____

Health Street
Health creation as a new mission for our high streets

March 2023

____Contents
Executive summary - 4
Building more hospitals - 6
A place for health - 8
Ambition of health centres - 14
Impacts of inequality - 18
Measures to empower change - 20
Nurturing health creation - 22
From health centre to health street - 24
New purpose for the high street - 26
How health street works - 28
The health street framework - 32
Putting the idea into practice - 34
What’s next - 42

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Health Street is a vision for a new kind of health space right at the heartof urban communities – the local high street. While hospitals are pushed to
the limit, many high streets across Britain are hollowing out. Our propositionshows how pressure in one area could be released where there is morecapacity in another. It envisions how communities can benefit from a shift
from treating illness to health creation by co-creating services that are moreconvenient, holistic, and relevant to their needs.

Health creation as a new mission for our high streets

The purpose of the report is to encourage people living in towns and cities
in the UK to think about health differently. Building on a growing recognition
that health is much more than an overly simplistic absence of illness, we
propose a new place focused on health creation. As most healthcare
outcomes are driven by social factors, Health Street builds connections
with charities, community and faith groups, local businesses, and social
enterprises as well as health services to deliver a new social and civic space
where residents and visitors will feel empowered to improve their health.
At Heatherwick Studio we believe in the power of architecture to change
how we feel. Our experiences in working on a cancer care centre in Leeds
have allowed us to explore the importance providing a set of a set of holistic
support services in a way that is accessible, understandable, and welcoming
to all. By co-locating mutually beneficial services and diversifying the useof local hight street, Health Street is based on community need rather thanmarket demand. Our vision adopts the key principles of regenerative retail,supporting local aims and activities, rather than imposing any set programme.
Most importantly, it can make use of spaces that already exist, which areconvenient, familiar, and connected to local transport.
We outline seven steps to creating a Health Street. From forming a coalitionof community champions, through creating a seed space with room to growand interconnected services and activities to the spill-over onto the street, we
present a vision of a theoretical Health Street in Lister Gate Nottingham.
We developed Health Street in collaboration with experts in medicine, social
care, place-making, real estate, data analytics, public policy and service
design. The idea aims to address growing social inequalities, and tosupport new initiatives, such as Integrated Care Systems and socialprescribing.
With this publication we looking to hear from a diverse range of voices in theabove fields, towns and cities, community groups and champions, and otherorganisations and individuals who might be interested in developing the vision
and who might help make it a reality.

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“Health is a state of complete
physical, mental and social
wellbeing and not merely theabsence of disease or infirmity.”

Building more
hospitals?
Heatherwick Studio has always had an

World Health Organisation

Building bigger, more advanced

interest in healthcare spaces. We believe in

hospitals seemed to be the prevailing trend,

the power of architecture to influence how

and in 2021 we submitted an entry for the

we feel. As countless studies have shown,

Wolfson Economics Prize, which explored

good design can make us more optimistic,

what the future hospital might look like.

What should this place for healthprovide? Where should it be? What should

calmer – happier, even. Nowhere is this more
important than the places we turn to for

Out of town
Health Centre

However, as our research evolved, theARGOS

our minds. We didn’t think that the solution
was more expensive hospitals. We believed

design focused on hospitals. We undertook

it was something different, something morein-depth research into the commissioning

affordable and sustainable – a new kind ofof new facilities; we engaged with health‘place for health’, which responded to local

ministers, specialists in hospital planning, the needs but addressed population-wide issues.
Royal College of Art, Helix Centre and manyother organisations.
Through discussions, design charettes
and team visits, we sought to deepen
our understanding of the key issues. We
examined health inequalities, an ageing
population in which many are living longer,
but not well, the rise of preventable chronic
illnesses and pressures on GPs and hospital
services.

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it look like and how might it feel? And how
does it relate to its setting – can it be partof the town or city it belongs to? We are still

healing, comfort and support with our health. evidence we had accumulated changed
Our early investigations into healthcare

VacantDepartment
Store

HEALTH CENTRE

benefitting from the legacy of transformativeNEXT

initiatives of the past, from Victorian sewers
HEALTH STREET!

to the 1956 Clean Air Act, but we have lostthat ambitious urban perspective on health.
We tried to find new synergies and

DATA

VOLUNTEERS
outpatient clinics

diagnostic testing
RETAILinspirational Environment

explore how town centres and high streets
could help to grow healthier communities.
by drawing on our insights from large-scaleurban, retail and mixed-use projects and ourWolfson Economics Prize submission - Reinventing
the health centre as an altnernative to building new
hospitals

understanding of healthcare priorities.
And we explored how to achieve this,not by building more, but by wasting less –repurposing existing buildings and bringing
together people and clusters of services that
fit, that can help each other out.

