The 'lift and shift' approach to future healthcare delivery

Published: 2-Aug-2022

ADP Architecture report explores the potential for relocating health services into local high streets

Health centres and outpatient clinics could soon be opening in high streets and shopping centres as changes to planning legislation and the fallout from the COVID-19 pandemic continue to impact on the way medical services are delivered.

The recent change to the Use Classes Order system in England is already having a significant impact on town centres: both the composition of future high streets and, more specifically, the various roles that healthcare will play in high streets of the future.

For example, the new Class E category, which has been created for commercial, business, and services, is wide ranging in use and will create greater flexibility for changes in use between what were previously-separate classes.

The way we are working now is very different and COVID has meant that we can start to look at alternative ways of delivering health and care services

For instance, a surgery may now convert to a soft play centre, a research facility to a retail unit, or a dentist to a day nursery without the need for planning permission.

And, in contrast, empty office buildings within town centres may, in the future, become health clinics or care facilities.

The recent pandemic has impacted how, and where, medical services are sited. And this has understandably led to a shift away from care being delivered on acute hospital sites, with many outpatient and community services now being relocated closer to patients’ homes.

Researching this growing trend is ADP Architecture, which has published a document entitled Shopping for Health, addressing both the strain NHS hospitals and healthcare centres remain under due to COVID-19, and the increasing number of long-term units vacancies in our high streets.

The research, undertaken in collaboration with iDEA, Carter Jonas, and Macmillan Cancer Support, aims to tackle both issues by retrofitting empty spaces into community healthcare centres focused on social and wellbeing care provision.

And, after initial successes with regional NHS trusts at sites in Runcorn and Gloucester, proposals for a national rollout of the strategy have now been shared with NHS England and the NHS Improvement central estates and facilities team.

The 'lift and shift' approach to future healthcare delivery

Speaking to BBH, Hannah Brewster (pictured left), regional healthcare director at ADP, explains: “The paper looks at this ‘lift and shift’ approach to creating more space in hospitals in order to expand ICUs and emergency departments and goes hand in hand with the COVID-19 ‘red’ and ‘green’ flows we are seeing in hospitals aimed at keeping complete separation from main hospital sites where possible.”

Emerging new primary care networks (PCNs) and integrated care systems (ICSs) also create an environment where local providers are coming together to provide specialist services to more patients in more-localised and accessible settings.

Brewster said: “Some NHS trusts and health providers are already trying to do things locally, but this was about how we could do these things on a wider basis.

“Our research explores the total demand versus supply and tests the size of units and what sort of accommodation would be needed to make them viable.

“It’s not just about moving services to solve an immediate problem. It’s about the whole post-COVID recovery and regeneration.”

ADP’s report concludes there is an estimated projected demand of 1.25 million sq m comprising PCN-delivered services and the ‘lift and shift’ of services from acute sites.

On the other side of the equation, Experian GOAD data from January-March 2021 shows a supply of vacant areas within English shopping centres of 1.63 million sq m.

Typical unit size demand for healthcare ranges from 490sq m to 1,680sq m, and vacancy within these size bands suggests an availability of around 1.3 million sq m.

Geographically, the report suggests that the highest demand is in areas of high deprivation which generally have the corresponding levels of retail vacancy, such as the North West, West, and East Midlands.

As well as helping to meet this need, the ‘Shopping for Health’ approach is also greener than new-build developments and presents an opportunity to deliver integrated health and social care services directly into the heart of local communities, in destinations that are readily accessible.

And, for shopping centre owners who have been hit by the exodus of shops from the high street, the potential rental income from the health sector will be increasingly attractive.

ADP has already put this new approach into action, with two schemes currently underway in Runcorn and Gloucester.

At Runcorn Shopping City, ADP is helping to transform a vacant 100sq m unit into a community health centre housing dietetics, ophthalmology, and audiology outpatient services.

To make best use of the space, these services will operate alongside the Citizen’s Advice Bureau and Halton Havens Hospice and the floor space has been designed with a single public entrance and front door.

At the other end of the scale, the former Debenhams department store in the heart of Gloucester city centre has been purchased by the University of Gloucestershire, and ADP is working with the university to reimagine the building as a new campus for teaching, learning, and community health and wellbeing partnerships.

The massive 20,000sq m unit will include clinical education training and simulation integrated with patient-facing NHS services and community-based support and care.

We already go to the high street for services like opticians and health food shops, pharmacies, and accessibility equipment, and it’s about expanding that and looking at the bigger picture

Brewster said: “The way we are working now is very different and COVID has meant that we can start to look at alternative ways of delivering health and care services.

“This report is aimed at trusts and clinical commissioning groups, but also at property landlords looking at how they can revitalise vacant spaces.

“We already go to the high street for services like opticians and health food shops, pharmacies, and accessibility equipment, and it’s about expanding that and looking at the bigger picture.

“It is evident that shopping centres provide a much-better match for the ‘lift and shift’ of appropriate outpatient services from acute sites combined with primary care services.”

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