50 Planning in London

Tackling wellbeing and health inequalitiesthrough planning

A new spirit ofcollaborationbetweenplanning andpublic health atnational,regional andlocal boroughlevel is set outby MichaelChang, SamCuthbert, AndréPinto and RachelFlowers

The profile of public health in planning has shot up recentlywith the transferring of public health responsibilities back intolocal government for the first time since 1974. This article, writ-ten in a personal capacity by officers from the Greater LondonAuthority, London Borough of Newham and the TCPA exempli-fies the spirit of collaboration between planning and publichealth at national, regional and local borough level.

The national pictureThe Health and Social Care Act 2012 brought about significantstructural reforms to public health by abolishing primary caretrusts, moving public health functions back into boroughs andestablishing local level Health and Wellbeing Boards, andClinical Commissioning Groups to oversee the development ofthe Joint Health and Wellbeing Strategy and Joint StrategicNeeds Assessment (JSNA). Around the same time, the LocalismAct abolished regional planning outside of London, introduced aDuty to Cooperate on strategic planning issues, and cementedthe primacy of the local plan with a new statutory tier ofneighbourhood planning. Government planning policy wasconsolidated into a National Planning Policy Framework (NPPF)in March 2012.

The NPPF solidified the policy link between public healthand planning by requiring Local Planning Authorities to under-stand and plan for needs set out in local strategies includingborough JSNAs, and Joint Health and Wellbeing Strategies.These policy links are clear as the TCPA explains and continuesto reinforce throughout its Reuniting Health with Planning pro-gramme of projects that seek to engage local authoritiesaround key local priorities.

London and the London PlanWithin London the context to these reforms of health andplanning policy is the most rapid growth in population that hasbeen seen since the 1930s. Further Alterations to the LondonPlan (FALP), which are expected to undergo examination inSeptember 2014, attempt to accommodate this growththrough mixed-use development focussed on Opportunity

Areas, town centres and other points of good public transportaccessibility.

In effect, London, as other very large cities around the world,is experiencing a form of re-urbanisation in which agglomera-tion economies outweigh the dispersive patterns of urban andeconomic development that dominated cities in the post-warperiod. This profound change to the nature of urban growth isalso strongly reflected within these cities themselves. InLondon this means an increasing concentration of retail andemployment functions in the centre at the expense of smallerand more outlying locations.

At first sight, the coincidence of exceptional growth in pop-ulation with profound restructuring of the health care systemmight seem to be inherently problematic and to raise questionsabout the capacity of all forms of infrastructure to cope withthe increase in demand. However, there is in fact a naturalalignment between each of these objectives and a significantopportunity for urban growth and the reform of health servicesto directly complement each other.

Firstly, the unavoidable concentration of London’s growth incentral locations and areas of high transport accessibilitymeans that there is now a dominant economic driver towardphysical forms of urban development that are significantly ben-eficial to the environment and public health in the form ofmixed, walkable, lifetime neighbourhoods. Complementing this,the high standards of housing design set out in the LondonHousing SPG should ensure that traditional public health con-cerns relating housing density directly to ill health no longerapply.

At the same time, reform within health and social care isdriving a paradigm shift towards primary and communitybased services with acute services provided in more specialisedfacilities. This means that the traditional way of modellinghealth within the planning context has shifted and is still shift-ing as Clinical Commissioning Groups and NHS England startto commission acute care in a way resulting, potentially, in thegreater dispersal of diagnostic and routine care provision.

The GLA through the London Plan and the supporting

HEALTH AND PLANNING | CHANG CUTHBERT PINTO & FLOWERS

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Authors from Left to

Right:

Michael Chang is the

Planning Policy Officer at

Town & Country Planning

Association (TCPA), and

leads on its health and

planning work.

