Social Infrastructure: Changing Demographics

The Bartlett Faculty of the Built Environment

UK BUILT ENVIRONMENT 2050

SOCIAL INFRASTRUCTURE:

CHANGING DEMOGRAPHICS

This report has been produced by The Bartlett, UCL’s Global Faculty of the Built Environment. The Bartlett would like to express special thanks to Mace, for both part funding this report and for arranging and hosting the workshop that was pivotal to this report’s creation.

About The Bartlett, University College London (UCL) The Bartlett is University College London’s global faculty of the built environment which, in partnership with others, develops new responses to pressing world issues.

About Mace Mace is an international consultancy and construction company shaping cities and building sustainable communities for the future.

Disclaimer All views in this report are those of the authors and do not necessarily represent the views of, and should not be attributed to, UCL.

1

1 Foreword...............................................................................................2 1.1 Introduction.............................................................................................4 1.2

Context: global and UK...........................................................................7

1.3 Social infrastructure.................................................................................7 2

Housing.................................................................................................8

2.1 Introduction...........................................................................................11 2.2 Housing demand...................................................................................13 2.3

Home ownership...................................................................................15

2.4

Homes for a life time..............................................................................17

2.5

An ageing population.............................................................................17

2.6

A green and pleasant land.....................................................................19

3

Education............................................................................................20

3.1 Introduction...........................................................................................23 3.2

Increasing demand for school places....................................................25

3.3

Higher and further education.................................................................27

3.4

A classroom anywhere..........................................................................29

4 Healthcare...........................................................................................30 4.1

Predictability of demand........................................................................33

4.2 Diagnosis..............................................................................................33 4.3

An emerging healthscape for comprehensive care.................................34

4.4

Showing the way...................................................................................35

5

Emerging topics.................................................................................36

5.1 Introduction...........................................................................................39 5.2

Cohesion, fragmentation and isolation...................................................39

5.3 Wellness................................................................................................41 5.4

Flexibility and adaptability......................................................................42

5.5

Refreshing our building stock................................................................43

6

Encouraging the conversation..........................................................44

References............................................................................................50

Appendix A...........................................................................................53

Credits..................................................................................................54 Contacts...............................................................................................55 Acknowledgements...............................................................................56

CONTENTS

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1: FOREWORD

By 2050 there will be nearly 10 billion people inhabiting our planet – an increase of almost 30% from today’s population.

4

1.1: INTRODUCTION

By 2050 it is expected that nearly 10 billion people will inhabit our planet – an increase of almost 30% on today’s population1. Whilst our world has always been changing, there is much speculation about what the future holds for us, and our planet.

This report is based on both a senior representative workshop held with UK built environment experts, and supplemental literature reviews, and aims to explore some of the most significant demographic-related issues that may affect our future for a discrete subset of the built environment. It is published by The Bartlett, UCL’s global faculty of the built environment, with support of the leading international construction and project management company, Mace.

We have focused on looking at the possible consequences for three key building types within the UK built environment that we consider sit within the heading of ‘social infrastructure’. These are housing, education and healthcare.

We will limit our interest in these three sectors to the issue of changing demographics, for to consider the other major concern, our changing climate, is too complex to deal with here in a digestible way. We are aware that both changing demographics and changing climate will be interdependent and we hope that we have considered this, where necessary.

The purpose of this report is not to provide answers. Rather, unlike many other speculations about our future, we hope that this report will add value by catalysing an ongoing debate amongst those interested in and concerned about our built environment. In this document we will set out the sense of how the future looks, at the time of publication, when considered from the perspectives we have taken. Effectively, this is a date-stamped view. What we are keen to explore is how the views presented here change over time.

The workshop referred to above was held in September 2014, and this report will be published over one year later. Why the delay you may ask? The answer lies in the recognition that over the past 12 months much has changed.

Consider, for example, the issues of possible Scottish devolution, the predicted continuation of a coalition form of UK Government, the wavering on a knifeedge of Greece’s position in the EU, the attempts by foreign nationals to enter the EU and UK by any means, and the economic and financial turmoil as the Chinese economy slows. In recognising the potential importance of each of these developments and issues, there was a concern that, upon the publication of this report, it would almost immediately be seen as out-dated and irrelevant.

However, in looking at the issues presented in the following pages, we still believe we are identifying some longer-term trends that may be resistant to the turbulence caused over any shorter-term. Indeed, our reason for persevering is the genuine excitement about trying to identify the more persistent drivers and forces that may shape an uncertain future. By continuing to investigate, we may see new patterns emerge, or longer-term pressures build from shortterm developments. Crucially, we will only see if our long-term speculations

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are heading off course if we routinely revisit them, and this is what we propose to do. This report is therefore presented in the hope that it will be the first in a series that look at what the future of the built environment may be like.

As you begin to read, consider that we know we are not predicting with certainty what will happen, but what we believe could happen. What we don’t know is how close the truth we are. Over time we will begin to see where we were prescient, and where we were misguided, and we hope that, as we learn where we were right or wrong, you will learn as we will, and be wiser for it.

6

UK POPULATION AND ITS GROWTH

+6.62%

5

62.8m 55.6m

56.3m

57.2m

58.9m 50

4

40

3

30

+2.97%

2

20

+1.6% +1.26%

1

1970

1980

10

1990

In 2012 the UK population was at 63.5 million and it was the fourth largest population in the EU. At the current rate of growth, by 2050 the UK could have the second biggest population in the EU†.

†

60

2000

2010

Change in UK population over the previous 10 years (%) UK population (millions)

United Nations. Population Division, Wold Population Prospects. http://esa.un.org/unpd/wpp/ [accessed August 2015].

