Information on Health and Spatial Planning in Surrey

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1. Background

1.1 The purpose of this document is to strengthen links across planning and health teams by outlining the organisations responsible for planning and health and signposting to tools which can be used for healthy place making.

1.2 The focus of this document is to highlight to individuals and organisations involved in the development process the benefits that can be achieved when health is considered as part of the development and planning process and to signpost to tools for healthy place making in Surrey. As well as being of interest to developers the document is intended for officers from health and planning teams across Surrey. It will also be of interest to other colleagues and elected members as well as adjoining authorities that share cross-boundary health issues.

1.3 There are two elements to planning and health; one in terms of creating healthy environments that support and encourage healthy lifestyles and the wider determinants of health, and the other to identify and secure appropriate local health infrastructure to support the health and care system.

1.4 The built and natural environment are major determinants of health and wellbeing. The built and natural environment refers to the characteristics of a physical environment in which people live, work and play, including schools, workplaces, homes, communities, parks/recreation areas, green (i.e. visible grass, trees and other vegetation) and blue spaces (i.e. visible water).

1.5 The linkages between health and the environment have long been established and the role of the environment in shaping the social, economic and environmental circumstances. For example, the design of our neighbourhoods can influence physical activity levels, travel patterns, social connectivity, mental and physical health and wellbeing outcomes.

1.6 The UKHSA defines the wider determinants of health (sometimes known as the social determinants) as "a diverse range of social, economic and environmental factors which impact on people's health".

1.7 The health map in Figure 1 shows visually how these factors relate to residents, communities and environments.
Figure 1: The health map, Barton and Grant 2006 (based on Dahlgren and Whitehead 1991)

Health map diagram showing the impact of the environment on health and well-being in our neighbourhoods. This is explained in more detail on the page.

  • Global ecosystem impacts:
    • Natural environments; built environments and activities
  • These in-turn impact:
    • Local economy; community and lifestyle.
  • Climate stability impacts:
    • Natural habitats; buildings and places; how we work, shop and move
  • These in-turn impact:
    • Wealth creation; social capital; aiet and physical activity.
  • Biodiversity impacts:
    • Air, water and land; streets and routes; living, playing and learning
  • These in-turn impact:
    • Resilient markets; social networks and work-life balance.

All of the above impacts people's health no matter what age, sex or any hereditary factors

1.8 The social, economic and environmental factors are influenced by the local, national and international distribution of power and resources which shape the conditions of daily life. They determine the extent to which different individuals have the physical, social and personal resources to identify and achieve goals, meet their needs and deal with changes to their circumstances.

1.9 The increasing focus on health and spatial planning provides a real opportunity to bring together health and planning specialists across Surrey. Enabling partners in Surrey County Council, District and Borough Councils and across the wider health system, to plan ways in which to improve the health of our current and future residents through the built and natural environment.

2. Planning in Surrey

2.1 "Planning ensures that the right development happens in the right place at the right time, benefitting communities and the economy. It plays a critical role in identifying what development is needed and where, what areas need to be protected or enhanced and in assessing whether proposed development is suitable." From the Governments 2015 Plain English Guide to the planning system.

2.2 The National Planning Policy Framework 2021 and relevant planning practice guidance sets out the Government's planning policies for England and how these should be applied. The planning system aims to achieve sustainable development through an economic, a social and an environmental objective. The social objective in particular links to the wider determinants of health: "to support strong, vibrant and healthy communities, by ensuring that a sufficient number and range of homes can be provided to meet the needs of present and future generations; and by fostering a well-designed and safe built environment, with accessible services and open spaces that reflect current and future needs and support communities' health, social and cultural well-being." Links to planning and health are found throughout the National Planning Policy Framework and the Planning Practice Guidance. Guidance on healthy and safe communities was last updated in August 2022.

2.3 Planning functions in Surrey are divided over three tiers of local government:

  • County Council
  • District and Borough Councils
  • Parish or Town Councils

Surrey County Council

2.4 The County Council is the Minerals Planning Authority and the Waste Planning Authority for Surrey and prepares Local Plans for both minerals and waste which set out a framework of policies to guide the development of minerals extraction and for waste management facilities in Surrey. The County Council deals with applications for minerals and waste related developments, and for its own developments, such as schools and libraries.

