COVID-19: Focusing on healthcare and placemaking

How we restart our country after the coronavirus lockdown is one of the most important decisions our politicians will have to take. Not just in terms of public health impact, but the kind of economy they want to encourage.

Over the last two decades, health inequality across the UK has increased, placing enormous pressure on the nation’s social fabric. Those outside of the London are dying years earlier and, in some areas, life expectancy is now falling. 

The global coronavirus pandemic has highlighted the importance of investing in resilient healthcare infrastructure and supply chains to provide the same level of care to people wherever they are across the country. By that I don’t just mean new hospitals, but holistically looking at the entire healthcare system, including the services that help keep people out of hospital. 

We see the impact of regional inequality in healthcare provision when looking at Clinical Commissioning Groups as they work to provide Covid-19 care. Data from the Office of National Statistics shows that, although London has the highest number of Covid-19 cases, it also has more hospitals, with more staff and better facilities. Meanwhile, regions outside the capital have exacerbating factors like older populations and more long-term chronic conditions but lack the same level of healthcare facilities. This is particularly true for step down care needs, where the regions outside of London are less well equipped to provide for those for those recovering from Covid-19 outside of the hospital setting.

As we begin to recover from the devastating economic and social effects of coronavirus, the government must combine its ‘levelling-up’ agenda with placemaking. A radically different approach to placemaking can help us tackle a range of inequalities in regions outside of London and make communities stronger and more resilient to future crises and disasters. 

Placemaking and health

Research from Mace, included in our recent Insights report on the UK’s inequality problem, identifies some of the key factors that create a healthy place to live and a resilient community. 

Residents must have the ability to easily access both good-quality employment opportunities and essential public services such as GP surgeries, schools, and social care for the elderly. Ideally, of course, these services should be ‘on the doorstep’, but where that is not possible then good quality public transport needs to be available. 

Perhaps trickier to measure is a sense of community or belonging. This is created by the presence of tangible social infrastructure such as local community groups and facilities, but also the less obvious social capital produced by groups of volunteers and civic organisations. We need to turn the 750,000 strong NHS volunteer army into a permanent part of our communities. 

Finally, we need commitment to improving and maintaining the natural environment by reducing air pollution, encouraging good quality parks and walking routes, planting flowers and trees, and ensuring that residents have access to plenty of natural light at home and at work. Many weeks of being stuck inside and gyms being closed has shown us just how critical these public assets are.

These interventions will help improve both physical and mental health, which have substantial impacts on our economy. According to Oxford Economics, the size of the UK economy in 2015 could have been over £25bn higher had it not been for the economic consequences of mental health problems and some analysts put a £20bn price tag on the impacts of air pollution.

Improving the policy environment for healthy placemaking 

If a healthy placemaking approach has the potential to add so much to the economy, why are we not doing it already?

Research carried out by Mace identified some of the common barriers to creating resilient and healthy places. 

Public service provision is often too siloed, with housing policy for example rarely in touch with the needs of adult social care. Many local authorities are often under-resourced and concentrate on dealing with the day-to-day.

The planning process for major developments, even those with clear and obvious health and wellbeing benefits, can be slow and cumbersome. The finance environment is unclear for developers, particularly those entering the market from outside the UK and especially as risk appetite changes due to Covid-19. In ‘left-behind’ communities around our country, tax and other incentives will need to be offered to encourage investment.

One concept which we think has the potential to drive this change is the creation of ‘supercharged’ development corporations. These could provide special ‘Foreign Direct Investment Finance’, along with accelerated planning, and could unlock public funding for interventions like the Stronger Towns Fund. There is also a role for the Department for International Trade in these areas, in promoting foreign direct investment to overseas investors and markets. 

Finally, a reform of the planning system is needed to accelerate development and promote the kind of developments we aspire to. With 300,000 new homes needed every year in the UK to keep up with demand, there is an urgent need to ramp up the pace of housing delivery. This could include broadening the use of Development Consent Orders for major schemes or encouraging local authorities to use more Local Development Orders.

Ensuring health inequalities do not continue to widen means ensuring the most ‘left behind’ parts of the UK play a greater role in the nation’s economy. However, simply throwing money at physical and social regeneration will not be sufficient. 

To finally make the right progress, we need a more holistic approach to planning and development, one which puts people at their centre and listens to their needs.