A shared heart: the story of Fleetwood’s community health hub

How one of the poorest towns in England bought its abandoned local hospital and transformed it into a model for the future of health care and public services.

Abandoned but unbowed 

You would have thought the NHS was escaping a hostile invasion force, like something out of the fall of Saigon. The NHS really went for it when it decided to close Fleetwood Community Hospital in Lancashire. Gone in a matter of days, it left behind beds, medical equipment, even scrubs hanging in lockers – all the trappings of a hospital, except for the two things that really matter: health care staff and patients. 

For the people of Fleetwood, it felt like just one more abandonment.  

Once a thriving fishing port famous for being the transfer point between boat and rail for those travelling between England and Scotland, the tides of economic change and government policy had not treated Fleetwood kindly.  

First, the trawlers began to thin out as the Cod Wars obliterated UK fishing rights in the North Atlantic during the 1960s and 1970s. At the same time, the rise of the cheap package holiday to sunnier climes left Fleetwood’s once-popular beaches and tourist industry in the cold. As if to confirm the town’s declining appeal, Fleetwood train station was closed in 1970 – a victim of the notorious Beeching cuts. Then most of the big employers followed -gone by the end of the century attracted by cheaper labour elsewhere or facing their own financial struggles. 

Within the space of 40 years, Fleetwood had gone from a vibrant fishing town, transport hub and holiday destination to one of the poorest places in the country. So, when the community hospital went it was just one more insult to add to decades of previous injuries. 

But one thing Fleetwood had that could never be taken away was its community spirit. Fleetwood had always been a friendly place where people looked out for each other and banded together to sort out problems. As a Fleetwood saying goes: ‘Kick one of us and we all jump.’ It is a town with a strong sense of identity and pride, despite the challenges of recent decades. It would be naive to think that those challenges did not leave the community spirit diminished somewhat, but it never died entirely. Maybe it was just waiting to be fully reanimated. 

Healthy and thriving

If any year can be pinpointed when that reanimation started it would be 2015. That was the year when a local GP, Mark Spencer, decided he had had enough of sitting in his surgery doling out medication, often to the same people day after day. Indeed, it was a conversation with a regular patient that finally sparked the GP into action.  

Once again, Mark found himself advising the patient, a long-time alcoholic, that he should give up alcohol if he wanted to live beyond 50 years of age. This time, however, the patient did not nod and promise to do his best. Instead, he told Mark quite plainly that he had no intention of stopping drinking because he was far more scared of life than he was of death. The man in front of Mark wasn’t just ill, he was also socially isolated and emotionally wrecked. The idea that this was a fight a GP sitting in their surgery could win alone was clearly nonsensical, particularly when there were hundreds, maybe thousands, of other people facing similar crises across the damaged town. 

So, Mark decided to start making allies in a battle to get Fleetwood healthy. Leaving his surgery behind, he began conversations with charities, churches, community groups, schools, individual residents and anyone else he could find based on a simple premise: the town was ill and only the town itself could do the healing. Doctors and nurses could be partners in that effort but the real power lay with Fleetwood’s people themselves.  

Those conversations led to the formation of Healthier Fleetwood in 2016. This is best described as a social movement encouraging people to take control of their own health, lives and community by setting up local groups to grow self-confidence, create connections and get people active. Entirely led by Fleetwood residents, it has been a remarkable success, with the number of groups growing rapidly.

Two things immediately stand out:

1. There is an effortless focus on the creation of good health. While the NHS struggles to break out of its highly specialised, medicalised approach to ill health and overwhelming focus on treatment, the community faces no such barrier and so automatically defaults to activities that keep people well. Indeed, one might argue that it is the very fact that the majority of community members lack the professional skills to do specialised medical care that means they have to work in a more holistic, preventive fashion.
    

2. None of this looks like conventional health care or even public health. There is no finger-wagging or scare tactics in relation to smoking, alcohol or weight. There are hardly any condition-specific networks bringing people with diabetes, chronic obstructive pulmonary disease (COPD) or arthritis together. The Healthier Fleetwood groups start with what is strong, not what is wrong. They do all the things we know keep people happy and healthy: physical activity and eating well, certainly, but, above everything else, human connection forged around all the joyous activities life has to offer. Indeed, badges bearing the simple phrase ‘Love Fleetwood’ are everywhere. Gradually one realises it has a double meaning: it is not simply about loving the town of Fleetwood, it is also about a place defined by love, friendship and mutual care. Love as an adjective as well as a verb. Mark may have been a catalyst but what really got the town activated was that very love, expressed through millions of voluntary acts of compassion, listening and care. 

