Calls for clearer rules to ensure healthcare infrastructure keeps pace with housing growth

The Health Scrutiny Committee at Lincolnshire County Council has written to the Government regarding pressures that population change and housing growth can place on NHS services and infrastructure across Lincolnshire.

Lincolnshire is seen as facing particular challenges from an ageing population, increased frailty, long-term health conditions, health inequalities and the rural nature of the county. Alongside these, significant planned housing growth has the potential to generate additional demand for all levels of healthcare services.

The committee's concern centres on Section 106 planning obligations, through which developers can be required to contribute towards infrastructure needed as a result of development and it is asking Government to recognise the impact of several developments creating a clear need for additional healthcare capacity, but no individual development would, on its own, justify a major infrastructure project.

Councillor Richard Cleaver, chairman of the Health Scrutiny Committee for Lincolnshire, said: “New homes bring new residents, and that inevitably has implications for local healthcare provision.

“The difficulty we are highlighting is that healthcare pressures do not always arise neatly from one development at a time. Several developments within a town may collectively create a need for additional healthcare capacity, even though no single development would justify that investment on its own.

“We fully recognise the importance of the safeguards governing Section 106 contributions and we are not asking for those safeguards to be removed. What we are asking for is greater clarity about how the cumulative effects of planned housing growth can be recognised and how proportionate contributions can support the healthcare infrastructure those communities will need.

“This is particularly important as the NHS develops more neighbourhood and community-based models of care. Healthcare infrastructure is no longer simply a choice between a GP surgery and a hospital. It can involve extending, refurbishing, repurposing or sharing facilities so that services are provided closer to people's homes.

“Ultimately, our objective is straightforward: where substantial housing growth is planned, the healthcare infrastructure needed to support that growth should be planned alongside it.”

The committee’s letter highlights that nine of Lincolnshire's ten largest settlements have populations between 18,000 and 48,000, and states that Local Plan housing allocations for many of these settlements appear substantial enough to require a step-change in locally available secondary and urgent care.

The committee has asked Government to consider seven areas, including:

- how healthcare infrastructure requirements associated with planned housing growth can be addressed;

- what should be used to demonstrate the relationship between residential development and additional demand for different types of healthcare infrastructure;

- how Section 106 and the Community Infrastructure Levy should work together responding to combined effects of several developments;

- when contributions might support new, extended, refurbished, repurposed or shared premises delivering NHS-funded services;

- whether directly related infrastructure such as access or parking can be supported when new development increases demand;

- whether national guidance should be reviewed to reflect changing neighbourhood and community-based models of healthcare; and

- whether Government will work with NHS bodies, local planning authorities and local government to develop a more consistent national approach.

The committee has offered to contribute Lincolnshire evidence to any future Government review or policy-development work.