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someone might start to accept a cancer

A place for healthdiagnosis. Not everyone will be ready to open
the door straight away, so there is a bench tosit outside, or a private path to wander quietly
through the gardens. Inside, visitors are notconfronted by a conventional reception space;instead, they find a welcoming window seat, a
notice board, and a view through to the heart ofthe centre, with its communal table in the arc of

We know what hospitals and GP

In 2012, we had the opportunity

a staircase leading to the kitchen.

surgeries look and feel like. We know their

to design a place with a very

corridors, waiting rooms, signs, their clinicaldifferent way of seeing health andsmell, beeping alerts and reception desks.

illness – a Maggie’s Centre, on theCentres, represents another threshold; theWhile these facilities play a vital role in our

campus of St James’s University

point where visitors feel ready to share theirhealth service, we currently understand them

Hospital in Leeds. Founded byexperiences. Everything is on display so there

as places for illness – where we go for an

the late Maggie Keswick Jencks,

is no awkward rummaging through cupboards

operation, tests or treatment.

these centres are designed to lift

to find a mug, and a clerestory fills the space

the spirits. They provide spaces

with natural light. Above this there is a private

where people with cancer, andspace for staff to rest and gather strength, andtheir friends and families can go toa sheltered roof garden. At every step of thefind free practical and emotional

design, we learnt more about the needs of its

support. This purpose is manifest

visitors and staff.

The kitchen table, a feature of all Maggie’s

through their architecture: a series
of inspiring, welcoming buildings byleading designers.
Heatherwick Studio’s Maggie’s
is set on a slope, surrounded bygardens. We considered every
aspect of the relationship between
its architecture and the experiencefor visitors. The front door, forexample, is a psychologicalthreshold – the point at which

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28%

One of the many successes of Maggie’s

The historical policy separation of health

Cost is also a key issue. The National

Centres has been bringing together a diverseand social care which took place in the 1970s

Health Service has become our national

range of holistic support services in a way

has also made matters worse. For a number of

emergency service, and it is under enormousthat is accessible and readily understoodreasons, ranging from political to administrative

pressure. For public hospitals, often vast in

as a concept. This mission is signalled andand financial the decision to decouple healthscale, it is difficult to justify less conventional

supported by bold, humane architecture –services from social care services createddesign approaches when any additional penny

spaces purposefully conceived as the antithesis

barriers between them. Countless studies andcould go towards treating another patient. Givenof clinical rooms. From our experience with

reports have since shown that the absence of

these pressures, it seems almost impossible toMaggie’s, we also recognised that the design ofa unified health and social care approach has

go beyond basic functional needs in planning

the service model is as, if not more, important

been a key stumbling block in the provision

services and facilities.

as these physical spaces.

of effective and holistic health care in the UK.
Although recent policy changes reintegrated theWhy don’t more healthcare settings

two services, most notably with a creation of

combine holistic support with humanea new minister for care in January 2018 whicharchitecture? Primarily, because the NHS wascoincided with the renaming of the Department

established to treat illness, and the form andof Health to include social care, the two services

feel of its buildings follows this function. A

are still not fully integrated

fundamental shift is needed from only treating
illness to also creating health and wellbeing.
This would demand a change, not only in theoperations and purpose of the NHS, but also in
its relationships with people, communities anda far broader range of organisations.

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19 million
people havea chronic
illness

70% of Hospital Beds are occupied
by patients with chronic illness

9 million people A year aresent home from a&e withadvice that could have been
received elsewhere

Bed occupancy levels
are consistently above
recommended levels; thenhs would have to treat anadditional 500,000 patientsfor four years to clear
the current backlog (thatdoesn’t include the hidden
backlog)

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There were more than
15 million wasted GP
consultations in 2019,at a cost of £216m peryear, and 1.2million
GP hours.

The story is much the same for GP

These pressures are combined with ourWhile online and telephone consultations

surgeries, albeit at a smaller scale of building.

understanding of healthcare buildings only

increased significantly during the Covid-19

According to our research, the size of theseas places for treating illness. And because

pandemic, along with the benefits ofspaces is driven primarily by out-of-date

we tend to go to these spaces when we areconvenience, they represent a further loss of

specifications based on the core quantitativeill, when something feels wrong, or in an

contact with patients, and of opportunities forfunction of consultations/number of patients,

emergency, the institutional nature of thesethem to meet each other.

making it difficult to justify more generous

environments can compound what is often

provision. GPs are also facing enormousalready a negative experience.

According to somespecialists, around one
in seven procedures in
hospitals shouldn’t be
taking place at allpressures.
The consequence is that we don’t engage
To help to address this, they have morewith healthcare settings unless we really

support functions, such as social prescribers

have to – and some people avoid themand dieticians, but they lack the facilities andentirely, falling through the net of preventative

budget for them to operate effectively. Eithercare. Missed appointments for GP and hospital

there isn’t space, there isn’t enough funding forappointments cost vast sums of money eachthat space, or there isn’t a network nearby toyear; not wanting to go may be costing usdeliver on these more holistic, comprehensive

millions.

health initiatives.

