Developer contributions play a significant role in providing capital for the NHS to build new infrastructure and services as communities expand. As housing development increases local populations, these contributions help the NHS to scale up in response by addressing funding shortfalls. Many NHS construction and service transformation initiatives have gaps that developer funds could be directed towards, helping the health service evolve to meet the arising needs of growing towns and communities. By securing these contributions, the NHS is better equipped to serve swelling patient numbers with upgraded facilities and care models in the areas experiencing the most development.
How are contributions secured?
S106 contributions seek to address the site-specific impacts of developments, whilst Community Infrastructure Levy (CIL) is intended to address the cumulative impact of development in an area.
We have developed a couple of practical guides that provide more details information and advice in relation to CILs and 106 agreements: The Basics: CIL and s106 and Practical Guide to Modification of s106 Planning Obligation Agreements.
S106 refers to Section 106 of the Town and Country Planning Act 1990. When negotiating s106 contributions, financial viability of the development and local priorities, especially affordable housing needs, must be considered.
Common obligations include affordable housing quotas or funding highways improvements. But s106 funds can also help address increased demand on services like the NHS from new residents.
Some ways s106 could support prevention include:
- Providing capital to expand primary care facilities with space for wellness programs like exercise classes, cooking workshops, mental health support groups.
- Allocating yearly payments to community charities/groups running services like walking buses, parks/gardens maintenance to promote activity.
- Developing new green spaces proportional to development size that increase access to recreation.
- Partially funding prevention projects like smoking cessation or diabetes reduction support workers.
By negotiating s106 funds upfront for preventative amenities/services, health boards can help developers meet planning conditions while proactively addressing future NHS strain in high-growth areas. Over the long term, this strategic use of s106 may see cost savings outweigh initial investments.
How do you calculate health care demands?
Establishing healthcare capacity demands from specific developments can evolve depending on developments and plans for an area.
Conducting a health impact assessment (HIA) helps decision-makers consider health implications of proposals. A structured evaluation of potential effects aids oversight of these crucial factors. Insights are paramount when acquired early in the process. Through proactively examining health influences and repercussions, leadership gains perspective to optimise benefits and lessen risks to community health from the onset. A thorough HIA establishes an evidence base for the inception of developments and communitiess planned to promote population well-being.
Where additional facilities are required, health care providers should seek relevant CIL allocations within the areas infrastructure delivery plan, if CIL is adopted. Alternatively secure s106 funding towards site specific needs. Close cooperation ensures funding streams are effectively leveraged to meet rising community health needs arising from new housing growth. Both viability challenges and varying funding purposes must inform the optimal joint planning approach in each case.
By understanding local planning processes and engaging early, health boards can help guide proposals to optimise health benefits. Discover how in our article: How can health care providers be more proactive in town planning?
How can Developer Contributions improve health?
Developer contributions can significantly improve local healthcare access and population health outcomes in several key ways such as:
- Increased capacity – Expanding existing health centres or building new facilities means more residents can register with a GP and access primary/preventative services close to home. This reduces travel times and improves continuity of care.
- Co-located services – Developments that include integrated health and wellbeing hubs co-locate services under one roof like physiotherapy, counselling, dietitians. This makes care more coordinated and convenient to access.
- Promoting healthy lifestyle – Investing in parks, trails, recreation facilities, and community gardens encourages physical activity and social interaction shown to reduce illness risks long-term.
- Addressing isolation – Projects focused on aging populations can help address risk factors for conditions like dementia through initiatives reducing loneliness and supporting independent living.
- Strengthening prevention – Dedicated funding enables outreach programs and resources that help detect issues earlier and manage chronic diseases proactively through education versus acute interventions.
- Easing NHS strain – By improving access to appropriate primary/preventative options close to home, developer- supported infrastructure supplements over-extended clinical services and helps curb expensive, preventable hospital use over the long run.
So in many ways, these contributions create healthier, more resilient communities with locally-driven solutions to future-proof public healthcare needs.
How does the NHS ensure Developer Contributions are effectively used?
NHS boards can help ensure s106 funds are used effectively by:
- Include clear implementation plans when negotiating agreements, outlining timelines, milestones and governance structures for overseeing projects.
- Specify funds can only be spent on agreed initiatives – don’t allow diversion to unrelated purposes. Use legal agreements with clawback clauses if needed.
- Work with local councils to establish ringfenced accounts for s106 healthcare/wellbeing funds with NHS oversight on spending decisions.
- Adopt transparent reporting requirements – demand regular updates on progress and audited financial reporting to track usage.
- Consider multi-year payments to align with project lifecycles rather than all at once to allow flexibility.
- Partner with experienced non-profits to deliver services, providing technical support on implementation where needed.
- Conduct needs assessments and community engagement to refine projects based on local knowledge and buy-in.
- Involve academic institutions to help evaluate outcomes and return on investment of different approaches.
- Celebrate successes and share learnings publicly to demonstrate value of S106 and accountability in spending.
Ongoing involvement and setting clear expectations upfront helps NHS ensure agreements achieve maximum health impacts from preventative investments in the communities they serve.
What will be the challenges?
Nothing is straightforward and there will be potential challenges along the way for NHS boards when implementing S106 projects:
- Securing buy-in from local councils, who control much of the planning process, to champion health-focused s106 requests. Council priorities may not always align.
- Developers resisting the scope or financial contributions of s106 obligations, requiring negotiation skills to find balanced solutions.
- Coordinating delivery across multiple departments within the NHS and external partners to execute complex, multi-faceted initiatives on schedule.
- Local opposition to new health facilities or greenspaces from some residents, necessitating thorough community consultation.
- Variable funding amounts and timelines from one-off s106 deals, making long-term resource planning difficult.
- Proving causal impact of preventative projects through robust evaluation, which is challenging without control groups.
- Securing ongoing operational or staffing costs beyond initial s106 capital since funds typically can’t cover long-term expenses.
- Changes in strategic priorities or reorganisation within the NHS that divert focus away from integrated planning work.
- Economic or political conditions reducing developer willingness to negotiate or stalling agreed plans.
Overcoming these challenges requires strong cross-sector collaboration, planning, community engagement and use of evidence to maximise benefits from developer opportunities.
Has there been success in securing developer contributions for health?
We’ve highlighted below some examples of successful developer contributions toward health through s106 agreements or similar mechanisms:
- In Cambridge, a large housing development contributed £4.4 million to expand a health centre, allowing an additional 8,000 patients to be registered. This helped accommodate new residents.
- In London, developer ICE provided £1 million toward opening a GP-led health and wellbeing centre in a new neighbourhood, co-locating services with a children’s nursery.
- In Manchester, the £17 million First Street development included £500k for nearby health centre improvements and extension of a walking/cycling trail.
- In Newcastle, the Hepworth Collection housing project funded a playground, community orchard and allotments to encourage activity plus investment in a nearby health centre.
- Bristol’s 3,500 home Avonmouth Village development allocated over £3 million for a community hub containing a doctor’s surgery, pharmacy and exercise facilities.
- In Reading, a £6 million construction of a 160-home community for elderly residents included warden support and an on-site cafe reducing social isolation risks.
- The 8,500-home Northstowe development outside Cambridge includes a multi-million pound health centre built in phases as the town grows.
Thoughtful partnerships like these help new communities integrate health supports that relieve pressure on local NHS services long-term.
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More information for you is available in our series of eBooks and Practical Guides which cover everything from the very basics of town planning to application processes and what developers need to consider.