The return of public health responsibilities to local
authorities through the Health
and Social Care Act 2012, and changes to the planning system
through the Localism
Act 2011 and the
National Planning Policy Framework 2012 (NPPF) , have resulted
in local government being required to give greater consideration to
local health and wellbeing in formulating policies and making
The government’s overarching objective for the
planning system is that it should facilitate and promote
sustainable patterns of growth. It should do more than merely
regulate development. Local planning authorities should be
place-shapers and place-enablers focussing equally on environment,
community and prosperity.
This section looks at the role of the planning
system in supporting and creating healthy communities. It has clear
links with many other chapters of this JSNA for example Housing and
Active Travel, and so does not consider individual subject areas in
detail. It gives an overview of the planning system and how it can
influence the health and wellbeing of our community.
Evidencing the links between health and
The link between health and planning has
always been acknowledged though it is only fairly recently that its
profile has been raised and health and wellbeing has been
explicitly reported in mainstream planning publications.
In 2008 Professor Sir Michael Marmot was asked
by the then Secretary of State for Health to chair an independent
review to identify the most effective evidence-based strategies for
reducing health inequalities in England. The final report ‘Fair
Society: Healthy Lives’ was published in February 2010 and
concluded that reducing health inequalities would require action on
six policy objectives:
- Give every child the best start in life
- Enable all children, young people and adults
to maximise their capabilities and have control over their
- Create fair employment and good work for
- Ensure healthy standard of living for
- Create and develop healthy and sustainable
places and communities
- Strengthen the role and impact of ill-health
Nationally the government’s Public Health White Paper,
Healthy Lives, Healthy People, cites the 2010 Marmot Review
which states that:
‘There are gaps of up to 7 years in life
expectancy between the richest and poorest neighbourhoods, and up
to 17 years in disability-free life expectancy.’
Following on from Sir Michael Marmot’s work,
in 2011 the Spatial Planning and Health Group (SPHAG) reported on
its extensive review of evidence into spatial planning and health.
SPHAG is made up of planning and health experts: academics,
practitioners and community representatives seeking to improve
public health through the positive use of town planning. In its
report ‘Steps to Healthy Planning: Proposals for Action’
SPHAG found evidence that the following ‘planning’ issues
impact on physical and mental health:
- The location, density and mix of land
- Street layout and connectivity
- Access to public services, employment, local
fresh food and other services
- Safety and security
- Open and green space
- Affordable and energy efficient housing
- Air quality and noise
- Extreme weather events and a changing
- Community interaction
The study concluded that formulating and implementing planning
policies and development proposals based on how they affect human
health is likely to improve our health. It is possible to ‘design
in’ health to urban and rural environments in the same way that it
is possible to ‘design out’ crime. Twelve actions are proposed by
SPHAG along with a Spatial Planning and Health Group Checklist.
These provide a useful resource for both planning and health
professionals. (add reference or add as an appendix)
In 2012 and in response to the new policy
environment the Town and Country Planning Association (TCPA)
carried out a ‘Reuniting Health with Planning’ project. An
output of this project is the handbook ‘Reuniting Health
with Planning – Healthier Homes, Healthier Communities’. The
handbook sets out how local areas can use the planning, health and
social care reforms to better integrate planning and health (add
In 2013 the project moved on to phase 2; to
focus on advice to help planning and health practitioners work
together to create healthier places and communities based on real
life case study areas. A second report ‘Planning Healthier
Places’was published by the TCPA in 2013 and draws on roundtable
events in eight case study areas. It considers how local
authorities and partners are putting this agenda into practice and
looks at the challenges they are facing and how places can be
shaped to respond to public health objectives.
The TCPA offers the view that ‘These are
formative times for the health and planning agenda. There is
pressure to act on a range of public health topics, from providing
sufficient affordable housing, to restricting the spread of betting
shops, to improving access to healthy food. New organisations and
policies will influence planning for health. Evidence on the
solutions the planning system can help to implement will continue
SPHAG contributed to the Planning for Healthier Places
report and has identified a number of key areas for further work
during 2014 including
- Progressing national guidance on delivering
health improvements through planning, either in National Planning
Practice Guidance or through sector led best practice
- Developing the evidence base to establish
more clearly what planning interventions affect health
- Developing partnerships and education to
promote planning for health across a range of sectors, including
the private sector and relevant professional bodies.
In their policy rainbow (below), Hugh Barton
and Marcus Grant present a diagram which reflects the relationships
between people, their local and global environments and the
determinants of health and wellbeing.