UK Population (millions)

Rate of change in UK population (%)

6

7

In many countries there has been experience of rapidly growing and increasingly urbanising populations. This puts strain on any nation’s built environment. The United Nations Population Division projects that by 2050 66% of the world’s population will be living in urban environments, up from 54% today2. This would mean that more than two billion people are expected to be in cities over the next 35 years. While there will be unquestionable challenges, this change offers major opportunities for businesses in the built environment.

1.2: CONTEXT: GLOBAL AND UK

The UK faces demographically-driven challenges, as we anticipate an ageing population, increasing geographical mobility within the UK, and migration to the UK3. These forces test the built environment’s ability to deliver what is needed, or desired. In some places, such as London and the South East, these pressures can be expected to be acute and persistent. To address this, we need to engage in multifaceted dialogue, and draw on a range of expertise. If we do so, we can seek to develop new ways of designing, constructing, and operating the critical aspects of the UK’s built environment.

The built environment is a complex accumulation of many types of built asset.

From the dwellings we live in, through the many types of buildings we will come into contact with during our lives, to the many other forms of civil engineering that we rely on, our built environment is a rich mix of buildings and structures. In this report we will focus on three critical elements of what we refer to as social infrastructure: housing, health and education. We do so as they share two critical things. First, they are all forms of building and thus can be considered as a separate class from assets such as roads, electricity production facilities, water treatment plants, and distribution networks. Second, as part of our social infrastructure, they provide us with the basics of our modern lives. We expect to have somewhere to live, to study, and we expect to have an accessible health service to call upon when we are in need of medical treatment. We therefore consider the provision of housing, education, and health as essential elements of our modern lives.

1.3: SOCIAL INFRASTRUCTURE

w

2: HOUSING

w

The built environment, wherever it may be, has to work for the population in that location.

10

SUPPLY OF NEW HOUSING

450,000 400,000 350,000 300,000 250,000 200,000 150,000 100,000 50,000 0 1950

1960

1970

1980

1990

2000

2010

Private enterprise Housing associations Local authorities All dwellings

Sources: P2 returns from local authorities National House-Building Council (NHBC) Approved inspector data returns Welsh Assembly Government Scottish Government Department for Social Development (NI), Northern Ireland Housing Executive, Local Authority Building Control (NI)

11

The UK can trace back many current settlements to Roman times (AD43410)4. Some, such as Amesbury and Thatcham, can even predate this5. Over time, the UK’s hamlets, villages, towns, and cities have ebbed and flowed.

Our nation’s population has tended to grow, sometimes slowly, sometimes much more quickly. As populations swelled and enthusiasm for living in certain locations increased, the pressure to build more densely increased. In the seventeenth century this led to major health problems with a pandemic of plague across Europe, followed in London with the great fire of 16666. Moving on to more recent history, with the advent of materials such as steel, concrete, and accompanying technologies and techniques to provide new composites and engineered wood products, modern housing is now provided in high-rise apartment blocks in many of our large towns and cities.

Yet despite the emergent types of housing supply, there is a real concern that, historically and currently, demand for housing continues to outstrip the supply7.

One can consider why this is by deconstructing the housing supply problem into its four elements: (1) the materials needed to create housing, (2) the labour and equipment that use these materials, (3) the land on which such housing will be built, (4) the types of organisations and markets that organise to provide this housing. While there may be periodic concerns about the amount of materials or skilled labour available, more debate has centred on the organisations and markets that provide housing. With labour, materials and equipment markets all relatively straightforward, the issue is the way that land has become a highly valuable asset, as long as it is in the right place and has the right permissions.

This has created a specialist market and one that has played well for private housing developers which have the ability to ‘land bank’ and then release as and when market demand warrants. As the UK has seen continuing, and in some cases spectacular, increases in property prices, it is inevitable that those firms that make money from housing will choose carefully and selectively where and how much to build. With the decline in the non-private sector providers of housing, this has become a chronic problem.

2.1: INTRODUCTION

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CITY GROWTH

Edinburgh Glasgow 0.2%

0.8% Newcastle 0.4%

Belfast 0.4% Manchester

London’s population is increasing faster than any other city, by an average of 1.2% per annum from 2002–12, driven by a combination of natural growth and immigration.

Liverpool 0.3%

0.8%

Bristol

1.0%

Centre for Cities. Centre for cities data tool. http://www.centreforcities.org/data-tool/

London

1.2%

13

As we noted earlier, global populations are urbanising. 54% of the planet’s population now lives in an urban environment, up from 34% in 1960. This global trend is being followed in the UK, and it is expected that the future demand for housing will be in our old and new towns and cities8.

Population growth, rising house prices that are forecast to continue, the associated shortfall of affordable housing and long-standing under-supply of housing, especially in South-east England, have led some commentators to suggest that, by 2040, half of 20-34 year olds could be living with their parents9.

The consequences of this, together with adversities such as those caused by the global financial crisis of 2008, have led to the average age of first-time buyers increasing, as larger deposits are required to secure mortgages10.

With an increasing age of commencing property ownership, via obtaining a mortgage, coupled with issues of affording repayments, an increasing proportion of such mortgage holders will have to prepare for repaying their mortgages well into later life. This is now feasible as life expectancy is increasing and the opportunity to stay economically active into later life is both legally permissible and culturally tolerated11. For those where obtaining a mortgage and becoming a property owner is not possible or desirable, there will be an inevitable rise in the rented sector. While it is possible that the State and other public sector providers could add to the provision of the rented accommodation sector, the current lack of available funds to produce more of this publicly provided rental stock is leaving the private sector to consider its appetite for providing more rented accommodation.

The enduring appeal of living in and around London has created a demand for new homes in this region. London’s population is increasing faster than any other UK city, by an average of 1.2% per annum between 2002 and 2012.

