reuniting health with planning - PDF document

to implement health and planning reforms in EnglandAndrew Ross,with Michael Chang Supported by Reuniting Health with Planning – Healthier Homes,Healthier CommunitiesBy Andrew Ross,with Michael ChangPublished by the Town and Country Planning Association July 2012The ‘Reuniting Health with Planning’ project webpage is at http://www.tcpa.org.uk/pages/reuniting-health-with-planning-healthier-homes-healthier-Printed with vegetable-based inks on chlorine-free paper from sustainably managed sources Town and Country Planning Association17 Carlton House Terrace,London SW1Y 5AS+44 (0)20 7930 8903 tcpa@tcpa.org.uk www.tcpa.org.uk healthier homes,healthier communitiesimplement health and planning reform in England 37 AcknowledgementsForeword Integrating health and planning in the reformsNational Planning Policy Framework (NPPF) and local plansNeighbourhood planning and community involvementHousing growth,quality and affordabilityHealth and wellbeing boardsJoint Strategic Needs Assessments (JSNAs) and Joint Health and Wellbeing Strategies (JHWSs)Clinical commissioning groups (CCGs)Public Health Outcomes FrameworkGetting startedRemember the shared origins of public health and planningReview the local plan for compliance with NPPF health policiesEngage public health on major planning applicationsInvolve health in infrastructure planningMeasure planning’s influence on health and wellbeing outcomesUnderstand the role of elected membersEngage a variety of stakeholdersEncourage your directorsHelp elected members to understand the links between planning and public healthDevelop a collaborative evidence baseEngage clinical commissioning groups (CCGs)Improve how you communicateNPPF and health and wellbeing checklistBristolKnowsley (First Ark Group)SandwellResourcesGlossary of termsProject stakeholder group healthier homes,healthier communitiesacknowledgements The TCPA wishes to thank everyone who agreed to be interviewed to provide informationand background for this handbook (see the case studies in Section 5 for listings).The TCPAis also grateful to the individuals and organisations on the stakeholder group fortheir input into the project (see Appendix 3).Special thanks are due to Stephen Hewitt, Specialist Professional Planner (HealthyLiving/Health Improvement), Bristol City Council, for his contribution to the NationalPlanning Policy Framework checklist (Section 4), and to Bristol City Council, Sandwell PCT,Luton Borough Council, Gateshead Council and First Ark Group for the use of theFinally,the TCPAis very grateful to those who provided funding to support this work:Planning Exchange FoundationNHS BristolFirst Ark GroupThe Hyde GroupLuton Borough CouncilSandwell PCTCentral Lincolnshire Joint Planning UnitAbout the authorsAndrew Rossworks at Final Draft Consultancy and is a writer and researcher on planning, publichealth and sustainability. He wrote the 2011 Local Government Association (LGA) guide Health into Planning: Evidence and Practiceand the Planning Advisory Service (PAS) briefingPrevention is Still Better than Cure: Planning for Healthy CommunitiesSpatial Planning and Health Group (SPAHG) and a Local Government Information Unit (LGiU)Planning Associate. He was Policy Officer at the TCPA from 1995 to 1998.Michael Changis Planning Policy Officer at the TCPA. He has a background in town planning andregeneration in New Zealand and the UK. He co-authored the TCPA guide , published in 2010. He works on a range policy agendas, including climate change, housing,green infrastructure, and culture, arts and leisure. Improved planning and better housing provision have long been identified as pre-conditions for enhancing the health of individuals and the communities in which theylive. Equally, health interventions can support communities and thereby encourage betterlifestyles and extend the opportunities available to residents.This handbook is important because it deals with many of the hard practical issues thatconfront us in our everyday lives, and it offers sound advice and guidance on what can bedone to improve the health and general wellbeing of both people and places. The general analysis is supported by detailed case studies which demonstrate that positiveprogress can be achieved even in adverse local circumstances. Such progress would appearto be based upon developing and applying integrated analysis, promoting partnershipworking, engaging local citizens and other stakeholders, and innovating in order to maximisethe gains from the use of resources. Professor Peter RobertsChair of the Planning Exchange Foundation, and TCPA Vice-Presidentforeword healthier homes,healthier communities ‘Too often we intervene too late in the pathway to ill health and forget thathealth starts where we live, learn, work and play. Research has shown thatthe key to foster good health is to build preventative services whichaddress these wider determinants of health and take care of our families,our schools, our workplaces, and our playgrounds and parks.’ Intervening in the Social Determinants of Health to Improve Priority Public Health Conditions and Reduce Health Inequalities . Institute for Health Equity, 2012, p.3‘Local planning authorities should work with public health leads and healthorganisations to understand and take account of the health status andneeds of the local population… including expected future changes, and anyinformation about relevant barriers to improving health and wellbeing.’ National Planning Policy Framework . Department for Communities and Local Government, 2012, para. 171‘By giving local government control of public health resources, we will shiftpower and accountability to local communities and create healthy placesto grow up and grow older in, with new partnerships in important areas,such as housing, planning, schools and transport.’ Healthy Lives, Healthy People: Our Strategy for Public Health in England . Department ofHealth, 2010, p. 32healthier homes,healthier communities Lyng,Sandwell –this community-ledredevelopmentspaces,affordablenew college This handbook was prompted by the Government’sreforms for England in three overlapping areas:The National Planning Policy Framework (NPPF),published in March 2012, is the overarchingguidance for local authority planners in makingrequires planners to promote healthy communities,and work with public health leads and organisations.The Health and Social Care Act 2012 transfers theresponsibility for public health to upper-tier localauthorities from April 2013. It also requires thetogether key commissioners from the local NHS andlocal government to strategically plan local healthand social care services.The Localism Act 2011 gives more power toneighbourhoods, including provisions forneighbourhood planning. The Act also introduces araft of other changes that have implications forimproving health, although they are largely beyondthe scope of this publication. These include changesto how affordable housing is provided andmanaged, and new mechanisms such as communityasset transfer, a community right to bid and acommunity right to challenge.other environmental functions have on improvingHowever, there is concern that with local areas havingto take on so much change at the same time,aspirations to improve joint working mightunderstandably be subsumed by the detail of internalThis handbook aims to keep the importance of integratedto push forward their intention to integrate their work,Inevitably individual areas are at very different stages:for some, the handbook will provide a chance to checktheir own work against what others are doing. Formany others, it will stimulate some early thinkingabout how to begin a conversation between healthactions that will achieve healthier communities – forpractice and policies in Appendix 1. Instead, it ishealthier homes,healthier communitiesintended to remind readers of what can be achieved ifAudienceThis handbook is targeted specifically at planners andthem to find ways of working together. It is alsoengage with other relevant disciplines such ashousing, transport, regeneration, communitydevelopment and environmental sustainability, andwith councillors and others on health and wellbeingboards, including representatives of clinicalOnce effective joint working has been established –both in terms of setting up more integrated structureshealth practitioners can then begin to address howthey convey their integrated approach to the widerworld, including developers and other partners with anStructureSection 2 describes the reforms on which thisSection 3 suggests actions that planners and publichealth specialists can take to bring their work closertogether. There are no rules for what will work where:readers will need to use their knowledge of localways to influence health outcomes in their area. Section 4 sets out a checklist intended to promptplanning and public health practitioners to think aboutbased on the requirements set out in the NPPF. Section 5 summarises information from the casestudies: Bristol, Gateshead, Knowsley (First ArkGroup), Lincolnshire (with Central Lincolnshire JointPlanning Unit), Luton, and Sandwell (other membersof the West Midlands Healthy Urban DevelopmentGroup – Birmingham, Coventry and Stoke-on-Trent –Section 6 sets out some observations on the factorsAppendix 1 provides a list of key resources andindicates where to look for further information.Appendix 2 is a glossary of key generic terms. planning in the reformsThis section describes the reforms covered by this handbook, andhighlights their relevance for integrating planning and public health.  the National Planning Policy Framework (NPPF) and local plans;  neighbourhood planning and community involvement; and  housing growth, quality and affordability.  health and wellbeing boards;  Joint Strategic Needs Assessments (JSNAs) and Joint Health andWellbeing Strategies (JHWSs);  clinical commissioning groups (CCGs); and  the Public Health Outcomes Framework.healthier homes,healthier communities Elements of the new system and their relevance to New housing inKnowsley by FirstArk Group – theauthorities andto collaborate onhousing growth andnew services tosupport healthycommunities National Planning Policy Framework (NPPF) and ‘The planning system can play an important role infacilitating social interaction and creating healthy,inclusive communities.’National Planning Policy FrameworkThe National Planning Policy Framework (NPPF)decisions and policies. Published in March 2012, it‘contribute to the achievement of sustainabledevelopment’ (para. 6). This includes but is not limited to:replacing poor design with better design;improving the conditions in which people live, work,travel and take leisure; andwidening the choice of high-quality homes.In line with the Government’s commitment to localism– where decisions are taken as closely as possible tothe communities affected – the NPPF says that localplans and planning decisions need to take local National Planning Policy Framework. Department for Communities and Local Government. March 2012.http://www.communities.gov.uk/planningandbuilding/planningsystem/planningpolicy/planningpolicyframework/2Annex 3 of the NPPFgives a full list of revoked policies healthier homes,healthier communities Box 1The duty to co-operate –why does it matter for health? Section 110 of the Localism Act introduces the duty to co-operate, and the NPPF provides further policy guidance.The duty means that local planning authorities (LPAs) and other bodies need to show evidence that they haveworked with each other when preparing their local plan.The duty applies where there is likely to be a significant impact across local authority boundaries – for examplewhen providing health, security, community and cultural infrastructure. It will be most relevant in two-tier areasand for authorities that are experiencing significant growth pressures along their boundaries. Both county andKey elements to note:  LPAs must co-operate with other organisations, including primary care trusts (PCTs), in plan-making.Regulation 4 of the local planning regulations gives PCTs legitimacy and equal representation alongsideagencies such as the Homes and Communities Agency. With the abolition of PCTs from April 2013 under theHealth and Social Care Act, clinical commissioning groups or the health and wellbeing boards may take onthis function.  