Insight: Shopping for Health

We know how changing living and working patterns have affected high streets, accelerating the demise in retail that was already underway before 2020. We also know the huge pressure the pandemic has put on our NHS, and all frontline healthcare workers. What’s too often missing from the conversation around these shifts in public life is how to respond with a holistic solution – for example, one that combines progressive healthcare provision with a new blueprint for our high streets.

In response to today’s burden on traditional hospitals, the government’s Health Infrastructure Plan – and within this its New Hospital Programme – sets out drivers to develop new planning capabilities, workforce models and ways of delivering care. This programme outlines the potential need for approximately 1.25 million m² of space for health services.

This huge figure comprises 1 million m² to move suitable outpatient-based services from acute hospital settings into the community – an initiative known as ‘lift and shift’ – and 250,000 m² to accommodate additional future clinical roles, as part of the government’s Primary Care Network manifesto to improve population health.

Concurrently, recent data from Experian shows that shopping centres have over 1.6 million m² of space that is vacant – a figure that represents more than enough to meet the projected demand for health services, and that is only likely to increase with time.

ADP joined forces with a wider team of built environment and healthcare specialists, including Macmillan Cancer Support, iDEA and Carter Jonas, to explore potential new models of healthcare delivery that would tap into this new supply and demand imbalance, resulting in the research white paper Shopping for Health.

At ADP, we are also working on projects on the ground that create the ideal test bed for bringing healthcare onto the high street – demonstrating that this is both a practical and deliverable solution. One of these is in Cheshire, where Warrington and Halton Hospitals NHS Trust is relocating its ophthalmology and audiology outpatient services into a vacant retail unit in Runcorn Shopping City.

The Runcorn project forms part of the ‘Healthy New Towns Programme’, an NHS England initiative to deliver a range of NHS outpatient services within the local community. This programme will provide health and care services within easy walking distance of people’s homes, and ensure people are both supported and empowered to look after their health and wellbeing independently. The vacant unit was slightly larger than required for the clinical functions, providing the opportunity to integrate two complementary wellbeing services alongside it – Halton Haven Hospice and the Citizens Advice Bureau.

Meanwhile, in Gloucester, ADP is helping to regenerate and transform a former Debenhams department store into a new city centre campus for the University of Gloucestershire’s Health and Social Care department. The campus, set within this iconic city building, will combine clinical education and simulation training for nursing and allied healthcare professionals with the opportunity for patient-facing NHS health and wellbeing services. The project exemplifies the integrated mix of uses, and users, that can make these projects so much greater than the sum of their parts.

It’s this breakdown of barriers between traditional uses that could open the door to projects like this on a much wider scale. The recent changes to the Use Classes Order system in England have not been without controversy. But behind the headlines, rightly condemning those developers who convert offices into substandard homes, there lies a wealth of opportunity to reshape our high streets for the public good. And the more recent Class E category means that everything from empty shops to town centre office buildings can become anything from health clinics to care facilities, without the need for planning permission.

Bringing healthcare facilities back into the heart of the communities they serve, often alongside a wider holistic offering, can open up the way we think about health, while also making preventative healthcare services more readily accessible to more of the population. There is also a sustainability angle to retrofitting existing shopping centre buildings, as opposed to building new spaces from scratch. This offers the opportunity to address the NHS Net Zero Carbon agenda alongside its other key targets.

In short, there are many advantages of using vacant retail spaces to house healthcare services: NHS Trusts have new, well-located spaces to provide care; patients can access healthcare in more convenient ways; landlords have reliable long-term tenants for vacant units, and the high street can evolve into a more relevant and connected community space. Our hope is that this white paper can also help local authorities, Primary Care Networks, hospital Trusts and other key bodies when it comes to resetting their services and priorities, while highlighting the role that the architecture and design community can play in pioneering and enabling this journey.