How we feel about these places is important.
If we associate them only with illness, then weneed a different kind of place for health – aplace that is not just for treating illness, butwhich aims to address wider issues and help
people live well for longer.
GPS are overloaded,
the number of patients
per gp practice is 22%
higher than it was in2015, but the workforce
has not grown with thisdemandGPS centres are not designed to accommodate thenumerouse support teams they now have.
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Ambition ofhealth centres
Health centres have already tried to beor the 1949 John Scott Health Centre in Hackney,a different kind of place for health, in their

which combined GPs, dentists, care services,original incarnations: not a hospital, but moreminor operations, diagnostics, psychiatry, athan a GP surgery. Early examples, which

lecture hall, garden and canteen. Or Finsbury

combined optimistic architecture with health

Health Centre in Islington, with its light, airy

services and other activities, have left anModernism. Even the NHS itself has its origins in

inspiring built legacy. In London, think of thea collection of health and community services,

ambition of the 1926 Pioneer Health Centre

which ultimately came together to improve the(often referred to as the Peckham Experiment),

health of the public at a national scale.

While the functionality of the health centre hascontinued, as a concept it has lost its meaning. For
many, it is just another word for GP surgery. Their lookand feel still tends to be institutional, perceived asplaces for illness, and when their health services andspaces come from the same model as the ‘enhanced’GP surgery, the offer is not radically different. Many
recent health centre developments have been built outof town, encouraging journeys by car. These facilities
bring together ever more siloed clinical services within amunicipal building around a clinical atrium. Social careis rarely incorporated. Subsequent models, such aspolyclinics, have also faced criticism.

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More recently, the wider civic role that

This new civic dimension comes ahealth centres can play has been recognised.

tendency to overscale the architecture andSome new facilities are being built in urban

over-medicalise the functionality. Most

centres and combined with complementarysignificantly, there is rarely any relationshipuses, such as leisure centres and community

between the different providers in aspace, like West Norwood Health and Leisurebuilding – a co-located library,

Centre. The Tessa Jowell Health Centre in Eastleisure centre and GP

Dulwich, offers a wider hub for health, the NHSpractice, for example,

Foundation Trust describes its aim as bringing

was not conceived‘hospital services’ closer to the community. The
Shields Centre in Glasgow, is a neighbourhood

THE SHIELDS CENTRE
EXTERIOR AND INTERNALATRIA

as an integrated
model, with eachhealth centre, incorporating two GP surgeries,

element now

social work services and community garden.

operating entirely
independently.

We need to think differently about what
‘health’ really means and how its created – tosee health as more than an absence of disease.
We need to rethink the problem and widen our
understanding of health to something much
more far-reaching and holistic. If
we don’t, can we really expect
different results if today’s
health centres don’t
have a different kindof service, or a morehumane kind of
space?

In character andfeel, they still result inclinical environments,
white atriums, co-locating
more and more curative, siloed health services
in one building. Its a pattern that persists
TESSA JOWELL CENTRE
EXTERIOR AND INTERNAL
ATRIA

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WEST NORWOOD HEALH
AND LIESURE CENTRE
EXTERIOR AND INTERNAL
ATRIA

throughout many of our new build healthcentres.

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“The last decade has been marked
by deteriorating health and widening
health inequalities. People living in moredeprived areas outside London haveseen their life expectancy stalling, evendeclining for some, while it has increasedin more advantaged areas.”
Health Equity in England:
The Marmot Review 10 Years On

Impacts ofinequalities
Most healthcare outcomes are driven by

A focus on improving health, or ‘health

To tackle health inequalities, we need tosocial factors, such as where you live, what

creation’ is vital, rather than simply treatingtackle socio-economic inequalities and create

they also need choice, respect, and the space

you do for a living, your income, education,

illness. Social determinants increasingly shape

the right kind of welcoming spaces in our

to pursue the activities that nurture them, andhousing, access to services, your social life.

our health outcomes through life; as

towns and cities can support that. And they

we need to better understand and respond

These are the social determinants

we live longer, we are more likely

need to offer more than medication. Whento these broader needs. There is a reasonof health. By

to develop complex, ongoing

GPs are allocated £150 per person, per year,

the concept of relational care has gathered

understanding

conditions, and the morethey simply can’t be expected, in 10-minute

momentum in recent years – empowering

these better, we

deprived we are, the earlier in

consultations, to explore the root cause of

the person in need of care and health support

can start to makeour lives this happens. The

underlying social issues, such as employment,

rather than providing them with one-directional,

more targeted

extra years added to ourloneliness, a language barrier, or poor housing

non-reciprocal service, allows for sense ofinterventions. They arelife expectancy, and theconditions. However, they are expected toagency and ownership.

the foundations of healthappearance of obesity

detect and make appropriate referrals.

equalities and inequalities.

related conditions such

Life expectancy is now

as diabetes, at everdeclining for the poorest

younger ages, puts

10% and is not rising for the

more pressure on

poorest 40%. There is also

our health and caredisparity in quality of life andhealth as we age, and a difference

People need guidance with their health, butsystem. As a result, many of us
might be living longer, but we’re not living well.

of 20 years in healthy life expectancy between
and within areas of the UK. It’s a social injusticethat needs long-term societal change, not justbetter access to healthcare.