What is evident from this diagram is the
breadth of other policy areas that planning can influence.
Planning is distinctly different from many other strategic needs
assessment chapters because it is the way that our environments are
planned and delivered that determines how successfully we address
health and the health inequalities described in detail elsewhere in
By creating health-promoting environments we
can improve the health and wellbeing of people living within them
and reduce health inequalities. By taking effective action and
investing in prevention we may also be able to reduce costs to
health and social care services.
For example, one study in Bristol found that
switching from commuting by car to an active travel mode could
create annual health budget savings from £1,121 (cycling) to £1,220
(walking) per person because of increased health benefits. But such
options will only be taken up where safe and direct routes have
been planned in.
The links between the health and planning
agendas are beyond question.
Hugh Barton and Marcus grant 2006 - -The
Health Map or Policy Rainbow
The National Planning Policy Framework 2012 is
a relatively short statement setting out the Government’s approach
to planning issues. It is supplemented by the National Planning
Practice Guidance (NPPG); an on-line resource expanding the
NPPF’s principles and setting national good practice. Locally
produced plans, i.e. Local Plans produced by local authorities such
as Bedford Borough Council and Neighbourhood Plans produced by
parish councils and other neighbourhood forums must comply with the
policies and guidance in NPPF and NPPG unless local circumstances
justify an alternative approach.
In the terms of the NPPF, there are three
dimensions to sustainable development; economic, social and
environmental. These dimensions give rise to the need for the
planning system to perform a number of roles:
●● an economic
role – contributing to building a strong, responsive and
competitive economy, by ensuring that sufficient land of the right
type is available in the right places and at the right time to
support growth and innovation; and by identifying and coordinating
development requirements, including the provision of
●● a social
role – supporting strong, vibrant and healthy communities,
by providing the supply of housing required to meet the needs of
present and future generations; and by creating a high quality
built environment, with accessible local services that reflect the
community’s needs and support its health, social and cultural
●● an environmental
role – contributing to protecting and enhancing our
natural, built and historic environment; and, as part of this,
helping to improve biodiversity, use natural resources prudently,
minimise waste and pollution, and mitigate and adapt to climate
change including moving to a low carbon economy. (Para 7).
All three dimensions have significant health
components and implications.
One of the NPPF’s core planning principles is
to actively manage patterns of growth to make the fullest possible
use of public transport, walking and cycling, and focus significant
development in locations which are or can be made sustainable.
Another is to take account of and support
local strategies to improve health, social and cultural wellbeing
for all, and deliver sufficient community and cultural facilities
and services to meet local needs (para 17.)
Section 4 of the document is given over to
promoting sustainable transport. The NPPF recognises that transport
policies have an important role to play in facilitating sustainable
development and also in contributing to wider sustainability and
health objectives. (para 29).
Encouragement should be given to solutions
which support reductions in greenhouse gas emissions and reduce
congestion. In preparing local plans, local planning authorities
should support a pattern of development which, where reasonable to
do so, facilitates the use of sustainable modes of transport. (para
All proposals for development that are likely
to generate significant amounts of movement should be supported by
a Transport Statement or Transport Assessment and possibly a Travel
Plan. These documents will consider the likely impact of additional
traffic on the local area (and possibly beyond) and ways of
reducing that impact. (paras 32-36).
Section 8 of the document is about promoting
healthy communities. It explains that the planning system can play
an important role in facilitating social interaction and creating
healthy, inclusive communities. In order to do this the preparation
of plans and decisions on planning applications should aim to
involve all sections of the community. Plans that enable new
development should promote interaction between members of the
community through positive design measures such as active
frontages. Safe and accessible environments should be created which
encourage the active use of open areas. (para 69).
The NPPF also explains that existing open
spaces should generally not be built upon and that new open spaces
should be created as an integral part of new developments. (paras
Bedford Borough Council as place-shapers and
The Sustainable Community Strategy
This is a core document for the Council when
exercising its duty to promote wellbeing under the Local Government
Act 2000. It provides the framework for the policies and objectives
of the Local Plan, for example in relation to quality of life,
safer communities and improving healthy living. It was produced by
the Bedford Borough Partnership in 2009 and its vision challenges
everyone within the Partnership to work together around seven
themes, which each have specific aims, to explain how the Strategy
will be delivered. The seven themes are:
- Thriving:– A strong local economy.
- Greener – Supporting a natural environment
that is valued and enjoyed by all and contributes to the
development of a low carbon community.