Sam Cuthbert is a

Strategic Planner and

Rachel Flowers is a Public

Health Specialist –

Planning at the Greater

London Authority

Andre Pinto is

Regeneration and Social

Determinants of Health

Specialist at the London

Borough of Newham

51Issue 89 April-June 2014

Supplementary Planning Guidance envisages co-location of dif-ferent types of social infrastructure, and of social infrastructurewith housing both due to land use pressures and as a potentialco-funding mechanism. In practical terms this will mean thatthe need for and the provision of health services can increas-ingly arise in the same places and at the same time, easing thepressures on both.

The Mayor has a duty to reduce health inequalities, and theMayor’s Health Inequalities Strategy is a good starting point toidentify significant health and wellbeing conditions across thecapital. There is an overriding need to improve air quality, andmaintain and improve access to green space in order to protectrespiratory health, encourage exercise and reduce the mentalhealth effects of isolation. In this context, the Mayor of Londonintroduced his 2020 vision for London as the greatest city onearth setting out plans for greater life expectancy, improvedpublic health and a narrower gap between rich and poor.

Borough perspective on policy and practiceNewham has been one of the leading London Boroughs inimplementing the planning for health agenda locally andacknowledging the importance that regeneration and spatialplanning can have in addressing the social determinants ofhealth. The links between deprivation, health and the built envi-ronment have been widely recognised. As an inner LondonBorough with high levels of deprivation but with an extensiveregeneration programme, the London Borough of Newham hastaken a joint approach to addressing the wider determinants ofhealth, by using planning policy and local planning powers tosecure health improvements for the whole of the local popula-tion. This approach allowed Newham to be a pioneer in termsof linking health with planning and to develop innovativeapproaches to tackle some of the social determinants of healththat are so deeply rooted in the form and shape of the builtenvironment.

Many of the preventable diseases that affect Newham’spopulation can be influenced by the built environment, particu-larly obesity, cardio-vascular disease and respiratory illnesses.Newham’s percentage of Year 6 children classified as obese ishigher than the national average, while the levels of adult phys-ical activity are lower than the national average. Meanwhile,levels of diabetes in Newham which are linked to obesity aresignificantly higher than the London and England average.

Recognising this, Newham’s adopted Core Strategy (2012)made it a requirement for all major planning applications to beaccompanied by a Health Impact Assessment (HIA) or toaddress its scope as part of their Design and Access Statementor Environmental Impact Assessment. This change in policy wasachieved through creating and sustaining close working rela-tionships between the Local Authority’s Public Health and

Planning Departments and through recognition that healthshould be a key principle in the regeneration and spatial devel-opment of Newham.

Previously, the submission of a HIA as part of a planningapplication was discretionary. The Core Strategy has now madeit mandatory, constituting a significant change in terms of howhealth outcomes are taken into consideration and at whatstage of the planning process this is done. The purpose andintention of the HIA is to inform the development and progressof a planning application, therefore it should be carried out asan integral part of the first stages of the design and develop-ment process. In order to achieve this, Newham is developing alocal Planning for Health Checklist which aims to provide aguide on the likely implications for health of given develop-ment.

In conclusion, recent structural and policy changes havealready produced some positive results in terms of confidencefrom the planning departments in engaging public health andvice versa, as we have seen in Newham in refusing permissionfor new hot food takeaways, and an increase in the number ofHIA submitted as part of the planning application process. It isclear that one of the most valued outcomes of the closer inte-gration has been the perceived importance that health hasgained within the Planning Department. The return of PublicHealth to the local authorities has played an important role infacilitating and promoting this partnership, as local authoritiescan take strategic action to prevent inequalities across a num-ber of functions. All these services are ideally placed to deliverreal public health benefits at a local level making the healthierchoice, the easier choice for the greater benefit of our commu-nities and places. n

52 Planning in London

PLANNING FOR AN AGEING POPULATION | ROGER BATTERSBY

The NHS is faced with ever-growing numbers of frail olderpeople bed-blocking in hospitals at huge expense to the state.In response, the government is allocating substantial fundingthrough the Better Care Fund towards promoting greater inte-gration of health and adult services to achieve greater efficien-cy in providing of care and support to older people in the com-munity.

