Late last year, the Prime Minister and Secretary of State for Health and Social Care launched Change NHS, a consultation on landmark efforts to modernise and rebuild the National Health Service. The initiative has three key ambitions: moving care from hospitals to communities, making better use of technology and focussing on preventing sickness, rather than just treating it.

The integration of transport and public health planning.

While public health is conventionally approached from the realms of medicine and government, our work at Momentum demonstrates that the built environment impacts profoundly upon well-being. We seek to reverse our sector’s traditional model of car-dominated development, which contributes significantly to harmful emissions, sedentary lifestyles and preventable injuries. We are committed to forging creative mobility solutions which encourage public transport uptake, safe and accessible active travel, and green, healthy streets for a diverse range of users.

Poorly designed housing and car-dependent urban planning limit opportunities for active travel and reduce access to green spaces while contributing to social isolation. These factors contribute to long-term health issues such as obesity, diabetes, cardiovascular disease and mental health challenges, all of which place significant strain on the NHS.

Planning for health

In December 2024, Momentum submitted an organisational response to Change NHS, arguing that there must be closer alignment between health policy and planning system reforms.

The links between poor air quality and respiratory, cardiovascular, and neurological health conditions are well documented, as are the health benefits of green spaces and outdoor play areas. Access to parks and green corridors has a proven positive impact on mental health, physical activity and social cohesion. Genuinely accessible, public green spaces are particularly important for children, the elderly, and disadvantaged communities.

The broader impacts of a poorly designed built environment – ranging from road injuries to sedentary behaviour – are significant public health concerns. Road traffic accidents alone resulted in over 28,000 deaths and serious injuries in the UK in 2022, while inactivity linked to car-dependent development is a leading cause of preventable chronic disease. Such outcomes disproportionately affect vulnerable groups, as poorer communities often live in areas with inadequate infrastructure for active travel or safe outdoor play.

The planning system should be harnessed to create healthier living environments by embedding health impact assessments into the approval process for new developments. These should evaluate factors like housing quality, access to green and play spaces, and opportunities for active travel. Developments that are likely to have long-term negative health impacts should face planning penalties, with funds redirected to support NHS initiatives and infrastructure improvements. The recent decision by Great Ormond Street Hospital to include postcode-level air pollution data in patient care recognises that health outcomes are deeply shaped by where and how people live.

Our recommendations

The NHS 10-Year Health Plan represents a critical opportunity to address the root causes of poor health outcomes by reforming the planning system to create healthier, more sustainable built environments. By embedding health considerations into planning policy and incentivising good development while penalising harmful practices, the NHS can reduce the long-term healthcare burden and improve population health for generations to come.

Specifically, Momentum has the following recommendations to help the government deliver on its 10-Year Health Plan:

• Embedding health impact assessments into the planning process to evaluate the long-term health effects of new developments.

• Encouraging developments that prioritise active travel, access to green/play spaces, and high housing standards, while penalising developments that fail to meet these benchmarks.

• Establishing a cross-departmental framework to align NHS reforms with planning policies, ensuring coordination between the Department of Health & Social Care and departments such as Transport, Environment, and Housing.

• Funding mechanisms to direct penalties from poor developments towards NHS infrastructure and preventive health initiatives.

• Expanding place-based initiatives to integrate “healthy streets,” active travel networks, and green spaces into urban and rural planning.

Healthy streets as preventative care

Since the consultation closed to organisational responses, the Chief Medical Officer’s annual report, Health in Cities, further underscored the role that urban design can play in fostering well-being: outlining how food environments, transport emissions and healthcare service planning all contribute to community wellness.

We believe a progressive, strategic approach to transport planning interacts with the three stated goals of Change NHS: moving care from hospitals to communities; making better use of technology; and (3) focussing on preventing sickness, rather than just treating it.

Shift 1: Moving care from hospitals to communities

The shift of care from hospitals into communities requires appropriate travel planning, strategically integrated with the land-use planning needed to facilitate this transition. In the UK, transport regularly charts as the highest emitting sector. New community-based treatment sites should be well-connected to public transport networks with genuinely accessible options communicated to site users and staff.

These sites also present a unique opportunity to set precedent for public space activation to promote healthy streets. One such example is the Great Ormond Street Hospital (GOSH) Play Street, an experimental pedestrianisation which allowed patients, families and staff to enjoy social activities and clean air when the hospital frontage was temporarily closed to traffic.

Shift 2: What are the biggest challenges and enablers to making better use of technology in health and care?

In line with GOSH’s decision to factor local air pollution data into diagnostics and treatment, we encourage a community-based care system to draw upon existing data related to public transport accessibility, casualty statistics, and other pollution databases. This would allow design teams for new centres to act as “intelligent clients,” advocating for the relevant funding, support or infrastructural investment where problems are identified in their environs.

When it comes to active travel uptake, local clinics could provide wellness training associated with the use of micromobility applications and other shared bike and scooter hire, encouraging their wider accessibility to a diverse range of users. Groups like Transport for All can assist with skills sharing and public educational programming for community members with additional mobility needs.

Other technology can support the greening of the healthcare fleet through consolidation schemes, targeting the impacts of deliveries and servicing on roads around local treatment centres. One such example is a project of Cross River Partnership’s Clean Air Villages, prepared to support Guy’s and St Thomas’ Trust in streamlining the logistics associated with the hospital supply chain. Refrigerated storage facilities with high hygiene standards and flexible internal space were found to help in the creation of a “last mile hub” in Dartford.

Momentum applied the lessons of this work to a Delivery and Servicing Action Plan prepared for the Harley Street Business Improvement District, which operates within an area characterised by private clinics and medical businesses. We demonstrated that an innovative cargo bike delivery regime – with sufficient refrigeration and hygiene considerations – could support the movement of medical supplies and waste, while mitigating congestion and improving road safety.

Shift 3: Spotting illness earlier and tackling the causes of ill health

We fundamentally see progressive urban planning as a preventative measure for tackling the causes of ill health. Poor-quality built environments – including substandard housing, car-dependent neighbourhoods, and inadequate green spaces – are well-documented as key determinants of poor health. Addressing these root causes requires a joined-up approach between planning and NHS reforms to ensure that our built environment actively supports healthier lifestyles and reduces the burden of preventable illness on healthcare systems.

Aligning NHS reforms with planning system changes offers a powerful opportunity to address the causes of ill health at their root. Poor-quality developments that perpetuate sedentary lifestyles, limit access to green spaces, or fail to promote active travel could be subject to stricter planning controls or financial penalties. The funds raised could be reinvested into NHS services or used to support local infrastructure improvements, creating a positive feedback loop that supports prevention and improves outcomes.