In two-tier areas the county council is the responsible local authority for health and needs to be engaged bydistrict councils in relation to strategic matters around health infrastructure.  LPAs need to demonstrate evidence of co-operation as part of the examination in public of the local plan.This evidence could include a memorandum of understanding with health and wellbeing boards, or could beimprove access to healthy food and reduce obesity Relevance for health and planning The NPPF requires planners to consider health in arange of different ways.The framework’s presumption in favour of sustainabledevelopment highlights the importance of achievingsocial, economic and environmental objectiveson promoting healthy communities, which states thatthe planning system can play an important role infacilitating social interaction and creating healthy,inclusive communities. This will include measuresaimed at reducing health inequalities, improvingaccess to healthy food and reducing obesity,encouraging physical activity, improving mentalhealth and wellbeing, and improving air quality totransport, delivering a wide choice of high-qualitymaking and planning decisions to take account of andsupport local strategies to improve health, social andcultural wellbeing, and to deliver sufficientlocal needs. One way to meet these multiple localobjectives could be through large-scale developmentbased on the Garden City principles. The NPPF setsand the TCPA has recently defined these in a reportCreating Garden Cities and Suburbs Today(LPAs) to work with public health leads and healthorganisations to develop a robust evidence base thattakes into account future changes and barriers toimproving health and wellbeing. In two-tier areas thedelivered by district councils. This might add a layerPractitioners need to make sure that the local plan isNPPF’s guidance on health and wellbeing outcomes.Section 4 of this handbook provides a checklist with aCreating Garden Cities and Suburbs Today. TCPA, May 2012.http://www.tcpa.org.uk/data/files/Creating_Garden_Cities_and_Suburbs_Today.pdf healthier homes,healthier communities Midlands Metro and Sandwell College – the NPPF promotes sustainable transport and high-quality design, which can both improve community involvement‘If you care about where you live,you should careabout planning.’Your Place, Your PlanA new level of planning is enshrined in the LocalismAct. Neighbourhood planning gives communities theopportunity to prepare a neighbourhood plan, whichplan. Parish or town councils, or neighbourhoodthe plan, which must win more than 50% support if itbecomes a legal part of the decision-making processNeighbourhood Development Orders – theseremove the need for certain developments toCommunity Right to Build Orders – these removethe need for planning permission for certainfor local authorities in supporting neighbourhoodcommunities to participate effectively. It is worthto include communities in planning. These include area Relevance for health and planning organisations have greater statutory support to takepositive action to improve their health and wellbeingimproving the quality of the design of new buildings. There is considerable overlap betweenMarmot Reviewon engaging and empoweringcommunities as part of an overall approach tocreating healthy communities. provision of health infrastructure and other localfacilities. This process guarantees the involvement,councils/forums that are preparing neighbourhoodplans or orders. They must also consult bodies thatdisabled people, black and minority ethnic (BME)groups and Healthwatch. LPAs are obliged to support neighbourhood planningprocesses, and an obvious way to do this is bysharing information that can inform the plan’sevidence base. This should include JSNAs and, whenunderstand the existing needs in an area and howthey might be tackled. Your Place, Your Plan. TCPA, March 2011. http://www.tcpa.org.uk/data/files/your_place_your_plan_guide.pdfFair Society, Healthy Lives. The Marmot Review. Strategic Review of Health Inequalities in England post-2010, February 2010.http://www.instituteofhealthequity.org. The Government’s Public Health White Paper – Healthy Lives, Healthy PeopleNovember 2010. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_121941) – endorsMarmot Review policy objective to create sustainable and healthy communities healthier homes,healthier communitiesKeeping residents informed at Easton, Bristol – neighbourhoodplanning can help to address a community’s health needs andempower people to take decisions about their local area Health and wellbeing boards‘The health and wellbeing board is where an awful lotof the influence is… you need to identify your route toget to it.’Paul Southon, Public Health Development Manager,Sandwell PCTFrom April 2013 health and wellbeing boards will be astatutory committee of upper-tier local authoritiesassess the current and future health and social carepromote integration and partnership workingbetween the local NHS, local government and otherlocal services;improve democratic accountability for the planningbring oversight and strategic planning to majorHealth and wellbeing boards have a core membership,as laid out in the Health and Social Care Act 2012, of atleast one elected councillor, a representative of eachsocial services, the director of children’s services and arepresentative from the local Healthwatch. In two-tierareas, the board is a committee of the county council,and there are challenges in adequately and fairlycreating a board that is too unwieldy to makedecisions effectively. Watch Out for Health:AChecklist for Assessing the Impact of Planning Proposals. NHSLondon Healthy Urban Development Unit, 2009, p.6.http://www.healthyurbandevelopment.nhs.uk/documents/integrating_health/HUDU_Watch_Out_For_Health.pdfLaying the Foundations: A Housing Strategy for England. HM Government, November 2011.http://www.communities.gov.uk/publications/housing/housingstrategy2011Policy Analysis of Housing and Planning Reform. TCPA, March 2011. http://www.tcpa.org.uk/data/files/tcpa_jrfpolicyanalysis_final_report.pdf Housing growth,quality andaffordability‘Access to decent and adequate housing is criticallyimportant,especially for the very young and the veryold in terms of health and wellbeing.’Watch Out for HealthThe Localism Act sets out a range of reforms to socialhousing, and the Government’s Housing Strategypulls these together with other development incentivesand initiatives to stimulate the market and promotebetter design. The NPPF also sets out policies forhousing, including a new definition for affordableIt is important that the overall impact of the housingand planning reforms, including new incentives such as the New Homes Bonus and changes to Relevance for health and planning The overarching message from the Housingin the social and private sectors is crucial to ourhealth and wellbeing. This is where planning canplay a positive role, particularly through pursuing agood evidence such as JSNAs.Requiring that new developments meet certainhelp to improve health and wellbeing outcomes.Another approach is for public health specialists andplanners to work through organisations that arecloser to local populations – in particular those whoare well placed to see at first hand the healthwider environment, such as social housingproviders. Relevance for health and planning Health and wellbeing boards may choose toglossary in Appendix 2) into these priorities, and thiswill be of particular interest to planning.How they do this is for local places to decide. Forexample, Knowsley and Sandwell have appointedtheir Head of Place (or equivalent) to the health andwellbeing board. In other places, such as Gatesheadadvised on environmental inequalities by a subgroup.healthier homes,healthier communities Joint Strategic Needs Joint Health and WellbeingStrategies (JHWSs)One of the core planning principles is to ‘take accountof and support local strategies to improve health,social and cultural wellbeing for all,and deliversufficient community and cultural facilities andservices to meet local needs.’ National Planning Policy Framework Clinical commissioning groups (CCGs) and upper-tierJoint Strategic Needs Assessments (JSNAs). TheHealth and Social Care Act 2012 requires that JSNAprocesses involve district councils and anyone wholives and works in the area. The priorities within Joint Health and Wellbeingidentified in JSNAs, and will be shaped by views gainedfrom involving the community. Alyson Learmonth,Director of Public Health at Gateshead (until May2012), notes that data and statistics are important butthat you need to add your understanding about ‘whatworks locally, local opinion and councillor views’. Relevance for health and planning The TCPA’s  housing quality and design;  transport; economic regeneration, employment and skillstraining; access to and provision of local services;  community safety and crime;  access to fresh food; and  risk and vulnerabilities to climate change impacts. Spatial Planning for Health:A Guide to Embedding the Joint Strategic Needs Assessment in Spatial Planning. TCPA and the Hyde Group,November 2010. http://www.tcpa.org.uk/pages/spatial-planning-for-health-guide.html healthier homes,healthier communitiesResidential community garden, Knowsley – planners should use health needs information to inform both local plans and infrastructure planning ‘It needs to be clear to GPs how planning relates totheir locality and to their patients,but it’s important tounderstand that currently this isn’t at the top of theirlist of things to worry about.’Liz McDougall, Health Improvement Coordinator, Bristol From April 2013 the majority of local health servicesof local general practices. Each CCG will have agoverning body that will also include at least onenurse and one doctor who is a secondary carespecialist, and two lay members. This change is part of the Government’s vision ofare best placed to understand the services that theirBoard (NHS CB). There is a phased timetable for thisprocess:by April 2013 all of England will be covered byhealthier homes,healthier communities 12 Relevance for health and planning As part of the authorisation process, each CCG needsto demonstrate that it is engaged with the health andwellbeing board. This includes participating in both aensuring that its own commissioning plan takesdifferent responsibilities for both levels of localrepresentatives accept that developing actions totackle the social determinants of health is unlikely authorisation process. But engaging with JHWSsrenovation of a local park to include an outdoorinfrastructureplanning process The body responsible for improving the health andin health and wellbeing outcomes is Public HealthEngland (PHE). Its role will include ‘delivering,supporting and enabling’ improvements in health andwellbeing set out in the Public Health OutcomesFramework.PHE does not begin its role officially untilApril 2013, although it is already establishingpartners, including local government. Improving Outcomes and Supporting Transparency. A Public Health Outcomes Framework for England 2013-16January 2012. