But the reorganisation of health systems to achieve these objectives is becoming increasingly difficult to implement. We have fewer doctors, hospital beds and high-grade diagnostic imaging machines than almost every country in Europe. This year’s political convulsions – Brexit, Trump, Renzi – with their contempt for ‘experts’ will make change at a local level ever-more difficult to achieve.

Despite being seen as the capital of the ‘metropolitan elite’, London has a much poorer health estate than many other UK cities and a higher proportion of trusts deemed to be failing. For four years, consultants have been preparing reorganisation strategies at vast expense, which can still be presented pejoratively as closing hospital beds, centralising tertiary services, increasing funding for primary and community care, and selling off the surplus estate. Whereas ‘experts’ understand the necessity for such change, the way in which these strategies are being developed and presented is alarmingly clumsy.

London has many priorities but those that top the agenda are how we can address the housing and healthcare crises. This paper is based on seven exemplar projects on seven London hospital sites, which can create model developments and new neighbourhoods. Each will maintain or re-provide secondary and/or tertiary hospital facilities, and develop community healthcare accommodation. Each will also develop a blend of residential accommodation for the elderly, sheltered housing, social housing, and housing for sale. Some will emphasise the need for landscape and parkland, others will achieve high densities, and all of them can serve as tools for developing a wider understanding.

Concrete visions such as these provide physical and comprehensible examples of what the new health estate can achieve, what choices are available, and why it’s essential to integrate social care and healthcare. At a local level, debate and argument must be generated and change championed.