Michael Wood, Head of Health Economic Partnerships, NHS Confederation

The response from local partners to the immediate and pressing COVID-19 health crisis was remarkable and continues to be.

With the health crisis developing into a health recession, and as elements of the Government’s policy response have shifted to the high street, the pressing need to maintain these local partnerships in support of our communities remains.

Strategic discussions around realising the potential of the high street have not traditionally been a priority for NHS leaders.

Similarly, those responsible for planning the future of our town centres often fail to see the economic and social value of health. With the increasing need to align public services with local economic and inclusive growth there is an opportunity to act. How might we embed health at the heart of our place?

The high street occupies a pivotal role in our communities. Situated at the very heart of every village, town and city they have for generations been the place for people to go, meet and spend money - an economic, social and cultural hub that shapes the vibrancy, wellbeing and prosperity of where we live, study and work.

For many of us the high street has been something of a salvation over the past six months in particular, the place where the changing picture of the government’s COVID-19 response has been most vividly illustrated.

While COVID-19 brings into a much sharper focus the economic and social plight of our communities the challenges facing our high streets are not new. Successive local economic strategies have focused on how to reinvent the ailing high street; generating footfall, reimagining the visitor experience, improving non-vehicle access, supporting innovative and sustainable business and civil society development and ultimately raising vital taxation to sustain local public services.

The ‘health voice’ in this debate has often been quiet at best, barring perhaps the occasional discussions around locating primary care services or being part of a renewed local public health focus. In isolation from, and in parallel to, these conversations about the beating heart of our place, the majority of NHS decision-making has been focused away from the high street on the hospital. The time to unify these two important agendas is surely now – with our prevailing inequalities driving a new form of collective, place-based decision-making.

Where should we start?

Taking a broad view there are some pretty obvious places to focus early discussions. Here are three ideas with which to test the water locally:

• Relocating services: there is no obvious reason why it should largely be our primary care services that are the face of the NHS on our high streets, particularly when we are witnessing a swing from inpatient visits to outpatient activity. Across health and care there are a range of clinical, community, diagnostic and mental health and wellbeing services which can be provided in high street settings. Let’s start with what the government has called the ‘most comprehensive flu programme in UK history’ which will be rolled out this winter. At a time when general practice is on the front line in the battle against COVID-19 and is rightly emphasising its digital potential, its ability to roll out over 30 million flu vaccines in a short space of time is going to be severely tested. Why can’t we make use of empty shops on our high street to provide this flu programme for a limited period, thus increasing our capacity and bringing much needed footfall, and salvation, to our local retailers?
  
   
• Mixed-use property development: the vibrancy of the high street is seen as a litmus test for the wider economy. Empty shops and a lack of diversity of ownership and breadth of choice often point to a wider malaise. What is bad for prosperity is also bad for health. In discussions about how and where our services are provided could we house public and private services together, balancing service provision with community benefit with lasting local income generation? Perhaps key-worker accommodation could be added to these local plans too. It cannot be right that in the deepest recession for 300 years the rolling programme of investment the government has committed to in the Health Infrastructure Plan will ignore the economic and social value that can be unlocked through these large-scale developments. Bold thinking must start by acknowledging that replacing a hospital with simply another hospital is a failure of public policy. Putting health at the heart of our high streets means putting health at the centre of our approach to regeneration.
  
   
• Developing a new experience: our economy has changed radically in just six months. Even if the forthcoming economic recovery resembles a V-shape (the best-case scenario) there will be a myriad of winners and losers. Retail for example, is taken as a homogenous sector yet it will involve many different things being bought and in many different places to back in January. Local economic plans will need to understand and adapt to this change, with particular focus being given to the experience that will bring people into our town centres. There is an increasingly powerful argument that health and wellbeing should be integral to this experience. Public health should motivate our designers and planners into getting rid of car parks and the barriers to walking and cycling, as well as fostering in a healthier approach to local food offerings. The well-known impact of recessions on our wellbeing should stimulate a renewed look at how the arts and culture sector can attract and retain people’s local interests and stimulate community activism and entrepreneurship. The value people have associated with their health during the pandemic should lead to new investment opportunities for innovative companies. Together these changes help to reimagine the high street of the future.

Pre-COVID19 the government had restated its commitment to supporting our high streets. Funding was directed on things such as improving and diversifying transport and access into town centres, converting empty retail units into new homes and workplaces, and investing in vital infrastructure. While these remain important local priorities, there is a need now to go much further and to push our conversations much broader – unlocking the potential of the breadth of anchor institutions within a place. Our future prosperity depends on us putting health at the heart of our high streets.  

Michael Wood is Head of Health Economic Partnerships at the NHS Confederation. Follow Michael on @NHSLocalGrowth.