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_132358Building a People Transition Policy for Public Health England. Department of Health, February 2012. http://www.dh.gov.uk/health/2012/02/phe-transition/ Framework‘There are many factors that influence public health…They all need to be understood and acted upon.Integrating public health into local government willallow that to happen.’ Public Health Outcomes Framework for England 2013-16The Public Health Outcomes Framework sets theinterventions they will make. It sets out twooverarching outcomes: increased healthy life expectancy; andreduced differences in life expectancy and healthyhealthier homes,healthier communities Relevance for health and planning The framework has four domains with supporting indicators, as shown in Table 1; the Table 1Public Health Outcomes Framework domains Domain Improving the wider Health improvementHealth protectionHealthcare public health andpreventing premature mortality Indicators relevant to planning Killed or seriously injured casualties on England’sroads Utilisation of green space for exercise/health reasons  Fuel poverty  Older people’s perception of community safety [this is a ‘placeholder’indicator,which means that majorwork is still required to develop the rationale andtechnical information]  Excess weight in 4-5 and 10-11 year olds  Excess weight in adults  Proportion of physically active and inactive adults  Self-reported wellbeing  Air pollution  Public sector organisations with board-approvedsustainable development management plan  Mortality from respiratory diseases getting startedOne of the overwhelming messages to come from the case studies andconversations that form the basis of this handbook is: ‘Do something toget started, however small.’Knowing where to start can be daunting when change seems to beeverywhere. This section includes examples of actions that are led byplanners, by public health specialists, and by both professions workingtogether. Each action is supported by a brief explanation of why it isimportant and examples from the case studies on how to do it. There are no rules for what will work where: readers will need to use theirknowledge of local priorities, policies and politics and assess the bestways to influence health outcomes in their area.healthier homes,healthier communities Ideas to help planners and public healthspecialists to integrate their work to implementthe NPPF and other reforms space,St Jude’s,Bristol – publichistory of improvingthe places wherepeople live Remember the shared origins Public health specialists interviewed for the handbookwere united on one piece of advice: don’t suggest toplanners that health is a new thing for them toconsider. Public health and planning were joined at the statutoryhip a century ago. And it remains true that much of theSo talking to planners as if this is new territory isunlikely to go down well. Alyson Learmonth, formerDirector of Public Health at Gateshead, recalled anearly meeting with senior planners where afterwardsone of them said to her that planners do get ‘a bit fedup with people from public health thinking we haven’tthought about any of this’. Said Alyson: ‘I have bornethat in mind ever since. People in planning have beencalled that but it is part of what you do when you’re atown planner.’can give planners a renewed sense of what planning isfor. Chris Pagdin, Head of Planning and Transportationat Luton, says that: ‘Sometimes planners can gets can getre-awaken that sense of standing up for the widerobjectives of the planning system.’healthier homes,healthier communities What planners and public health specialists can do and working together. What planners can do:  Review the local plan for compliance with NPPF health policies  Engage public health on major planning applications  Involve health in infrastructure planning  Conduct health impact assessments (HIAs)  Measure planning’s influence on health and wellbeing outcomesWhat planners and public health specialists working together can do:  Encourage your directors  Help elected members to understand the links between planning and public health  Develop a collaborative evidence base  Engage clinical commissioning groups (CCGs)  Improve how you communicateUnderstand the role of elected members Review the local plan for compliance with NPPFhealth ‘The NPPF has made it a bit easier to plug health intoour draft local plan… it is making a difference.’Angela Hands, Public Health Practitioner, Coventry Why? starting point for decision-making, and emphasises theapproving proposed developments without delay.From April 2013 development proposals will beapproved in areas where plan policies are absent,If a local plan does not have any health-orientedNPPF will have greater weight. This is both anopportunity and a challenge. Understanding the quality and capacity of health andand is an important part of getting a local planHeads of planning need to make sure their local planconforms with the NPPF, including the requirementthat it promotes healthy communities and takes intoaccount and supports the JHWS.closely with the county council, which is responsiblefor relevant services such as waste, minerals,transport, education and social care, and the countylevel public health service (which from April 2013 will How? A checklist to help practitioners assess whether theyhave adequately considered the NPPF’s health andwellbeing elements is presented in Section 4 of thisThe authors have also selected a list of examples ofrecent and forthcoming local plans (also called corestrategies) that include health-specific policies. This isavailable as an online resource on the TCPA website, at http://www.tcpa.org.uk For example, Gateshead and Newcastle’sjoint draft  development promotes and positively contributes tocreating a healthy and equitable living environment;  the roles of allotments, garden plots and farmers’markets in providing access to healthy, affordablesafeguarded and, where appropriate, opportunitiesfor unhealthy eating are restricted; and  a health impact assessment is prepared as part ofBristol’score strategy (local plan) has an objective tocreate ‘a pattern of development and urban design thatpromotes good health and wellbeing and providesgood places and communities to live in’. Its draftDevelopment Management Policiescauses of ill-health, improving health and reducingwellbeing will not be permitted.’Sandwellis the Black Country corestrategy. This plan is unique in that it contains a planners reuniting health with planning healthier homes,healthier communities 16 Three Acre Market Garden, Sandwell – Sandwell’s Black Country core strategy considers access to fresh food when assessinghousing proposals planning applications ‘Policy links between health and planning inevitablyneed to be translated into physical development ifthey are to effect change.’ Why? and impact of a development when investing in theassessment of the application (taking a ‘proportionate’approach). Deciding what is proportionate is mademore challenging by the widespread cuts to planningbudgets. One way to fulfil this requirement is tocould make the best contribution to achieving the localvision and objectives, or to clearly set out approachesfor different scales of development. A local plan willneed to set out how an area will improve health andwellbeing, and this is a reason to involve public healthpublic health expertise will be at county level. Thecounty’s capacity to respond to requests to assessfactors, including the number of applications they mayreceive from the multiple districts in the county area. How? development management protocol in May 2011. As aresult the Public Health Directorate is included in pre-application discussions on ‘super’ major developments(for 100 or more dwellings, or 10,000square metres offloorspace) and is formally consulted on all planningapplications for major residential (10 or more dwellings)and non-residential (1,000square metresof floorspaceand above)developments, proposals that would resultfor the establishment of A5 (food and drink) uses. CoventryNHS Coventry located within the City Services andDevelopment Directorate (which includes planning).One of her first tasks was to set up a system so that Involve health in infrastructure ‘The local infrastructure plan is really importantbecause it is about the whole range of fundingopportunities – Community Infrastructure Levy,section 106,mainstream funding programmes.Healthservices should be around the table.’Tim Chapman, Spatial Planning Manager, ATLAS Why? An infrastructure plan should set out objectivelycosts, funding sources and responsibilities for delivery.various public and private sector sources of fundingand investment. Some sources will be availableCommunity Infrastructure Levy (CIL). CIL is a charge onthe specified development, to contribute towards aIt is important for health to be represented when localpreparing their CILcharging schedules. There arepotential opportunities as CIL can be used to help toprovide new health facilities needed as a result of newdevelopment. For example, Huntingdonshire Districtand running. It is charging an £85 standard rate for alldevelopment types, which includes a contributiontowards Hinchingbrooke Hospital’s Critical Care Centre(estimated to cost £7.5million). Historically, section 106 planning obligations orsource for new or improved infrastructure. However,the process for securing contributions to offset theimpact of a development, such as the need it createsfor a new GP practice, is changing. The changes limitthe use of planning obligations on site-specificmitigation measures (in line with the introduction oftowards, and avoid double-charging for infrastructurein areas where a CIL schedule is in place. where investment from a range of partners and12A. Ross:Plugging Health into Planning:Evidence and Practice. Local Government Group, June 2011, p.25.http://www.idea.gov.uk/idk/aio/28692849 reuniting health with planning healthier homes,healthier communities 17 sources should be pulled together, it is unclear forsome of the case study partners how the process ofputting this plan together will involve newstakeholders such as clinical commissioning groups(CCGs). This process may also need to includenegotiation over the spatial implications ofdecommissioning some services or of shifting theirlocation – for example from a hospital into community-based settings. How? KnowsleyJoint Strategy Unit, which is preparing the CIL. Birmingham’sthe LPA’s consultation on the city’s CIL. Kyle Stott,Health Improvement Specialist at Birmingham Publicin some ways at odds with the way that public healthwould prefer to work: ‘It’s OK asking us what we think wemight like generically, but it’s not very easy to answerbecause we are evidence-based and we are reactive aswell. So ideally we would like to know more about adevelopment first; then and only then would we lookat that area and work out what the priorities are.’Knowsleylocal enterprise partnerships to identify ways ofattracting more funding for a key objective for bothcouncils, with significant impacts for health: providingmore affordable housing. Hyde Housing Associationworking with the London Borough of