However, the lack of a comprehensive and coordinated national level housing policy further contributes to the increasing unaffordability of homes in London and the South-east. The fastest growing cities outside London, during the same time period, were Bristol (1.0% p.a.) and Manchester (0.8% p.a.), with Belfast, Liverpool and Newcastle all at under 0.5% p.a. In Scotland, Edinburgh experienced an average growth of 0.8% p.a., while Glasgow grew by only 0.2% p.a.12

2.2: HOUSING DEMAND

14

1981

2001

2011

Ownership

1991

64%

58%

Renting 1971

Office for National Statistics – www.ons.gov.uk/ons/rel/census/2011-census-analysis/a-century-ofhome-ownership-and-renting-in-england-and-wales/short-story-on-housing.html

36%

31%

32%

42%

50% 50%

58% 1961

69%

1953

68%

1939

42%

68%

68%

32%

1918

32%

23%

77%

OWNERSHIP V RENTING

15

Over the past 10 years, UK average residential property prices have nearly doubled whilst in Germany they have risen by 2-3% p.a. In Germany, and elsewhere in Europe, there is a more balanced approach to what is considered as an ideal form of tenure, whereas, in the UK, there is a dominant desire to be an owner-occupier13. It is interesting that it is somehow ingrained into the UK psyche to aspire to owning one’s own home. To not do so is felt to be financially failing14. In financial terms this has historically been a very sound investment, but there is more than just investment strategy at play. Whether this can endure is one area to speculate upon, but for it to change in the UK there would need to be a dramatic shift in the social acceptance of long-term renting. An issue to note in this speculative space is the growing appeal of the long-term, regulated private renting sector by major institutional investors such as pension funds and insurance companies. For these types of investor there is great appeal to know that long-term tenants are looking after their capital asset and generating a regular stream of rental payments. For those renting, to know that they are in secure occupation with predictable rental costs, mutual codes of conduct and an obligation to take care of the property can provide much peace of mind.

An additional symptom of the UK’s ageing population is the previous generation’s ownership of a significant proportion of the housing stock – particularly the average and larger family homes. These are typically houses and are increasingly found to be occupied by one or two ‘empty-nester’ inhabitants, who are effectively caretaking inheritance assets for their descendants. These inhabitants will feel settled, and in many cases will seek to stay as long as they can in their homes. There is also a fragmentation of household types resulting in an increasing number of people buying property and then living on their own15. With property prices increasing and the high costs of moving, the UK housing stock has become, in market supply terms, increasingly ‘sticky’. With a growing population, the demand for housing is increasing, and if the supply is sticky then the result is inevitable price rises and a market increasingly out of equilibrium.

In practical terms, this raises the questions of where, what, and when firsttime buyers will buy. What we do appreciate is that the growing, pent-up demand to find somewhere to live, when very little is available to buy or rent affordably, is increasing the need for additional housing, and this challenges the UK-wide planning policy. Governments have been aware of this but, for reasons linked to national, regional, and local politics, are loath to do more than marginal alteration to policies, such as making brownfield development easier16. However, if the demand pressure keeps rising at the pace experienced over the recent past, alternative supply solutions will need to be found, and found quickly. How this problem will be resolved over the years ahead to 2050 is beyond obvious and easy solutions. The solution is not to be found in one ‘magic bullet’ but is rather a contribution of changes to regulation (some of which may be radical), widening the range and adapting to four types of housing providers, addressing variable regional economic performance, adapting technology and adjusting our cultural expectations.

2.3: HOME OWNERSHIP

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NUMBER OF WORKING AGE PEOPLE PER STATE PENSIONER

600

500

400

300

200

100

0 1971

1981

1991

2001

2011

2021

2031

2041

Old age dependency ratio, United Kingdom

Past dependency ratio (DR)

Ratios per 1,000 people of working age

Projected DR with SPA change Projected DR without SPA change

1. Working age population is defined as individuals aged 16 to SPA. 2. Ratios between 1971 and 2008 are based on mid-year population estimates. From 2009 onwards, ratios use 2008-based mid-year population projections.

Source: Population estimates and 2008-based principal population projections, Office for National Statistics

2051

17

If it appears that our future cities will have to cope with all our desires and needs, then so too will our homes. Reconsidering the traditional forms of residential property results in emerging concepts such as ‘adaptable homes’ or ‘lifetime homes’. If future housing becomes more expensive, or problematic, then maybe we should reconsider what we need from the homes we have.

This may involve designing an entirely new type of housing and tenure – where the housing unit provides multiple long-term residency through different life phases. Conceptually, this may mean a dwelling that could be conceived to operate in different modes. For example, it could operate as two separate smaller units, but could easily be converted to a single occupancy space, depending on demand by the users. This concept would translate well to the multi-generational occupancy of housing units, which we expect will continue to increase as demographics change and our population ages. We have seen much conversion activity along these lines, especially in the property boom of the late 1980s, but this was invasive conversion of property not designed to be sub-divided. From this experience we can learn to design accommodation knowing that this conversion and reconversion may take place. The question is, who should be investing in this area, and what is the risk/reward profile for such an innovative solution?

2.4: HOMES FOR A LIFE TIME

The number of working age people for every state pensioner in the UK is expected to fall from 3.21 in 2012 to 2.74 by 203717. The number of people aged over 80 is projected to more than double to 6 million by mid-2037, and the number of those drawing State pensions may increase by 31% to 16.1 million18. It therefore seems very likely that older people will make up a much larger proportion of the UK population in the future.

2.5: AN AGEING POPULATION

By 2050, we will all expect to benefit from advances in technology. For example, ‘tele’ and ‘remote’ type presence is expected to increasingly allow monitoring, communication and intervention to become more routine, automated and immediate. This may help those who are frail and elderly to remain in their existing homes for longer, possibly all their lives. Other members of society, however, will require intensive medical and lifestyle interventions, leading to specialised accommodation and facilities. Whilst this may change the way we have to design and operate health facilities and the areas in which they are located – a topic we will discuss later on – the design of future housing could stimulate a much more comprehensive provision of social and economic services and facilities. How can the built environment support these developments or combine the provision of health and social care with housing?

