Health activation is increasingly presented as one solution to the decline of the high street. The logic is compelling: bring NHS services into vacant retail space to provide accessible and integrated care – in a cost-effective way – whilst enlivening our town centres. 

But the reality is considerably more complex and considerably more strategic. Our experience at Barking Riverside – where we have worked in partnership with NHS North East London – indicates that health on the high street should not be treated as a cheap or quick fix. Instead, it represents an opportunity to test and refine a new model of care for our emerging population, ensuring it aligns with the NHS's three strategic shifts: from hospital to community, from analogue to digital, and from treatment to prevention. 

Therefore, it is worthy of the time and investment required. 

At Barking Riverside, we have been working for several years to deliver an integrated Wellness Hub within our District Centre. The objective is to create a significant piece of social infrastructure for the new community that re-enforces our legacy as London’s only Healthy New Town. 

The difficulty has been delivery. 

Despite various exercises, market uncertainty has meant that construction costs have continued to rise between tender and contract award. Whilst all stakeholders remain committed to the long-term ambition, residents want and expect a local healthcare option now. 

As a partial remedy, BRL offered the NHS a 250m² shell-and-core retail unit as an interim facility. Surely this would be a “quick win” for all stakeholders, as well as the community? 

The NHS was understandably focused on the permanent Wellness Hub. Larger facilities provide greater clinical flexibility, workforce resilience and operational efficiency. There was also a legitimate concern that the interim facility could divert attention from delivering the long-term ambition. 

Eventually, a solution was agreed. BRL committed not only the retail unit itself, but also to fund the fit-out, furniture, fixtures and equipment, alongside operational support covering rent and service charges. 

We now had a proposition that worked for everyone, but the cost of delivering something “interim” was suddenly substantial. 

Initially, the fit-out was estimated at around £650,000 based on benchmarking from comparable projects. However, all tender returns subsequently exceeded £1,000,000, despite the small size of the unit. There were further costs associated with professional fees, regulatory requirements and design development. 

Further, the fact that the unit was located within a “Tall Building” introduced additional complexity, including concerns around Building Safety Regulator approvals. Ultimately, this impacted contractor appetite – multiple procurement exercises were required before a viable route to delivery was secured, again increasing cost and programme.   

After significant perseverance from all, we are finally in contract and moving towards completion. 

The hurdles encountered above are not uncommon. Almost any capital project now is tackling these pressures and stresses. In this instance, stakeholders have persisted because the opportunity is significant. 

Barking Riverside is a rapidly evolving London town, whose population, demographics and health needs continue to change year by year. The health challenges facing a young family moving into the first phase of the development may differ significantly from those of the mature community. 

The interim facility provides a real-world test bed through which the NHS can better understand our emerging local needs. Together, we can trial new approaches to care delivery – shaping the future model that will be delivered through the permanent Wellness Hub. Rather than simply responding to demand, this approach allows services to evolve alongside the community itself. 

In this sense, Health on the High Street is not simply an interim solution to make better use of a vacant unit. It has a critical strategic function. 

Perhaps the most interesting lesson is that the physical limitations of the retail unit may be one of its greatest strengths. 

Healthcare facilities are designed around long-term requirements for a defined catchment. Retail spaces, by contrast, encourage a local and human-scale approach. They sit alongside the everyday destinations that make up neighbourhood life. 

As the NHS develops neighbourhood health models across the country, there is a growing recognition that care should be delivered within communities rather than adjacent to them. Health on the High Street offers an opportunity to explore what this looks like in practice, better integrating healthcare into the wider neighbourhood ecosystem. 

This is why we should reconsider how we talk about health on the high street. 

If the expectation is that health providers can simply “plug in” to existing retail space and create savings for everyone, the reality will disappoint. 

Healthcare remains specialist social infrastructure, whether it is delivered within a purpose-built health centre or a converted retail unit. Clinical standards, digital requirements, infection control measures, workforce considerations and regulatory obligations do not disappear because a building was originally intended for another purpose. Yet if we measure value solely in terms of capital expenditure, we risk missing the broader opportunity. 

For new communities, smaller neighbourhood facilities can provide an invaluable platform to understand demand, test new models of care, and inform the design of larger infrastructure. 

But, if health is to become part of the future of the high street, we need to treat it as investable from the outset – recognising that it may take significant time and budget to deliver. 

The principle of Health on the High Street is right. 

But making it work requires considerably more than an empty shop. 

It requires partnership, investment and perseverance. Barking Riverside demonstrates that when those ingredients come together, health on the high street becomes much more than an interim solution. It becomes a foundation for neighbourhood health.