2.5 Additionally, Surrey County Council is a statutory consultee for Local Plans produced by District and Borough Councils and, as the Highway Authority and Lead Local Flood Authority for Surrey and lead authority for education and archaeology it is consulted on planning applications for developments that are likely to have impacts related to those roles and functions. The SCC Public Health team review and comment on Local and Neighbourhood Plans to ensure they deliver health infrastructure and meet SCC's objective of tackling health inequality. As the local highways authority, Surrey County Council prepares the Local Transport Plan (LTP) which is a statutory document setting the strategy for the management, maintenance and development of the county's transport system. The LTP is presented to the Department for Transport and although it is not part of the Town and Country Planning Act it is closely related. See paragraphs 4.18 and 4.19 below for more details on the Surrey Local Transport Plan 4.

District and borough councils

2.6 In Surrey, District and Borough Councils are responsible for most planning matters. They have two statutory functions:

  • Plan making – the Local Plan sets the vision for an area (spatial strategy), allocates sites and sets the framework for consistent decision making (development management policies)
  • Development Management – District and Borough Councils determine planning applications for building, extending or converting homes, offices and shops and development other than minerals and waste and major infrastructure projects

2.7 The Local Plan addresses needs and opportunities in relation to housing, the economy, community facilities and infrastructure, as well as a basis for safeguarding the environment, adapting to climate change and securing good design.

2.8 Districts and Boroughs have a statutory duty to cooperate with numerous stakeholders when preparing the Local Plan. This includes health providers and the County Council in relation to the provision of additional infrastructure and services such as education and transport. Planners should work with colleagues in public health to understand specific local health priorities.

2.9 The preparation of development plans involves the following key stages:

  • Information gathering: the District/Borough gathers evidence of the issues the plan needs to address such as need for new development and infrastructure and on spatial constraints
  • Consider issues and options and early-stage consultation (Regulation 18): the District/Borough engages with residents and stakeholders to consider the different ways to address the issues identified and then determines the optimum approach
  • Consult on a draft plan (Regulation 19): the District/Borough publishes a draft plan with supporting evidence, requests stakeholder views on a preferred spatial strategy and policies
  • Submission of the document and independent examination: the plan and evidence are submitted to the Government's Planning Inspectorate. The plan must be 'positively prepared', 'justified', 'effective' and 'consistent with national policy' (the 'tests of soundness')
  • Adopt the plan: provided the plan has been prepared in the right way, the council can formally adopt it and use it to determine planning applications

2.10 As Local Plan are developed by individual District and Borough Councils, they are not prepared to the same timetable and have different timescales. The position for Surrey District and Boroughs as of August 2023 was:

  • Elmbridge: Regulation 19 consultation ended July 2022. Plan submitted for examination August 2023
  • Epsom and Ewell: Regulation 18 consultation February/March 2023
  • Guildford: Local plan (Part 1) adopted 2019; Part 2 (development management policies) examination hearings ended November 2022
  • Mole Valley: Local plan examination hearings ended October 2022.
  • Reigate and Banstead: Core Strategy adopted 2014 (2012 to 2027). Reviewed in 2019 and no update needed. Development Management Plan adopted 2019. New Local Plan preparation to commence in 2023.
  • Runnymede: Local plan adopted 2020. Early review required and the council commenced the review of the Local Plan in January 2021
  • Spelthorne: Examination started in May 2023 and is paused
  • Surrey Heath: Regulation 18 consultation ended May 2022. Regulation 19 consultation autumn 2023 and submission 2024
  • Tandridge: Examination started in 2019 and is ongoing
  • Waverley: Local Plan Part 1 adopted 2018. Local Plan Part 2 (development management policies and additional site allocations) adopted March 2023. Council commenced the review of Local Plan Part 1 and Local Plan Part 2 in July 2023
  • Woking: Core Strategy adopted 2012 (2010 to 2027). Reviewed in 2018 and no update needed. Site Allocation DPD adopted 2021. New Local Plan preparation to commence in 2023.

2.11 The format of Local Plans is individual to each local authority but generally consists of:

  • Spatial strategy and strategic site allocations
  • Development Management Policies
  • Supplementary Planning Documents (statutory documents which add further details to the policies in the local plan)

2.12 An application for planning permission is required by planning law to be determined in accordance with local planning policies unless there are material considerations that indicate otherwise. Pre-application engagement, although not a requirement of developers, is an important feature of the development process providing an opportunity to engage with statutory and non-statutory consultees before submission of a planning application.

Parish or Town Councils

2.13 Parish or town councils are not Planning Authorities, but they are important statutory consultees in the planning process. They can also produce neighbourhood plans for their local areas that are in general conformity with the Local Plan and can include site allocations. There may also be formally designated Neighbourhood Forums in unparished areas that are able to produce a neighbourhood plan for their area. Neighbourhood plans form part of the development plan.