Moreover, with the growing reliance on technology in our smarter homes and in our smarter cities, what will houses and apartments of 2050 look like? Will they remain largely as we know them now, or will they become technology hubs to enable flexible home workers and those others that will find themselves increasingly staying at home? Will they really become more intelligent to help actively monitor and assist the elderly and vulnerable members of society? If

18

19

we look to the modern car, we see an increasingly autonomous and intelligent setting designed to transport us19. Will our homes of 2050 move along a similar development trajectory?

What is clear is that the housing problem in the UK is set to remain, for the immediate and medium term future at least, yet there are many areas where solutions can be found. England was, and remains, a largely ‘green and pleasant land’ and there are rightly those who are deeply concerned that those in the built environment should not pour concrete over this land20. The UK’s strict planning regime is there to safeguard against this, but within this regime lies the problem and, therefore, the key to the solution. It may be the case that some sacrifices will have to be made. Any land taken away from the natural beauty and biodiversity is a loss. However, if this loss is clearly identified, explained and appreciated, then it can be understood where compensating measures are needed. Intelligent and thoughtful solutions can be found that ensure minimal loss and impact. In some cases it may be that objective and provable net benefits are found for all - more people have homes, important landscapes are protected, and biodiversity is increased. Such arguments are central for the possible creators of the next generation of garden cities21.This will not be easy, and it will only happen if differing experts come together to seek solutions that can be confidently committed to before they can be made to work.

2.6: A GREEN AND PLEASANT LAND

3: EDUCATION

One new school would have to be built every 2 days for the next nine years in order to accommodate the anticipated population growth.

22

23

During the past decade, the UK education sector has undergone substantial structural changes, whilst facing significant pressures. One of the most prominent developments involves an increasing degree of freedom from detailed central management oversight, coupled with an obligation for financial self-reliance and accountability that are expected from organisations across all levels of education. This pressure has been heightened during the recent period of extreme economic instability and public sector financial cutbacks22.

At the school level, while there has been a loosening of strict ties that drive academic uniformity, there has been a widening of the range of building types and conditions of schools themselves. At one extreme, there are those school buildings that have received significant capital investment (academies, free schools, schools built or upgraded under the Building Schools for the Future (BSF) programme), and at the other, there are school buildings that have not been substantially improved for many years.

Beyond schools, further and higher education establishments have seen a growing demand for places. However, funding for students has become more complex as reduced core funding, for both further and higher education, has been accompanied by changing fees and the widening use of student loans.

3.1: INTRODUCTION

24

INCREASING DEMAND FOR PRIMARY SCHOOL PLACES

1,073 2,700

13,736

new primary ...or newschools... schools... new classrooms

forfor

343,399 800,000 new school places

new school places

...by 2024?

...by 2020?

Source: See Appendix A

25

Based on current population projections, the number of school pupils is predicted to increase to 8.7 million by 202423. Currently, there are approximately 7.7 million pupils in primary, middle, and secondary schools in England24. This rise will inevitably lead to a large number of schools being built, remodelled, or refurbished.

Unsurprisingly given our previous comments on the population trends, demand in London for primary school places is growing faster than anywhere else in the UK. This pressure is acute with four Greater London boroughs expecting to increase school capacity by 25% by 201625. To cope with this there has been a trend in the UK for the physical space per pupil to decrease. This looks set to continue as a result of the reduction in capital investment triggered by the financial crisis of 2008.

Of the additional 979,182 school places needed by 2024, 343,399 will be new primary school places, and 635,784 will be for secondary school places. This roughly equates to 1,073 new primary schools and 675 new secondary schools in the next nine years26. That is the equivalent of an additional 13,736 primary school classrooms, and 30,275 secondary school classrooms.

In other words, four primary school classrooms and nine secondary school classrooms would need to be built every day for the next nine years in order to accommodate the anticipated population growth.

As we move into the future, appreciating the pressures on both funds to build with and land to build on, can we foresee a need to address the shortage of space through solutions other than constructing more new buildings? The challenges presented now, and into this future, will require even more focus on solutions that maximise functionality, affordability, and the alignment of timescales of construction delivery with the identification of, and funding for, pupil place demand.

Whilst there will be pressure to increase the space to cope with this rise in demand, there is a growing need to consider the whole life cost of public buildings. We have learned that creating cheap and quick to build solutions can lead to many legacy problems, and high costs in use. Poor thermal performance has led to high running costs, and greater contributions to greenhouse gas emissions. This high running cost is compounded by inabilities to cheaply and easily alter functional use. These problems have all been experienced too many times in our past and we must try our best not to repeat our mistakes. We must act quickly, but not rashly.

3.2: INCREASING DEMAND FOR SCHOOL PLACES

26

INCREASING DEMAND FOR SECONDARY SCHOOL PLACES

675

30,275

new secondary ...or schools... new classrooms for

635,784 new school places

...also by 2024

Source: See Appendix A

27

As a result of increasing tuition fees and the need to take out loans, some potential university students were predicted to have felt they could no longer afford to study for as long as they would like, or in the subjects they would prefer27. Yet, after the first few years of the student loan’s operation, it is clear that the total number of students has increased, and this has had an impact on the value of a university degree as more graduates fight for each job28. But, as we emerge from the global financial crisis of 2008 we are also starting to see an increase in the number of companies employing people with vocational qualifications, or enrolled in apprenticeships29. It is too soon, and still too uncertain, to know if these patterns will continue, and whether it will lead to a rebalancing in the supply and demand in the higher, and further education sectors, as the UK grapples with its role in the turbulent global economy, and the skills its workforce will need. This may well change these institutions in terms of both the types of courses offered over the years ahead and how these intitutions are funded.

