Healthy New Towns four years on: the legacy of a national innovation programme

It’s often said that the NHS is good at trialling new approaches through pilot schemes but less good at locking in the benefits or spreading the learning more widely. The Healthy New Towns programme was part of a flurry of innovation in the years following the publication of the NHS five-year forward view. The programme involved 10 ‘demonstrator sites’, all areas with significant population growth (but not necessarily ‘new towns’ in the strictest sense – although some were).  These sites took action at three levels with the goal of improving population health and reducing inequalities:

• creating built environments that would promote physical activity and healthy lives more generally

• developing new models of care, including through the creation of ‘health and wellbeing hubs’ that bring together health services, leisure services, and community-controlled spaces

• stimulating community connectedness and community-led activities that promote health and wellbeing, and linking this to NHS services through social prescribing.

Having been involved in the programme as a learning partner, I was hugely impressed with the ambition and creativity of the demonstrator sites. One of the lessons I took from their work was that the impact can be greatest when care is taken to design a mutually reinforcing set of interventions, with changes to the built environment, new care models and community development activities all supporting and adding value to each other. This, to me, illustrates the value of taking a place-based approach to health that brings local agencies together to focus on a defined place and the people who live in it.

'This, to me, illustrates the value of taking a place-based approach to health that brings local agencies together to focus on a defined place and the people who live in it.'

Eager to know what the longer-term impact of the programme has been, we recently brought together people involved in the former demonstrator sites to hear how their work has continued since national support from NHS England ended in April 2019. So, what has the legacy been?

We heard that there has been a lasting impact in some of the local authorities involved in the programme. Where there has been a collective will to do so, the Healthy New Town principles described in the ‘lessons learnt’ document, Putting health into place have been embedded in key local documents such as health and wellbeing strategies and the local plans that shape the decisions made by planning teams. In principle at least, this should help local authorities to ensure that ‘healthy place-making’ (creating places that promote health and wellbeing) is a key goal throughout their work.

However, it seems less clear that there has been a sustained impact in the NHS. Participants in our workshop attributed wavering NHS involvement in part to organisational instability and change. Where key personnel have remained in post this helped maintain momentum, but many sites have been hampered by significant staff turnover, and the transition from clinical commissioning groups to integrated care boards (ICBs) also contributed to instability.

A major concern is that local NHS organisations lack the capacity and skills to contribute to healthy place-making initiatives. This was highlighted as a risk during the Healthy New Towns programme and it seems the situation has not improved since. For example, we heard that ICBs tend to have limited capacity or expertise in relation to primary care estates and are often unable to speak the same language as developers. As a result, opportunities to use new housing developments or regeneration schemes to create better community-based health facilities and to improve population health are being missed.

'A major concern is that local NHS organisations lack the capacity and skills to contribute to healthy place-making initiatives.'

Progress on some things has been frustratingly slow. One of the centrepieces planned in several of the demonstrator sites was a new health and wellbeing hub that would support a more holistic, integrated approach to health. While local partners are still committed to this vision, pinning down the practicalities and getting the funding agreed has proven difficult. Previous research found that the full benefits of these facilities are realised only when partner agencies go beyond co-location and seize opportunities to integrate services by sharing resources and data. The experience of the demonstrator sites is that this can take many years and a lot of perseverance to get right.

As with the New Care Models programme, Healthy New Towns stimulated some inspiring local innovation but the national support for wider roll-out has been limited. National bodies will need to play a more active role in future if the Healthy New Towns principles are to be put into practice more widely. There needs to be cross-governmental alignment to help local partners make faster progress (for example, plans for health and well-being hubs currently pass through separate approvals processes for the Department of Health and Social Care and the Department for Levelling Up, Housing and Communities, and we heard that these processes could be better aligned). NHS England should help ICBs build the skills they need to make the most of the opportunities that exist. And finally, national bodies could play a vital role in influencing major housebuilders to adopt the Healthy New Towns principles.

The Healthy New Towns programme remains a powerful illustration of how local partnership working can develop innovative new approaches to improve health and wellbeing, and in many of the demonstrator sites work continues to ensure it has a lasting legacy. Without clearer national leadership, however, the opportunity to deliver similar benefits in other parts of the country may be missed.