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when Gps are allocated £150/person/year,
they simply don’t have the Resources to get
to explore in (10-minute consultations),
underlying social issues, such as
employment
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Measures toempower change“Social prescribing is thegreatest cultural shift inmedicine in generations.”
Health Equity in England:
The Marmot Review
10 Years On

Social prescribing aims to addressThis approach often builds connections

Reaching into many different aspects ofis positive to see growing realisation that theunderlying social issues by enabling people

with charities, community and faith groups,

society, the methods of social prescribing lie

primary care workforce needs to expand andto be referred to non-clinical services, fromlocal businesses, and social enterprises. The

at the core of health creation. Although social

diversify, they need more and different types oflegal and housing advice to exercise classes.

‘prescriptions’ connect people to activities likeprescribing has been around for decades,

spaces to work effectively as multi-disciplinary

It is based upon understanding the social

art classes, choirs, gardening, and carpentry

it wasn’t adopted by the NHS until 2019. At

teams. Otherwise, this holistic expertise is notdeterminants of health. Link workers – or social

workshops, to name a few. There is no single

present only the social prescriber is funded, notbeing used to its full potential to benefit theprescribers – are trained to ask, ‘what mattersset of needs, however, as every community is

the services – and many GP premises do not

public.

to you’, as opposed to ‘what’s the matter withdifferent. In one deprived area, for example, 40%

have the space for these link workers. While it

you’. From this, they help people find a moreof referrals are about housing, debt, welfare

personalised solution to help address theirsocial, emotional, or practical needs
to improve their health.

benefits and access to emergency food
– and around 10-15% ofsocial prescribing clientsin such communities
present withsuicidal ideation.

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Nurturing healthcreation
Bromley by Bow Centre in East London

Its origins are in meeting local needs

is a place where social prescribing is used

– it started out as a cluster of services,to its full potential. The centre puts the idea

including a nursery, dance school andof treating the root cause first, and has done

community café, in a church. It remained

It has created the ideal conditions forsince 1990s. Recognising that “health isin this form for over a decade before theself-initiated referral, with the vast majority

primary driven by social factors, not medical

decision was made to expand to incorporate

accessing the community centre and its

ones”, current activities at the centre include

a health centre. This incremental growthprogrammes without being prescribed. The

welfare, legal and financial advice, including

allowed a values-based approach towards

activities of Bromley by Bow Centre are 70%

fuel poverty support, a food bank, healthy

an understanding of health based on social

health creation and 30% treating illness.

lifestyles programmes, extensive adult learning

determinants and prioritised the agency ofAnd most importantly of all, it is owned andand employability initiatives, arts and cultural

local people. Today the General Practice has

managed by the community. Designed forprogrammes. Instead of a single centre, it is a

7,500 registered patients and the community

people, rather than systems or machines, theframework of activities and related spaces. This

programmes serve around 12,000 people

centre sees the community as co-producers.

has been a catalyst for innovative programmes,

each year, of whom around 1,000 come via

such as Planet Asthma , a learning resourcesocial prescribing. As a highly successfulwhich used art and technology to raise

initiative, Bromley by Bow has often beenawareness of childhood asthma and was rolled

studied internationally as a model without in primary schools.

potential wider applicability.

PLANET ASTHMA SCHOOLS PROGRAMME22

As a result, the place feels like theirs, as
opposed to the anonymous service user ina typical health centre. The design matches
place to principles in a similar way to a Maggie’s
Centre. The spaces are bright, welcoming, andincorporate a garden where visitors can relax,
do some gardening or an outdoor class. The
paving and facade incorporate elements madeby people using the centre, while inside, thegardens and rooms are adorned with artworkand sculptures made in its various classes.

“95% of healthcare spending is spenton people who are ill. That would makesense, perhaps. But in practice, it’s likehaving a football team of goalkeepers
by the net, waiting for problems. We
need more strikers anddefenders, more positive,
active measures that canempower people to makechanges before they getto the point of needing any
medical intervention.”
Dan Hopewell, Director of Knowledge andInnovation, Bromley By Bow Centre

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From health centre
to health street
Like Bromley by Bow, the model for HealthToo many healthcare initiatives
are tweaking something that isalready broken, like pruning thebranches of a fallen tree. We thinkit’s time to try planting a new tree.

Focused on towns and cities, Health Street

A larger street presence brings

Now the NHS has adopted social

Street is based on recognising that health istakes the opportunity to shift in scalepotential to take advantage of theprescribing, there’s opportunity to create

mostly driven by social, not medical factors.

from the neighbourhood health centre to anational drive of moving outpatient

places where this approach is used to its

Taking this broader view of health, the goal istown-centre health street. Scaling up from adiagnostics out of hospitals intofull potential on a bigger scale. Its part ofto:building within a neighbourhood, to a street

the community. Missed outpatienta shift toward preventative medicine andin the town-centre brings a broader urban

appointments cost the NHS millions

wellness – the idea that health is more

help change the perception of what

presence where the range of services can be

annually and occupy precious

makes up our health,spread out across numerous buildings andspace in hospitals that

establishment of Integrated

broaden the understanding of social

outdoor spaces along a street.

don’t need to be there.

