Public healthcare delivery is in crisis, is it time to rethink permitted development constraints?

26th September 2017

If the supply of housing can command relaxations in planning rules, surely healthcare, arguably a greater moral good, deserves equal or better treatment?  Mike Harris, Senior Associate Town Planner, talks about improving the system of healthcare town planning.

mike haris town planning stride treglown

Modern town planning has its roots in public health concerns, and planning has been inextricably linked with healthcare ever since. Both the NHS and the planning system we are familiar with today were born out of the Beveridge Report of 1942 and the subsequent creation of the welfare state. Indeed, modern planning policy explicitly promotes development that supports positive health outcomes.

It is a shame, therefore, that the two systems are so poorly aligned. The misfit is storing up fundamental tensions that are part of the problem in our hospitals. Rearranging two such behemoths is an unpromising prospect, but could a few deft legislative moves be part of the solution?

The mismatch in healthcare planning

As a practice, Stride Treglown is deeply involved in the healthcare sector and well placed to comment. Our teams of architects, landscape designers and town planners are trusted to develop estate strategies, design effective buildings and secure planning consents for our many long-term clients.

Our planning expertise extends to all scales. We work on major new build projects, spearheading the revolution in how care is provided. For example, we are currently involved with designing a critical treatment hospital for Hampshire Hospitals NHS Foundation Trust, a completely new concept at the intersection of clinical and management thinking.

We work just as successfully on smaller ancillary development projects to keep operations running efficiently by reconfiguring existing assets for short- and medium-term strategic gain.  We also regularly support the delivery of temporary space to ease the perennial but unpredictable pressure on beds over the winter months.

healthcare modular units

It is at this scale that the mismatch between healthcare and planning is felt most keenly. In a sector that struggles to keep pace with change and amid a tightening of the public purse strings, we should try to design out unnecessary obstacles for quick, efficient and cost-effective development. For now, though, the planning system is a significant roadblock.

The solutions

There are solutions out there. Another crisis – housing delivery – has been eased with the introduction of permitted development (PD) rights to convert office space to residential. This right curtails the determination period, smoothing the way for local authorities to give consent quickly where office space is otherwise redundant or underutilised.

Although there is a PD right for hospital development, it is very restrictive. Any project over 100 sq m has to secure full planning permission. To put this into context, another of our recent projects for Hampshire Hospitals NHS Foundation Trust measured a mere 150 sq m and provided just 9 beds. This is a drop in the ocean of need and yet required a full planning application. The enforced process ate up time, risked delays and obstacles, all of which could impact upon delivery this winter.

So what is the answer? Quite simply, new PD rights for hospital estates. This would speed up the delivery of much needed (possibly temporary) bed space and other development, giving healthcare clients more flexibility in how they plan their complex services.

If we can use PD rights to support economic growth and housing supply, why not service improvement in healthcare? A new class of PD that balances need against impacts equitably, considered within 28 days (akin to agricultural prior approval), would be a significant help to our hard-pressed hospital trusts.

The right would only extend to ‘commonsense’ situations where objections are minor or non-existent. Heritage constraints would be excluded, for example. The onus would be on the applicant to supply information in advance, covering highways impacts (often just parking for hospital sites), flood risk, and contamination impacts so that local authorities could retain proper control.

Clearly, the details need to be carefully scoped. But the principle is unambiguous: we should have a planning process that facilitates the delivery genuinely positive impacts on society. After all, as the National Planning Policy Framework says, planning is “a creative exercise in finding ways to enhance and improve the places in which we live our lives”. What could be more central to this than our NHS?