- Aspiring – Children and Young people may lead
safe, healthy and happy lives and are provided with life
- Healthy – Everybody has access to high
quality health and social care services when needed.
- Safer – People live without the fear of
- Inclusive – People whatever their background
feel part of the wider community. Inequalities are reduced.
- Sustainable – The supply and quality of
housing is capable of supporting the anticipated increased
population. Housing and economic growth are built on sustainable
improvements to related infrastructure.
Bedford Borough Council Corporate Plan
The Council’s Corporate Plan explains what the
Council will itself do to meet the objectives of the Sustainable
Community Strategy. Four themes are identified and within each
theme a number of distinct objectives are explained. The four
Theme 1: Providing a Healthy Future
Theme 2: Protecting and Preserving the Local
Theme 3: Brighter Futures for Children
Theme 4: Serving Customers Effectively
Planning policy documents must deliver the
objectives of the Corporate Plan. It is expected that the Council
will be able to identify clear paths between the broad nature of
its corporate objectives and its specific planning policies and
A growing population
With a rising population and increasing demand
for jobs and housing, planning policy documents have a very
important role to play in explaining how growth to meet the local
needs of Bedford Borough will be achieved.
There is a lot of factual information about
Bedford Borough on the ‘Bedford Borough Statistical Profile’ page
of the Council’s web site. Some key information is below:
Bedford Borough’s population rose from 148,100
in 2001 to 163,900 in 2014, an increase of 11%. By 2021 the
population is estimated to reach more than 175,000. This represents
a 7% increase in population between 2014 and 2021, yet the 65+ age
group is forecast to increase by 16%. In particular, the 85+
population is forecast to increase by around 32%. This represents a
significant ageing of the population which will continue beyond
2021 and must be taken account of in planning policies and
There are major differences between the age
structures of the Borough’s urban and rural areas. The population
of Bedford and Kempston is much younger on average, with only 46%
of the population aged 40+ compared to 55% in rural areas.
Bedford Borough has an ethnically diverse
population. The 2011 Census indicates that 28.5% of the population
was from minority ethnic groups (BME), compared to 20.2%
nationally. The BME population increased by 16,400 between 2001 and
2011, whereas the White British population declined by 6,900.
The BME population is extremely diverse and
the Borough ranks in the Top 100 of 348 English local authorities
on the proportion of its population in 15 of the 17 minority ethnic
groupings – in particular the ‘white other’ (e.g. Italian and
Polish), Indian, Bangladeshi and Black Caribbean groups all exceed
the England average.
The BME population is concentrated in the
urban area of Bedford and Kempston, with particularly large BME
communities in Queens Park (75%) and Cauldwell (59%) wards. The BME
level is higher among younger age groups and a majority (51%) of
the 0-4 population in Bedford and Kempston is non-White
Working in partnership
Preparing a new local plan containing planning
policies that direct and shape growth must take account of these
facts and trends and also of evidence of future change over the
plan period. It must be an inclusive process. A sound plan
can only be achieved if a wide cross section of the community has
had appropriate opportunity to help shape it. Information and
evidence contained in other chapters of this JSNA will also
influence the plan’s policies and proposals.
In order to judge inclusivity, the Council
regularly gathers information during consultation events to see
whether responses have been received from a representative sample
of the Borough’s residents. It has been difficult to draw any
meaningful conclusions from these exercises because most people
choose not to complete the optional personal information sheet.
However, we are aware that organisations representing hard to reach
groups or those with protected characteristics do not often respond
to our invitations to get involved in plan making. This is a
concern and requires further investigation.
The statutory duty to co-operate requires us
to work with nearby councils and other public bodies to consider
strategic cross-boundary issues. Included in this list are the
Clinical Commissioning Groups and National Health Service
Commissioning Board who are required to work positively with the
council in the preparation of its plan.
Bedford Borough Council has recently updated
Statement of Community Involvement; a document setting out when
and how people and organisations are encouraged to get involved in
the plan making process and in the determination of planning
applications. This has helped to raise awareness of the different
opportunities there are for people to become involved in preparing
plans and other policy documents.
Without an up to date local plan the Council
will not be able to guide when, where and how development takes
place. The best way to deliver sustainable growth that meets the
needs (including health needs) of communities is to prepare and
adopt a relevant and up to date plan.
A Local Balance
There are many tensions in the planning
system. For example:
- The Government would like to see local plans
prepared quickly yet the need for a robust evidence base,
consultation and effective engagement, along with the complexities
of the duty to cooperate all add to the timetable.
