Planning for patients: The role of Section 106 planning contributions – Full report


The NHS estate is in urgent need of improvement. In 2017 the Naylor Review of NHS property and estates shone a light on the scale of the challenge facing England’s healthcare infrastructure, with crumbling, unfit for purpose buildings presenting a significant threat to the NHS’ long-term sustainability.

The Spending Round 2019 committed to investing £850 million to upgrade hospitals across the country and address the growing backlog of maintenance works affecting the estate – with £110 million earmarked to fund primary care infrastructure. The Conservative Government further outlined its ambitions to build 40 new hospitals in the next 10 years and continue to invest heavily in equipment and infrastructure.

Greater investment in the NHS estate is urgently needed. However, it is also crucial to ensure that money already available to NHS trusts to improve and upgrade its buildings is spent to the greatest effect. This does not seem to be the case. Agreements between Local Planning Authorities (LPAs) and developers, known as section 106 planning contributions, can be an important means for the NHS to secure funds to upgrade their estate when housing growth places additional pressures on them. In effect, these are contributions and concessions made by developers in order to reduce their impact on the community and secure planning permission. However, few trusts are taking advantage of these funds, with only 105 out of the 293 LPAs responding in full to the FOI securing investment for healthcare projects – less than 36 per cent.

Between 2013-14 and 2018-19, LPAs captured over £87 million worth of developer contributions to invest in healthcare infrastructure, yet over £34 million are currently sitting unspent. Reform’s research shows that a lack of awareness of the section 106 process, insufficient expertise and skills amongst staff, poor coordination are key barriers to the use of section 106. By failing to act, the NHS is missing out on potentially millions of pounds that could go towards improving and delivering vital services for patients.

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