How urban planning can help hospitals come in from the cold | Layla McCay

Layla McCay

Can hospitals stop being monoliths of mystery and isolation and join wider urban life, asks Layla McCay, director of international relations at the NHS Confederation in an article originally published in the HSJ.

A hospital where I once worked had a high stone wall around its grounds. On the bus to work, I heard the local schoolchildren speculating about the mysteries beyond that wall. The hospital felt disconnected from their lives at best, and sinister at worst.

And that’s a missed opportunity.

Hospitals are community anchors – and they normally underpin the local economy. But very often, ill-thought-out urban planning and design means hospitals just don’t seem that way.

Think about it for a moment: people who live nearby may be patients, or have friends and relatives who use the hospital. But they may also work, train, or sell goods or services at the local hospital.

And of course, patients and their visitors go out to shop, or walk, or get involved in community events and services.

Hospitals have plenty of other links to their communities, too. The local community’s health and social wellbeing matters a lot to hospitals, and influences everything from what services and facilities the hospital needs to provide, to how quickly people might recover after being admitted.

Of course, local access to healthy food and physical exercise affects the community’s health. But so too does having secure jobs that pay the living wage; supportive networks of friends and family; safe, affordable housing; and even transport to get to health appointments.

Yet historically, hospitals have been shackled by their design as single-use buildings segregated from the community – islands for the sick in a sea of the generally well.

But modern life has moved on. People now want health and care to be delivered in many settings, physically and digitally.

With a population experiencing an increase in multiple diseases over a longer lifespan, and with people increasingly keen to be treated in the community, healthcare design needs to evolve to meet these trends.

Breaking barriers

One question is gaining a lot of traction among health and urban planning experts: what role can architects and town planners play in redesigning hospitals to help make their local areas and people healthier?

Abroad, other countries have shown us how hospitals can be more tightly knit into the communities around them.

In Detroit, the non-profit Henry Ford Hospital, named after the faded US auto capital’s most famous figure, is moving away from the old-fashioned model of physically isolating the hospital from the community it serves.

The 800-bed hospital, located in a run-down area of the city, has worked to open up its campus as a safe thoroughfare for pedestrians and cyclists.

As part of this, it has moved many of its shops, cafeterias and services to the street front, helping it become an integrated part of a newly-thriving mixed-use neighbourhood.

Another idea gaining international traction is the concept of a “health precinct”. As seen in Japan, this is where health facilities are clustered within the community, amidst other health-supporting facilities like places to socialise.

These health precincts in Japan feature so-called “healthy streets” – where certain pavements are made wide and accessible – and key facilities like libraries and day centres strategically sit alongside health clinics. 

Like Japan, the UK has an increasingly ageing society. This means that design and planning of the places people live, work and socialise is an opportunity for hospitals to join the community to reach beyond their walls and boost local health.

There’s also a lot of scope for well-placed greenery to boost mental health and lower air pollution, and well-designed walking and biking routes to help people get more fit.

As the NHS seeks to deliver accessible, sustainable, high-quality care for all, it will need to get more involved in a community’s health beyond the hospital gate. 

Blurring the boundaries of where health is delivered means you can reach more people and influence their health and recovery far beyond the hospital walls. 

Community care, rather than just hospital care, is an essential choice for a lasting, sustainable health service – and the opportunities within that term will start to define the UK’s health over the next decade.

If this is done well, schoolchildren will no longer need to whisper about the secrets behind the hospital wall. The barriers between the community and the services designed to keep it healthy may hopefully soon be a thing of the past.

Layla McCay is director of international relations at the NHS Confederation. Follow her on Twitter @LaylaMcCay. This article was originally published in the HSJ.

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