Brilliant as it was, Healthier Fleetwood had a blind spot: children and young people. So, Fleetwood set about addressing the problem by establishing a new initiative: Thrive. Under the leadership of Liz Loftus, Thrive brings young people together with schools, youth services, a very wide range of public services including the NHS and, of course, the wider community to improve life for the town’s young people.

Its initial focus has been on mental health – a priority that the community itself identified. And, of course, the key principles underpinning Healthier Fleetwood still apply – a combination of: 

• deep collaboration across the public sector 

• a determination to work in a holistic, preventive way 

• always designing and delivering interventions with the community and young people.

The impact has been striking. Referrals to child and adolescent mental health services have been cut by more than 50% and there has been a large reduction in antisocial behaviour incidents in one of the poorest wards in Fleetwood – by 67%. But beyond the stats is the deepening of the Fleetwood way: care that puts human connection and the building of a healthier, happier place above everything else. 

A hospital reborn

Just as Mark Spencer was stepping out of his GP surgery to start talking to the Fleetwood community, leaders from the town’s faith sector began to think about how the now-abandoned local hospital could be brought back to life as a vibrant community hub. Its loss wasn’t simply an inconvenience that meant health care would now be provided outside Fleetwood, often many hours’ travel away. The hospital had been a fixture of life in the town since the 1890s and, as one might expect, it had touched the lives of most of the residents of the town. Birth, minor ailments, accidents, serious illness, palliative care, the death of loved ones – the hospital inevitably sparks plenty of memories. For many, of course, it was also a place of employment: Joseph Travis, for example, a local artist working closely with the community, has a special connection to the building given it was where his mother worked as a nurse for many years. 

When the hospital closed, that was all gone, and Fleetwood lost another institution anchoring it to previous, more secure times. While some outpatient services did remain in a small part of the hospital, the rest of the large three-floor building was left to rot. The elements did their work and soon part of the building’s roof had collapsed, floors were flooded, windows were broken and internal walls were disintegrating. Once a central feature of a thriving town, the hospital building was now a monument to decline. 

With the support of local philanthropists and inspired by the reanimated can-do community spirit on which the town thrived, the idea that the old hospital might provide a focus and a home for that spirit began to take hold. A new charity, the Fleetwood Trust, was set up in 2018, chaired by veteran Lancashire parliamentarian Lord Tom McNally, with the ambition to obtain the hospital from the NHS. Their initial suggestion was that they should essentially be gifted the building, for which the health service clearly no longer had any use, but the NHS rejected this. Instead, £585,000 was the price tag, with another £2 million required to repair the building and refurbish the ground floor. Many places may have given up at that point but Fleetwood is a resilient town and the money for purchase and refurbishment was raised through a combination of donations from wealthy benefactors with links to Fleetwood and grant-giving bodies. Fleetwood Community Hospital – or what was left of it – had passed into community ownership.  

Suddenly, the Fleetwood Trust, under the leadership of its Chief Executive, Charley Wilkinson, had the challenging task of turning a wreck of a building into a vibrant… something. No one at that stage knew what this would be. 

That lack of clarity wasn’t an oversight or some failure of governance. Everyone around the Fleetwood Trust was determined that clinicians, public sector professionals and even the Fleetwood Trust’s board would not decide the future of the hospital. This time the community was going to be in charge. It would be the residents and their networks who would get to shape what happened in the building and, just as importantly, they would be at the heart of delivering it. The place may have been called a ‘community hospital’ for decades but that only referred to its location and the nature of its services. Now the term would really mean something: a space run for, with and by the community. 

