The Healthy New Towns programme started life as a flagship for the much-vaunted ‘radical upgrade in prevention’ outlined in the Five year forward view. Ten demonstrator sites were selected for their potential to showcase effective approaches to making new housing developments actively promote health. The King’s Fund was keen to be part of this work for three main reasons – which we think are equally reasons why the NHS locally will see it as important for any major new housing developments.
First, this is in some ways a new level of working together for the NHS and local authorities, one that requires depth and maturity of relationships. People often comment that the NHS and local authorities speak different languages. That is certainly a risk in new towns: NHS commissioners, focused on the four-hour accident and emergency target, need to engage with planners, who typically work in 20–30-year time frames! But the complementary nature of local authorities’ place-shaping role together with the NHS as both an anchor institution and an expert health resource makes it a powerful combination. The Healthy New Town demonstrator sites are proof that focusing on common purpose can unlock that power.
The second reason is that housing is such a major determinant of health (and one with an increasingly compelling evidence base). As we argued in our report, A vision for population health, clinical services contribute only around 10–20 per cent to population health; so if integrated care systems’ (ICSs) two core aims are to both ‘redesign care and improve population health’, then the latter of these aims will require them to extend beyond the health and care sector. But our analysis found that sustainability and transformation partnerships – the forerunners to ICSs – usually only acknowledged the importance of housing to health but did not then act on it. There is a need to move up a gear in developing partnerships between the NHS and the housing sector if we are to realise the potential that exists for improving health.
A third reason is that the Healthy New Towns programme illustrates so powerfully the value of engaging residents and working with them to design health promotion opportunities that they will actually use. It is well known that NHS services often fail to make full use of all the insight already available to them from patients, and it turns out that joined-up listening across multiple services and organisations has its own additional complexities that can get in the way. But examples in Putting health into place where people were involved early and took responsibility – sometimes as new communities formed, without existing community infrastructure – showcase what joined-up listening can achieve.
Since 2013, when public health departments – together with their responsibilities for prevention and health promotion – transferred from the NHS to local government, there has been some confusion over where the NHS’s responsibilities for improving health begin and end. The Healthy New Towns programme shows that the NHS is both a legitimate and essential partner in place-based approaches to actively improving health. Let the confusion be over: this is what core NHS business looks like in a population health system.