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Creating health in communities; the role of NHS spaces

Ask 10 members of the public to name one type of NHS building, and I would put money on more than half of them offering ‘a hospital’. This is, in the main, how we think about the NHS. Hospitals, hospitals, hospitals… and perhaps a local GP surgery.

As well as premises for treating ill-health, it is now well known that ‘space’ is an important building block in creating health; and the NHS can play its part. People need ‘physical spaces’ to connect with others, ‘emotional space’ for reflection and ‘systems space’ that makes it possible for communities to make their contribution. Having access to the right sort of physical spaces also offers people greater opportunity to employ and enjoy their skills and passions and this helps to build their confidence to take control. Having control over our lives and environments enhances people’s health and wellbeing; it is Health Creating

In a piece of research The Health Creation Alliance (THCA) recently carried out for NHS Property Services, we sought to explore what it is that a range of people from many different types of ‘underserved’ communities really want from NHS premises, apart from treatments and medical services when they are poorly. You can find the publication here: THCA Creating community spaces for patient and community wellbeing. 

We spoke to 10 ‘communities’ and asked them what it is about spaces, and about the processes involved in making those spaces available, that helps or hinders people to be well and stay well. We didn’t survey them, because surveys frequently don’t reach the people we wanted to reach, but we approached them through trusted relationships and talk to them in depth about what it is that people most value. 

The 10 Communities
  1. Carers
  2. People with and recovering from drug and alcohol dependency
  3. Rural communities
  4. People with a learning disability
  5. People of Somali origin or heritage
  6. People with experience of mental iIl-health
  7. People from the LGBTQ+ community
  8. Women from Asian origin or heritage
  9. People with a disability
  10. People from the Roma community

What we found is that what matters to different types of communities is more similar than we’d expected, and that diversity is widely welcomed. We also found that the differences in what matters, and why, between communities are often nuanced, and that the nuances are important to understand: we dug deep to bring them to the fore; here are a few of the highlights.  

Many underserved groups have been let down by statutory services in the past so it is important to understand and work out how to overcome the trust-deficit. There is a desire to have more positive relationships and a willingness to engage, as long as services are listening. “A lot of communities have had such a lot taken away. The trust is gone... people think it’s a fad.”

It’s important not to see NHS community spaces as being only or even principally for delivering services to people or for social prescribing. There is so much health creating potential in peer support and community-led activity; the NHS can get behind this by offering suitable spaces for peer support to take place and for communities to do the things that matter to them. “Immigrant communities go to families and close networks for Mental Health (not GPs). I don’t want to talk to the GP about what’s going on in my head.”

While people want to be able to provide appropriate services for their community and to express things that are culturally important to them, most want buildings to be multi-purpose and used by many different types of people from different backgrounds. They have largely positive experiences of sharing spaces and mixing with others who are different to them. Providing NHS spaces that enable this mixing and diverse participation will help to build strong, connected, healthy communities and reduce demand on health services. “It’s about linking people to where they might find the wellbeing… rather than the prescription note.”

The location of the premises is critical and not all NHS premises will be inherently in a good location. It is essential to talk to and listen to the local community to understand what makes a good location for them. We found many rationales, from “close to other facilities please”, to “not on the borderline between warring gangs” to “flexibility of access to unused NHS buildings” without bureaucratic booking systems for people living in rural areas. 

Good, affordable transport and parking options can, of course, make all the difference so this must be part of the conversation, especially with rural communities. 

Disabled people can face particular issues accessing and moving around buildings but accessibility is a concern for most people; they want their elderly and disabled friends to be able to participate too. Having a regularly updated Access Statement, informed by disabled people and made available through a website helps disabled people to anticipate any difficulties they may have. 

Calming, sensory, ‘low stress’ environments are highly valued by many as are smaller spaces where people can find refuge and talk in confidence. A welcoming environment for some LGBTQ+ people means seeing a poster actively communicating they are welcome there. “Getting into a building is one thing, feeling you belong there is another.”

Inclusivity training is seen as a bare minimum for facilities management with several suggesting that some form of lived experience may be a good ‘qualification’ for this role. “Populate spaces with people with lived experience; they will have a heart for things”. 

Having a say in the development of the space and some control over how they use those spaces is highly prized. Some groups are well equipped to take on ownership of the premises and felt this would be the best way of supporting the diverse aspirations of communities. 

This publication is a valuable resource and guide for anyone involved in the development of NHS premises to support patient and community wellbeing and reduce health inequalities. 

Hear more from Merron Simpson, CEO of The Health Creation Alliance, who will be speaking at 11.30am on19 April on Creating Spaces for Community and Patient Wellbeing. 

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