October 31, 2025

England’s 10-Year Health Plan is Medicine for the City

topic:	Health and Sanitation
located:	United Kingdom
by:	Katie Mulkowsky

For the past six years, I’ve visited the same local clinic in East London, watching it mirror the contradictions facing today’s National Health Service (NHS). It sits just a stone’s throw from glossy, venture-backed developments yet serves the heart of Hackney – a diverse borough marked by health inequalities. Since the pandemic, the morning queue for same-day appointments has only grown. When I do have the luck of being seen, conversations with their dedicated, if overstretched, staff often circle back to the same themes: dwindling resources and exhaustion.

The picture is far from an anomaly. Across the NHS, high waiting times for all areas of care, including A&E and non-urgent clinical pathways, coupled with staff shortages and ageing infrastructure, are revealing cracks in a system under pressure. In response, public healthcare in England has been slated for transformation since last year's mammoth Change NHS consultation, which emphasised three strategic shifts: from analogue to digital, sickness to prevention and hospital to community. 

I should concede that as an urban planner, I’m naturally inclined to see solutions in place-based approaches to the wider budgetary and capacity shortfalls challenging the NHS. But notwithstanding my own disciplinary bent, the shifts reveal a fundamental awareness of the complex environment surrounding clinics like mine. Specifically, they embody an understanding that chronic illnesses can largely be tackled outside of the medical system by fostering healthier places. 

Place-based approaches to public health 

Worldwide, medical care is estimated to account for only 10-20% of the so-called ‘modifiable contributors’ to population health. The rest, a whopping 80-90% of factors, are considered social determinants. These are shaped by varying experiences of housing security, educational achievement, monthly income, employment, community networks and exposure to health risks like air pollution. While social determinants can involve personal behaviours like diet and alcohol or tobacco consumption, they are largely driven by wider economic and environmental forces: structural factors beyond many of our control. 

Across the UK, it is well-documented that the built environment, meaning the physical and ecological fabric of our towns and cities, impacts profoundly upon population health. Car-dominated planning and insufficient access to green space reduce physical activity levels and increase rates of chronic disease and depression. It is currently estimated that 40,000 people die prematurely each year from causes related to air pollution, and that beyond being devastating, this results in annual economic losses of £27 billion. Moreover, substandard housing with indoor air quality issues like damp and mould or dangerous structural hazards costs the NHS £1.4 billion every year in treatment. 

While these statistics paint a very troubling picture, they also make a clear case for addressing social health determinants through urban planning – alongside strategic attention to budgetary and staff shortfalls. At least when it comes to ‘built environment’ externalities, we know exactly where these problems unfold, and have the skills and influence to do something about them. By decarbonising our buildings and reducing vehicle traffic while improving air quality and encouraging movement, we can design against negative health outcomes. 

Bringing diagnostics into local communities

In July 2025, the government released its long-anticipated 10 Year Health Plan for England. Its top-line ambition is to move away from an illness-focused system that treats people when they’re sick toward one focused on prevention, diverting cases before they happen. As part of this, 300 new neighbourhood health centres are to be created by 2035. They have the potential to fundamentally reshape where the general public will soon most frequently experience medical care.

Rather than big, clunky hospital sites, which are often removed from city and town centres, generating car-dominated travel patterns to begin with, the idea is to bring more community health hubs into local neighbourhoods. These are outpatient clinics which offer essential diagnostic resources like MRIs, CTs and ultrasounds without requiring patients to experience long travel times or waiting room queues. 

They have a clear potential to de-mystify health by making care a more normal, accessible part of people’s everyday lives. They also present an opportunity to strengthen local economies and facilitate wider place partnerships. Community health providers should have the agility to join up with assets in their surrounding neighbourhoods, like gyms, pharmacies, cafés and social prescribing initiatives like walking groups or community gardens.

The shift, in action 

In architecture and design, we understand these projects as the adaptive reuse of existing infrastructure, which turns buildings with functions that are no longer serving the public into something new. ‘Retrofits’ can offer massive carbon savings while delivering air quality, climate and public health benefits. They also diversify land use and draw more consistent footfall into commercial centres. 

A few recent cases demonstrate this potential – but also highlight that there’s no one-size-fits-all approach to improving neighbourhood care. Every site is structurally different, and more importantly, has a range of local needs that must be responded to. 

In Stockton, for instance, the Tees Valley Community Diagnostic Centre has been positioned within a masterplan seeking to restore the connection between the high street and riverfront. There were longstanding perceptions that Stockton had ‘turned its back’ on the water, and that the former Castlegate shopping centre had served as an architectural blocker between the river and the town edge. Stockton-on-Tees Borough Council took a bold position that demolishing Castlegate could make way for a new urban park, increasing biodiversity while creating more opportunities for movement and socialisation. 

Meanwhile, in Gateshead, the Queen Elizabeth Community Diagnostic Centre has taken over vacant retail space within a shopping centre and entertainment complex. Its architectural team found that big retail spaces with high ceilings and open layouts work surprisingly well for NHS requirements. The project also revealed that good design can support workplace desirability and staff retention. After all, it is critical that NHS staff feel the benefits of working in a different way. How can we balance the needs of communities that rely on these services with those of the staff who deliver them? 

Centring local expertise in the process

Underlying all of this is the fact that community engagement (and indeed, community wisdom)  is essential in ensuring that health planning is meaningful. The voices of those most impacted by health inequalities should be centred in the process. A collaborator recently said something that really stuck with me: ‘We need to reach people, and there are no hard-to-reach communities if we’re trying hard enough.’ 

Integrating sustainability, social inclusion, staff wellbeing and place health is a multidisciplinary undertaking that requires collaboration across specialist sectors. Yet, its outcomes will only be as good as those involved are willing to be humble, eager listeners responsive to issues like those facing my local clinic.

Katie Mulkowsky is the Director of Research and Urban Health at Future Places Studio and a PhD Researcher in Urban Planning at the London School of Economics.

Image by Lucy Saunders.