The shift from institutionally-focused planning and delivery of services towards a more collaborative approach to population health sets the scene for trusts and their system partners to think differently about how they use their respective skills, assets and resources to drive change for local people. The development of joint strategic plans for how ICSs will contribute to improved health outcomes and more sustainable service delivery is a core part of how systems will drive progress in this arena.
Town centres and high streets are vital social infrastructure, attracting people for work, leisure, social connection and local economic growth and productivity, all of which contribute to health. However many areas, particularly those with higher levels of deprivation, have experienced a decline in the health of their local high streets, and Covid-19 has accelerated this change.
As anchors, trusts can contribute to the health of local places and high streets by investing resources to make them more economically and socially sustainable. At a time when inequalities in access to care is a key priority for trusts looking to improve health outcomes for people who struggle to access services in traditional settings, 'health on the high street' initiatives can bring services closer to people that need them, while also bringing footfall to local town centres and attracting further business investment and regeneration.
This shift in how services are delivered relies on close partnership working with local councils, whose stewardship of high streets can help trusts reshape their services to better meet people's needs while contributing to community wellbeing. Warrington and Halton Teaching Hospitals NHS Foundation trust has worked with Liverpool City Council to develop a series of health hubs which will integrate services and support regeneration.
Case study
Warrington and Halton Teaching Hospitals NHS Foundation Trust
Warrington and Halton Teaching Hospitals NHS Foundation Trust is collaborating with health and care organisations, and local government across the region, to develop three health and wellbeing hubs based in local town centres. These hubs will focus on integrating health, wellbeing and education services, bringing care closer to people's homes, and leveraging resources in the health sector for the broader wellbeing of communities.
Communities across Warrington and Halton within Cheshire and Merseyside face a range of health and wellbeing challenges. These include a ten-year life expectancy gap between the most and least deprived within each of the boroughs, and rates of deprivation and child poverty higher than the national average. The development of two of the three hubs is enabled by funding from the government’s national Town Deal programme. While the Town Deal programme is designed to support better economic, education and employment outcomes rather than being focused on health, after a conversation with the trust, the councils recognised the links between good health and thriving economies.
The first of the hubs, Halton Health Hub, opened in November 2022 in a redeveloped retail space in Runcorn Shopping City. The shopping centre is essential to the local community in terms of jobs, services and social value, but is in need of investment and regeneration and was at risk of closure due to the cost of the work needed. The hub will provide around 8,000 ophthalmology, audiology and dietetics outpatient appointments per year, and is expected to increase footfall in the shopping centre by at least 150 additional visitors each week, helping to kickstart wider physical regeneration of the town centre.
The clinical and operational benefits will also support local people's health directly with more than 3,000 additional NHS appointments available through the hub, and a reduction of long waits for ophthalmology services by up to eight weeks after one year of being open. It will enable people to have regular appointments closer to where they live, relieving capacity pressures on acute hospital sites, while also reducing barriers to accessing care for people who would have otherwise had to travel further.
The funding for the Halton hub is shared between Liverpool city region town centre fund, bringing £350,000 funding, and Warrington and Halton Teaching Hospitals NHS Foundation Trust providing capital funding of £500,000. There have been challenges to navigate around investment and funding, including the complexities of investing public sector capital funding into assets that are leased, rather than owned, and negotiating funding around capital spending limits. Those working on the programme cited recognition of the trust's role as an anchor institution – a core objective in its strategy – and acknowledgement that prevention will positively impact on the biggest problems facing an acute trust (for example, overcrowding in A&E) as key to getting agreement from the trust to support the project. Commitment and interest from board members was also central to securing investment.
While the additional funding helped to pump-prime the work, these initiatives also demand strong cross-organisation collaboration. Partners have navigated differences in governance in order to bring together these vital services. Those involved in the programme believe the benefits outweigh these challenges, and are expecting this work to bring about improvements in life expectancy, healthy life expectancy, and widened access to education and employment.
In the coming years, two further hubs will open in Warrington and Runcorn, bringing together health, wellbeing, education and support services. Each of the three hubs is tailored to the health and wellbeing inequalities faced by the communities they will serve, with a focus on areas of health where outcomes are poorer, or where access inequalities are more prevalent and have greatest impact. Trust leaders say the commitment from senior leadership across the place has enabled greater innovation, a better understanding of the communities they serve from all perspectives, and a shared vision for better health and wellbeing across the region.