- In particular political sensitivities and the
re-apportionment of growth across boundaries through the duty to
cooperate (in Bedford’s case potentially from Luton and London)
take time to resolve.
- Nationally there is clear evidence of a
housing shortage yet locally many people are reluctant to support
growth near to where they live. This is especially so in
countryside and village locations where the local context is
particularly valued and change is often resisted.
- Early work on the Local Plan 2032 shows that
there is a reluctance to support additional growth without a
guarantee that local infrastructure will be provided or
improved. This may include open spaces, sports pitches and
health facilities to support growing communities.
- The costs of infrastructure add to the
overall costs of development and in difficult economic
circumstances may make it unviable. This means that unless the
costs associated with development are reduced, development will
simply not happen. The difficult choice may then be between no new
housing or housing delivery with reduced infrastructure
- The development of brownfield sites is
preferred by many people to the development of greenfield sites but
the supply of available brownfield sites in Bedford Borough is
small. Most of the older outdated industrial sites in Bedford and
Kempston have now been re-developed, predominantly for housing.
Brownfield sites in villages are hard to find.
- The most sustainable location in the borough
is the urban area of Bedford and Kempston yet opportunities for
development (not already identified) are few. Congestion, and in
some places air quality, is a concern and new or intensified
development would potentially make the situation worse.
- Locations away from the urban area are less
sustainable and likely to lead to reliance on the car for essential
journeys, unless the location and design make more sustainable
modes more attractive.
The challenge for the local plan process is to
consider these and other issues and create and deliver a strategy
that provides sustainable growth in the best place to meet local
What are we doing?
Local planning documents
The NPPF reinforces the plan-led system as the
starting point for making decisions on planning applications. This
means that it is important that the Council has up to date local
planning documents to set out the locally agreed development needs
and priorities of the area.
Bedford Borough Council has a number of
documents that together make up what is known as the statutory
development plan. All current planning policies are contained in
these documents. They are :
These documents make allocations for
development to meet identified needs up to 2021. The Council is
currently preparing a replacement Local Plan that will look forward
to 2032. More information on the progress of that plan can be found
on the Council’s
The Localism Act 2011 introduced a new tier of statutory
planning documents. For the first time neighbourhood areas can be
identified for which local groups can prepare a Neighbourhood Plan.
This tier of plans sits below the Local Plan and must be consistent
with it. It can however go into far more detail than a borough-wide
plan can and can address issues that are important locally.
Concerns about the health of local residents could help to shape
the policies in a neighbourhood plan.
A Neighbourhood Plan must be prepared in accordance with the
regulations and will be scrutinised to ensure it is capable of
being adopted and implemented. A local council or
Neighbourhood Forum is responsible for preparing the neighbourhood
Plan but Council Officers will provide appropriate help and
guidance. The Council has a web page explaining more about
neighbourhood planning in Bedford Borough.
Development Management; making
decisions on planning applications.
Planning decisions on proposed development are
made in accordance with the policies of the development plan (the
documents listed above).
Design and access statements continue to play
an important role in getting developers to think about design early
on in the development process. Where appropriate these statements
can be used by public health colleagues as the basis for evaluating
the health and wellbeing impact of a proposed development.
In particular people’s health and wellbeing
are influenced by their access to and quality of housing, including
affordable housing. There is more about this in the Housing chapter
of this JSNA.
What do we need to do?
We need to:
- Review saved policies and draft new policies
taking account of the impact that they can have on health, both
positive and negative. Use the JSNA and health and Wellbeing
Strategy to assist this process.
- Use the checklists in ‘Reuniting health With
Planning’ (TCPA) (section 4) and Steps to Healthy Planning (SPHAG)
to guide the development of the Local Plan 2032.
- Work more effectively with CCGs and Public
Health colleagues in preparation of the Local Plan
- Consider health issues as part of
Community Infrastructure Levy list of priority infrastructure
(Regulation 123 list) when it is reviewed.
- Agree the extent to which and how Health
Impact Assessment (HIA) is to be used both in plan making and
- Related to this, consider whether the
articulation of the health impacts of development proposals should
be an integral part of the determination of planning
- Consider whether it would be appropriate to
add ‘assessment of health impacts’ in all planning committee
reports and prepare standard answers from which to select.
- Monitor the use and effectiveness of HIAs and
consideration of health in the development management process
through monitoring of relevant planning policy in Local Plan
- Keep up to date with best practice and help
to shape national guidance where possible through responding to
- Continue to improve engagement, especially
with hard to reach groups.
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