Then, in March 2020, the Covid-19 pandemic hit the UK and for a while, like everywhere else, Fleetwood had other things on its mind. The town had a ‘good pandemic’, with many community-led organisations already in place to provide support and care for those in need throughout the two challenging years of the pandemic. But the old hospital wasn’t completely unused. Fleetwood’s churches were the first to move into the space, setting up a food bank in 2020, the need for which only intensified as the cost-of-living crisis began to bite. Then, as the pandemic eased, the next obvious step was to create a volunteer centre in the building – a place where Fleetwood’s myriad community-led groups could hold meetings, plan activities and do their admin. Even at this early stage, the hospital was focused on very different things from what one might find in NHS-run buildings across England. 

Soon, bigger plans were taking shape. Numerous community conversations and countless informal discussions about what the hospital should look like and do were held – all led by a newly established Fleetwood Trust board of 12 people living in or with very close links to Fleetwood. 

Things stepped up a gear with the choice of an architect to design the ground floor of the hospital. Everyone involved credits Lee Donner of Mason Gillibrand as having played an absolutely central role in turning community ambition into reality. Lee understood immediately that this was not a commission to design a conventional hospital. What the community wanted was a space that worked for them, not public sector professionals: somewhere that would be welcoming, flexible and open enough to accommodate the multidimensional nature of holistic care, and a place that the community could be proud of. 

Nothing epitomised that spirit more than the decision to place a vast community cafe at the heart of the building. For most hospitals (and other public sector buildings), the cafe is an afterthought, squeezed into as little space as possible to allow the ‘real work’ of triage and treatment to occupy everywhere else. But Fleetwood has turned this on its head. Rooted as the town was in the practical realities of population health, it knew instinctively that a space to come and relax, enjoy good food and, most importantly, connect was fundamental to the physical and mental wellbeing of Fleetwood’s people. 

Lee’s involvement in the project and the final emergence from the pandemic turbocharged activity. The scale and scope of that activity were inevitably vast, involving endless rounds of discussions, submissions and contracts with the council, builders, regulators, potential tenants, funders and many others. But slowly, organisations moved in, people began using the rebuilt spaces and a unique energy started to fill the building. The culmination was the opening of the cafe in July 2025. This was the moment when everyone involved in the project felt the building was finally fully transformed from an abandoned state-owned hospital to a resurrected community-owned space – what everyone in Fleetwood now calls ‘The Hub’.

The Hub: a big cuddle of a place

There are two sides to what the people of Fleetwood have created in The Hub. 

First, there is the bare fact of a thriving space that dozens of organisations and people taking part in activities designed to make Fleetwood a healthier and happier place use. The outpatient service is still there, and it has now been joined by child and adolescent mental health services, the ambulance service, adult counselling, a health bus and Macmillan Cancer Support. But this is a centre dedicated to the holistic prevention of ill health, not just treating ill health, and so there are a range of organisations and activities one would never find in a conventional hospital.  

And, of course, there is the café, now named ‘The Heart of the Hub’, run by a local social enterprise and staffed by people with learning disabilities who receive accredited training in hospitality and catering. The Heart has rapidly become much more than a place for good coffee and great food. It is a relaxed, friendly space for people to connect and, if so minded, plan new initiatives – that was always the idea. But it has also become a place where people working in the public and voluntary sectors can meet the people they hope to help, in a less intimidating, more convenient space. It is not unusual, for example, to wander into The Heart now and find police officers engaged in conversation over coffee and cake with community members and organisations about working together to improve safety in the town. 

But none of this quite captures the other side of the place – its unique energy. Walking into The Hub is a completely different experience from entering a hospital, town hall or any other public sector building. Instead of an air of intimidating professionalism and the sense that one is immediately being fed into a process of ‘service user’ management, The Hub feels like a place for the people using it. Part of that is down to Lee Donner’s brilliant architectural design of the re-formed building, but a greater part is the result of a space that the community not only runs, but also owns. A different spirit infuses the place – it is open, inclusive and malleable. Put simply, it feels and behaves like something that is part of the town and its people – not part of the state. 

No one really put it better than Jane – a regular visitor to the building for a training course, which the Blackpool and The Fylde College provides, and an enthusiastic participant in the regular sporting competitions held at The Hub. Jane has multiple health conditions and has faced recent bereavement. For her, The Hub has been a lifeline. That is no metaphor – Jane credits The Hub with literally preventing her descent into ever-more severe ill health, both mental and physical. So, how does she describe the place? As somewhere that feels like getting a ‘big cuddle’ every time she visits.