Care Systems. Across theOver 50 Community

UK, there are 42 new••factors influencing our health••than ‘not ill’ – which has led to theencourage people to take active

Where the health centre focuses deeply on

Diagnostic Centres

partnerships between

positive measures to improve their

one local community, the health street has(CDCs) are planned

local authorities, thehealthpotential to reach numerous communities

nationally withvoluntary sectors andsupport our primary and secondary

within a town or city. It’s more central

more in the

NHS services. Their aim ishealthcare places with a new placelocation can connect with people of different

pipeline. They will

to facilitate more joined-focused on health creation.

ages, interests and needs. It can benefit

house diagnostic

up care. Health Street canfrom the “while I am in town” mentality ofservices from blood-support and build on thesepeople likely to stop-by while visiting as well

testing to MRI scans.

initiatives

as connecting with people working with jobs

Vacant retail spaces like large

in the city centre.

anchor units in shopping centres arebeing transformed into them.

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New purpose forthe high street
Combining the principles of health
The so-called ‘death of the high street’

The high street represents an ideal

creation and regeneration retail Healthmeans more than empty shops andplace for heatlh – an accessible, everyday

Street can give the high street a new social

streets, it means the hollowing out of any

space, for everybody. It has scope to allow

and civic purpose. It’s conceived as a placesocial purpose. Although always a place formore generosity in terms of space, and morethat encourages people not only to improve

shopping, the high street has also served

unconventional design approaches for boththeir health but also to inspire people to starta social function: as a point of connection,

health creation and retail. With large-scalebusinesses – social enterprises that attract

a place to meet, gossip in the post office,retail no longer requiring the same volume

and become part of the community, starting

discover the local area, find out what’s goingof city centre sites, high streets have been

conversations, not just transactions.

on in the community.

left with difficult holes to fill, but they bring
opportunities for new health initiatives like

It’s decline is not just a result ofcommunity diagnostic centres.

online retail and the pandemic; it’s also a
consequence of development strategies

The health street model is basedthat respond only to market opportunity.

on community need rather than simply

We have witnessed short-term solutions

market demand. Just because there isresult in failure. Large clusters of businesses

market demand doesn’t mean its good•retail that builds community and local investment

exploit commercial footfall but are not infor a community or good for health. The•

food retail linked to regenerative farming

service to the community. The trend in our

benefits can be economic, as well as social.

•cluster complimentary businesses that sharetown and city centres has been to prioritise

The rise of regenerative retail initiatives infootfall and spend, but now there’s an

the UK, like Incredible Edible in Todmorden,opportunity to prioritise once again this free

the Small Food Bakery in Nottingham orand informal social interaction.

the ‘community-wealth-building’ model in

Principles of regeneration retail•sell things that are good for the community andenvironment

knowledge and resources•

collaborating with suppliers to strengthen bothbusinesses

Preston, demonstrate the potential of thisapproach.
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How Health Street
Works

Health Street is a flexible framework forgrowing wellbeing. It’s not a rigid formula but

Ideal conditions to grow:•conditions to grow and requires some essential
ingredients in a certain order.
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a retail street in the town or city centre, inneed of re-activation

just like anything that grows, it needs certain••

proximity to multiple residential
communities within a 15minute walk

excellent public transport links, cycle•

routes and bike parking.
•a nearby public green space ideallywithin walking distanceplans for relocation of outpatient
services into the city•

local businesses and community groups
passionate about health creation & anambitious innovative ICS
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How Health Street
Works•

identify some room to grow: pinpointing other vacant spaceson the street for future growth, like other vacant groundfloor units or the spaces above them, taking into account their

Essential ingredients in order:

availability and ownership. Bringing more diverse uses to thestreet, means more of these spaces can now be activated.

••assemble community champions: the key decision makers•

provide community diagnostics: inviting the relocation offor how the street grows, these are a committed group of

outpatient services to the street, to become an anchor tenant.

representatives across local community groups, businesses,

Spaces like department stores or multi-storey anchor retail units

charities, and healthcare, who believe in the value of supporting

have large spaces above ground with good service access which

health creation.

makes them ideal for CDCs.

find the seed space: the catalyst for incremental change on the•build a network: researching other businesses, groups andstreet this is a large ground for retail unit with flexible open space,activities to join the street. It needn’t be retail but what theyused as a community hub. It needs capacity to host community

should support health creation and have mutually beneficial

events and offer locally grown or made healthy food.

relationships with businesses and groups already connected withthe seed space. Incrementally they will reactivate the street.

•30

make it feel welcoming: an inspiring environment and frontage•

expand to the outdoors: extending the presence of healthit needs planting, natural materials and daylight. Community

creating activities out onto the street, with outdoor exhibitions,champions can engage local people in its design, and explore co-pop-up events, play areas, drinking fountains, communal seating,creating it with them, so the space feels theirs, without excluding

better lighting, public toilets. More planting can help make athe broader population who it should also attract.

stronger connection with a nearby public green space.

