The Healthy New Towns scheme aims to ease the housing crisis while reducing the burden on the health service. Late-stage diagnosis, or the right prescription?
An ounce of prevention is worth a pound of cure. Sage words from Benjamin Franklin back in the 18th century. What was intended originally as fire-fighting advice has, in the years since, become synonymous with healthcare, to the point of being cliché. But in the case of the Healthy New Towns scheme announced last month, it is one that the NHS seems to have taken to heart.
The publicly funded health institution is buckling under the weight of ever-increasing cost burdens. It saw its deficit in England soar to £1.6bn for the first six months of 2015 and predictions of a £30bn black hole by 2020 loom large.
The NHS spends £11bn every year treating lifestyle-related illnesses, which is almost 10% of its £116.4bn budget for 2015-16. Given that figure, increased efforts to reduce spending through better public health are not only predictable, but necessary.
The March announcement by NHS England head Simon Stevens that the service plans to create 10 NHS-supported “healthy new towns” across the country was a step in that direction. With support from Public Health England, the programme includes more than 76,000 new homes with potential capacity for around 170,000 residents.
But while Franklin’s expression is elegant in its simplicity, its application could be much trickier. Will it be possible to generate and maintain enough momentum for such a long-term vision to succeed? How can the other 53m residents of England benefit? And how original is the notion of using health and well-being as a primary director of masterplanning?
Sustainable vision
When the NHS Five-Year Forward View was published in 2014, it outlined a vision for a longer, more sustainable future. To help realise that vision, Stevens had the idea of creating new housing developments with health improvement built into them, and to introduce healthcare systems that are not bound by legacy constraints.
According to Emily Bird, policy leader for the programme, the need to build more than 200,000 new homes every year to accommodate the growing population offers the chance to tackle more than the housing crisis.
“We’re also facing increasing crises in people’s health, such as obesity, the needs of an ageing population, people with mental health problems or disabilities,” she says. “This is a real opportunity to address all of those things as a package and get it right as we design places from the outset.”
When the programme kicked off last summer, it attracted 114 applications from local authorities, housing associations, NHS organisations and housing developers, and included a broad variety of ideas and interpretations of the brief.
Of these, 10 were selected to become demonstrator sites to be used as examples of what can be achieved.
For Louise Wyman, director of strategy at the Ebbsfleet Development Corporation, which is behind the UK’s first new garden city in more than 100 years and one of the demonstrator sites, the idea of addressing health through new housing makes perfect sense.
She says: “I’m a surveyor and a masterplanner and for me it is absolutely right that we should be thinking about the built environment and healthy cities at the same time. It’s an opportunity to bring the placemaking and town planning agendas together with ways to address obesity levels in children and to encourage people to stay active and in their homes for longer.”
Tech advances
The selected new developments are diverse, in terms of region, demographics and size; some are urban extensions and others regeneration projects. The smallest comprises 393 houses in Bicester, Oxfordshire.
Ebbsfleet is at the other end of the scale, with plans for up to 15,000 new homes. Access to nature is at the core of its agenda. Wyman describes it as a landscape-led plan that takes inspiration from Milton Keynes’s parks system and Redways, a 169-mile network of shared-use paths for cyclists and pedestrians.
In Hampshire, a fundamental principle of the Whitehill & Bordon regeneration project, where total investment into commercial development and 3,500 homes is just shy of £1bn, is connectivity through technology. Project director Steve Pearce says: “Nowadays you can wear something around your wrist that monitors everything your body is doing all of the time.
“That could be linked back into your local GP and the super surgery that we’re looking to develop in our town centre, enabling health professionals to keep an eye on their more vulnerable patients – the ones that opt in. This won’t be imposed on anyone.”
The team is also investigating ways in which facial recognition technology could be used in the development’s health and social care village to help people with dementia lead independent lives. If a vulnerable resident visits a shop in the village and forgets his or her purse, the retailer can easily identify the person and return it.
Technology is also expected to play a big part in Darlington’s involvement in the programme, which includes the development of a virtual care home in which a group of homes with shared facilities link directly into a digital care hub. It is a strategy that avoids the institutionalisation found in nursing homes.
Meanwhile Cranbrook, in Devon, has three times the national average of infants (0-4 years) and its developers will look at how healthy lifestyles can be taught in schools.
