With the second NLA Healthcare Expert Panel meeting having taken place last week, the trajectory of the recommendations for the New London Agenda continues to focus on the power of the ‘neighbourhood’ for bettering health & wellbeing.  London like many similar cities around the world, suffers with immense disparities in healthcare and education provision, the resulting effect of this on the city’s population can be significant.  For example, Londoners living just 2 miles apart, in either Edmonton Green or Highgate, can have a difference in their average life expectancy of 15 years; highlighting the vastly different pressures experienced across London NHS Trusts. 

To further understand the opportunities and challenges of delivering healthcare both on and off campus, the panel facilitated a roundtable that bought together the London ICS Estates and Facilities Leads, the GLA and London Estates Delivery Unit and Hackney Strategic Property Services. Discussions centred around the need for alignment with clinical and infrastructureal strategy; asset privatisation for strategic capital; and the utilisation of planning policy to anchor healthcare into neighbourhood development. It was also highlighted that legal constraints to procuring healthcare facilities paired with a blurred understanding of building requirements has resulted in many developments abandoning the concept of embedding healthcare within their designs 

Developing on from the first meeting of the cycle and the ICS Roundtable, the concept of ‘’looking beyond the red line boundary’’ became central to the focus of the panel; this being much further reaching than that of a simple architectural intervention. It was agreed that the Expert Panel will utilise the post-pandemic refresh of the Mayor’s Six Tests, a key indicator of the widened health inequalities and disproportionate impact Covid-19 had on Londoners to aid the development of the recommendations for the New London Agenda. Scrutinising how these six tests can be successfully implemented in conjunction with the NHS Integrated Care Systems (ICS) and the constraints that may hinder this progress will be key to providing clear, actionable solutions. 

Given the accelerated changes to healthcare delivery; the requirement for climate adaptive buildings; and widespread adoption of flexible working during the past three years it was agreed it is vitally important that the strategic ambitions of NHS Estates be revisited before any future major development of healthcare facilities. An exploration as to the opportunities outside of the red line boundary continued, questioning how the NHS can capitalise on London’s diverse and developed landscape to aid the implementation of ICS infrastructure strategies. These included: 

- Upskilling of NHS Estates and Development Teams through the support of London Universities; with focus on the reuse of existing assets; funding and partnership models; accessing S106 and Community Infrastructure Levy (CIL) funds; and the interrogation of NHS asset usage, capital and carbon cost 

- Utilisation of vacant assets, such as high street retail units, that ensure a mutually beneficial deal for the NHS and the Local Authority.  The panel will continue to develop the idea of a pilot for Health on the High Street, with focus being placed on the shift towards social prescribing.  Precedence can be taken from the successes and failures of the Community Diagnostic Centre (CDC) projects across the country as well as the TfL model for developing land, and the recent London Borough of Hackney healthcare developments.
 

- The implementation of a Social Value Framework spearheaded by the GLA that embeds health and wellbeing into all built environment sectors, not just that of healthcare facilities

- Embedding decarbonisation strategies and demonstration of flexible and adaptable alternative uses into major detailed planning applications to encourage retrofit, safeguarding against demolition and rebuild in the future. 

What is abundantly clear is the importance of implementing neighbourhood focused prevention and treatment for the benefit of the community, climate, and the recovery of our NHS. It is these values that will underpin the Expert Panel for Healthcare recommendations for the New London Agenda.