Southwark todeliver over 900 new homes by 2013, two doctors’surgeries, a dentist’s surgery, a pharmacy and severalre-landscaped open spaces. The council and Hydemarket changes to make the scheme commerciallyviable while ensuring the facilities and new affordablehomes were delivered. For example, Hyde was able torenegotiate with the PCT on size, access, layout andparking at a site earmarked for a health centre at thenew development, to accommodate the PCT’s newspace requirements and keep the centre on-site. Thescheme’s design, space standards and sustainabilityDespite its high density (over 1,000 habitable roomsper hectare), the scheme boasts a large amount oflarger and better laid out homes. Conduct health impact assessments (HIAs) ‘Testing out an HIA together is really useful.Everyonehere has benefited from that.’Judy Kurth, Healthy Cities Programme Manager, Stoke-on-Trent City Council Why? proposal/masterplan. The earlier it is commissioned, themore influence it can have. HIAs are not compulsory,but the case study areas report that they are a goodway of getting traction between planning and publichealth because of their potential to foster betterworking relationships and a shared understanding.Some councils already set out a local plan requirementthat planning applications for a certain size ofdevelopment are accompanied by an HIA. Cumulatively,HIAs may help to improve health outcomes in a locality.Publishing information and guidance on HIArequirements to support LPA policies will providecertainty about what is required earlier in the process. How? Sandwellhas undertaken six ‘table top’ HIAs onspatial masterplans. There is a cross-agency workinggroup for these HIAs which includes public health,planning, economy and jobs, and anti-povertyspecialists. This has helped to develop a sharedunderstanding of the issues.Planners at Stokehave prepared a draft Healthywhich requires HIAs for large-scale major planningapplications. This proposal builds on a history of jointworking between public health and planning. Plannersrequested a supporting HIA review service to check thatHIAs that are submitted with applications are of a highstandard. Public health has commissioned this service. early meetings between planners andthe Director of Public Health led to public healthofficers commissioning a rapid HIA of a proposedmajor retail development. The authority, as landowner,approval. This experience spurred planners and publichealth specialists to include in the draft core strategy planners reuniting health with planning healthier homes,healthier communities 18 Measure planning’s influence on health and wellbeing ‘Monitoring and review is a vital component of effectivestrategic planning and for understanding ‘what works’.’Sarah Davis, Senior Policy and Practice Officer, Chartered Institute of Housing Why? Planners should work with health authorities tomonitor the individual and cumulative impact of, andpositive outcomes from, development proposals, whichcan then feed back into the policy-making process.review, this will help to inform the next round of plan-making, and could form part of the evidence base. It willservices could be improved and made more effective. How? This is an area that needs further development at locallevel. The Spatial Planning and Health Group (SPAHG)suggests four ways that local areas can improve how  objectives set out in the local plan;  use the monitoring mechanisms set out in thestrategic environmental assessment (SEA) process;  ensure the health and wellbeing board considerstheeffectiveness of work to link planning and health; and  ensure that scrutiny committees agree a protocol forintegrated scrutiny of planning and health issues.The TCPA’s an example from the London Borough of Brent, whichuses an indicator to monitor the amount of floorspaceevery increase of 1,500 people in the population. It alsohighlights the previous government’s guide to monitoringwhich suggested thatLPAs report policies against the percentage of newtransport of a GP, hospital and a major health centre.Both indicators are appropriate for NPPF policies forhealth infrastructure provision and access.Steps to Healthy Planning: Proposals for Action. Spatial Planning and Health Group, June 2011. http://www.spahg.org.uk/Local Development Framework Monitoring:AGood Practice Guide. Office of the Deputy Prime Minister, March 2005.http://www.communities.gov.uk/documents/planningandbuilding/pdf/147438.pdf reuniting health with planning healthier homes,healthier communities 19 The Derwent Walk, Gateshead – conducting an HIA can be a – which develops joint planning policy for West Lindsey,North Kesteven and City of Lincoln District Councils,scope of a (statutory) sustainability appraisal to includehealth and equalities impacts. Officers from the JPUundertake the IIA on draft policies. These assessmentsestablished by the JPU, which includes a representativefrom the neighbouring county area of South EastLincolnshire (South Holland and Boston Councils), fromone of the equalities teams at West Lindsey, NorthKesteven or City of Lincoln Councils (on rotation). TheIIA approach has been welcomed by NHS Lincolnshirefor improving health considerations. The CentralLincolnshire Joint Strategic Planning Committee –which includes councillors from the county and thethree district councils – also feels it is more user-friendly compared with receiving multiple impactreports, and is a more efficient use of officer time. Focus on topics that matter ‘The data from the public health intelligence team hasexcited planners because they have never had thislevel of information before… they just weren’t aware it existed.’Kyle Stott, Health Improvement Specialist, Why?The case study areas stress that each place will havedifferent priorities. But these may not necessarily benationally or locally.To have influence it will be important to demonstratehow you can help to address the issues that mattermost to elected members and local communities. With the inclusion of health in the NPPF, assemblingrobust evidence to inform policies to improve healthand wellbeing will now be important in justifying theHow?Public health officials at innovative approach to finding out what matteredlocally. They monitored the local press closely to seewhat topics came up repeatedly, and which of thosethey felt they could influence. They eventually chosethe proliferation of hot-food takeaways, based oncomplaints that they caused litter, anti-socialbehaviour, noise, and so on. This led to updatedguidance on hot-food takeaways in a new shopping(SPD). Adopted in March 2012, the SPD includes apolicy that no more than 10% of units in a set of shopsshould be hot-food takeaways. In the first month afteron this policy., community health workers have workedwith strategic policy-makers on a series of healthyneighbourhood checks. These explore with the localcommunity those factors in their built environmentthat support health and those that limit choices for ahealthier lifestyle – and identify opportunities forassociated actions. They consist of a half-daywalkabout with local residents, workers andcouncillors and a plenary session based around threeWhat are the opportunities for improvement?practitioners in the food industry in Sandwellthe 1980s. The area has a long history of food growingand supporting community agriculture, which ties intowork on anti-poverty and sustainable development. Bycontinuing to focus on this important local issue,public health practitioners have intertwined publichealth principles into waves of successful project workand food policy development. Sandwell has achievedstructures. However, it is now developingtransformational change by adopting a food systemsapproach to achieve multiple outcomes at all scales –(including planners). healthier homes,healthier communities public health specialists Bristol’s healthy neighbourhood checks involve residents inidentifying opportunities to improve health locally Understand the role of elected members‘We can encourage people to exercise properly but ifthey haven’t got a decent green space or the right20mph zones they're not going to do it… the decisionsthat councillors make have a massive impact.’Paul Southon, Public Health Development Manager,Sandwell PCTWhy?be operating in an environment where electedmembers are democratically accountable for thedecisions they make. Elected members influence planning decision-makingin a range of different settings. Councils have differentstructures, but most are likely to have an executivemember for planning, housing, transport and (now)public health. They will also have regulatorycommittees, including one or more for planning, whichmake decisions about planning applications. Somecouncillors are also members of scrutiny committees,which investigate how local authorities and partnerscan improve what they do. All councillors represent award and have an advocacy role for health andadded complexity of influencing councillors at bothcouncillors given different political complexions andresponsibilities. Public health specialists may find thatthey need to spend time understanding these tensionsas they will become county council staff from April2013; there may be a perception at district level thatview. How?and wellbeing board to help relevant councillorsunderstand the new reforms and to increase the linksto the wider work of the council. The sessions alsoprovide an opportunity for public health staff to hearthe views of members. The council has a portfolio-holder for public health who acts as a champion forgetting councillors to address the social determinantsEngage a variety of stakeholders‘A public health specialist can help to create a dialoguewith a variety of different stakeholders around healthand wellbeing,which is often quite difficult for peoplefrom within planning to do.’Alyson Learmonth, Director of Public Health (until May 2012), Gateshead CouncilWhy?intervention and an improvement in health is verydifficult to do. However, the evidence of the linksbetween environmental quality and people’s healthcontinues to grow. To create healthier environments,public health specialists will also need to engage withtransport, regeneration, environmental health, climatechange and sustainability. located in a different organisation. By 2013 public healthwill be an upper-tier local authority responsibility; insome places, such as Luton and Stoke, these teamshave already transferred to the council.How?Knowsleyrange of services that affect health. They already have akey role in the lives of many of the people with the worsthealth, and have a network of housing officers andcommunity involvement processes established. However,it is challenging to find a way to channel the multiplicityof landlord views via one representative organisation.Lisa Harris, Service Director for Regeneration, Knowsleyhealth within the council will build capacity in this area. a memorandum of understanding wassigned in 2010 between the four local authorities andthe health sector in the West of England to promoteeffective co-ordination and co-operation between theorganisations in relation to transport and health. Thishas led to the creation of the West of England Healthand Transport Forum which brings together publicambulance service and transport planners. healthier homes,healthier communities 21 reuniting health with planning healthier homes,healthier communities planners and public health specialistsworking together decisions on most matters, while counties areresponsible for local plans on waste and minerals, andfor planning