population-level changes in areas including energy provision, transport infrastructure, green infrastructure, water and sanitation, and housing.”

More on The Bartlett’s work with CUSSH can be found here.

Another initiative was the Living with Buildings exhibit, which took place at the Wellcome Collection over 2018-2019. It asked visitors: We’re surrounded by buildings all the time, but how do they affect our physical and mental health? and examined how architects, planners and designers “influence our health, self-esteem and ideas about society” asking visitors to “consider the urgent connections between our homes and our health and look anew at the future of our built environment in this major exhibition.”

A RIBA review in 2018 described it as a “wide-spanning look at the way in which the built environment shapes mental and physical health in both positive and negative ways. Brought into sharper focus by the Grenfell Tower tragedy, this exhibition is an excellent overview of a very large and important subject, taking in everything from poverty maps and philanthropic model developments through to New Towns andMaggie’s Centres for cancer patients.”

Five years ago the Wellcome Trust took another step in exploring and shaping the built environment by acquiring the master planner and property developer Urban + Civic.

It’s now five years that Urban + Civic have been owned by the Wellcome Trust as an investment within its investment portfolio. In its shareholder report, Urban + Civic states that he aim of the Wellcome Trust’s investment portfolio is “to maximise returns over the long term to ensure that the Wellcome Trust continues to have sustainable resources for its charitable activities. Wellcome’s investment strategy also targets companies that take their environmental, social and governance responsibilities seriously.”

Adding

“The Urban&Civic business model aligns strongly with this strategy and investment horizon.”

I went to speak with some of its leadership team to explore how this close connection with the world’s largest health charity influenced their mission, approach and practice in developing homes and places across England. Here is my interview with Rebecca Britton, Director of Communities, Communications and Partnerships.

Do you implement a code of practice for developing healthy places?

We have always sought to deliver great places and healthy lifestyles have been fundamental to that. Alconbury Weald followed Sport England’s Active Design principles and followed the NHS Healthy New Towns work, and Alconbury and Houlton have been used by Sport England as best practice case studies.

From that learning we have developed a Healthy Places Toolkit, which we use and issue to our design teams. This draws on the latest guidance from Sport England, TCPA, Healthy New Towns pilots and others to set core principles which our developments should be designed to reflect. Activation of the designed spaces and amenities and long term management to keep them in good condition are also included as part of this. We also have a range of metrics in our Sustainability Framework which set out commitments across all our projects around proximity of homes to green space, to active travel routes / bus stops, and delivery of cycle and walking routes.

We recognise a key responsibility and opportunity that in designing new communities in a way which encourage people to live more actively each day, and get about using active travel, we can play a part in supporting healthier and happier lives for our residents.

We also monitor the effectiveness of the design and activation approaches through a 3 yearly Quality of Life Resident Review, carried out by the QoL Foundation using their 6 core themes of health and wellbeing. We review the scores and analysis and agree an action plan in response with the community, sharing the outcomes with the wider business and feeding findings into new areas / places coming forward in design and delivery.

What elements of this do you see as being particularly distinctive in improving health - eg BNG at 25%.

Our key focus probably come down to:

• Doorstep access to nature and green spaces – you can design it in when masterplanning  a new place, and the BNG drive, has also ensured we put more landscaping and habitats along green links and in all green areas.

• Green routes that connect you to more strategic green space / amenities / sports – this provides green routes for nature, but also people, and encourages safe off road access to key facilities, or an entirely immersive nature walk, which benefits active travel – see below!

• Green routes with a cycle and walk route in them provide off road connections between homes and other amenities, encouraging healthy living options whether leisure walking/cycling or doing that commute / trip by walking or cycling instead of in the car. Our routes connect homes and schools very deliberately in this way to encourage safe active travel to school, but also shops/local centres, workplaces, and onward connections to bus stops, and of course to get to bigger spaces like our larger park areas.

• Strategic green spaces that immerse you in nature: larger pieces of green spaces are essential part of the BNG / open space design of new places, and we have worked hard to make them interesting to people too, with wayfinding and interpretation on tree species, heritage of orchard trees, species information, as well as paths and seats to sit and enjoy. The Communities team do a level of activation too to help people understand the nature around them, especially on things like SuDs systems, which many are not familiar with. We work with Wildlife Trust, Groundwork, Nene Park Trust – a range of local partners to hold nature walks, pond-dipping, and promote Garden Bird Watch, Big Butterfly Count etc. They also encourage people to out walking and enjoying these spaces, so help activity levels too and mental wellbeing.

• There’s a whole other aspect around community engagement and information about the plans coming forward as well to support people to have agency, and influence the spaces around them, as we recognise that these are key aspects of mental wellbeing, and ensure a sense of ownership of the spaces coming forward. 

• Opportunities in the allotments, community gardens and orchards are also being activated at the moment for bringing people together and supporting those managing physical or mental health challenges, as well as more formal social prescribing initiatives.

• Access to local food and understanding food journeys are something we are keen to start embedding, with the community gardens in a couple of locations exploring community pantries etc. We are still early on that journey, but keen to support those initiatives.

• Our toolkit also ensures we don’t lose focus on very practical support tools like appropriate seating to help those less mobile, paths, signs, maps etc and organised walks to help people learn the routes around them and explore more. Landscape design also teases some of this, with views and feature planting planned to encourage people to explore further on some of our walking routes.