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The Health Street
framework

Establishing a successful Health Street

It would also require incorporating

New activities and programmes could

Health Street serves the needs of theframework will require an incremental

place-based programmes targeting

emerge from the tenants of Health Street,

community, rather than only the market; itprocess of ‘design’, ‘curate’ and ‘sustain’.

some of the more deprived communities.

such as retailers helping people to findgives people the opportunities they need,This means surveying the needs andThese programmes, run by the community

clothes post-surgery. Over time, there isnot simply more things to buy. It aims toopportunities of the city, researching andchampions, would usually start inscope for primary care services to relocate,bring life back to the high street by increasing

curating businesses that have mutually

the community but after establishingwith a GP centre that puts social prescribing

the diversity of uses in a way that supports

beneficial relationships, and testing, toparticipation would move to the seed space,first like at Bromley by Bow, or other

health creation and helps businesses doensure that the design and relationships

allowing participants to see themselves incomplimentary services like pharmacies,

more for local people, encouraging new

are in support of the service, and that there

the space which otherwise might not feel

dentists, opticians or blood donation centre.

services and businesses to reactivate theis flexibility and sustainability built into

relatable, and forging a sense of ‘ownership’

Although the community champions rolevacant spaces over time. The seed space

the framework. It will also require closefrom the outset thus maximising chances foris to ensure the feel of the place does notprovides a new social hub whilst the whole

cooperation with Primary Care Networks

them to use the seed space to their greatest

become ‘medical’ in any way.

framework along the street becomes a new(PCNs) and the city’s Integrated Careadvantage.

place for health for the city.

System.

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Putting the idea
into practice
To develop the idea, we looked at

Lister Gate has the ideal conditions to

how Health Street might take root in agrow a Health Street framework. It currently

declining city centre high street. The

has a high proportion of vacant premises, astudio is currently working in Nottingham,

major department store that closed during

the 9th largest city in the UK with an inner-

the pandemic, and some high street chains.

city population of approximately 330,000

It has excellent public transport links bypeople. It is ranked as 11th most deprived

bus, tram, and train nearby, making it highlyout of 317 local authority districts in Englandaccessible to large numbers of people.

, with many of the consequent health issues

Being a relatively compact city, its location ishighlighted in this report. We chose Lister

accessible within a 15-minute walk, or shortGate, a pedestrianised high street locatedjourney on public transport, by numerous

very centrally within the city centre ofneighbouring communities with potential

Nottingham.

to access residents from at least four

the green heart

lister gate within the city context

lister gate within the future context of broad marsh visionneighbourhoods experiencing deprivation,
including The Meadows, St. Ann’s, Sneinton
and Radford. The Green Heart* is a new
public green space planned at its southernend, and the city has plans for a centrally

lister gate today

located community diagnostics centre.

listergate city centre locationsome of the vacant units
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Assembling community
champions
Knowing some key businesses and organisations through our workin the city, we considered who could be likely community champions
to instigate a health street. City Arts breaks down barriers to reconnect
people with art, their work includes place-based arts programmes
focused on health in nearby communities. Small Food Bakery is a local
bakery and advocate for food justice. Trinity Farm believe everyone
should be able to get fresh healthy, organic food from their local area,
they deliver food boxes and are looking for a city centre presence.
Primary, an artist-led contemporary visual arts organisation that run afree public programme of exhibitions and events. There is no doubt many
more great possibilities. Other key stakeholders to involve early on could
be the city’s culture board The Nottingham Project and key figure fromthe city’s ICS.

Making it feel welcoming

Finding the seed space
The next step for the community champions would be to finda seed space on Lister Gate. For this theoretical scenario, we haveselected No. 10-12 Lister Gate, a vacant former EE mobile phone
shop with a generous street frontage, 3 floors above and basement,with remnants of historic charm dating back to 1903. With thediverse mix of community champions, there is potential to house aform of indoor food market on the ground floor to entice people in,

We learned at Maggie’s how the entrance can be a major psychological threshold; its“We all need to eat and the appreciation ofgood food is innately human. It’s also themost powerful component in improving
health and building community. If you
have good food, you have community. If
you have community, youhave health. If you have
healthy people, you havecommunity, and the cycle
goes on. The community
becomes self-medicating.”
Jonathan Casciani, BEAM Editions,
Nottingham

appearance signalling whether it’s a place for you. The existing shopfronts of the seed spacecan be transformed to create an inviting experience; a space you enter without somehow
acknowledging you’re entering it, with a design that draws people naturally inside without
intimidating or feeling unattainable.
Here, the feel of an indoor food market with awnings, enticing displays of local food, large
openings to walk through and changing displays that sparks curiosity could help achieve

and then host community events on the floor above, programmed,

this. Working with local groups and community champions, would be crucial to identify thein the first instance, by the different arts organisations but would be

cultural barriers that might be at play to design an entrance point that feels equally friendly towelcome and open to many others.

different people from across the city.

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Identifying room
to grow
The next step involves understanding the possibilities of otherbuildings and spaces along on the street to be able to envisage
new opportunities for future tenants of Health Street. Identifying
ownership structures, existing and upcoming vacancies, and relevant
planning applications in the short to medium-term, is part of thisprocess. In the next decade hundreds of new homes are likely to bebuilt near the Broadmarsh site. With that may come demand for a
new GP surgery. There will be hundreds of students living on Lister
Gate in the former M&S department store soon. Medical students
could occupy space a GP surgery for opportunities for practicalexperience.

