Developer contributions (section 106 payments) secured as part of planning permissions for new developments have provided significant funding for the new healthcare infrastructure needed to support growth.

A key change now taking place in the planning system is the phased introduction of­ the Community Infrastructure Levy (CIL for short). This involves changing from an up-front negotiation of developer contributions (section 106 payments) on a site by site basis around a planning application to one where, when CIL is implemented, health professionals (including CCGs) will need to make the case to the local planning authority (LPA) for investment and release of appropriate funds. There is likely to be significant competition for CIL funding, and the prioritsation and allocation of funding is a matter for the charging authority.

“Local planning authorities should work with other authorities and providers to… assess the quality and capacity of infrastructure for transport, water supply, wastewater… health, social care, education, flood risk and coastal change management, and its ability to meet forecast demands.”

NPPF, 2012

CIL is a development tariff (charged per square metre of net additional increase in floorspace) that can be charged on new developments to contribute funds towards a list of local infrastructure projects (known as a Regulation 123 list). CIL charges and items on a CIL list need to be justified by local evidence, which could include the identification of specific healthcare infrastructure needs resulting from planned growth, such as GP surgeries or hospitals. The list could also include contributions to wider infrastructure that could improve health or reduce health inequalities, such as green infrastructure or cycle paths.

It is not compulsory for LPAs to prepare a CIL charging system. In the absence of CIL not being adopted by a council then Section 106 planning obligations remain the primary means to ensure that developments pay for the infrastructure that supports them. Section 106 planning obligations require developers to make a financial or in-kind contribution to mitigate on-site impacts from new development. However from April 2015, Section 106 policies will be scaled back to on-site contributions, regardless of whether or not an LPA has a CIL in place. Moreover, LPAs will only be able to pool and use up to five Section 106 planning obligations for a particular infrastructure requirement.

It is critical that public health practitioners provide costed evidence of infrastructure needs and gaps when planners prepare a CIL Regulation 123 list, and that this is aligned with the local authority’s infrastructure planning process and local plan-making, and takes into account the scale of planned new development. This collaboration is particularly important in two-tier areas where the county is responsible for strategic infrastructure such as health, education and transport and the districts are responsible for planning.

Two key tools for addressing the health service implications of development are highlighted below.

The London Healthy Urban Development Unit (HUDU) Planning Contributions Model is a comprehensive tool to assess the health service requirements and cost impacts of new residential developments. The model is licensed by HUDU for use within the NHS.

The model uses a range of assumptions based on the most up to date information available. However, users can also manually adjust or input new assumptions. Although designed for use in London, local authorities in other areas can apply the model by manually inputting their own data (e.g. the latest population projections from the Office for National Statistics).

The model uses data on the increase in population from new development and health activity levels to calculate primary healthcare needs (GPs and community health facilities), hospital bed and floorspace requirements, other healthcare floorspace and capital and revenue cost impacts. This information can then be used to influence the planning process via S106 planning negotiations or CIL and to gain necessary resources for health improvements or expansion.

Users need to apply for a licence but there is no cost to use the tool.

SHAPE is a web-enabled, evidence-based application provided by Public Health England which informs and supports the strategic planning of services and physical assets across a whole health economy.

The SHAPE application:

  • Links national datasets for clinical analysis, public health, primary care and demographic data with estates performance and facilities location;
  • Enables interactive investigations by Local Area Teams, Providing Trusts, CCGs, GP practices and Local Authorities;
  • Supports key policy initiatives such as QIPP, JSNA, Pharmaceutical Needs Assessment and Transforming Community Services;
  • Provides you with a range of flexible capabilities

SHAPE has been used by Kent County Council to assist the strategic planning of health services and assets, taking into account future planned housing developments.