• Our experience is that landscape is a major motivator/aggregator for community groups. We have lots of good examples of this: running clubs and men’s health walking groups, school nature champion projects and community growing initiatives. We also saw during the Covid lockdowns the real benefit of having these routes and links and activities to support people.

You’ve mentioned that securing GP practices are a particular challenge in your regeneration schemes. Can you describe how this is playing out?

This has been a learning curve for us, but we are making progress. We have had some positive sessions with local health partners, that we can design in 7.5 of the 10 principles of healthy places set out by the NHS, but the delivery of services and care needs partnership.

It is not always straightforward to integrate health effectively into the planning system, and how it is prioritised or addressed can vary significantly from place to place. S106 agreements can not always give health all of the things it needs. With all of the restructuring and changes in health too, we recognise how hard many partners find it to prioritise the bigger and complex projects we do.

Through engaging with health partners and the process on our early sites, we have evolved our approach: and it really is all about partnership. We are not clinicians who can understand the delivery of services, but we can support health partners with design, delivery and lease arrangements for surgeries and health centres and these often seem to be the things that hold delivery up. So on the Cambs and Herts sites, we now have active and strategic partnership discussions around what facilities are needed, when, who will be involved in service delivery, and agree a process to support good design, masterplanning in facilities to the right cluster, and then supporting building design and even delivery. We look at options for leases, which provide greater flexibility within the new GP contract structure, and respond to the challenges of local care boards and local practices to agree something that works for that project. Each project is different, but being actively engaged and providing solutions to their challenges seems to be bearing fruit. We will have our first centre opening later this Summer at Alconbury Weald and we are involved in the design and strategy on the next 2 on our Cambridgeshire sites and rolling out this approach across the business.

It remains a complicated area, with very complicated processes on the health side, which will change again with the merging of ICBs and changes to NHS England, but by continuing to work with local partners we hope we will be able to ensure good and timely delivery of services.

The work we are doing on all of the wider health and wellbeing  strands, and being able to design in health centres and diverse health services into clustered locations close to parks and community orchards / allotments, as well as clustering with other health providers like dentists, optometry etc, and libraries for information prescribing, citizens advice etc, is entirely possible to plan in and deliver in a new place. So we see ourselves as at the heart of being able to deliver high street and neighbourhood health, and support long term management of conditions / healthier living.

How does your approach to regeneration fit into the NHS vision of Neighbourhood Health?

See above how we think we can design in new amenities that bring a range of services into the heart of a new community! We are looking at these centres being an integral part of high streets and local centres and bringing together a range of services. We have also spoken to health partners about approaches whereby we could consider going beyond the S106 agreements to explore decanting services from hospital setting into the centres we have been discussing, especially looking at diagnostic and treatment centres. The scale and layout, and accessibility of our schemes, provide an opportunity for hubs which serve a larger area not just the new homes.

This will require funding outside of our planning obligations, so will be subject to further work with local partners, but those discussions are ongoing. We can update on this as we move through the process, so happy to keep you posted, as some of the live discussions start to embed in design, planning and delivery.

Does an emphasis on health & wellbeing help with local consultation?

Absolutely. Health provision – in terms of services – is increasingly top of many people’s agendas as they feel local services are squeezed, so we have to have responses and solutions on this issue. But also people care about their own health and wellbeing, and can envisage benefit in the designs of the places we are consulting them on and co-designing with them. The role of greens spaces – both larger areas and green links – often focusses now as much on health as on nature, as people recognise the benefits and needs for this as part of healthy living, and I believe most of the people we talk to recognise and like the preventative approach we can provide to health by putting in place building blocks which provide people the opportunity to lead healthier and more active lives. There is still a lot of cynicism in the early days, but we now have good examples we can take people to and share where this is happening.

How do  you think that Section 106/CIL monies can be optimised to improve local health?

 The critical thing for us as we go into new schemes is to support Health partners to be actively involved in the planning discussions, so that we really think about what they need and want in the context of the wider health and wellbeing debate. We have learnt that where capacity or capability means health have been under prioritised in planning frameworks, only means we have to help reset that balance later on. CIL has been helpful in providing funding where S106 has not been able to meet those needs. But ideally we want to work closer with health and planning partners to bottom out the need, commit to an approach which meets it, and is flexible enough to respond should things change, and then keep working together to deliver that or respond as needed.

Flexibility is better than prophecy is a strong mantra of our Planning Director! As an example, we have recently been supporting an existing GP practice where we are developing an urban extension to the town, to be part of the discussion with the ICB so that we don’t just mitigate impact, but explore opportunities to deliver a shared vision and then work back what that looks like in facilities and phasing of those. It’s always a journey, where you learn something new each time, but it provides real potential to support partners to deliver against the wider vision for health in communities, and the role of new communities / places in being part of that. This is a critical part of the opportunities of New Towns for us.

How does ownership by the Wellcome Trust influence your approach to health prevention and creation?

We are here to facilitate Wellcome’s mission rather than to deliver it directly and take great pride in the fact that the profits generated by our developments are put to such positive uses.  That said we gain considerable insight into health prevention and creation through understanding their wider work.  We also partner with Nuffield Trust in our St Neots developments and we find that all our partners are focused on delivering healthy places.  Their support enables us to continue to prioritise and invest time and money in ensuring we design in health and healthy living to our new communities, and support effective delivery of health facilities.

Thanks to the Urban + Civic team, and especially Rebecca Britton, for their time and interest.

Clare Delmar

Listen to Locals

27 January 2026