However, moving older people from acute hospitals to thecommunity will put a greater focus on the quality and appro-priateness of our existing housing stock and much greaterpressure on community based care facilities, home improve-ment agencies and home care services.

At the same time the relatively affluent Baby Boomer gen-eration now at or fast approaching retirement age is under-occupying family homes and creating a logjam in the housingmarket.

The recent Demos Report - The Top of the Ladder, referredto this as 'our next housing crisis' and pointed out that morethan half the people over the age of 60 would be interested inmoving if appropriate accommodation was available. However,there is virtually nothing available in London that would con-stitute attractive, age-appropriate housing in good locationsfor 'younger' older people looking to downsize.

Why is the 'market' not responding to meet this demand?The answer is not straightforward.

Firstly, housing for older people is regarded by most hous-ing developers as messy. It is not just a case of building andselling. Whether catering for the upper end of the market orfor social/affordable housing, there must be a longer termcommitment to residents to provide a housing managementservice and facilitate care and support delivery when needed.Added to this, most typologies are more expensive to buildboth in terms of space standards for ageing in place and inproviding the communal areas that offer a lifestyle alternativefor residents. These costs are not always recoverable in the salereceipts.

Secondly, land availability and affordability in appropriatelocations is a major issue particularly when competing withgeneral needs developers in an open, overheated market with amore complex and expensive product!

Thirdly, there remains a surprising lack of awareness, both inboth government and the community at large, of the chal-lenges involved in housing and supporting an ageing popula-tion. This is illustrated by the paucity of strategic policy andplanning. We frequently witness open hostility at planningcommittee meetings to the prospect of developing specialisthousing or care facilities.

Fourthly, and this is often cited by housing developers oper-ating in the senior housing sector as their greatest challenge,there is a planning regime which is anything but 'age-friendly'.

Before we elaborate on this last point, some backgroundwould be useful on where the GLA currently stands in terms ofstrategy for London's ageing population.

Planning for an ageing population

Our nexthousing crisiswill very soon beupon us saysRoger Battersby

Roger Battersby is

managing partner at PRP

Architects LLP

The Offer - Independent Living HAPPI Housing

Halton Court, Kidbrooke

53Issue 89 April-June 2014

PLANNING FOR AN AGEING POPULATION | ROGER BATTERSBY

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Staying putAs highlighted in the London Housing Strategy [April 2014draft] - Homes for London, the great majority of us will chooseto continue living in our own homes in the community wherewe will be supported by spouses and/or family and/or HomeCare services.

There is also broad acknowledgement that the LifetimeHomes and Lifetime Neighbourhoods policy from the previousadministration is still valid in promoting 'inclusive' designwhere new housing and communities are planned.

The Mayor's Housing Strategy also recognizes that 'stayingput' is no panacea. We have all been witness to the shortcom-ings of Home Care Services highlighted by Panorama andother programmes. Social isolation in the home will becomean ever-greater issue. At the same time, much of our existing

housing is inefficient in terms of energy use and unsuitable forfrail older people. Home Improvement Agencies can only do acertain amount to address this situation.

Specialist housingAdd to this the issue of 'house-blocking' with the under-occu-pation of family homes and this all points to a growing needfor more specialist housing which must include a range oftypologies that cater for a very diverse market in terms ofaffordability, social status and level of dependency.

At the one end of the spectrum, as highlighted in theHanover@50 Debate, we need to provide for those of us in our'extended middle age'; today's 65 was yesterday's 55, today's75 was yesterday's 65. Many of us are living longer more activelives and a new housing product needs to be developed tocater for this market.

At the other end of the spectrum, the demographics tell usthat the over-85 group will double by 2030. Therefore demandfor assisted living and more institutional typologies that caterfor higher levels of care and support in the community willalso increase sharply.