The focus of each pilot might vary according to individual needs but there is a common thread: a determination to make it easier for people to make the so-called “right” choice – the healthy or sustainable choice – and harder to make the “wrong” choice.
“It is standard these days to talk about designing out crime in housing, retail or whatever it might be,” says Pearce. “This is the same as that. It’s about designing health and well-being into everything we do.”
Facing the critics
Although the good intentions of the Healthy New Towns scheme are clear, it has not been without its critics. The day after the demonstrator sites were announced, a scathing comment piece by Simon Jenkins was published in the Guardian. In it he calls on the NHS to campaign to make existing cities healthy, “not a few privileged out of towners”.
But the 10 pilot schemes are intended to be only a beginning. They are envisaged as pioneers, with both new and existing developments able to cherry pick and apply the innovations most relevant to them.
And because the number of applicants to the programme far exceeded expectations, Bird is keen that this appetite for participation will be satisfied.
“We’re really keen to maintain a network with that broader range of sites,” she says. “They have a lot of exciting plans in mind and see the potential in healthy development, so this is not the end of the story for them, or for other stakeholders and potential developments that have an interest in that field.”
At the same time, we are in an era of enduring austerity. Public spending is under constant scrutiny and the idea that the NHS has resources it can afford to direct away from frontline care could spark further scepticism.
But while there will be some grant funding available – enough for someone who can take the programme forward at a local level, maybe, or to run community engagement events, says Bird – the demonstrator sites will not be on the receiving end of a big cheque.
It’s about bridging expertise, Wyman says. “I’m very good on the built environment and the Department of Health is very good at things like online diagnostics. We’re getting exposure to the expertise that exists more in the health sector.”
With support from multiple government departments, including those concerned with transport, education, science, culture, media and sport, not to mention health, the Healthy New Towns programme aims to provide a level of joined-up thinking that the public health agenda demands.
As with so many things, its success can be measured only after it has had some time to grow and develop. The first few years are expected to be critical, says Bird.
“The idea is that we will have set in place everything we can within those couple of years to get sites on the right track,” she says, “and that we’ll have built enough of a community and momentum around the concept of healthy development so that it becomes the norm, rather than the exception.”
VIEW FROM…
…The architect
David Lewis, partner at NBBJ, applauds the programme but warns that community engagement will be crucial to ensure success and combat criticism, particularly among those impatient for swift results.
“It takes a while to get these things going and organise, but unless you engage with all the stakeholders, you will not get a successful outcome,” he says. “The main challenge will be following through. It won’t happen overnight and if you have dissenters say it has failed after two years, that’s not right.”
…The masterplanner
Luke Schuberth, UK managing director at Aukett Swanke, considers the idea of building housing with health in mind to be a great one, but he is not sure it is entirely new.
He says: “I would argue that good masterplanners should be doing that anyway. It doesn’t sound like the fundamental principles of forming a healthy community and place to live are changing.
“It’s giving more emphasis to health and well-being, which can only be a good thing.”
…The agent
Phil Hall, JLL’s chairman of healthcare alternatives, suggests the initiative could help tackle Britain’s housing shortage by doing more than just creating new stock. By producing more aspirational housing with the elderly in mind, it might free homes better suited for families.
“It is in the government’s interest to free up housing with one or two people rattling around in it for families and make better use of stock. It suits elderly people to be able to make that move, and it suits society as a whole,” he says.
The 10 Healthy New Towns demonstrator sites:
Whitehill and Bordon, Hampshire
3,350 new homes on a former army barracks
Cranbrook, Devon
8,000 new residential units
Darlington, County Durham
2,500 residential units across three linked sites in the Eastern Growth Zone
Barking Riverside, Essex
10,800 residential units on London’s largest brownfield site
Whyndyke Farm, Fylde, Lancashire
1,400 residential units
Halton Lea, Runcorn
800 residential units
Bicester, Oxfordshire
393 houses in the Elmsbrook project, part of 13,000 new homes planned
Northstowe, Cambridgeshire
10,000 homes on former military land
Ebbsfleet Garden City, Kent
up to 15,000 new homes in the first garden city for 100 years
Barton Park, Oxford
885 residential units
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