It is a revolution that might just save the NHS – and the high street. Imagine being able to have your eyes tested, mole examined or get an appointment with a consultant without going to your local hospital – and maybe fit in some shopping or a cinema visit afterwards.
That, increasingly, is what people in Barnsley are doing after an unprecedented relocation of medical services from the district general hospital into a purpose-built outpatients centre in the Alhambra shopping centre, which is getting a new lease of life thanks to the experiment.
Those involved say the initiative – the first of its kind in the NHS – is trailblazing and revolutionary. After a recent visit, Wes Streeting, the health secretary, described it as “really inspiring”. He said: “What we’re seeing right here in the heart of Barnsley town centre is the future of the NHS.”
The outpatients centre has been created as a result of a collaboration between Barnsley hospital NHS foundation trust and the town’s Labour-run council. Hundreds of people a week are visiting it to have tests or treatment, including minor operations,for example to treat cataracts, blocked tear ducts or ingrowing eyelashes. Soon the number will rise to 1,000 or more.
It gives patients easier access to a range of non-urgent services than at the hospital on the town’s outskirts, where parking is limited. Through the extra footfall it is generating, it is also boosting custom for shops, cafes, restaurants and leisure facilities.
“It’s about having your mammogram while your husband wanders around at Sports Direct, or meeting your friend for a coffee after a dermatology appointment where someone looked at your rash,” says Michael Brown, the architect who designed the new facility.
Helen Campbell, 68, from Barnsley, being examined at the outpatients centre. Photograph: Joel Goodman/The Guardian
The centre, which opened last October and cost £8.8m, occupies what used to be a large branch of the variety retailer Wilko on the first floor of the Alhambra, which the council bought to stop it going bust. Services have been moving in from the hospital gradually since then.
Ophthalmology, optometry and retinal screening arrived first. Dermatology began seeing patients there last week and rheumatology and orthotics care opened for business this week. In all, 121 staff who used to work at the hospital – mainly nurses and healthcare assistants but also some doctors – now do so in the new facility.
The trust and council intend to turn the entire first floor of the centre into a health and wellbeing hub through their “health on the high street” joint plan. Shops – some open, many shuttered – will be replaced by a private gym, a council-run healthy eating cafe and mental health services provided by the local NHS mental health trust.
The trust and council intend to turn the entire first floor of the centre into a health and wellbeing hub. Photograph: Joel Goodman/The Guardian
Barnsley hospital was encouraged to create the outpatients centre by the success of a community diagnostic centre (CDC) it opened in April 2022 in the shiny, modern Glass Works shopping centre beside the tired-looking Alhambra. NHS England and Streeting see the expanding network of CDCs, which provide blood tests, X-rays and scans in community settings, as a way of helping to crack the service’s 7.25m-strong backlog of care. The hope is that faster, easier access to tests – in convenient locations, not hospitals – will mean treatment starts sooner.
The Barnsley CDC already carries out 50,000 to 60,000 tests a year. The trust hopes that it and the outpatients centre will between them provide more than 200,000 appointments. The latter is expected to offer 38,000 slots a year for adults with eye conditions, another 4,400 for children with sight problems, 19,500 episodes of care for people with skin conditions, 10,400 for rheumatology and 4,200 for people who have issues with their feet.
The outpatient centre’s location is proving a hit with patients, partly because it is a quick walk from the bus and rail station, says Alan Heathcote, Barnsley hospital’s project manager. “Patient feedback has been very positive. And the themes are consistent: easier access, a better location, less walking, shorter waits and no need to battle for hospital parking”, he says. Parking near the Alhambra is plentiful and cheap.
The experience of the CDC so far suggests that offering care in a town centre location has helped to reduce “DNAs” – patients who don’t show up – by 24%.
Alan Heathcote, the project manager: ‘We see this as a trailblazing model.’ Photograph: Joel Goodman/The Guardian
Heathcote says: “For Barnsley hospital, this is about much more than relocating clinics. We see this as a trailblazing model that puts health at the heart of Barnsley town centre. It’s about making care easier to reach, more joined up and more suited to how people live their lives, while also helping to support the wider regeneration of the town.
“We recognise that bringing hospital services into the town centre has a wider benefit. It increases footfall [and] supports local business.”
Each patient attending the CDC spends an average of £17.50 while in the town, the trust has found. Expected spend for those visiting the Alhambra is slightly less – £15 a head. But if that is borne out then the projected 100,000 appointments could yield £1.5m of extra spending in a town centre that, like so many, needs help to survive the challenges of decay, online shopping and the cost of living crisis.
“Our first priority is always better care and a better experience for patients [but] we are proud that this investment can also contribute to the vitality and long-term renewal of the town centre,” Heathcote says.
Visitors in the waiting room. Photograph: Joel Goodman/The Guardian
The layout, furniture and colour scheme have been designed to make it not look or feel like a normal clinical facility, to help reduce patients’ anxiety about receiving care.
When the Guardian visited the facility last week, the dermatology service was about to see its first patients in its new home. They have conditions such as psoriasis, eczema and impetigo. Some receive UV light therapy to relieve their inflammation and itching.
For Lisa Shaw, the service’s lead nurse, the outpatients centre is a welcome change from her previous base at the hospital two miles away. “It feels very welcoming when you come in,” she says. “There’s better parking than at the hospital, where it’s horrendous. There are several pharmacies nearby where patients can get prescriptions dispensed. [Until now] our services at the hospital were provided in an old building with a flat roof which always leaked.”
Barnsley’s innovation is attracting attention. Officials from Bradford’s NHS trust have visited to see how it works, as have delegations from five councils, the Department of Health, the Ministry of Housing, Communities and Local Government and even a German town. The Commons health and social care select committee has begun an inquiry into how Streeting’s promise of a network of new “neighbourhood health centres” – offering health services under one roof, closer to people’s homes – can move from rhetoric to reality.
A sculpture based on a character in the film Kes outside the main entrance to the Alhambra centre. Photograph: Joel Goodman/The Guardian
Streeting has urged the NHS to undertake “three big shifts” – from an analogue to a digital service, from hospital-based to community-based care and from treatment to prevention – to help it cope with the intense pressures on it. Progress is mixed. But the outpatients centre in Barnsley is an example of the strategy in action, with economic benefits an added bonus.
Brown says: “When people look at their town, they look at the high street. If they see boarded-up shops, it’s depressing and gives a sense of ‘my town’s not going well’. Barnsley’s initiative – putting healthcare in a town centre shopping centre or empty units – could be a good way of the government reviving their northern towns and even helping to fight off Reform.”
Radix Big Tent, a centrist thinktank, is about to launch a commission of inquiry into how healthcare – both NHS and private – can help save ailing high streets.
“Barnsley NHS trust are potentially providing a model not just for better health but also for the revival of our high streets,” says Ben Rich, its director. “Visitors spending £17.50 in local restaurants, cafes and retailers is money that’s gamechanging for a town like Barnsley and could be gamechanging for other struggling town centres and high streets across the country.”
