Issue: 2015, Vol 1, No 3, Pages 84–119

Healthy New Towns – again!

Tam Fry

Tam Fry
Spokesperson for the National Obesity Forum

This column aspires to be one that focuses on a piece of news that may surprise readers (see “Cameron for Obesity Czar” in the previous issue of this Journal, page 46), so I’m trying my hand now to coax out a little more detail on an idea likely to crop up in the Prime Minister’s Framework to tackle the epidemic. The proposal is that England develops healthy new towns, and the surprise will be if it ever comes to fruition, given the results of a previous attempt to do just this in the not too distant past (see below). It would be wrong to describe the NHS’s venture into urban planning as a rehash of that project – one that even today no-one in Whitehall is willing to take the can for – and it should be of concern that no official detail will be published until December. I write in hope that the planning is successful but am wary of the NHS getting involved in Local Government issues.

The Healthy New Towns proposal is the idea of Simon Stevens, now firmly in charge of pursuing his Five Year Forward View to tackle obesity and save the NHS. Its goal is to remodel communities to keep residents fit, limit the opportunity for eating fast food and develop sheltered housing where the elderly can live under electronic surveillance in homes fitted with “amazing new digital health technology”. The intention is that this feature alone will put an end to hospital bed blocking and make a face-to-face chat with a GP no more complicated than remotely logging into the surgery from the comfort of your living room. A smartphone could be the tool with which the NHS could save a fortune and provide home care from a remote distance.

It sounds a neat idea, but will it work? So far, the signs are less than promising. For an initiative designed to spawn a showcase for the entire country to replicate, only £4 million has been allocated to the design stage. That is barely enough to pay the travel expenses of the planners and, ominously, their continued work is still at the mercy of the Government’s Spending Review in November. Furthermore, only five towns are being planned, although some 40 excited local councils have already bid for whatever money the Chancellor can throw their way.

If Mr Stevens does pull it off, these new garden cities – for that is what the bid from Ebbsfleet in Kent proudly calls itself – sound like bliss to live in. They will have safe cycling, walking and running routes for all, as well as safe routes to school to allow children to avoid busy roads. They will have safer and more accessible playgrounds at the centre of developments so that, 7 days a week, children can play outside until teatime, just like in the old days. Outdoor table tennis tables and gyms will be dotted here, there and everywhere, not only to help residents stay fit but also to help create a sense of community. Lest the people get exhausted from these novel exertions, parks will be furnished with adequate supplies of benches to recuperate on and, crucially, public toilets and water fountains will make their comeback. Finally, it is acknowledged that the Victorians knew a thing or two about the need to provide for recreation and how disgraceful it is that we have, in the main, allowed our open spaces to become so derelict. The bids also had to guarantee that the obesogenic environment in which most of the population lives starts to become a thing of the past and that priority will be given to people and not cars. Some of the bids’ detail is intriguing, too: they provide for pavements without kerbs for the elderly to trip on and drains and grates designed so they don’t pose a hazard to pedestrians. A pipedream?

Should the money to build this vision arrive in the Spending Review in November, it will be a triumph for Mr Stevens. His new towns may well have soaked up all the money that local councillors, fuming in their town halls, were hoping for themselves. They put in a plea to the Treasury in the run-up to the election for £1 billion a year to bring their own recreational facilities remotely up to scratch, but they have yet to see it. To add insult to injury, they have also suffered £200 million cut from their existing public health budgets. That is, of course, a bungle that Whitehall is noted for.

As for bungling, it will be essential that Mr Stevens’ project does not suffer the same fate as the Healthy Towns project of 2008. This first foray into local planning bore all the hallmarks of a Government scheme planned to produce some sexy headlines in time for a general election. It was launched at a time when a French programme designed to curb obesity in the community was winning accolades for effectiveness across mainland Europe, and so a scheme was dreamt up to replicate this success across the UK. Had it been truly replicated it might have worked, but only enough cash was allocated to cherry-pick the more glamorous bits of the programme and parcel them out one by one. In total, £30 million was shared out between nine towns to fund whichever bit suited them the most and could be augmented with matched funding. The towns were then left to get on with it, with the exception of Tower Hamlets, which gave Whitehall the bonus of being seen to promote the forthcoming 2012 Olympics. Tower Hamlets, arguably the least likely place in the world to give up burgers and fries, was given millions to spruce up its cafés and restaurants because of its claim to be a “gateway” to the Olympic Park. The Department of Health press release (see: even referred to its main thoroughfare as “High St 2012”! Manchester opted to reward people with free activities or healthy food when they took exercise, and Dudley, West Midlands, decided to transform its parks and play areas into family health hubs. Whatever morsel the remaining towns went for – and some of their achievements may still remain – the whole project got and is still getting a bad press. Seven years after the event, research papers are appearing blasting the Government for not better aligning planning and health policies to support collaboration between planners and public health practitioners (Sautkina et al, 2014). Uncertainty over the programmes’ aims and objectives, and the absence of a clear direction from central government, resulted in local programmes relying on traditional multicomponent approaches to programme delivery. Mr Stevens, you have been warned.

Healthy New Towns, 2015, must be a different kettle of fish. Encouragingly, the Design Council has been wheeled in to ensure that the mistakes of the past are not repeated. We shall see.

Sautkina S, Goodwin D, Jones A et al (2014) Lost in translation? Theory, policy and practice in systems-based environmental approaches to obesity prevention in the Healthy Towns programme in England. Health Place 29: 60–6