decisions relating to these matters andtheir other strategic responsibilities (such as transport).districts and the county are to be engaged adequately. How? To help embed public health priorities for action intoHealthy Urban Development Group. The group issenior managers from public health, planning andSandwellHealthy Urban Development Unit(SHUDU) was set up to improve joint working betweenspatial planners, transport planners and public healthspecialists – over time this remit has expanded toinclude issues such as community agriculture, food andMembers include the cabinet member for jobs andeconomy, the PCT chair and officers from across thecouncil and the PCT. To improve co-ordination and raise the profile of thefood agenda, a cross-departmental Food InterestsGroup was set up in ,including healthrepresentatives. Planning issues that have come upinclude land for food growing, markets, hot-foodtakeaways, access to food, retailing, and protectingWho Feeds Bristolreportand the setting up of the Bristol Food Policy Council. Encourage your directors ‘People who are leading the directorates of publichealth,planning,and environment need to understandthat there are mutual benefits of working together.Ifyou don’t have that then it is always difficult.’Chris Pagdin, Head of Planning and Transportation, Why? From April 2013 the director of public health will be astatutory role within upper-tier authorities (unitaryauthorities and county councils), and will report directlyto the chief executive. Directors of public health willtherefore be influential individuals within a council.They should already have an understanding of the roleand wellbeing of the local population. Directors ofplanning directors: the NPPF says that LPAs should‘work with public health leads and health organisationsto understand and take account of the health statusand needs of the local population’ (para. 171). Notethe structures of upper-tier authorities in differentways. For example, Gateshead’s public health team islocated within the Community Based ServicesDepartment of Public Health. It is too early to say whatmodel will be the most effective for integrating publicHowever, planning responsibilities are divided Local centre in Sandwell – planning and public health can bring a cross-cutting focus to issues such as access to healthy food Help elected members to understand the links between ‘Better housing,employment,education,social careand environment are not only important inthemselves,but are essential – perhaps the mostimportant – factors in improving the health of thecommunity.’Councillor Martin Gannon, Deputy Leader, Why? Creating healthy places in which to live does nothappen by accident. Such places need advocates andchampions. As local representatives, no-one is betterplaced than elected members to make the connectionsbetween healthy environments and improvements inCCGs and others and their wider implications.Councillors will be only too aware of the health problemsin their locality, even if they aren’t using the samelanguage to describe what they encounter. Paul Southon,Public Health Development Manager at Sandwell PCT,reflects that the term ‘health inequalities’ doesn’tresonate for councillors in his area. However, Sandwell’selected members are passionate about increasing theamount of paid work locally and understand the valueof a community-based asset approach to developingresilient places. Public health and planning can usethese hooks to achieve the same health outcomes. How? Gateshead’sThe theme is supported by a Place-shaping forWellbeing group, chaired by the council’s GroupDirector of Development and Enterprise, which reportsback to the health and wellbeing board. One of theboard’s members, Deputy Leader Councillor MartinGannon, says that the key to keeping this on theboard’s agenda will be to develop a ‘tight set ofobjectives that, whilst challenging, are achievable andclearly demonstrate the positive health impacts thatcan be achieved’.Sandwell’sMarmot objectives as its framework for settingpriorities. The board includes the council’s Corporatetransport and other environmental responsibilities. Thisprovides a direct link between planning and thepriorities of the health and wellbeing board. Thisenvironment is a result of the long-term influence ofthe Director of Public Health. different stages of integrating health and planning.there is some concern about the impact on developersof adding further assessments and about the extraworkload for development management planners. Inraise member and officer awareness of the potentialorganising a county-wide conference to highlight theAs part of his work on hot-food takeaways, the publicmember who he knew was concerned about thenumber of premises and impacts such as litter, parkingproblems and anti-social behaviour. The memberthe scale of the issue. Member support has since beenkey to pushing the agenda on restricting the numberof hot-food takeaways in the city.Planners at try to get member support byobjectives, one of which is to improve health andwellbeing. This makes sense in planning terms andindirectly helps members to understand howimproving the quality of the environment contributesto a range of outcomes, including better health. healthier homes,healthier communities 23 Develop a collaborative evidence base ‘Planners know about evidence because of the natureof their job,so that is a common understanding;mapping is a common understanding;so it’s aboutwhat you share and about learning the language soyou can talk both.’Paul Southon, Public Health Development Manager,Sandwell PCT Why? The Department of Health will be producing statutoryshould be formatted. However, in order to be a usefuland robust evidence base on environmental factorsThe NPPF makes reference to the requirement forevidence around health and wellbeing needs. Plannerscan use JSNAs as part of their proportionate evidencefurther studies. How? ‘Better planning – design a healthy city with greenspace and less congestion and pollution to improvepeople’s health and wellbeing’ is one of the 12 priorityBristol’sJSNA. Reciprocal links arebeing made between the JSNA and the local plan’sannual monitoring review.Sandwellhas established the first environmentalpublic health tracking system in Europe. This is acombination of surveillance, horizon scanning,exposure assessment, research and the integration ofoutcomes. It includes routine background surveillanceof environmental hazards and environmentally relateddisease. Work to date includes analysis of public healthnuisance, the efficacy of local authority practice, localhorizon scanning, and the use of industrial qualitycontrol methods to target interventions to tackleenvironmental hazards. planners and public health specialistsworking together reuniting health with planning healthier homes,healthier communities 24 Windmill Hill City Farm Allotments, Bristol – local plans can help to secure access to green and food-growing spaces Engage clinical commissioning groups (CCGs) ‘GPs are now much more aware that they need to getout into the local community and talk to local peopleand understand their needs;they realise that theycan’t do everything sitting in their GP practices.’Morag Stewart, Deputy Director of Public Health, Why? connections to JSNAs and JHWSs, which are likely toinclude aspirations to improve the local environment.In due course CCGs will need to make decisions abouthow and where they will provide services in the future.beneficial conversations on matters such as co-location How? To help engage CCGs in the social determinants ofbenefits for improving health. The group identifiedhousing quality (which had already been highlighted indemonstrate how investing in better housing couldadmissions). This led to the strategic health authorityfunding some improvements to local housing stock: bythe end of May 2012, hazards had been removed fromfeedback has been received from residents who havebenefited, and early indications are that Accident andEmergency admissions for the over-50s in the priorityneighbourhood have decreased in early 2012.Planners at staff around Luton and Dunstable Hospital as theyaway from the congested hospital site to other parts ofthe town. Planners hope that by engaging early theymight be able to influence hospital managers toprovide some services in areas that the local plan maydesignate as district and neighbourhood centres. Thiswould make it easier for people to travel to them bypublic transport and would help to stimulate furthergrowth and activity in these centres. As part of its regular scanning of planningSandwellfor a new nursing home. It used this as an opportunityon the application by the developers (they hadn’t).health team and planners are keen to maintain it. healthier homes,healthier communities 25 Improve how you communicate ‘Good writing is where the meaning is so clear that noreader can possibly misunderstand you or be puzzled.’Mind the Gaffe Why? glossary in Appendix 2 for an outline of key planningand public health terms). In the past, these differenceshave made it daunting for many individuals to tellare learning how to bridge this divide. As public healthmoves to local authorities there is more incentive tomake sure that people understand each other. Improving how you communicate and presentstory goes that in some local authorities councillorsare banning staff from using graphs and pie charts inpresentations because they don’t like or understandthem. They prefer pictures. While there is no need to abandon Excel completely,can convey some aspects of what healthy places looklike, and could perhaps help to inspire people who finddata intimidating or difficult to interpret. How? Gateshead’sDirector of Public Health organised aworkshop as part of the consultation on thepreparation of the city’s joint core strategy withNewcastle. This included providing funding for theparticipation of a health and planning specialist whowas skilled at bridging these different areas. It wasfollowed up with workshops around particular areas ofconcern attended by urban designers, planners,regeneration officers and public health professionals. Birmingham’sgenerated a map of all the hot-food takeaways in thecity. It identified more than 1,000 premises; otherversions show the proximity of schools to these shops.Feedback from councillors and officers is that this wasa very powerful way of demonstrating the level ofLincolnshire’sinteractive website, hosting data for all seven districts.The user-friendly format presents data on mapswherever possible and gives a very strong indicationof the spatial distribution of different needs. It alsoincludes full qualitative interpretation of the datasetsto help users to understand what they are viewing. Since 2000 the health service in and planning teams at the council. This link has beenimportant for raising the awareness of healthearly as possible). It has also helped planners totalking to non-planners.15R.L. Trask:Mind the Gaffe:The Penguin Guide to Common Errors. Penguin Books, 2001 healthier homes,healthier communities planners and public health specialistsworking together A fast-food outlet – in some places, for example Birmingham, produce guidance on restricting hot-food takeaways 26 reuniting health with planning healthier homes,healthier communities wellbeing checklist This checklist focuses on the key operational policies in the NPPF andPlanning Policy for Traveller Sites. It will help users of the planning systemto consider opportunities to improve health and wellbeing through keyNPPF policies as they relate, primarily, to plan-making, but also to planningUse the questions in the checklist as a starting point for developing policy,gathering evidence and/or conducting pre-application discussions,depending on the stages of the local plan process you are involved in. The degree of influence and your capacity to contribute will depend on thestage the local plan is at. Engagement earlier on in the preparation processwill be of more benefit than simply responding to consultation at the draftplan stage or at the examination in public. When considering the questions in the checklist, first answer the following:  What stage is your local plan at (review, issues and options, preferredoptions, publication draft, examination in public)?  