Active Travel England

As of 1 June 2023, Active Travel England (ATE) is officially a statutory consultee on all planning application for developments equal to or exceeding 150 housing units, 7,500 sqm of floorspace or an area of 5 hectares. The new role will enable ATE to help planning authorities in their work to implement good active travel design – for example, by ensuring developments include walking, wheeling and cycling connectivity to schools and local amenities. This will help improve public health, save people money and reduce harmful emissions. See the ATE website for details of the ATE planning application assessment toolkit.

3. Health landscape and commissioning responsibilities

Integrated Care Systems (ICSs) in Surrey

3.1 ICSs are partnerships of organisations that come together to plan and deliver joined up health and care services, and to improve the lives of people who live and work in their area. There are two ICSs in Surrey:

  • Surrey Heartlands Health and Care Partnership which covers around three quarters of the overall population of Surrey: including Surrey Downs, North West Surrey, Guildford and Waverley and East Surrey
  • Frimley Health and Care which includes parts of Surrey, Hampshire and Berkshire.

Integrated Care Partnerships (ICPs)

3.2 ICPs are partnerships of local health and care organisations responsible for improving the care, health and wellbeing of the populations of approximately 250,000-300,000.

3.3 Most of Surrey - almost 1.1 million people - are served by Surrey Heartlands Health and Care Partnership while residents of Farnham and Surrey Heath are part of Frimley Health and Care.

3.4 Each ICS is made up of two parts - an Integrated Care Board (ICB) and Integrated Care Partnership (ICP), they cover the same populations, but the ICB leads on commissioning and the ICP leads on partnerships with wider stakeholders and on the ICP strategy. Within each ICS there are smaller 'places' where much of the partnership work takes place:

In Surrey Heartlands ICS the places are:

  • Guildford and Waverley Place
  • North West Surrey Place
  • Surrey Downs Place
  • East Surrey Place

In Frimley ICS the places that are also in Surrey County are:

  • Surrey Heath Place
  • North East Hampshire and Farnham Place (of which only Farnham is in Surrey)

Some of Frimley ICS's other 'places' are in Hampshire and Berkshire.

3.5 Working through their ICB and ICP, ICSs have four key aims:

  • improving outcomes in population health and health care
  • tackling inequalities in outcomes, experience and access
  • enhancing productivity and value for money
  • helping the NHS to support broader social and economic development.

3.6 ICSs are the centrepiece of the reforms introduced through the 2022 Health and Care Act and are part of a fundamental shift in the way the English health and care system is organised. Following several decades during which the emphasis was on organisational autonomy, competition and the separation of commissioners and providers, ICSs depend instead on collaboration and a focus on places and local populations as the driving forces for improvement. The King's Fund have produced further information on ICS's.

Primary Care Networks

3.7 Primary Care Networks are groups of local GPs and other partners operating at a local level to plan and buy care for local populations of generally between 30,000 and 50,000 people. There are 24 Primary Care Networks across Surrey Heartlands Health and Care Partnership and 14 Primary Care Networks across Frimley Health and Care.

Director or Public Health, Surrey County Council

3.8 The Director of Public Health (DPH) is responsible for the health and wellbeing of Surrey's population and is a statutory role in the local authority. The DPH sets out the overall vision and objectives for public health in the local area and provides system leadership in order to address those priorities. The DPH works across all three domains of public health; health protection, health improvement, and health intelligence/healthcare public health. The Director of Public Health at Surrey County Council is Ruth Hutchinson. The Public Health team aims to support the DPH in improving and protecting the health of the local population.

3.9 The Public Health team will review and comment on Local and Neighbourhood Plans to ensure they deliver health infrastructure and meet SCC's objective of tackling health inequality. The team will also comment on planning applications that meet threshold limits (to be agreed) to ensure they have considered health impacts and/or carried out a Health Impact Assessment.

Health and Wellbeing Boards

3.10 Health and Wellbeing Boards (HWB) were set up around the country in 2013 as part of the Health and Social Care Act 2012 and the Government's changes to the NHS. The Board is the place for the NHS, Public Health, Children's and Adult Social Care, local councillors, voluntary, community and faith sector and service user representatives to work together to improve the health and wellbeing of the people of Surrey.

3.11 HWBs have a duty to encourage integrated working between commissioners of services, and between the functions of local government (including planning). Details of the Surrey Health and Wellbeing Board are on the SCC website. Each HWB is responsible for producing a Health and Wellbeing Strategy which is underpinned by a Joint Strategic Needs Assessment (JSNA). The JSNA is an assessment of the current and future health and social care needs of the local community.

