Ageing Cities: health and the built environment

Healthy placemaking is an essential part of delivering age-friendly cities, but it requires robust cross-sector collaboration. Planning can improve public health by promoting active travel, enhancing air quality, delivering and protecting open space. Social isolation, a key issue for our ageing population, can be reduced by supporting social interaction in town centres and ensuring an accessible public realm. Public health departments can emphasise the health benefits of good placemaking; assisting decision makers and linking improvements in the built environment to wider health outcomes. However, the sectors do not always support each other as well as they might. How can they work together more effectively?

Future of London’s first Ageing Cities roundtable, supported by Barton Willmore, British Land, Arup and Pollard Thomas Edwards, brought together developers, housing associations, consultancies, London boroughs, the GLA and the NHS to discuss how cross-sector working could help ensure London is a good place to grow old.

The roundtable kicked off with presentations on the theme of healthy environments for ageing. Nicola Mathers, Head of Networks at FoL, presented a preview of findings from research by the Design Council and Social Change UK. The partnership explored the barriers to creating healthier places. Findings indicated that healthy placemaking is the exception rather than the norm, and that changes to policy, education and regulation could combat this.

Iain Painting, Senior Planning Partner at Barton Willmore, shared insights from his work translating healthy principles into strategy and delivery at Barking Riverside Healthy New Town. He spoke about the importance of involving organisations from occupancy phase in the planning stages and ensuring healthy principles do not get engineered out during construction.

Kevin Beirne, Group Director of Housing Care & Support at One Housing, spoke about the neglected middle market in older people’s housing, the poor reputation of parts of the sector and the challenge of costly service charges. He argued that developers need to recognise that “older people are savvy consumers with high aspirations”.

Anonymised highlights from the discussion are summarised below.


Planning for older people

• Despite reference to older people in the National Planning Policy Framework, only 17% of Local Plans make reference to housing for older people.

• While high-end and social housing for older people are relatively well provided, the middle of the market is being neglected. To address this, “all local plans must address the needs of all older people in all tenures”.

• Land use classes pose a challenge: homes with an element of extra care or adaptation lie between C2 and C3 use classes and it’s often unclear which category developments should fall into.


A disjuncture between planning and health?

• Southwark Council works closely with Clinical Commissioning Groups (CCGs), focusing on primary and community healthcare and helping to secure sites for new facilities to deliver these services. However, most participants felt this was not the norm.

• Participants agreed there is a need to break down silos between planning and health, bringing the NHS and CCGs into the planning process as standard and at an early stage. Joint ventures between the NHS and developers have the potential to deliver better planning outcomes than developing health facilities through tender processes.

• Leadership, professional and political, needs to send a clear message that siloed working is no longer acceptable. There are clear benefits to working together: the burden on the NHS and social care bills can be reduced through healthy placemaking and the middle market is an under-exploited opportunity for developers.


Developing and adapting

• There is a clear need to get the views of health and care providers during the planning process. This will help ensure the right infrastructure is built, management is considered from the start and residents’ needs are met.

• There is a need to incentivise developers to remain engaged during occupation phase, ensuring developments deliver on their health commitments. The Private Rented Sector has potential to attract investors who will take a long-term view.

• The case was made that community-based care delivers better results than staying in hospital: adapting properties to facilitate this is a priority.



• Opportunities through the Mayor’s Care and Support Specialised Housing Fund were identified to support housing for older people; these should be fully explored.

• One model for housing associations is to use private sales and rentals to subsidise support services for older people.

• Financial models such as pay-at-the-end or equity shares could be used to address the service charge issue, but these require the developer to stay engaged into occupation phase.

• There is potential to fund developments through long-term savings on healthcare costs, but this “comes down to the ability of organisations to be creative in how they think about returns”.


The housing offer: key points

  • It is crucial to understand what older people want, and to recognise the huge diversity within this demographic. Counter to the narrative of quiet retirements by the sea, participants noted that accessibility to London’s cultural offer is important to many older people.
  • There needs to be choice for older people across all tenures: the PRS is predominantly marketed to young people and this is a missed opportunity.
  • A better range of options can help promote downsizing, freeing up family-sized properties across sectors.
  • Participants agreed the focus should be on building homes for life: we need homes that people can stay in as care needs increase over time.
  • Most homes people will live in are already built; we shouldn’t forget the need to address both the funding and lengthy process of home adaptations.
  • Loneliness was recognised is a key issue for health and wellbeing. One housing provider stated that the ability to socialise is a top priority for older clients.
  • Alternative models such as co-housing and intergenerational living, common practice overseas, should be explored for the UK market.
  • Looking to the future, we need to consider the increase in working age and the increase in care responsibilities. It was reported that Japan has a scheme preparing 80 year olds to look after their parents in their 100s.

We’ll investigate where to take some of these challenges and recommendations in our “addressing the middle market” roundtable on 8th November.

Next steps:

Fill in Future of London’s Ageing Cities survey on the policy landscape in London.

Upcoming events:

  •  18th Oct – Bringing together health, care and built environment professionals
  • 8th Nov – Addressing the over 60s middle market (invitation only)
  • Details of further site visits tbc, details will be circulated in early November
  • January – Report launch