The UK’s health and care system is long overdue reform, as needs have shifted and technology has advanced since the NHS was founded in 1948
In more recent years, the urgency of the climate crisis coupled with the impact of the Covid-19 pandemic has supercharged the need for change in the UK’s health and care system, as services are near a breaking point.
All of this is forcing us to rethink our approach to built and natural environments. The way we live, work, shop and play have evolved, and we must respond in a way that prevents ill health, provides care closer to home, supports the environment and helps create thriving communities.
Addressing this transformation will require input and collaboration from new voices, including community representatives, as well as experts across the health and care system, government and local authority representatives, and industry leaders. We must think about health in a far more dynamic and integrated way, argues Jamie Tucker, an Associate at Arup.
90% of good health comes from factors outside of these systems
Our new report, co-authored with the Bevan Commission, the leading health and care think tank in Wales, paves the way for reform by identifying five key steps needed to transform the design of the UK’s health and care systems.
The report – People, place, health: constructing a health and care ecosystem for Wales – combines our placemaking expertise with the Bevan Commission’s health knowledge, alongside case studies and expert testimony from a broad range of contributors. While the report draws on research in Wales, its findings provide a blueprint for transformation across the UK and beyond.
Health and care should be integrated into the planning and design of places, while supporting and being supported by communities, the economy and the environment
It found that the UK’s health and care systems cannot remain separated from peoples’ daily lives, given that 90% of good health comes from factors outside of these systems. Instead, health and care should be integrated into the planning and design of places, while supporting and being supported by communities, the economy and the environment.
The report identifies five key ingredients for an ecosystem that puts health and care at the heart of the place, builds on the concept of a 15-minute neighbourhood and outlines immediate next steps required to implement these strategies.
The five necessary steps to transform the UK’s health and care system
Five key changes are necessary if we are to truly integrate our health and care system into our society and the built environment. These have been developed based on present health and care challenges, insights from panel interviews, current drivers for change and existing best practices.
1. Move to a preventative model for health
A preventative approach is prudent. We must invest in what keeps us well, rather than waiting for our health to deteriorate and then relying on the health and care sector to deal with preventable ill health. The main function of the NHS in its current form is to manage and support ill health, while most of our health and well-being is created outside of health and care systems – in our homes, local communities and workplaces. We need to leave behind the “fix and treat” approach and make prevention the centre of all thinking and action.
2. Enable a culture shift
Change will not happen if people don’t want it. We must find ways to capture the ideas, enthusiasm and the “hearts and minds” of people and professionals in our communities. By finding solutions together, we are not only likely to source the best ideas, but also to engage the support and skills of people along the way – as exemplified during the response to the pandemic. We must break down existing silos and move to a much more collaborative approach between partners at national and local levels.
3. Consider people and place
By thinking through the health and care ecosystem and collaborating with people from local communities, including those with health and social care needs, we have the potential to re-engineer the health and well-being of local people, while ensuring that all local assets such as green space, community buildings and informal support networks are maintained and used effectively.
4. Embrace technology to bring about change
We are in a new age of data and technology, which is changing how we live and work. Advances in machine learning as well as the sheer availability and increasingly effective analysis of data are changing our expectations of, and interactions with, health, care and other services. But technology should not be viewed as an instant panacea; significant obstacles remain and the level of technological maturity within the health sector remains stubbornly low – something that must be improved.
5. Changing models to embrace a shift from hospitals to community-based health and social care
The consensus from contributors to the report was clear – large-scale general hospitals should become a thing of the past. When we need to access health and care, it should be convenient and close to where we live and work. Only those with acute illness should be admitted to hospital. Our homes, high streets, community buildings, and even rugby clubs, should be the places where we can access the right support as we need it. Over time, technology will enable us to access more services remotely.
Bringing these five steps to life through a ‘15-minute neighbourhood’
The concept of a 15-minute neighbourhood, one in which we can access all our daily needs within a 15-minute walk from our door, is becoming increasingly important. The report uses this concept to explore how the five steps can be realised within our communities.
For example, we could invest in a preventative model by transforming open spaces into essential green community spaces to help educate people on food origins, encourage healthy eating and provide opportunities for physical activities.
Similarly, underused buildings such as chapels, libraries or vacant retail units could become community anchors by creating a hub which reaches large numbers of people through collaboration between GPs’ surgeries, community space, social care or housing offices.
The 75th anniversary of the NHS in 2023 as a turning point
Immediate suggested next steps include setting up pilot projects across Wales and using the 75th anniversary of the NHS in 2023 as a turning point to draw support from new stakeholders.
Longer-term, we must see a shift in the roles of government, health leaders, city planners and policymakers. Better collaboration, cooperation and coordination across agencies, organisations and professional boundaries will be essential to deliver an effective healthcare ecosystem. There must be a new approach to funding and policy that reconnects the mechanisms for shaping and improving places with measures to prevent ill-health.