Local authority role is pivotalIf we are to rise to this challenge, local authorities and localcommunities have a pivotal role to play in promoting aware-ness of the issues, preparing Local and Neighbourhood Plansthat include sustainable housing provision for all generations,forging partnerships with developers and providers across thevoluntary and private sectors, promoting greater integration interms of health, adult services and housing and not least interms of bringing their own Adult Services, Housing andPlanning departments together to work more closely in facili-tating appropriate provision for older people.

Local Authorities also have the opportunity to bring for-ward appropriate land in good locations for older people'shousing. However, in the context of ever-increasing pressureon their budgets, the temptation to accept the highest receiptmust be strong rather than assessing value in terms of thewider community benefits.

Of course the elephant in the room is funding. In our expe-

Halton Court, Kidbrooke

Merton, The Oaks

54 Planning in London

PLANNING FOR AN AGEING POPULATION | ROGER BATTERSBY

rience, the newly enacted Care Bill, for instance, isalready having a negative impact as planningcommittee members take fright at having to pickup the tab for the care of relatively wealthy peo-ple once they pass the £70,000 self-funding ceil-ing.

The planning challengeWe need to recognize that Local Authority plan-ners are encumbered by planning case law thatprovides little leeway in interpretation and aPlanning Use Class system that does not acknowl-edge the housing with care typologies that havebeen extensively developed over the past 15 - 20years.

Applications for housing 'with care', particularlywhere the private sector is involved, are oftentreated as sui generis, and are therefore assessedon their merits. As a result the planning systembecomes a lottery for the developer of older peo-ple's housing. The outcome of an application canoften depend on the previous experience of theofficers involved.

If we are to address the market for the 'BabyBoomer' generation to downsize, there is theadded difficulty that the product is not very differ-ent from general needs housing. At its core it mustprovide attractive, spacious, 'inclusively-designed'

accommodation that is flexible and adaptable forchanging needs. But the offer needs to be wider interms of tenure that enables one to stay in controlof one's assets, a lifestyle alternative that providessome communal provision for people to gettogether, a location that enables one to stay intouch with community/friends and family in anage-friendly neighbourhood where shopping,transport and local amenities are easily accessible.

Its distinction lies in its space and accessibilitystandards and communal provision. But this willprobably not be recognized by most authorities aswarranting any dispensation or facilitation.

Perhaps the solution here might be a minimumage-restriction condition.

Facilitation for downsizingWe believe that a range of measures should beintroduced to address the blockages in this mar-ket.

Appropriate housing for older people should begiven equal weight to affordable housing so thatany larger urban regeneration or extension proj-ects should be required to provide for a balancedcommunity that includes a range of housingtypologies for older people.

Planning policy for housing 'with care' needs tobe clarified urgently by new guidance which might

include a review of the Use Classes.Dispensations in terms of Section 106

Agreements and Community Infrastructure Leviesshould be available to developers building housingand other facilities for older people in recognitionof the wider community benefits.

The Treasury, instead of facilitating first timebuyers through Right to Buy, should rather consid-er waiving Stamp Duty for 'later life movers' tocreate room at 'the top of the ladder' (DemosReport).

Whilst the Mayor's support, in Homes forLondon, for the introduction of tax incentives fordownsizers is to be welcomed, we need to start ata local level by increasing awareness and changingattitudes at local authority level to incentiviserather than block housing for older people, other-wise 'our next housing crisis' will very soon beupon us. nRoger Battersby has been involved in the design and delivery ofhousing for older people for over 20 years. His knowledge of thesubject extends across both the private and public sectors andfrom independent retirement living to high care and communitybased health facilities. He was a panel member of the InnovationPanel for Housing our Ageing Population (HAPPI) initiative com-missioned in 2009 by CLG and the HCA to make recommenda-tions for a new generation of housing for older people. Hechaired the working group for the Housing Forum for its reporton Affordability Later in Life in 2010 and he is currently a mem-ber of the HCA’s Vulnerable and Older People Advisory Group(VOPAG).

Merton, Gresham House