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Improving Health through the Built Environment – panel discussion at the NHS ICS/ICB Congress

The GIANT Health event, now in its tenth year, took place earlier this week, and I was invited to convene a panel for the NHS ICS/ICB Congress 2023 to discuss how developers and stewards of the built environment can create the conditions for the NHS to thrive through its new(ish) delivery bodies, the ICS (Integrated Care System) and ICB (Integrated Care Board).

Chaired by health writer and broadcaster Roy Lilley, the event was a welcome opportunity to engage a convention of healthcare professionals around the importance of integrating policy and practice in developing the built environment with principles of public health and health equity. Planning, housing and the NHS are the most important issues facing many voters at our next election, so the discussion is timely and in need of both amplification and progression.

The focus on ICBs creates an opportunity to advance this agenda as their mission and mandate are driven by cooperation with local communities:

“within each ICS, place-based partnerships will lead the detailed design and delivery of integrated services across their localities and neighbourhoods. The partnerships will involve the NHS, local councils, community and voluntary organisations, local residents, people who use services, their carers and representatives and other community partners with a role in supporting the health and wellbeing of the population.”

Joining me on the panel were Michael Chang, Programme Manager, Planning and Health, Office for Health Improvement and Disparities; Pete Gladwell, Director, Social Impact, Legal & General Group; Magali Thomson, Project Lead for Placemaking, Great Ormond Street Hospital; Natasha Reid, Founder, MATTER SPACE SOUL; and Lisa Finlay, Group Leader & Partner, Heatherwick Studio.

All of us work at the interface of developing the built environment and promoting health and health equity. I began my life in healthcare when, as strategist for a leading UK construction company, I faced a major pivot in public procurement – the Private Finance Initiative – which led to many years developing hospitals under the new procurement regime. While controversial and highly contested, PFI hospitals required a comprehensive understanding of the integration of design, space and operation, and a collaborative, multidisciplinary approach to procuring them. These disciplines are exactly what are needed now to create the conditions for ICBs to thrive.

There has been an acceleration of evidence in recent times on the co-dependency between the built environment, health and health equity, manifesting in challenges at both national and local levels. The recently published annual report from the Chief Medical Officer on health in an ageing society devotes considerable attention to how places and housing support healthy ageing and what needs to be done to ensure the built environment is sufficiently designed and managed for this purpose.

At the local level, the pressures put on local communities from new housing developments increasingly manifest in reduced healthcare provision, causing friction between the local NHS, local residents, and housing developers. The BMA (British Medical Association) in Scotland has asked that developers be required to fund GP surgeries through contributions, and in England several communities have used Section 106 payments to fund GP surgeries.

ICBs have a unique and timely opportunity to embed this evidence into practice and create a new sustainable approach to improving health and health equity in local communities by working with developers of the built environment, and we discussed a range of ideas and interventions to make this happen:

1. Bring health into the planning process as a community engagement platform – all agreed that health can be the connector in what are often adversarial planning processes. The HIA (Health impact Assessment) plays a role in this, and should be a more inclusive, locally-generated input into all planning proposals.

2. Educate developers of the built environment about their impact on local health, and inspire them to embrace this as part of their ESG (Environmental, Social and Governance) agendas. Pete Gladwell described how L&G add “H” to “ESG” so that their investments are guided by a set of principles and practice that includes health and health equity. Language can also influence practice and adopting some of the language of health practice (eg “do no harm”) can drive engagement and underpin more sustainable built environment projects.

3. Use the wealth of data in local communities to understand demographics, non-clinical health assets such as green spaces, active travel and, crucially, the social determinants of health to develop local health strategies and interventions. Magali Thomson described how places benefit from designs that incorporate these social determinants. Natasha Reid highlighted the value of using local, spatial data as the baseline starting point for the design process.

4. Help hospitals and health facilities to lead by example through community-led placemaking, public spaces, and wellness activities. Magali discussed how Great Ormond Street Hospital is not only a facility for sick children but a place for everyone to experience beautifully designed spaces and social activity. Lisa Finlay spoke about her experience in designing Maggie’s Centres for cancer patients and their families with a focus on wellness and inclusivity.

5. Encourage ICBs to approach their local areas as potential “Blue Zones”, places where residents enjoy high quality and length of life – as popularised by the recent Netflix series. Natasha Reid described her work incorporating health and wellness strategies into planning at the London Borough of Brent, suggesting that “Brent is a Blue Zone”. Lisa Finlay talked about the Heatherwick initiative to transform high streets into “Health Streets”, places that convene events, organisations and facilities that promote health and wellbeing.

6. Focus on Health Creation through language and practice to support ICBs in these actions and share best practice. This is best done through effective stewardship of projects and places, argued Pete Gladwell. Michael Chang believes it also requires effective regulation to set the standards we need for health equity, preventative health and longevity, commenting that “A1 health requires A1 housing”.

It was very appropriate that this event took place in December, at the end of a year of great progress in bringing planning and health together and embedding it into conversations across sectors. A good springboard for acceleration in 2024.

Clare Delmar

Listen to Locals

8 December 2023


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