How can you positively and appropriately influence your local plan at its  Are there existing corporate or informal joint structures or processesalready set up that you can tap into?  What existing evidence do you have, does it need updating, and/or doyou need new evidence?healthier homes,healthier communities Links between the National Planning PolicyFramework and opportunities to improve healthand wellbeing Achieving sustainable developmentPlanning system to perform a social role, supportingstrong, vibrant and healthy communities, and creating ahigh-quality built environment, with local services tosupport health, social and cultural wellbeing (para. 7,Planning which takes account of and supports localstrategies to improve health, social and cultural wellbeingfor all, and delivers sufficient facilities and services tomeet local needs (para. 17, final bullet point).Promoting sustainable transportLocal plans and policies should protect and exploitopportunities for the use of sustainable transport modesRequiring good designPolicies and decisions to ensure that developmentsaccessible environments, and incorporate green spaces(para. 58, first, third and fifth bullet points).Promoting healthy communitiesLocal planning authorities should create a shared visionwith communities, and aim to involve all sections of thecommunity in the development of local plans and inplanning decisions (para. 69).To deliver the social, recreational and cultural facilitiesPlanning policies for open space, sport and recreationbased on assessment of need and provision (para. 73).Does your local plan reflect this as a key vision,objective or planning priority?How does your plan help to create healthy places toWhat are the local strategies for health and wellbeing,and how will your local plan take them into account?How will your local plan address the current and futurehealth and social care needs and challenges of yourDoes your plan provide a network of routes for walkingand cycling that make this the easiest, safest and mostpleasant option for short journeys (20-25 minutes orabout 2kilometres walking or 8kilometres cycling)?Does your plan promote the use of Design ReviewPanels using CABE’s ten principles?How does your plan promote patterns of development,street layouts, permeability, connectivity and urbandesign quality that support active travel, physicalactivity and mental wellbeing?development by promoting ‘safety in numbers’ andSecured by Design principles?Does your local plan reflect the need to support andimprove health and wellbeing as part of a vision,objective or planning priority?Does your plan create an environment that supportspeople in making healthy choices, and that makesthese choices easier?What processes do you have to involve residents,spaces can be provided through new development?Is the provision of open space advised by the evidencebase demonstrating benefits associated with physicalhealth and mental wellbeing?Is the local authority planning team aware of the needto plan for healthy communities?How are you involving the planning team in theDo you have an understanding of how planning canhelp to deliver local public health priorities?What conversations are you having with planningcolleagues through the Local Transport Plan process?What conversations are you having with colleagues inhealth leads be better engaged and involved in the NPPF policiesQuestions with a planning leadQuestions with a public health lead healthier homes,healthier communities Meeting the challenge of climate change, floodingand coastal changeLocal plans should take account of climate change overthe longer term. New development should be planned toavoid increased vulnerability to climate change impactsConserving and enhancing the natural environment Planning policies and decisions should ensure that newdevelopment is appropriate for its location, taking intoaccount effects of pollution on health (para. 120), andshould avoid the adverse impact of noise on health andquality of life (para. 123, first and second bullet points).Plan-making: using a proportionate evidence baseThe strategic housing market assessment (SHMA) shouldidentify the scale, mix of housing and the range oftenures (para. 159, first bullet point).Local planning authorities should work with otherauthorities and providers to assess the quality andability to meet forecast demands (para. 162, first bulletLocal planning authorities should work with public healthleads and health organisations to understand and takeaccount of the health status and needs of the localpopulation, including expected future changes, andrelevant barriers (para. 171).Planning strategically across boundariesLocal planning authorities should work collaborativelyreflected in individual local plans (para. 179).Do you have a climate change strategy?What, where and for whom are the risks andvulnerabilities to climate change impacts (people,address or mitigate the range of local climate changeimpacts, and implications for health and wellbeing?What, where and for whom are the risks andvulnerabilities to significant impacts from pollution andprevent or mitigate the impacts?housing needs of your population?planning obligations/Community Infrastructure LevyHow can you make better use of JSNAs in plan-makingfor local health needs, changes and barriers?How are you working to embed the health andwellbeing risks identified locally and regionally throughthe climate change risk assessment in the local plan?How can you raise better awareness or presentevidence to planning colleagues to enable them todevelop policies and make informed judgements onappropriate land use activities? How can you be involved in the development of thecouncil’s Community Infrastructure Levychargingschedules and infrastructure assessments, and whatsupporting evidence can you bring to the table?How are you involving the planning team in thedevelopment and implementation of JSNAs?Do your JSNAs include the evidence needs highlightedin this checklist, and is the evidence in a format thatused by your planning colleagues as part of theAre you co-operating with the relevant health bodies in your local plan on the strategic priority of health andcommunity infrastructure provision?What will be the product or evidence of your co-operation: a joint plan or policy, a memorandum of understanding,What mechanisms or structures do you have to continue the process of co-operation?healthier homes,healthier communities NPPF policiesQuestions with a planning leadQuestions with a public health lead 30 Neighbourhood plans should reflect the local planpositively to support them (para. 184).Local planning authorities should consider using LocalDevelopment Orders to relax planning controls, or theuse of Article 4 directions to remove national permitteddevelopment rights to protect local amenity or thewellbeing of the area (paras 199 and 200).Local planning authorities should consider whetheracceptable through the use of conditions or planningobligations (para. 203).Can the parish/town council or neighbourhood forumdemonstrate how it is seeking the views of the widerHow will neighbourhood plans positively contribute tolocal health and wellbeing?Is there scope to relax or restrict certain uses ordevelopments to help to reduce health inequalities?Will planning obligations as part of planningWill planning obligations meet the key tests ofIs public health represented in steering groups for thedevelopment of neighbourhood planning documents?How can you raise awareness or present evidence toplanning colleagues to enable them to develop policiesand make informed judgements on planningLocal planning authorities should ensure that policiespromote, in collaboration with commissioners of healthservices, access to appropriate health services (para. 11,In decisions on applications, weight should be attached topromoting opportunities for healthy lifestyles (para. 24,In co-operating with the relevant health bodies whenWhat level of engagement and involvement do youhave with the traveller community?Is there scope to include travellers in the assessmentsof needs, changes and barriers required in the NPPF?Are you working with planning colleagues to engagetravellers and assess their specific needs for access toDo JSNAs reflect the specific needs of travellers?healthier homes,healthier communities NPPF policiesQuestions with a planning leadQuestions with a public health lead Planning Policy for Traveller SitesQuestions with a planning leadQuestions with a public health lead 31 This handbook is based on experiences gained in six case study areas (asat June 2012):  Knowsley (First Ark Group);  Lincolnshire (with Central Lincolnshire Joint Planning Unit);  Luton; and  Sandwell (the handbook also includes experiences from other membersof the West Midlands Public Health Learning Network – Birmingham,Coventry and Stoke-on-Trent).The case studies were chosen because of the willingness of theorganisations concerned to share their emerging stories as they developtheir response to the reforms set out above. They also have some history ofjoint working and so have valuable lessons to pass on to other areas thatmay only now be starting out. Work in five of the areas is led by the local authority and the healthservice. In the sixth, First Ark Group – a group of four businesses, includingKnowsley Housing Trust – is taking the lead. It sees itself as an organisationthat provides housing but also invests in the wider community to helpmake a positive difference, including improving health and wellbeing. Thegroup’s model provides an insight into the future of registered sociallandlords, using an approach that blends the traditional public, private andvoluntary sector roles. It is an interesting perspective on starting with theneeds of a local community when thinking about how to improve healthand wellbeing.healthier homes,healthier communities Background information on how six different localities are Bristol Progress towards 2013  The health and wellbeing board has 15 members.  Bristol’s Health Improvement Partnership – asubgroup of the local strategic partnership – is stillactive, and the health and wellbeing board iscurrently determining how to manage the  The draft structure for the transition of publichealth staff (120) into the local authority has been organisations and interest groups that want to  The JHWS is being prepared.  The core strategy was adopted in June 2011.planning/housing and other builtenvironment service areas  Narrowing the Health Gap in Bristol: How toMake Sure we Impact on the Social Determinantswellbeing board’s deliberations on how best tomanage its work to tackle health determinants.  and includes representatives from health policy,economic regeneration, transport, planning,children and young people, and health and social The 2012 JSNA includes a section on healthy citiesand the determinants of health that are affected bythe built environment.  