Building a network
Then the network for the health street

Providing community diagnostics

Building this network of organisations

Next the community champions

above ground level. It was also benefit fromframework on Lister Gate is built by

involves testing how new businesses would

would advocate for the location of a CDC

being located next to the seed space. As

surveying the needs of the city and thenbe mutually beneficial to others on theto Lister Gate. There are plans for a city

CDCs lack after-care, nothing happens after

researching and curating businesses andstreet. For example, a rehearsal space forcentre community diagnostics facility inthe appointment – the seed space can bridge

organisations to suit those needs. Our

the Nottingham Operatic Society could also

Nottingham. The former M&S and WHS are

the gap and help ease the anxiety caused byresearch involved taking to a group of young

offer breathing classes for people living withboth suitable for a CDC but are scheduled

receiving or waiting for a diagnosis, providing

people from Nottingham about what they

COPD, thereby supporting social prescribers

for student housing. The New Look, whilst

a space where people can find information

would want to see in the city centre. Many

based in the seed space.

currently occupied, could become a viable

and connect with others. The CDC could beof the ideas, listed here, are fully aligned with

option soon, with the company closing storescomplimented with primary care support likehealth creation and would diversify the highacross the country. It has servicing fromsocial prescribing, physio, dieticians withinstreet offer.

Stanford Street and two large floorplates

other spaces on the street.

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Expanding to the
outdoors
Finally, the framework should extend further outdoors, withinitiatives that create something unexpected on the street, tosignal this street is a Health Street.
There could be a giant outdoor communal table to encouragesocial lunch breaks for people working in the city, seating could
be designed to encourage talking to someone new, or outdoor
exhibitions run by free public art programmes could activate thestreet. Drinking fountains, accessible public toilets, and bicycle
parking could be designed in an inventive way whilst providing
vital infrastructure enabling people of all ages to spend time here.
More planting and greenery could be introduced, and roof
top spaces could be used for outdoor activities. Our researchwith the young people we spoke to in the city indicated the kindsof things they would like the Green Heart, the new public green
space planned at the southern end of the street, but some ofthese things, listed here, could start on Lister Gate.

Ideas from young people
space for yoga / space for making music
free wifi so everyone can do their college orschool work / a community youth centre where
kids from different backgrounds can come together
street food stalls / an arcadea place where you can see people skating, where
people can spray paint, where people can express
themselves /a knife crime workshop, wherechildren could learn about it / a free youth gym / aspeakers corner, for talks and discussions

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What’s next

We want to refine the model by working“You don’t have to go to
the health centre, the cityis the health centre!”

We want to hear from an ambitious ICS

with a town or city interested in pursuinginterested in testing a place-based approacha Health Street pilot. Through this launch,

to health creation. Now the leads for all 42

we would like to hear from places that areplaced-based ICS’s have been implemented,

interested in bringing new mission and purpose

we are interested to learn of places that wantto their high streets through a focus on healthto take a more radical approach, and would

creation and regenerative retail, with a view to

be willing to explore what supporting a Healthfinding a place willing to be the location for a

Street framework would mean for them, andpilot of the model.

what opportunities it could bring.

We want to connect with community

We want to develop an operational model

We want to consider opportunities forchampions to learn how the model couldof the Health Street framework. We have had

innovative design within the model. By

adapt to work in their location. This could

offers from other organisations to share theirconnecting with the place, community

involve working with community groups

lessons learnt and from this we would build

champions and ICS that could make Healthcurrently delivering place-based programmes

the operational model using their experience

Street a reality, and by developing an operation

to trial moving an established programme fromand expertise. Based on incremental growth,model, we may then be able to identify

a residential area to a central location nearby

we would explore models which take accountinnovative design opportunities that could

and explore potential updates required to theof the growing seed space to also incorporate

bring a strong visual identity to a Health Street.

programmes to make the transition successful

social, educational as well as commercial

This could relate to street furniture, shopfronts,

for its participants.

aspects of the vision to maximise the chances

public realm design of the street itself, or theof the projects longevity and lasting impact.

interior of the seed space. We’re very open towhat these could be.

4243Other opportunities to consider next are:•how a high street location could
engage with young people, who tend to•to focus solely on the area of one Healthinteract less with health services, even

Street. Local Authorities could take thisthough it’s the time they are laying thefurther by overhauling business rates forfoundations for their future health.
•

how health street could help medical
students gain practical learning frombusinesses offering wellbeing services.
•

and individuality, in contrast to themore holistic care network as well as

homogenous high streets of today, with

providing spaces for adult learning andthe same chain of shops wherever you

ESOL classes.
how health Street could provide a forum
to engage the public on national healthgo.
•with treating chronic illness by betterand understanding on national priorities

supporting individuals through care in

and innovation like the human genome.
how health Street could play a role withdigital inclusion, helping people getonline, with capacity to support digital
inclusion and outreach schemes, as well
as future NHS digitisation initiatives.
•

how Business Improvement Districts(BIDs) could be refocused on
improving health, as part of the healthstreet framework. This could shape
the content and outlook of retailers to

how Health Street could help reducethe disproportionate costs associatedissues – a place to share knowledge•

how Health Street could help thehigh street regain a sense of identity

its everyday operation as part of a•

how a ‘micro-BID’ could be establishedthe community**.
•

how Health Street could halt
unnecessary demolition andconstruction in a climate emergency,
as the framework is based upon making
use of existing spaces. If successful asa service, it may reduce both the needand desire to construct more out of town
health centres, medical schools andhospitals.

promote healthier choices*.