Moving on up (to the second floor)

One of the more remarkable things about The Hub is that it is only just getting going. Everything that has happened so far has happened on the ground floor. The second and third floors remain untouched. If random pieces of obsolete medical equipment are your thing, then those floors are the place to be.  

But bold plans are being formulated. The negotiations are complex and money will be required but the hope is that The Hub will bring back to the town some of the medical care that was lost when the hospital closed down and as NHS services more generally have deteriorated. But being Fleetwood, things will be done very differently.  

A group of medical students from Lancaster University visited Fleetwood and quickly realised something important and new was happening there. They wrote to the Dean of the university’s medical school and urged closer contact with The Hub. An ambitious idea was formed in further conversations in the community to give the medical school a permanent space on the second floor, where students could be trained in community-led, preventive health care – not sitting in lecture halls but actually providing primary care, dentistry and pharmacy services for the people of Fleetwood. The emphasis would be on making these services as integrated and holistic as possible, not just with each other but also with all of the other services and opportunities available on the ground floor. 

Put another way, not content with reinventing what health care looks like, the people of Fleetwood also plan to completely rethink the curriculum for medical students. 

And what of the third floor? As those involved in The Hub will repeatedly tell you when you ask about long-term hopes, it is all up to the community. What they decide is what gets done and, until that conversation happens, no one knows.

The meaning of Fleetwood

Fleetwood shows that something magical can happen when two things come together: a community able to lead and public sector workers willing to be led. It is the state doing with rather than doing to, taken to its logical endpoint. And that endpoint is a place where the boundaries between public sector institutions and community become so porous that they begin to break down and a town like Fleetwood becomes a place where everyone – no matter what their status, expertise or authority – is working together as equals. Ultimately, no one individual is doing to or even doing with, things are simply being done by the town and its people for the town and its people. 

Fleetwood gives us a peek into what the future of health care and wider public services could and should be like. It is not high tech. It doesn’t require vast amounts of extra money. And there is no need for complex and lucrative contracts with multinational corporations. As Liz Loftus, who leads the Thrive project, puts it, it is simply ‘a different way of being’. It is a way of being that always strives to put the hopes of place and people before the interests of institutions. 

Fleetwood is unique, of course. Its history, geography and people are Fleetwood’s own. But then so is every other place in the UK. There is nothing particularly special about Fleetwood itself that enabled it to go down the route that ultimately led to The Hub. Indeed, one could argue that, given its history of abandonment and the resulting poverty, Fleetwood started with significant disadvantages. But if you go right back to the beginning of the journey, the underpinning practices are clear and it becomes obvious that they could be applied anywhere. 

It all began when Mark Spencer, GP, stepped out of the usual way of doing things as a health care professional and just simply started having conversations with his community – not telling people what to do but listening deeply and taking his lead from what the people of Fleetwood told him they wanted. His role was not to be in charge but to be a connector, an encourager, an enabler.  

That led to community-led initiatives and services built around the holistic needs of individuals, families and communities, not conditions or pathways that professionals have preordained. Thrive is a case in point – an approach to mental health that starts with efforts to really understand what is going on in a young person’s life and builds a response specific to their needs and hopes.  

Finally, it all results in The Hub – a place built around the deepest possible collaboration between the public sector, the voluntary sector, social enterprise, business and, of course, the community itself, to deliver for the town and its people. 

The principles of deep understanding, bespoke solutions and collaborative delivery can be applied anywhere. But what they will not lead to is a replication of Fleetwood. If the lesson you take from this piece is the need for a community-owned hospital or hub in your area, then you have missed the point – you have already decided what the community wants, a position clearly antithetical to the doing with spirit of Fleetwood. The most important thing that Mark Spencer did in 2015 was to set out on a journey with no clear destination. The journey still hasn’t ended – perhaps it never will – but the journey itself and the waypoints along the route are making a difference. 

On my most recent visit, a volunteer at The Hub told me that what made the place special was that everyone involved shared the same heart. That heart is Fleetwood itself. A place that has been knocked about for decades. But a place that the people who live there still love. What the community, supported by great public servants, has done in the past decade and a half is put that love of place and its people back at the centre of health care and a whole range of other services and activities. It is a shared heart that will keep beating for many years to come.