Bristol has a Specialist Professional Planner(Healthy Living/Health Improvement) who islocated in the Planning Department and a part-timehealth and transport specialist in the TransportDepartment.Learning and challenges  How to include the large number of organisationsthat want to contribute to the work of the healthand wellbeing board in a way that is productive  health and wellbeing board will ‘drown in detail’.  the existing strategic bodies – such as the localstrategic partnership and the local enterprisepartnership – and the health and wellbeing board.  Bristol’s track record of integrating public healthculture change. Interviews:Stephen Hewitt, Specialist Professional Planner(Healthy Living/Health Improvement), Bristol CityLiz McDougall, Health Policy Coordinator, Bristol CityProgress towards 2013 The Health Reform Transition Group (HRTG) hasbeen set up as the precursor to the shadow healthhave 16 members.Public health staff will be located in theCommunity Based Services Directorate, whosestrategic needs assessment – this is currentlyThe draft local plan (joint with Newcastle) is beingissued for consultation later in 2012. The Big Shiftin 2011, which is ashort-term (to 2013) action plan.This strategy will be superseded by the newActive, Healthy and Well Gatesheadwhich is currently being drafted.planning/housing and other builtenvironment service areas The HRTG is supported by a Placeshaping forWellbeing subgroup – chaired by the Director ofhealthy communities.The current JSNA includes an objective to useplanning powers to create an environment thatencourages people to be more physically activeThe draft local plan includes a policy to create ahealthy and equitable living environment.The Head of Development and Public Protection isalso in charge of environmental health and has setLearning and challengesShort-term timescales of restructuring and healthbudgets are at odds with the long-term (up to 2030)already very tight, how can investment in long-term environmental changes be packagedpersuasively? Joint working needs to create policy hooks toinfluence more widespread change at local level.Interviews:Anneliese HutchinsonPublic Protection, Gateshead Council Alyson Learmonth, Director of Public Health (untilMay 2012), Gateshead CouncilCouncillor Martin Gannon, Deputy Leader, Gatesheadhealthier homes,healthier communities Knowsley (First Ark Group) About the organisation  First Ark Group is made up of four companies thatwork together to make a ‘real positive difference toour communities and to people’s lives’.  One of the companies is Knowsley Housing Trust(KHT), which has 14,000 properties, providinghomes to more than 25,000 people (one in fivepeople in Knowsley live in a KHT house).  company (First Ark Ltd) and a non-regulatedsubsidiary (KHT Services), to broaden thecommercial reach of the group through creatingand investing in social enterprises and re-investingthe profits back into the housing and community-based services that the group offers.Approach to the social determinants of The aim of the model is to improve the health andapproach that connects the quality of housing to asuch as training and employment, as well asimproving local environments and opportunitiesLearning and challenges  Housing providers are very well placed to facilitatecommunity engagement and feed backcommunity-based intelligence to public health and  networking and for information to be conveyed in  It is unclear how best to include the diverse viewsof the housing sector on a tight representativebody such as a health and wellbeing board.  New models such as the one adopted by First Arkdemonstrate the potential for service providers tore-invent themselves to better reflect the needs ofthe client/customer group – there are lessons forpublic sector organisations as they learn tooperate in a new statutory environment thatright to challenge and the community right to build: integration is key.  As a developer, maintaining commitment to thehighest environmental and health standards fornew building is difficult when working inpartnership in tight economic circumstances. Interviews:Louise Harris, Head of Corporate SocialResponsibility, First Ark GroupStephen Heverin, Operational Director (Investment),First Ark GroupLisa Harris, Service Director for Regeneration,Progress towards 2013 The current shadow health and wellbeing boardhas 16 members – including representatives fromtwo district councils (there are seven in the county).Consultation on the draft JHWS is complete – finaldocument approval is targeted for September 2012.Central Lincolnshire Joint Planning Unit (JPU) – apartnership between City of Lincoln, NorthKesteven, and West Lindsey Councils, withLincolnshire County Council– is currently writing alocal plan covering the three district council areas.planning/housing and other builtenvironment service areasassessment (IIA) tool for assessing draft planningThe process has been well received and has beenwelcomed by NHS Lincolnshire as a way ofThe Central Lincolnshire draft core strategyimprove health and wellbeing. Learning and challenges that the shift of public health to the county mayactually create a barrier if it leads to public healthbecoming caught up in any political tensions thatNHS Lincolnshire is willing to engage more withwas take-up by all districts this would presentcouncillors on the shadow health and wellbeinglower-tier councils and organisations can berepresented effectively without making themembership so unwieldy that it paralyses theThere is also a challenge of how to ensure that thedistrict members on the board disseminateTimescales tend to be longer in a two-tier areaadvantage is that it builds in time for reflection, whichcan improve communications and process; butthere is also a disadvantage when trying to quicklyfind the right person with the right area of influence.Interviews:Charlotte Robinson, Principal Planning Officer,Central Lincolnshire Joint Planning UnitChris Weston, Consultant and Associate Director ofPublic Health, NHS Lincolnshirehealthier homes,healthier communities Luton Progress towards 2013  The health and wellbeing board has nine members.  Public health staff have located to the localauthority. shortly on the draft JHWS – it has been written bya subgroup, which includes the EnvironmentalHealth Services Manager (on behalf of theCorporate Director of Environment andRegeneration). The council recently introduced an integrated  The draft core strategy was withdrawn in July 2011for completion before 2014).planning/housing and other builtenvironment service areas  The Director of Public Health and the DeputyDirector of Public Health both sit on the health andplanning/environment concerns.  The draft JHWS includes a priority to develop ahealthy environment.  The Department of Environment and Regenerationdepartment since 2000 – that role now is located inthe Department of Public Health.  The council set up an officer Health and BuiltEnvironment Group in 2008 – currently decidingLearning and challenges  Departmental leadership has been crucial togetting health onto the council’s agenda, and tokeep it there.  Barriers do exist, such as different language/effort from all departments is needed to overcome authority is giving public health a legitimateInterviews:, Advanced Health ImprovementChris Pagdin, Head of Planning and Transportation,Morag Stewart, Deputy Director of Public Health,Gerry Taylor, Director of Public Health, NHS Luton andSandwellProgress towards 2013 The health and wellbeing board has around 12members (subject to current restructuring).The local strategic partnership health and wellbeingboard was disbanded at the start of 2011 – the newboard has been in place since June 2011.The Public Health Development Manager hasdrafted the JHWS.Sandwell has one CCG, although it covers bothSandwell and West Birmingham and thereforeplanning/housing and other builtenvironment service areasfor planning, housing and other environmentalThe draft JHWS structures themes, actions andindicators according to the Marmot Review’s sixpolicy objectives – including integrating publichealth, planning, transport, housing andenvironmental services.Sandwell Healthy Urban Development Unitenvironment professionals to co-ordinate theLearning and challenges managers in accessing public health expertiseahead of the transfer in 2013.Public health needs to simultaneously demonstratehow council departments already help to deliverpublic health objectives while also making a casefor the importance of maintaining a public healthA key challenge for the health and wellbeing boardis the size of its remit and the process for makingdecisions (Sandwell estimates that the combinedbudget of organisations sitting on the board isaround £1billion).Interviews:Paul Southon, Public Health Development Manager,Sandwell PCT Sandwell is a member of the West Midlands PublicHealth Network – representatives from other memberKyle Stott, Health Improvement Specialist for Place,Partnerships and Communities, Birmingham Public HealthMartin Reeves, Chief Executive, Coventry City CouncilAngela Hands, Public Health Practitioner, CoventryJudy Kurth, Healthy Cities Programme Manager,Stoke-on-Trent City Council healthier homes,healthier communities healthier homes,healthier communities A children’s playground in Luton – creating healthy communities could take a generation Navigate through the greyOne clear message is the need to tackle the barriersthat stop professionals from working better together.Martin Reeves, Chief Executive of Coventry CityCouncil, and a passionate supporter of integratinghealth with planning, housing, transport andregeneration, observes that: ‘Achieving healthy andsustainable communities is quite straightforward – youlock professionals in with politicians, developers andstakeholders and you imagine what might bepossible… and then you navigate through the grey.’No magic bulletsThere is no one idea or initiative that unlocks betterjoint working. The overarching message of thishandbook is to start somewhere, and to build fromclear the way to overcome some of the barriers thatexist when people work in different organisations withdifferent priorities, culture and language.That’s a good start, but working together to createhealthier environments will not happen by magic.People who are making progress on this have anexcellent understanding of the purpose of planningand the role of evidence. They look methodically forthe hooks that matter locally, build networks, stay corporate systems and processes to make a case forchange as and when they can.It takes timeWriting policies into local plans takes time, andunderstanding different approaches takes a very longtime; changing the layout of an urban environmentmay take a generation. Planners do not expect to see change quickly. Andalthough the NHS tends to work to targets with muchshorter timescales, public health specialists will alsoknow that changes to policy, practice and outcomescan take decades (it is 50 years since the first report onthe health dangers of smoking was published by theRoyal College of Physicians in 1962).Will future generations look back in 2062 and spot inwork done today the beginnings of a concerted effortto create healthier communities?And will they wonderhow we could ever have worried that there would befrom climate change?If at first you don’t succeed...This handbook attempts to set out a reasonable pathtowards healthier homes and places for all. Hopefullyexperiences of the case studies. It is also