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Team
Heatherwick Studio designs places that put people first: a new public park, a workplacethat doesn’t feel like work, homes surrounded by gardens, a Maggie’s Centre that gives
respite from the hospital environment. We are curious about how things work, from themechanism behind the button that calls the lift the top floor, to the reasons for making abuilding so tall in the first place. As designers, our approach is holistic. With every project,
we bring together the expertise of a broad multidisciplinary team – engineers, architects,
specialists in data, modelling and landscape – with the shared aim of making a place better.
The Health Street vision has been informed by a series of workshops with people who havespent decades working in the UK’s civic and health sector, from clinicians on the frontline to“Design is more than a nice chair, or an interesting looking building – it can be asystem, a service model, a way of looking afresh and creatively at a problem. The
innovation comes from the same place – that desire to make something work
better, improve the places where we live and, ultimately, to help people. HealthStreet is a vision for the kind of health spaces we would want to visit, whether we’re
ill or not. It’s also a timely solution to the problem of visibility, how you make people
aware of new Integrated Care Systems, how you match place with concept. We
want to explore its potential to create something powerful for communities and in
the process, help to heal our high streets.”
Thomas Heatherwick

researchers turning innovations into improved care provision, including:•Ana Yael, artist•

Chris Santin, former Chief Investment Officer, Primary Healthcare Properties PLC,
now Fund Manager, Schroders Capital•

Clare Richards, Founder of ft’work•

Dan Hopewell, Director of Knowledge and Innovation, Bromley By Bow Centre•

Dr. Hugh Porter, GP at the University of Nottingham Health Service, Clinical Director
and Interim lead of Nottingham City Integrated Care Partnership (ICP)•

Dr. Jonathan M Clarke, Imperial College London•

Emma Andrews, Director of Planning, Savills•

Lee Walker, Director, The Nottingham Project•Jackie Marshall-Cyrus FRSA, Jackie’s Revolution•

Fiona Wright, Director, British Business Improvement Districts•

Suzannah Bedford, City Arts, Nottingham•

Wolfson Prize collaborators include: Daniel Dickens, Innovation lab, Helix Centre;
Helen Rowbottom, KHP Ventures; Roger Graef, documentary film maker; Stephen
Barter, real estate investment advisor; Harry Hymen, Founder of Primary HealthProperties

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Endnotes
1. Channon B. (2019) Happy by Design:
A Guide to Architecture and Mental
Wellbeing,RIBA Publishing
2. Deeny S., Thorlby R., Steventon A (2018)
Briefing: Reducing emergency admissions:unlocking the potential of people to better
manage their long-term conditions, The
Health Foundation, https://www.health.org.
uk/sites/default/files/Reducing-EmergencyAdmissions-long-term-conditions-briefing.
pdf
3. Rolewicz R. (2021) What does the GP
workforce look like now, Nuffield Trust,
https://www.nuffieldtrust.org.uk/news-item/
what-does-the-gp-workforce-look- like-now
4. NHS England (2019) Missed GP
appointments, https://www.england.nhs.
uk/2019/01/missed-gp-appointmentscosting-nhs-millions/

Image Credits
6. Decades ago, more than 50% ofconsultations were carried out by GPs,
now that is well under 50%: nurses andhealthcare assistants take up more than half,
pharmacists undertake some medication
reviews, and there is support from link
workers, care co-ordinators and health andwellbeing coaches for the 30% with longterm conditions.
7. Coughlan Y., Hopewell D. (2018) Planet
Asthma: Art and Activity Book, Bromley by
Bow Centre, https://www.bbbc.org.uk/wpcontent/uploads/2018/05/Planet_Asthma_
Art_and_Activity_Book.pdf
8. Nottingham Insight, (2019) Depravation
and Poverty, Nottingham Insight, https://www.nottinghaminsight.org.uk/themes/
deprivation-and-poverty/

All images© Heatherwick Studio unlessotherwise stated.
Allan John: 15
Arc Design: 35 (bottom 4)
Bromley by Bow Health Centre: 22 (bottom
left)
Channon Ben: 9 (illustration)Charles Martin/RIBA Collections: 15
Hufton + Crow: 8-9 (photographs)
Hunter Keith: 16 (top right)
Imperial War Museum collections: 14
Luxmoor Benedict: 16 (bottom left corner)
RIBA collections: 14
Soar Timothy: 16 (bottom right)
Yael Ana: cover image, 4, 6, 19, 30-31, 36-41(close ups), 44

5. Stokes Lampard H. (2018) Good GPs
have always practised social prescribing,
GPOnline.org.uk, https://www.gponline.
com/professor-helen-stokes-lampard-goodgps-always-practised-social-prescribing/article/1463868#:~:text=In%20fact%2C%20
a%20recent%20RCGP,to%20a%20social%20
prescribing%20service.

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