Healthy place-shaping in Bicester

This case study was entirely compiled in Spring 2020.

The town of Bicester lies in the Cherwell district of North-Eastern Oxfordshire. Its population stood at 35,300 in mid-2016, according to ONS estimates. Due to its location in the Oxford-Milton Keynes-Cambridge corridor and its good road and rail links, it is expected to grow to 50,000 residents by 2030.

Cherwell District Council has a strong belief in working with its communities to reduce health and income inequalities and improve community cohesion. The scale of the population growth expected in Bicester provides both a challenge and an opportunity. The council and its partners are using this opportunity to test innovations to improve healthy behaviours, a healthy environment, the wellbeing of residents and inclusive growth.

From 2016 to 2019, Bicester was one of ten demonstrator sites for the NHS’s Healthy New Towns (HNT) programme. The outputs achieved under this programme have been varied and numerous, as described below. However, this is not the only national programme the town has been involved in (and indeed, the HNT programme has been used to lever in other funding).

For example, Bicester became UK’s first Garden Town in 2014. Garden Town status was awarded in recognition of its ambitious vision for holistic, sustainable growth. It carried Government funding for studies to enable the town’s managed growth, supporting infrastructure and improvements and allowing local people to get actively involved in shaping their town. The resulting transformation of the town includes the UK’s only eco-development (true zero carbon) at Elmsbrook and largest self-build scheme at Graven Hill.

Cherwell places a high value on working with and supporting community groups and other local partners, such as schools, businesses, health and care providers and housing developers.

The council approached the NHS regarding the HNT programme, then worked with its partners to submit a bid. Elmsbrook provided a focal point for the bid, but the “Bicester team” always intended to make it a whole town approach. The aim was to make Bicester a place where “healthy behaviours are easy, fun and affordable –where being active, eating healthy food, and being a good neighbour are part of normal daily life”.

The Bicester team was notified that its bid was successful in March 2016. The next year then focused on developing a detailed plan, shaped by local communities, converting some basic principles and overall aims into a comprehensive programme of practical activities. This involved finding and utilising opportunities for pump-priming funding. The programme was based around three workstreams: built environment; community activation; and new models of health care.

The HNT required robust evaluation, so that learning could be disseminated to others. Academic institutions were involved from the start. They helped to ensure that proposals were evidence-based, that outcomes could be measured and that the programme and its impact were robustly evaluated. There were several strands to the evaluation and associated research, within the lifetime of the HNT, including:

• An initial baseline survey on health and wellbeing – this covered topics such as diet, physical activity, social networks and general health state, with additional sampling of older residents and residents with learning difficulties.
• Focus groups and interviews with those involved in designing and delivering the programme, in early 2018.
• A review of progress at the end of the second year, to inform planning for the final year. This also considered an extension beyond March 2019.
• An evaluation of the economic impact of the programme.
• A longitudinal study across five of the HNT sites.

The overall approach to the evaluation of the programme was designed by Oxford Brookes University and the University of Oxford, with academics from other institutions running individual strands. The evaluation incorporated a “rapid cycle” approach, allowing feedback and similar qualitative data (such as posts on Healthy Bicester’s Facebook page) to be used to make ongoing tweaks to particular projects.

Achievements of the programme include:

• A new cross-town cycle route, bike repair sessions and improved pedestrian and cycle-way signage.
• Three 5K routes for walkers and runners marked out with blue lines, as well as a 15-minute town centre walk. These are fully accessible for wheelchair users and those with buggies.
• Support for walking and cycling groups, including training walk leaders and bike-ability trainers.
• Outdoor gyms in strategic locations in more deprived areas.
• Healthy design principles incorporated into housing and planning (including estate planning for primary care) – by altering local planning requirements, working with developers and improving green spaces.
• Improved diets and cooking skills – by working with Tesco, the Food Bank and schools, and introducing a scheme to promote healthier options in food outlets.
• Work in schools to promote physical activity, volunteering and intergenerational projects with older residents.
• Pupils’ involvement in developing a mental health website for teenagers.
• Funding and training provided to help community groups and others deliver healthier outcomes, for example training for primary school teachers to provide outdoor lessons.
• Developing local networks for voluntary organisation & intergenerational connections.
• A “little lunch” initiative, a play and other community activities to address social isolation.
• A web platform to allow people to identify others who share their interests, to reduce social isolation.
• A Healthy Bicester Facebook site, promoting PHE apps and providing healthy living tips and information about events.
• The Cherwell trial of ‘Thrive’, developed by West Midlands Combined Authority. This is a free programme to assist SMEs in looking after their employees’ mental and physical health.
• A programme of training in the Making Every Contact Count (MECC) approach, for library staff, primary schools, public-facing business people and others. This is about having the confidence to pick up on cues and engage with people in conversations about lifestyle changes to improve health, and providing appropriate signposting.
• Improving care for most complex NHS patients, by establishing new relationships between professionals across organisations and a training programme for un-registered support workers.
• Improving care for people with diabetes – piloting a new GP-based pathway, and running evenings to inform patients about community-based support and how they can better manage their condition.
• Partnership work to determine needs for health facilities, resulting in discussions to find sites for two new health and wellbeing “campuses”.
• An urban air quality project using satellite data.

The evaluation programme has provided statistics on the effectiveness of some of these:

• Healthy Bicester’s Facebook page reached an average of 13,540 people every month by June 2018.
• 450 new downloads of the PHE apps in Bicester.
• A 27 per cent increase in footfall as a result of the 5K routes.
• A three per cent increase in healthy walking in 2018 alone.
• An eight per cent increase in children’s lunchtime activity, and a 12 per cent increase in attendance at “holiday hubs” to keep children active in school holidays, in 2018 alone.
• 150 sixth formers attending a volunteering fair.

The process, evaluation and achievements are set out in more detail in Bicester Healthy New Town Case Study[1]. This explains how the programme addressed three challenges: coping with both limited national funding and a context of cuts to public services, and ensuring residents felt an ownership of the programme. As learning points for others, it also identifies eight “success factors”, based on Bicester’s experience:

• Close partnership working, with an existing town team covering a range of core skills and expertise, and a local authority providing strong political leadership.
• Key individuals with interest, enthusiasm and capacity – and planning for continuity should they be replaced.
• Early engagement of local stakeholders to ensure a sense of local ownership.
• Close alignment with partners’ existing strategies and local priorities.
• Enabling a connected system to develop and focusing on improving this.
• Strong, dedicated, flexible programme management.
• Being part of a wider programme (in this case part of the NHS England HNT programme).
• Dedicated yet flexible funding.

While the HNT programme ended in 2019, the healthy place-shaping agenda continues. Cherwell is currently commissioning an evaluation of the whole system. They have secured funding from Sport England, some of which will pay for this evaluation. It will draw on data gathered under the HNT programme and gather new data.

Cherwell will fund the continuation of this agenda, rolling it out to the neighbouring communities of Kidlington and Banbury.