3.3: HIGHER AND FURTHER EDUCATION

28

29

Across all parts of education new technologies have become available that allow for innovative ways to deliver education to large populations. As a result, we are witnessing the emergence of many new educational concepts and styles.

One example of this is the ‘flipped classroom’ concept, which is growing in popularity, especially at the levels of advanced school learning, as well as further and higher education. The ‘flip’ is where the learner watches and studies the class from home, or elsewhere prior to the timetabled learning event (class or lecture), and comes to school/college/university mainly for practice, discussions, or debate with teachers and other students30. Both the flipped classroom, as well as other technology-enabled solutions for teaching and learning, can be seen in light of the larger scale developments in education offerings globally. A good example of this is the emergence of Massive Open Online Courses (MOOCs). An increasing number of universities offer these free, or low cost, courses on many topics to an online audience who can be anywhere in the world31. Taking these digital and internet-based developments, and the trend that underpins them, into account, there is real opportunity for greater levels of learning taking place online, and asynchronously, as long as learners have IT tools and access to the internet. This may provide the opportunity to radically revisit the traditional concepts of an educational facility, and especially the eccentric loading that puts specific types of spaces, such as classrooms and lecture theatres, under great pressure at critical times of day, and for certain parts of the year.

What is becoming increasingly clear is that an important component in designing and building educational facilities for the future will be the need to cater for the increasingly diverse needs of learners. For instance, attempting to replace primary school attendance with online modules is less attractive than it is for university-level students. One of the reasons for this is that schools encourage the development of vitally important social skills, and in some areas provide an environment of stability and pastoral care, as well as appreciation of different cultures and values. Once learned early on, these skills can be built on as the learner matures, and is able to absorb education in many varied ways.

How we ensure the learners of the future become skilled, knowledgeable and excellent citizens will see a significant role for technology. What this will do for and to our schools, colleges and universities of the future is an ongoing area for significant discussion and debate.

What is emerging is that with changing employment opportunities and a need for lifelong career flexibility, we appear to be moving into an era where it is impossible to be ‘too old to learn’.

3.4: A CLASSROOM ANYWHERE

4: HEALTHCARE

For the first time in history, there are 11 million people aged 65 or over in the UK.

32

UK’S OLDER POPULATION

10

80+

9

75-79

7 6

70-74

5 4 3 2

65-69

Total of people aged 65 and over in the UK (millions)

8

1 0 1951

1961

1971

1981

1991

2001

Age structure of people aged 65 or over in the UK

Office for National Statistics – http://www.ons.gov.uk/ons/rel/pop-estimate/population-estimates-for-uk-england-and-wales--scotland-and-northern-ireland/mid-2014/sty-ageing-of-the-uk-population.html

2011

33

According to the latest reports by Age UK, for the first time in history there are 11 million people aged 65 or over in the UK32. Methods available for healthcare diagnostics and screening have accelerated and improved the detection of medical conditions to the extent that many formerly incurable diseases and conditions can now be identified earlier and be effectively treated before they reach a critical stage33. As more data becomes available on health risks for different population groups, healthcare policy planning is better informed, and opportunities for early intervention are increased34.

4.1: PREDICTABILITY OF DEMAND

If we understand both the location and specific sections of a population (e.g. age, sex, and ethnicity) that are likely to be affected by possible disease or condition, we can prioritise our healthcare services accordingly. But the inherent contradiction is that while there may be increased opportunity for identification, diagnosis, treatment and intervention, these will always be set in the context of a constrained supply, where there will be budgetary and other resource pressures. A further pressure will be the trade-offs as, for example, more improved, precise and targeted healthcare may mean less time by the patient spent in the traditional acute clinical space, but may lead to additional pressures for care and carers in the home and community. In the UK, with its modern health system founded on the National Health Service, these pressures of budget and responsibility boundary will warrant increasingly rigorous prioritising in NHS-related budget spending, resource allocation and accountability. These are accepted as being very difficult challenges within and beyond the NHS, but they are worth tackling as the result will be a population of individuals that are healthier and capable of being productive, both in economic and social terms.

In relation to the demand within healthcare, we are increasingly looking for delivery across a range of community settings. One of the key issues is the interaction between the healthcare providers and a growing and ageing population that has greater expectations. While there will be an inevitable rise in the use of the internet and telephone-based health advice and diagnosis, along with access to health data from wearable technology, a significant degree of healthcare will still need to take place in physical settings - at one’s home, or in the facilities of the various healthcare provider organisations. But this is a shifting landscape as increasingly a broadening range of technology becomes increasing pervasive and this is enabling a wider range of interaction between the general population and healthcare providers.

4.2: DIAGNOSIS

34

4.3: AN EMERGING HEALTHSCAPE FOR COMPREHENSIVE CARE

Late 20th century research into healthcare environments sought to create an evidence base on the physical design of healthcare facilities, in particular the link between design of the facility and healthcare as a way to improve patient safety and quality of care35. But as we move towards 2050 it is feasible that the future will see the development of the concept of an integrated ‘healthscape’ of real and virtual facilities and services. In the future, there would be greater levels of comprehensive care provision as directed by smarter research methods and evidence that, together, will help steer the design of the facilities, treatments, systems, practices and skills required36.

With demographic and technological change coupled with financial pressures, a major challenge will be conceptualising and planning the physical settings where healthcare will be provided37. We may need to radically rethink fundamental questions regarding primary care and hospitals as being the traditional units for healthcare delivery38. While this is primarily a healthcare planning concern, disciplines spanning the healthcare built environment look set to have the opportunity to come together and, in collaboration with those from the healthcare service providers sectors, create new approaches, and improve the provision of sustainable healthcare.

Such innovative concepts might become less focused on the traditional centres of care and more on managing healthcare networks, both inside and outside hospitals and General Practitioner (GP) surgeries. This idea is not new: the ‘polyclinic’ idea gained ground in 2000’s as a comprehensive primary and community care service, and through both economies of scale and scope it sought to blur the line between the traditional GP surgery and a hospital39.