worthremembering that in many examples the driving forcebehind the dynamic that leads to change is aninfluential individual. This will be increasinglychallenging, and potentially even more important, incommitment to investing in healthier environments.Different ideas should be explored to see what sticks –have where, and with whom. This remains true even invery far apart?The case studies all reported that although planningand health may have drifted apart, there are still manyoverlaps. By making the potential for these links moreplanners to connect into what public health has tooffer, and vice versa. It won’t be easy: the pressure onplanners to deliver growth during an ongoingeconomic slump will make it challenging to balancethis effectively with other priorities, such as betterhealth and environmental sustainability. However,achieving that balance is the core purpose of planning,and improving health and wellbeing and reducinghealth inequalities is now a very important part of healthier homes,healthier communities Government policy and strategyHealthy Lives, Healthy People: Our Strategyfor Public Health in EnglandDepartment of Health,November 2010The Public Health White Paper makes several keylocal government in public health, and to http://www.dh.gov.uk/en/Publicationsandstatistics/ Publications/PublicationsPolicyAndGuidance/DH_121941Joint Strategic Needs Assessment and JointHealth and Wellbeing Strategies ExplainedDepartment of Health,December 2011The purpose of this document is to support theNHS, local government and emerging health andwellbeing boards as they engage with the refresh ofJoint Strategic Needs Assessments and developtheir strategy. It describes what support theDepartment of Health will provide, including whatand wellbeing boards. The Department of Health is currently finalising its guidance for JSNAs andhttp://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_131733.pdfNational Planning Policy FrameworkPlanning Policy for Traveller SitesDepartment for Communities and LocalGovernment,March 2012National planning policy guidance, providing theEngland. Both documents make significantplaying a key social role, including Section 8 of theNPPF, ‘Promoting healthy communities’.http://www.communities.gov.uk/planningandbuilding/planningsystem/planningpolicy/planningpolicyframeworkUK Climate Change Risk AssessmentDepartment for Environment,Food and RuralAffairs,January 2012The CCRA is the UK’s first assessment of risks andopportunities as a result of climate change. A sectorperspective on health was published, detailingpotential negative impacts as a result of projectionsfor changing temperatures, rainfall patterns and sealevel rise. Results are presented nationally andregionally.http://www.defra.gov.uk/environment/climate/government/risk-assessment/Practice. A Guide to Help PractitionersLocal Government Group,June 2011 around England. Its purpose is to help practitionersto ensure that the planning functions they deliverprovide the most beneficial outcomes for the healthand wellbeing of the community.http://www.idea.gov.uk/idk/core/page.do?pageId=Spatial Planning for Health. A Guide toTCPA and the Hyde Group,November 2010This guide was published during a transformationaland town and country planning systems. The JointStrategic Needs Assessment of local health andwellbeing provides an excellent opportunity tohelping to deliver sustainable developmentobjectives.http://www.tcpa.org.uk/pages/spatial-planning-for-health-Local government and healthHealthy Places: Councils Leading on PublicNew Local Government Network,May 2012The NLGN’s report maps out how local governmentcould take up its new role in public health. It drawson a survey of over 50 councils and interviews with28 senior officials involved in setting up the newchallenges and emerging best practice.http://www.nlgn.org.uk/public/2012/healthy-places-appendix 1resourceshealthier homes,healthier communities A Foot in the Door: AGuide to EngagingNorthern Housing Consortium,October 2011organisations to take when putting together their offerand building stronger collaborative relationshipswith the new leaders of health and wellbeing.http://www.northern-consortium.org.uk/Page/QualityOfLife/Afootinthedoorpublication.aspxOther reform-,evidence- and practice-oriented publicationsFair Society, Healthy Lives. The MarmotReviewStrategic Review of Health Inequalities in EnglandPost-2010,February 2010The tasks of the Marmot Review included identifyingchallenge facing England, and showing how thisidentified addressing the impacts of climate changeas a key objective, and made a key recommendationto fully integrate the planning, transport, housing,environmental and health systems to address thesocial determinants of health in each locality.http://www.instituteofhealthequity.org/Policy Analysis of Housing and PlanningReformTCPA,March 2011 This report analyses planning and housing reformEngland and the implications for housing provisionGovernment’s reforms and makes a first assessmentof their cumulative impact.http://www.tcpa.org.uk/pages/policy-analysis-of-housing-and-planning-reform.htmlMarmot Indicators for Local Authorities inEngland, 2012London Health Observatory,February 2012The London Health Observatory has producedbaseline figures for some key indicators of thesocial inequality, corresponding to the indicatorsproposed in the Marmot Review.http://www.lho.org.uk/LHO_Topics/national_lead_areas/marmot/marmotindicators.aspxHealth Inequalities and Determinants in thePhysical Urban Environment: EvidenceBriefingUniversity of West of England,March 2012This briefing provides a concise up-to-date accountof the influence of urban settings on healthhttp://www.healthycities.org.uk/uploads/files/health_equity_and_urban_environments_briefing_22mar12.pdfSome national sources of useful information and adviceHIA Gatewayhttp://www.apho.org.uk/default.aspx?QN=P_HIANHS London Healthy Urban Development Unit(HUDU), key documents on planning forhttp://www.healthyurbandevelopment.nhs.uk/pages/key_docs/key_documents_hudu.htmlNational Institute for Health and ClinicalExcellence (NICE), guidance on healthierhttp://www.nice.org.uk/guidance/index.jsp?action=folder&o=53883Public Health Observatorieshttp://www.apho.org.ukSpatial Planning and Health Group (SPAHG)http://www.spahg.org.ukUniversity of the West of England, planninghttp://www.bne.uwe.ac.uk/who/hia/planning.asphealthier homes,healthier communities This appendix defines some key generic terms to helppromote a shared understanding of agendas. Fordescriptions of specific elements of the reforms (suchin the Public Health White Paper (for health terms) or inthe National Planning Policy Framework (for planning).with capacity. There are some similarities between thisprocess and the responsibility on planners toundertake infrastructure planning and delivery. Development managementdevelopers submit proposals to obtain planningpermission to build. Proposals are assessed againstLocal authority refers to all tiers of local government:unitary councils, district councils, London boroughs,have different responsibilities in the same area),practitioners will need to align the statutory role ofcounty councils regarding public health (whichincludes things such as the need to prepare JSNAsand JHWSs) with planning, which is primarily theLocal planning authority (LPA)An LPA is the local authority responsible for makingplanning decisions in an area. Planning officers incouncils can be broadly categorised as policy plannersor development management planners, and theyLocalism is the generic term for the aspiration todevolve decision-making and delivery through a moremembers, GPs and to some extent local communities.One consequence for planning is likely to be anaspirations. This marks a shift from recent years, whereMaterial considerations are factors considered in thedevelopment plan. They include central governmentPublic healthPublic health is defined in the Department of Health’s2010 Public Health White Paper as ‘the science and artorganised efforts of society’. There are three domains:health improvement (including people’s lifestyles as welldiseases, environmental hazards and emergencyplanning, efficiency, audit and evaluation).Social determinants of healthAlso referred to as the wider determinants of health,factors that influence an individual’s health. The WorldHealth Organization defines them as ‘the conditions inwhich people are born, grow, live, work and age,including the health system. These circumstances areshaped by the distribution of money, power andresources at global, national and local levels.’SoundnessBefore all statutory local planning documents – such asInfrastructure Levy charging schedules – are adopted bya local authority, they must go through a formal processof inquiry to test their ‘soundness’. This means beingtested against the criteria set out in the NPPF: does theplan positively promote sustainable development, and isit justified, effective and consistent with national policy?WellbeingThe Government Office for Science defines wellbeingas ‘a dynamic state, in which the individual is able todevelop their potential, work productively andcreatively, build strong and positive relationships withothers, and contribute to their community’.appendix 2glossary of termshealthier homes,healthier communities Angela BlairFood Access Manager, Sandwell PCTSpatial Planning Manager, HCA ATLAS, and Chair, Spatial Planning and Health Group (SPAHG)Sarah DavisSenior Policy and Practice Officer, Chartered Institute of HousingAdvanced Health Improvement Specialist, Luton Borough Ilaria GeddesResearch Fellow, Health Inequalities Review for England, University College LondonStephen HeverinOperational Director (Investment), First Ark GroupStephen HewittSpecialist Professional Planner,Bristol City CouncilAnneliese HutchinsonHead of Development and Public Protection, Gateshead CouncilDaria KuznetsovaResearcher, New Local Government NetworkKathy MacEwenCatherine MiddletonNetwork Manager, RTPIGinder NarleManager, Learning for Public Health West Midlands, Sandwell PCTProfessor Peter RobertsChair, Planning Exchange FoundationElena ScherbatykhPublic Affairs Officer, Hyde HousingPaul SouthonPublic Health Development Manager, Sandwell PCTRichard TisdallPrincipal, Tisdall AssociatesSusanna WhiteSue WrightHIA Gateway Content Manager, West Midlands Public Health appendix 3project stakeholder healthier homes,healthier communitiesAbout the TCPAFounded in 1899, the Town and Country Planning Association (TCPA) is the UK’s oldest independentcharity focused on planning and sustainable development. Through its work over the last century,the Association has improved the art and science of planning both in the UK and abroad. TheTCPAputs social justice and the environment at the heart of policy debate, and seeks to inspiregovernment, industry and campaigners to take a fresh perspective on major issues, includingplanning policy, housing, regeneration and climate change.TheTCPA’s objectives are:To secure a decent, well designed home for everyone, in a human-scale environment combiningthe best features of town and country.To empower people and communities to influence decisions that affect them.To improve the planning system in accordance with the principles of sustainable development. Town and Country Planning Association17 Carlton House Terrace,London SW1Y 5AS+44 (0)20 7930 8903 tcpa@tcpa.org.ukwww.tcpa.org.uk Reuniting Health with Planning – Healthier Homes,Healthier CommunitiesBy Andrew Ross,with Michael ChangPublished by the Town and Country Planning Association July 2012