Last November, the controversial Darzi Report,1 in its recommendations for the future of the NHS, stated that, ‘Too great a share [of NHS funding] is being spent in hospitals, too little in the community’, and emphasised the importance of locating healthcare facilities on the high street — closer to where people live, work, and shop.
In the same month, the Built Environment Committee of the House of Lords published High Streets: Life beyond retail.2 The report recognised that people wish to have a mix of provisions on the high street, which may include public services such as health services. As well as boosting NHS capacity and meeting the needs of local communities, the report says health centres could act as new ‘anchor’ sites for high streets and bring in more people to the local high street.
Introducing the potential for change of use
The benefits of locating healthcare services in town centres and high streets has been widely recognised for many years. The reasoning was conveyed very comprehensively in a 2020 report by the NHS Confederation, Health on the High Street.3 The report recognises, among other benefits, the role that public healthcare performs in broadening the range of services within communities, supporting and participating in the design of healthy communities and utilising vacant properties. Specifically, the report states that, ‘Health and wellbeing are central to community life, and a new vision of a civic, more community-centred high street must have health services at its heart and promote healthy living’.
It found that across the 22 busiest high streets in the UK, shop units owned by overseas investors were more than twice as likely to be empty than shops under public sector ownership; vacant shops were also more likely to be under real estate company ownership (one quarter of empty shops) and overseas investor ownership (around one in five) — but those under community, social, or public sector ownership made up only one in 10 empty shops.
The same year as the report was published, the then government added greater flexibility to the planning system, introducing a new planning use class, Class E, which encompasses commercial, business, and service (including healthcare) sectors. As such, Class E enables the repurposing of buildings on high streets and town centres from retail or office use for use as a GPs’ surgery or community health hub without the need for planning consent.
The timing of the COVID-19 pandemic acted as a timely opportunity to re-think NHS services, specifically in relation to community development, and to support ailing high streets.
Adapting commercial spaces into healthcare facilities offers several practical benefits: typically these are large units with high ceilings, which enable the installation of the necessary mechanical and electrical services, such as ventilation, air-conditioning, and air quality controls. Reuse over rebuild has numerous sustainability and economic benefits.
New and timely opportunities
The potential for change opens new and timely opportunities, linking to a nation-wide rethink of the UK’s high streets, and the role that health services and communities can play. It’s a ‘win-win’ situation: from a healthcare point of view, the move to high street premises can help address health inequalities while offering much-needed additional capacity for health service delivery. From a regeneration perspective, meanwhile, encouraging a more diverse group of people to visit and use high streets can be of considerable benefit to existing businesses. Furthermore, placing healthcare services in central areas can reduce carbon emissions by reducing the need to travel to distant hospitals.
Architectural advice on successful conversions
When converting a building, there are a number of considerations that must be taken into account from an architectural perspective:
- Ensure that there is adequate access to natural light, as commercial buildings often have deep floorplans, with windows only on the narrow elevations. The existing availability of daylight can be improved by installing rooflights or new windows, although there is a limit to how much of this can be done under permitted development rights, as any external changes to an existing building are subject to an additional planning application. It is therefore more cost-effective to select buildings that have sufficiently sized and orientated windows on most or all elevations.
- The quality of the existing building fabric, in terms of thermal and sound performance, must be considered. Thermal insulation — either via retrofit or upgrading the existing fabric, is almost always required to meet current building regulations. Single pane windows and single skin buildings will usually require more work to meet current performance thresholds, although some older buildings make good conversions if they are of good build quality. Upgrading an existing building’s thermal performance can be demanding, as older buildings often have crooked walls and are prone to air leakage, and are thus not best suited for high thermal performance.
- Sound insulation is also difficult to improve without significant alterations to an existing building. Replacing windows, for instance, will be subject to a further planning application, and will likely be required to meet current building regulations and provide a comfortable space for healthcare use. An alternative can be secondary glazing, but the cost and user convenience must be considered.
- Windows of commercial buildings are likely to be the sole means of ventilation in a conversion. If it is impractical to keep windows open — for instance if the building is public facing with no or little separation from public realm, there may be little or no ventilation. If this is the case, it may be best to submit an additional planning application to enable increased ventilation, either passively through more windows, or through additional mechanical systems.
- Landscaping can provide external amenity space, which is not easily found with existing commercial buildings: an opportunity to utilise a commercial building with external spaces would almost certainly be of benefit; albeit the maintenance aspect must be considered in advance.
- Privacy is a key consideration for buildings for healthcare use. Patients and healthcare professionals will not want to feel exposed to either external onlookers or other building users. Commercial buildings often do not make provision for providing the levels of privacy required for healthcare use. This should therefore be considered, as significant external amendments will likely be required.
Key planning considerations
Of course where existing buildings fall short of potential for conversion under change of use, this can be compensated for by the submission of further planning applications. While change of use is an easier route for a simple conversion, we should not dismiss planning applications on the basis of being needlessly complicated — since a more comprehensive conversion can create a more valuable end-product, and help achieve greater opportunities for natural light, ventilation, amenity space, and security. If there are too many constraints, such as contamination or a poor existing structure, then it may well be better to demolish and rebuild.
Conversion of existing buildings, whether through full planning application or change of use application, can be of great benefit to the high street, but suitability for conversion, as outlined above, must be assessed on a case-by-case basis. Engagement with architects and planning consultants from an early viability stage can enable healthcare providers to select the most suitable buildings for conversion, and help avoid unforeseen challenges.
High street rental auctions
Another potential, albeit more short-term, use of high street properties is high street rental auctions, which were introduced in December 2024 as part of the previous government’s Levelling Up and Regeneration Act. The initiative exists to give local authorities (in England only) the power to force landlords to let their long-term vacant properties for community use. Essentially a form of compulsory rental (as opposed to compulsory purchase), this will mean that properties that have been vacant for more than 12 months in a 24-month period may be let through auction by local authorities. Importantly for the NHS, the original consultation on this policy proposed that the preferred tenant may not be the one who is willing to pay the most for a spot on the high street, but rather one that brings greater variety to the high street offer.
Considering that places blighted by long-term vacancy tend to be those where low incomes and high unemployment are rife (Manchester and Luton were cited as examples in the consultation), there are clear benefits — as discussed earlier — in utilising such buildings for healthcare.
Whether through new build development, conversion, or simply the short-term use of a retail unit, the opportunities for healthcare services to relocate to high street settings are considerable and well worth further consideration, both on a national level (building on the Built Environment Committee and NHS Confederation reports), but also a local one.
References
1 Independent investigation of the NHS in England. Department of Health and Social Care, 12 September 2024. Updated 15 November 2024. https://tinyurl.com/4e2kb5vp.
2 High streets: Life beyond retail? House of Lords Built Environment Committee, 7 May 2025. https://tinyurl.com/ttje9bsd.
3 NHS Confederation. Health on the high street. 3 December 2020. https://tinyurl.com/yrzfmd3n.