4. Tools for health place making in Surrey

4.1 A large amount of research has been carried out on healthy place-making. For example, see the TCPAs work on healthy place-making which includes links to their own publications and links to resources from external organisations and Public Health England's Getting Research into Practice study report. This section summarises the specific groups and strategies which are being developed in Surrey.

Health and Planning Forum

4.2 The health and planning forum has been re-established to strengthen links across planning and health teams (including public health, local Integrated Commissioning Systems and Integrated Care Partnerships) by providing a forum for health and planning officers to come together to:

  • Discuss planning and health infrastructure issues
  • Maximise opportunities for health to influence Local Plans and draw on available funds, including the Community Infrastructure Levy
  • Help embed health and wellbeing into planning policies and decisions
  • Champion health with providing health and wellbeing evidence for Local Plans
  • Promote use of the Joint Strategic Needs Assessment, Health and Wellbeing Strategy, Health Intelligence and other health strategies as evidence for local planning
  • Explore the use of health impact assessment as a tool guiding planning process.

Health Impact Assessment

4.3 Health Impact Assessments (HIA) are a tool used in the planning process to ensure health and wellbeing is a key consideration. A HIA assesses both the positive and negative health impacts of a plan, project or proposal and produces recommendations that maximise the positive impacts and mitigate against the negative impacts.

4.4 Local Plans are required by law to go through a sustainability appraisal at the outset of each stage of plan preparation. The sustainability appraisal considers the potential social, environmental and economic impacts of the plan and should incorporate a HIA through the inclusion of relevant indicators. Some Districts and Boroughs in Surrey have included policies in their plans requiring HIAs to be carried out for developments over a certain size.

4.5 Guidance on Health Impact Assessment in spatial planning was published by Public Health England in October 2020. The Health and Planning Forum are considering if it would be useful to produce a HIA model for Surrey and produce county wide guidance on HIAs. This would signpost to the national guidance and highlight Surrey specific issues such as:

  • Topics to include in HIA that are specific or relevant to the Surrey context
  • Thresholds for which HIAs should be carried out for developments of different types
  • The Surrey organisations and individuals who can help carry out the HIA and provide guidance or evidence
  • Local data and data sources which can be drawn on in preparing a HIA.

Considerations for health in local plans

4.6 District and Borough Councils should ensure that the principles of health and wellbeing are integrated into local plans and related documents. They should involve public health colleagues at an early stage in plan development. Considerations include:

  • Use the JSNA, academic evidence and other sources of information as the evidence base for policy making and decision taking and ensure local plans reflect the issues set out
  • Ensure health and wellbeing principles are supported by policies
  • Include measurable outcomes on health and submit health data for monitoring and plan review
  • Ensure that health-related infrastructure is factored into infrastructure assessments produced in support of the Community Infrastructure Levy (see Coplug analytics tool below)
  • Ensure health and wellbeing is adequately incorporated into the Sustainability Appraisal of Local Plans or consider requirements for a separate Health Impact Assessment (HIA)
  • Consider including a policy requiring a HIA for all developments of 100 units and above.

Coplug analytics tool to assess the health service requirements of new development

4.7 Surrey Heartlands ICS commissioned Coplug Ltd to develop an analytics tool for use by Surrey councils (based upon the London Healthy Urban Development Unit planning contributions model). The tool uses a range of up-to-date assumptions to assess the health service requirements and cost impacts of new residential development. Outputs from the model have contributed to infrastructure assessments either for entire Local Plans or specific large development sites. The tool also captures pipeline health infrastructure projects both to inform Local Plan development and discussions around CIL/S106 needs.

Planning obligations

4.8 For new development to be acceptable there may be a requirement for investment in affordable housing, infrastructure and supporting services. Section 106 agreements are put in place to make it possible to approve a planning proposal that might not otherwise be acceptable in planning terms. For example, a S106 agreement might require a developer to fund improving the access to a site, paying for a new health clinic, or ensuring the need for affordable housing is met.

4.9 The Community Infrastructure Levy (CIL) is a general charge which can be levied by local authorities on new development in their area. CIL is different to S106 in that it is levied on a much wider range of developments and according to a published tariff schedule. It is an important tool for local authorities to use to help them deliver the infrastructure needed to support development in their area. Most new development which creates net additional floorspace of 100 square metres or more, or creates a new dwelling is potentially liable for CIL. CIL can be used to fund a wide range of infrastructure, including transport, flood defences, schools, hospitals, and other health and social care facilities.