Whether this form of solution will be developed in the future or not, it is possible to see a range of intermediary health and social care providers extending their reach, via technology, to users of such healthcare services. For example, this may be through extended use of paramedic systems including our high street pharmacies, our gyms and leisure centres, or places of work. One can conceive of this ‘healthscape’ as both a real and virtual healthcare cluster of facilities and services providing various types of both routine and specialised healthcare treatments. Where justified, such as in major urban, or suburban areas, this could be more concentrated in a physically compact space, or location. This is more than simply envisaging an extension of the role of the GP surgery or the reconceptualisation of the role of the hospital. As opposed to the traditional concept of the hospital as the setting for concentrated expertise, located on a dedicated site, a healthscape allows for a much greater flexibility in organising the individual medical processes and systems, through a range of service providers while maintaining the benefits of centralisation of key resources, and scale of operation40.

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With technology making expensive medical equipment both cheaper and more portable, these healthcare spaces may indeed even become mobile41. Where they are fixed in location, there is clear potential that they could evolve into more than offering just healthcare, encouraging interaction with other critical services, such as social care, education, leisure, and recreation. A prerequisite for this is universal access to our medical data. Despite the problems of scale, complexity, and security that have been experienced to date, widening whilst securing access to our medical data is a surmountable problem and, once solved, it will allow more and better healthcare options to exist.

There are signs of possible trajectories to the healthscape future if we look to building located facilities. For example the Cambridge area now has healthcare, pharmaceutical and bio-technology providers and firms clustered and working together. We are seeing the creation of leading edge research institutions such as the Francis Crick Institute at King’s Cross, or the recently completed UCL Cancer Centre. Facilities like these are indicating the way forward for the design of research-led health systems and space. If we then consider future healthcare services that are not necessarily needed to be housed in such fixed facilities then we find early indicators of how the future may unfold via examples such as the planned mobile city-wide networks involving track and map interventions for the diagnosis and provision of Tuberculosis. These initial services are primarily focused on the informally housed and individually homeless, but the principle is that both client and health provider are ‘at large’ with the service being fundamentally orientated to follow and respond to the needs of the patient wherever they are.

The interest for those in the built environment is the growing recognition that successful healthcare interventions need to be about more than dealing with illness or injury, but to provide social and wellbeing support linked to housing, and employment initiatives for diverse and increasingly ageing population.

What may occur as the future unfolds is a very different sense of what could be considered as the traditional ‘front door’ of the health system as it exists today.

4.4: SHOWING THE WAY

5: EMERGING TOPICS

As technology continues to integrate into our lives, more choices and new opportunities are open to us.

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Having looked broadly at what the future may hold for the three sectors of housing, education and healthcare, in light of changing demographics, we have identified areas, topics and issues that we believe are worthy of consideration when contemplating how the social infrastructure of the UK will evolve by 2050.

These key issues arose from the many discussions that were had during and following the workshop. In this section we will look at issues that cut across the three sectors.

5.1: INTRODUCTION

Our social landscape has always evolved. In the UK’s history there was the rise of organised religion, which led to large numbers of churches being built.

Today, without revolution or reformation, many of these same churches lie idle, or converted42. Yet, organised religious worship continues in many places other than traditional UK churches. The industrial revolution triggered the construction of many new forms of building, many of which have since gone, some having found new uses. Public houses - an enduring cornerstone of British society - have fared in a similar way43. These changes in popularity of parts of our built stock of assets are simply an inevitable result of the changes in our wider society and economy.

5.2: COHESION, FRAGMENTATION AND ISOLATION

As technology pervades our lives, there is more access, more choice and richer experiences. This means the world increasingly comes to us and, for more and more of us, there are fewer incentives to interact with each other. Consider that public washhouses disappeared decades ago, as homes were equipped with bathrooms, and today the majority of us have access to our own washing machines - so many of us no longer need to use launderettes. This washing, of us or our clothes, brought us into contact with each other, providing a chance to make friends, gossip, and enrich our lives. Now, if we want to listen to some music, play bingo, or watch a football match or a film, we don’t have to go to go out as we once did - our homes can provide us with much entertainment.

Another sector that has a modern role in our society that is undergoing change is retailing. It is claimed that Napoleon once said that the British were a nation of shopkeepers44. Today’s traditional local shopkeepers in the UK face the pressure of the quadruple phenomena of the change in preference using (1) supermarkets, (2) shopping centres/malls, (3) the internet, (4) and giant global brands. All have had, and are having, an impact on our traditional high streets.

As a result, the number of traditional town centre stores fell by almost 15,000 between 2000 and 2009, with estimates of a further 10,000 losses over the past couple of years45.

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If our traditional places of congregating, such as churches, libraries, pubs and even our shops are no longer the focus for our social interactions, then where will communities meet and interact? Is it going to be in the coffee shops and cafes, the betting shops and nail bars, all of which are currently doing well?

Or will we see the renaissance and re-invention of some of these established building types? Is it possible to see a genre of new libraries, not simply as the place to borrow books and read, but for courses to be taken and groups to meet? Will more and more pubs move to being more cafĂŠ/pub/restaurant? Will the shopping centres of the future also be our community halls i.e. places of learning, meeting and celebrating?

What is clear is that traditional places that provide or encourage community cohesion are being lost faster than they are being created. If our homes will be able to do more - allow us to work, learn, entertain and even monitor our health and well-being - then will we have less and less reason to have face-to-face interactions? Yet we are social beasts, we like company, and so a key question is: what is it that will draw us out of our homes in the future?

Whose problems are these to solve? The answer is that it is ours, or specifically all of us who wish to live in a cohesive and pleasant society.

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If having fewer interactions becomes widespread then we, as a nation, will need to consider the prospect of isolation and loneliness that may invade our lives.

