Is there a doctor in the house?

Housing-led schemes in the Thames Gateway illustrate some of the opportunities and issues around planning for social infrastructure. Education, health and other facilities should be required as part of major housing schemes, but an appropriate balance needs to be struck. Under-provision will harm communities, while too onerous a requirement will hinder investment and regeneration.

There is an increasing body of work that focuses on good practice in assessing social infrastructure requirements and some examples from our experience are given here. The overarching context is set by DCLG Circular 5/05 on planning obligations. This reiterates the well-established principle that planning obligations should address needs that have arisen as a consequence of proposed development. Developers should be expected to cover new demands, but not to address existing shortfalls. A useful way to assess requirements within this context is a process that:

• Assesses demand arising from development
• Compares this with existing provision
• Assesses the gap between demand and spare capacity
• Puts forward proposals to fill any gaps.

This article focuses on education and health but other areas of social infrastructure such as open space, local employment, training, business support, and so on, are also relevant.

Education

Education facilities are key to a sustainable community. As the controversy over Brighton and Hove council’s lottery system for the allocation of school places illustrates, services can affect house prices and perceptions of a neighbourhood.

1: The process of assessing demand can get very involved. Pre-school, primary, secondary and further education age groups should be considered. The numbers of children living in a development is usually assessed using child yield factors. There is a growing body of evidence on appropriate child yields from surveys of completed schemes (a good example is a survey in Wandsworth, south-west London, looking at newly completed housing developments).

Child yields depend on the type of units (flats, houses), tenure and population profile. Information suggests that generally there are fewer children in flats than houses, and fewer in private sector households than in social housing households.

2: An interesting innovation on education proposals is to provide private schools as part of housing schemes in east London. Although the quality of schooling in east London has increased significantly in recent years and is much closer to national averages than it used to be, there is still a perception that schooling is poor.

A private school could help sell developments to owner occupiers. This is particularly relevant if there is to be a move towards more family-sized apartments on major schemes. However, need assessment should also cover provision for children from households not able to afford private schools.

3: Traditionally schools have been built as standalone buildings. However, proposals are coming forward incorporating them into the lower floors of mixed-use residential blocks. In New York City, there is a high school that leased out two storeys of an office block – maybe this idea could be transferred to the Isle of Dogs or City of London.

Health services

Access to health services for all is one of the defining tenets of the NHS. However service provisions, particularly GP surgeries, are coming under increasing pressure to see and treat more patients every day. The government’s housing agenda will continue to put stress on local health services.

Traditionally schools have been standalone buildings. But proposals are coming forward that incorporate them into the lower floors of mixed-use residential blocks. In New York City, a school leased two storeys of an office

1: Local primary care trusts (PCTs) are taking an increasing interest in proposed developments and the likely impacts on health provision in their area, often requesting that developers make contributions towards new facilities or expanding capacity at existing facilities.

2: To help with negotiations, a first step is to get an understanding of what the current service provision is: if there are existing GP surgeries near to the development site and, if so, if there is spare capacity. The national average list size is about 1,800 people per GP, though list sizes vary greatly between regions and health authorities and there is no nationally recognised guidance on what is considered adequate provision.

3: A key factor is whether GPs in the area are accepting new patients and the relative capacity of each surgery compared to the likely new population of the proposed development. A gap analysis will determine whether there is sufficient provision or if some level of contributions is required to accommodate the future population.

4: The NHS London Healthy Urban Development Unit (HUDU) has established its own S106 planning gain model that is ambitious but controversial. The HUDU model is designed to forecast additional health demand and to assess the appropriate level of developer contributions. The intention is for the model to be adopted by local authorities and incorporated into supplementary planning documents.

The model goes beyond estimating the demand for GPs and covers the estimated need for acute care and other services. The model calculates a S106 financial contribution that covers a capital sum for the provision of new facilities and, more controversially, a revenue sum that covers likely treatment costs until the new population is accounted for in NHS funding streams. This can be from one to three years’ worth of funding.

Revenue calculations can represent up to 80% of health planning gain contributions and, together with capital contributions, can shift health planning gain costs from tens of thousands of pounds to millions on large housing schemes.

While the principles of the HUDU model are consistent with Circular 5/05, we believe it is pushing the argument too far, particularly on the revenue side. In effect, it is saying developers should pay for poor NHS planning systems. Perhaps there is a need to further review and clarify what is and is not acceptable as elements of planning gain.

Conclusion

This is a rapidly evolving field and future initiatives, including the proposal for a planning gain supplement, may alter the landscape and require revised approaches.

As the controversy over the HUDU model illustrates, there is a need for a wider debate on the balance of conflicting requirements for planning gain, including land preparation and infrastructure costs, lowering carbon emissions and affordable housing.

• By Rory Brooke, managing principal economics and development, Trina Gaddes, consultant economist and Esther Howe, regeneration consultant of URS Economics and Development