4.10 For example, in 2022 Elmbridge Borough Council awarded £530,000 of CIL funds to the NHS for reconfiguration works at Walton Health Centre in order to provide additional clinical space for treatment. The works were proposed to provide additional capacity at the centre and respond to the growing number of patients, in part a result of additional development.

Surrey 2050 Place Ambition

4.11 Surrey Local Authorities and their strategic partners have developed the Surrey 2050 Place Ambition which sets out the collective long-term ambition to achieve good growth. Critical to this will be our ambition to improve the overall quality of health and well-being across Surrey, recognising that healthy places and people are a key factor in our long-term prosperity and fundamental to the delivery of good growth. The Place Ambition is currently being refreshed to reflect the impact of the pandemic, the urgency of the climate crisis and actions needed to support a zero-carbon future and updated work on local and county wide strategies and plans. The new document is expected to be published in summer 2023.

Sources of local data on health and wellbeing

4.12 Data on health and wellbeing in Surrey can be found on Surrey-i. See the County and Borough summaries for local population data at different levels of spatial aggregation. The Office of National Statistics provide local data on population, including information on social and economic wellbeing.

Joint Strategic Needs Assessment

4.13 The Joint Strategic Needs Assessment (JSNA) is an assessment of the current and future health and social care needs of the local community. Surrey's JSNA is divided into chapters and follows a life course approach. The age categories are;

  • Starting Well (0 to 4 years old)
  • Developing Well (5 to 16 years old)
  • Transitioning to Adulthood (17 to 24 years old)
  • Living Well (25 to 64 years old)
  • Aging Well (65+ years old)

4.14 The life-course approach recognises that the conditions in which people are born, grow, live, work and age can lead to health inequalities. The JSNA is hosted on the Surrey-i website which brings together data from key stakeholders across the county and makes it accessible to partner organisations and communities.

4.15 Each chapter looks to understand the health need within Surrey's population, identifying levels of need, current service provision and gaps, and recommendations for commissioning. The range of evidence contained in the JSNA can help inform and influence key planning decisions in policy, planning and individual development schemes. There are several health and wellbeing determinants where planning can make a key contribution. The JSNA can inform these determinants through its evidence base, which includes:

  • Housing
  • Transport
  • Physical activity
  • Employment and skills training
  • Education and early life
  • Access to and provision of services
  • Community safety
  • Open space and public realm
  • Air, water and noise quality
  • Access to fresh food
  • Climate change

4.16 Most chapters are supported by a Data Dashboard, which provides a more visual way to look at the data, allowing users to explore it in detail by selecting geographies or indicators of interest. The JSNA can help boroughs and district councils to understand their resident and predicted population, in terms of ages and needs.

  • Starting Well (0 to 4)
  • Developing Well (5 to 16)
  • Transitioning to Adulthood (17 to 24)
  • Living Well (25 to 64)
  • Aging Well (65+)

Health and Wellbeing Strategy

4.17 The HWB produces a Joint Health and Wellbeing Strategy, which is informed by issues highlighted in the Joint Strategic Needs Assessment (JSNA) and from the input of Surrey residents, partner organisations and key stakeholders, in order to decide what it should focus on. The Board refreshed the Health and Wellbeing Strategy in response to COVID-19, to ensure it had a greater focus on reducing health inequalities so no-one is left behind.

Local Transport Plan 4

4.18 The Local Transport Plan 4 was approved by Surrey County Council in July 2022. It sets out a roadmap for a transport network in Surrey that helps tackle the climate emergency and includes healthy planning policies such as increasing walking and cycling and Liveable Neighbourhoods (LNs).

4.19 LNs are themed spaces that upscale the importance as places for people, and not just their importance for the movement of vehicles. Key characteristics of Liveable Neighbourhoods include; increasing the comfort, safety and accessibility of walking and cycling; creating space for community facilities like parks, gardens, play spaces and seating; creating attractive local environments and welcoming neighbourhoods that people want to live in; reducing the dominance of cars and goods vehicles resulting in improved safety, air quality and noise pollution to encourage more walking, cycling and social interactions.

Health Streets for Surrey design guide

4.20 The Healthy Streets for Surrey design guide was approved by Surrey County Council in October 2022. It establishes the standards that the County Council would expect newly designed streets to meet. The aim is to enable the creation of places that improve Surrey residents' physical and mental health and reduce their environmental footprint by encouraging cycling and walking more often; streets in which children can play safely; improved air quality; re-greened streets and public spaces; a reduction in residents' transport carbon footprint; and the creation of beautiful, resilient and popular streets that will ultimately require less long-term maintenance.

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