As noted in the previous section, at all locations, from villages to city centres, we are experiencing a reduction in traditional meeting places. With the noted exception of the rise of the city centre coffee shop, our local pubs, churches, shops, libraries, leisure centres, theatres and similar buildings, which historically used to provide a place for people to interact, are coming under pressure to survive, with lifestyle changes and the impact of technology.

If one projects trends being observed today, it is perfectly feasible to see a bleak future. There is the prospect of a future for the UK made of more sedentary, disconnected and thus increasingly socially impoverished and technology dependent citizens, leading increasingly isolated lives in more compact housing units. This could occur at the same time as we note other parts of the UK’s built environment gradually becoming redundant, and falling into decline. Whilst this is not a prediction, the realisation that it is a possible future for us should spark debate, and stimulate our planning for the future.

We can look to our recent history for precedent. A sufficient proportion of the large-scale social housing estates that were created in the 1950s and 1960s have failed to deliver the community spirit expected of them46. As some of these have not worked, and indeed caused sets of new problems to emerge, those that cannot be improved are now being demolished and replaced. Whilst we may believe we are now creating better housing solutions, we hope we will not learn in the future that we are making similar mistakes now.

Within this speculation of our possible future, there are issues that are raised for those working in the built environment. We will next outline two key issues that arise from our considerations.

5.3: WELLNESS

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5.4: FLEXIBILITY AND ADAPTABILITY

Consider in 2050 being able to use the same built structure for many uses. In a post-industrial economy with more and more ‘knowledge workers’, our homes are already becoming our offices and shops, as technology allows us to both work and shop more from our kitchen tables. Our homes will become even more flexible as technology evolves. Who knows what our kitchen tables will be capable of allowing us to do in 2050?

Similarly, if educational facilities can provide both practical interactive learning space for individuals to collaborate, as well as rich technology hubs, where individuals can ‘plug in’ to learn, then we could begin to see truly flexible buildings in the future.

Now consider 2050 where a building is reconfigurable to change its function.

Adaptable buildings are routine wherever you have sliding or demountable partitions. Even the humble hospital cubical curtain is an illustration of adaptable space - sometimes public, sometimes private. As building technology allows more provision of new types of built space, will we see new buildings where ‘pop-ups’ are routine? In our homes we could see kitchen or bathroom facilities that simply plug in where needed; lighting, acoustic or thermal parameters could be adjusted locally, down to the individual occupant space. Technological advances may make many options to adapt buildings that are currently unfeasible, both practical and simple. Such visions of ‘smart buildings’ have been around for a long time - yet there has been limited evidence of such adaptable spaces. One has to ponder whether the issues stopping such transformation to adaptable spaces are linked to problems in supply, demand or regulation.

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The preceding section may hold the prospect of new forms of adaptable, and flexible buildings using new materials and technologies, but very many of the buildings of 2050 are already with us today. It is simply impossible, within budget constraints, to rebuild large amounts of current built stock.

As a result, much of the housing, healthcare, and education requirements of 2050 will be accommodated in these currently existing buildings. Without action, this existing building stock will broadly look the same, have the same functionality, and perform as it does today, particularly in terms of energy consumption.

Changing the look, functionality, and performance of buildings involves intervention in the form of refurbishments and retrofits. Current and future policies and regulations, financial incentives, penalties, and technologies have essential roles in making our existing building stock work well in the world of 2050. For some buildings there will be financial incentives to develop and deploy technologies that allow new uses, and new levels of performance, for these buildings. For some of the more cherished, or important buildings there will be special measures to protect, or enhance them. However, for many other buildings there may be no viable solution to fully remedy the building’s inherent problems. In such cases, the options will remain - ignore and continue to use as best one can, abandon, and/or demolish.

New options will continue to emerge. Adjustable, demountable, modular solutions are already well understood, and these solutions can only be expected to improve by 2050. Modern materials, such as aerogels, and more complex and automated manufacturing techniques, such as 3D printing will also allow bespoke solutions to be made available easily and cheaply4. The increasing ability of computers to link from the scan and measure stage to final delivery and install stage, will open up many new possibilities for building adaptation. Whilst costs and diversity may make the challenge appear improbably complex and unreasonable, there is clear evidence from other sectors where technological developments have moved from one development trajectory to another. Whether the built environment sector will be fundamentally impacted by such technological advances, or remain broadly unaffected by it is an ongoing and open question.

5.5: REFRESHING OUR BUILDING STOCK

6: ENCOURAGING THE CONVERSATION

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SOME THINGS LOOK EASY TO PREDICT

100m

Cost ($)

10m

1m

100k

10k

2001

Cost per genome †

2003

2005

2007

2009

2011

Average trend for cost of genome sequencing Predicted cost of genome sequencing Actual cost of genome sequencing

http://www.genome.gov/images/content/costpermegabase_apr2015.jpg

2013

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As we have noted throughout this report, changes in the UK’s demographics are expected to create further strains on our built stock, especially in some of our cities. In the areas of housing, education, and health, we have touched upon some interesting developments, some of which we can see emerging, but many of which are currently only speculations. Changing demographics, coupled with relentless technology development and ongoing climate change, will have a continuing set of impacts on our daily lives. For those working in the built environment, there will be the need to find ways of preparing for this uncertain future by thinking both more carefully and radically, and then doing all things better, faster, and always more sustainably.

History tells us that the predictability of the future cannot simply be achieved by always relying on the analysis of historic trends. Take for example the cost and time needed to sequence the human genome. Initially, the improvement was linear and similar to ‘Moore’s Law’, but then significant technological improvement dramatically reduced cost and time. But to assume we are facing a brave new world, and thus completely ignore the past is foolhardy in the extreme. Where we can we should endeavour to learn from our past, so we can try to avoid repeating the mistakes we have made previously and try our best to prepare for what appears will be an uncertain and turbulent future.

