How can NHS estate management reduce health inequalities?

Simon Corben explains how the NHS can reduce health inequalities by using the ‘10 building blocks for health’

CREDIT: This is an edited version of an article that originally appeared on NHS

The NHS has summarised the key ways that estates and facilities can play their role in reducing health inequalities in the 10 building blocks for building for health. The ‘building blocks’ can be applied to all aspects of estates management including in the:

• delivery of new healthcare buildings – for example, through the new hospital programme or the development of community diagnostic centres;
• modernisation of NHS facilities;
• prioritisation of investment;
• management of the use of NHS buildings and spaces;
• ‘disposal’ or repurposing of facilities the NHS no longer needs.

The 10 building blocks can be applied to all the key concept, detailed design and construction and operation stages: 

1.    Supporting community development

• the use of premises by the community and voluntary, community and social enterprise (VCSE) organisations;
• co-location of community facilities and public services;
• supporting integrated care and partnership working;
• using and supporting community assets.

2.    Improving location and access

• estate located in areas of high deprivation or improving access from those areas (for healthcare and employment);
• catalysing improvements to transport infrastructure – particularly affordable public transport;
• encouraging active travel such as walking or cycling;
• exemplar inclusive physical and cultural design.

3.    Supporting healthier communities

• providing healthy and affordable food options for patients, visitors and NHS staff;
• improving connectivity to wider public services in areas of greatest need;
• enabling social interactions, and reducing isolation, through volunteering;
• inclusive indoor and outdoor exercise facilities, supporting prevention programmes.

4.    Facilitating economic development

• catalysing regeneration of communities in urban or rural areas;
• improving footfall of high streets;
• enhancing civic pride;
• supporting town and spatial planning and improving public realm – attracting investment.

5.    Enabling access to green space

• use of estates and land for social prescribing and community projects;
• creating new or improving quality of natural environment and green space for people and wildlife;
• use of green space for physical activity, play spaces, socialising and food growing.

6.    Access to good inclusive employment and training in estates

• enhancing access to employment, skills and training programmes for communities that experience inequalities (across planning, construction and facilities management);
• fair terms and conditions and supporting the health and wellbeing of employees and career progression, including supply chains;
• provision of space for training, education and upskilling.

7.    Improved design

• developing safe, healthy, physically and culturally-inclusive spaces;
• embedding community engagement;
• supporting digital inclusion;
• quality public realm.

8.    Access to quality and affordable housing

• re-using and developing estate for affordable and inclusive key worker accommodation;
• re-using and developing estate into housing to support vulnerable communities.

9.    Reducing negative environmental impact

• supporting net zero carbon targets and sustainable consumption and production;
• reducing air pollution through fleet innovation (eg low emission vehicles);
• raising awareness of environmental actions that staff, patients and visitors can implement at work and home.

10.  Social value in procurement

• consideration of social, environmental and economic impacts of supply chain;
• embedding at least 10% social value, and optimising social, economic and environmental investment;
• sharing investment.

To optimise the impact of the 10 building block for health, estate teams can:

• Focus on priorities – aim to support communities that experience the most heath inequalities, and address social and economic issues identified by integrated care partnerships.

• Work in partnership with communities and stakeholders – identify what is important and of value to support innovation and help ensure that local assets are used and enhanced where possible. Engagement should be inclusive, meaningful and embedded throughout the design and delivery process. Working with voluntary, community and social enterprise, and with partners, on the design and delivery of any estates initiative can help ensure this is achieved.

• Measure, evaluate and iterate – to ensure the initiative is making a difference, it is important to evaluate the impact; this can inform next steps, including any iterations required. Sharing impacts also supports transparency and accountability and allows successes to be shared and celebrated.

• Provide training and share good practice – increase awareness of health inequalities and the role of the NHS as an anchor, including how estates can address them through training and development and sharing inspiring good practice examples.

Improve leadership, culture and governance – embed the role of estates in reducing health inequalities into strategy, decision-making, policy and guidance.