Whilst we can be confident about some trends, such as our ageing population, there are likely to be significant shifts to the composition of the UK population and changes in the way we live, work, and learn that cannot be predicted today as we look towards 2050.

It is down to us individually, collectively, and through those who represent us in positions of political power, to set in motion now the discussions and debates about what we want from our built environment in 2050, and what we need it to do for us. It will also take the combined efforts of many diverse skill sets, and knowledgeable experts from the built environment sector, to produce the solutions we will need.

Although technology may be a catalyst to solving some of our problems, it also causes a great deal of the uncertainty in any predictions of the future. However, technological advances also offer us greater understanding, as well as toolkits that we can deploy to help discover the solutions we will need to find.

As in history, the future between now and 2050 will see some built environment organisations thrive, some survive, and, inevitably, some will face their demise.

For those that wish to do more than simply survive, there is an obvious reason to try to see what lies ahead, and make the best preparations to seek to grasp the opportunities that present themselves.

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As we outlined at the beginning of the document, we hope, plan, and expect to revisit this report periodically, in the company of those similarly interested in the future of the built environment, and provide updates. We will note where we were close to forecasting the future, and where we missed the signals. We propose to do this as UCL is a place of continual learning and growing wisdom.

For any of us to be in any way wise about the future of the built environment, we must continue to learn about the forces and concerns that will shape it.

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50

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23

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41

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43

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Mobile MRI Scanner.

Image courtesy of Siemens Healthcare UK (http://www.healthcare.siemens.co.uk/)

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DFE projection figures for the number of pupils in state funded primary and secondary schools predict an inflation rate of c.7.6% by 2024 (4,735,000/4,400,000) for primary school pupils, and c.20% (3,287,000/2,740,000)i. These inflation rates were applied to current student numbers from the 2015 school census of pupils in state funded primary and middle, and secondary and academiesii.

1

Total number of additional places required by 2024 was calculated by subtracting the current number of pupils (7,695,040) from the projected total of pupils (8,674,222), equalling 979,182.

2

The number of places was split between primary and middle, and secondary and academies according to government figuresii.

3

Additional primary schools places were calculated by subtracting the current total of pupils (4,510,310) from the projected number of pupils (4,853,709), equalling 343,399.

4

Additional secondary schools places were calculated by subtracting the current total of pupils (3,184,730) from the projected number of pupils (3,820,514), equalling 635,784.

5

The number of new primary schools required was calculated by dividing the number of additional pupils (343,399) by the average number of pupils per primary and middle school (320). This average was obtained by dividing the current number of pupils (4,510,310) by the current number of schools (14,087). The current number of schools was obtained from the Department of Education and included free schools and LA maintained schoolsiii.

6

The number of new secondary schools required was calculated by dividing the number of additional pupils (635,784) by the average number of pupils per secondary school (942). This average was obtained by dividing the current number of pupils (3,184,730) by the current number of schools (3,381). The current number of schools was obtained from the Department of Education and included free schools, LA maintained schools, and academiesiii.

7

The number of new primary school classrooms required was calculated by diving the number of additional pupils (343,399) by the average primary school class size (25). The average class size was obtained from the OECDiv. 8

The number of new secondary school classrooms required was calculated by diving the number of additional pupils (635,784) by the average primary school class size (21). The average class size was obtained from the OECDiv. 9

The daily build rate was calculated by dividing the number of classrooms required by 2024 by the number of days from 1st September 2015 to 1st September 2024 (3,285).

10

i https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/446633/SFR24_2015_Projections_Text.pdf ii https://www.gov.uk/government/statistics/schools-pupils-and-their-characteristics-january-2015 iii http://www.education.gov.uk/edubase/search.xhtml?page=1 iv http://www.telegraph.co.uk/education/educationnews/11083683/OECD-UK-class-sizes-among-biggest-in-developed-world.html

APPENDIX A

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UCL PANEL

Professor Alan Penn Dean The Bartlett, UCL’s Faculty of The Built Environment Professor Alexi Marmot Chair of Facility and Environment Management University College London Professor Jim Meikle Professor in the Economics of the Construction Sector Philip Astley Visiting Research Fellow The Bartlett School of Construction and Project Management Professor Tim Broyd Chair of Built Environment Foresight University College London Professor Andrew Edkins Director The Bartlett School of Construction and Project Management

AUTHORS

The Bartlett School of Construction and Project Management Andrew Edkins Director Vedran Zerjav Research Associate in Infrastructure Delivery and Management

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Donna Gage Communications Administration

PRODUCTION

Robert Arbuthnot Communications Intern

Pola Berent

RESEARCH

Tom Bolton Lia Chatzidiakou Felicity Davies Hina Lad Rosica Pachilova Anna Plyushteva

David Bill Group Marketing and Communications Director

THE MACE TEAM

David Rumsey Director Sharrie Anderson Marketing Manager

Sharrie Anderson sharrie.anderson@macegroup.com +44 (0)203 522 3000 Alice Chilver Business Development Manager The Bartlett School of Construction and Project Management a.chilver@ucl.ac.uk +44 (0)203 3108 9194

CONTACTS

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Acknowledgements A special thank you to those who attended the Changing Demographics workshop and for their invaluable contribution to the formulation of this report.

Argent plc ARK Schools Aston University Centre for Cities (London School of Economics and Political Science) Education Funding Agency Greater London Authority Hampshire County Council Harris Federation of South London Schools Hertfordshire County Council Housing Learning and Improvement Network Institute of Healthcare Engineering & Estate Management (IHEEM) Institution of Civil Engineers Kings College London University LandAid Charitable Trust Ltd Leeds City Council London Borough of Camden London Borough of Harrow Medway Council Metropolitan Housing Association Netley Primary School Open City Originate Architects Oxford Brookes University Peabody Trust The Bartlett, University College London University College London Hospital University of Essex