I’ve been working with the Avril Baker Consultancy to facilitate and manage a range of stakeholder consultations for Wiltshire Clinical Commissioning Group.

As part of the team it’s been great talking about WCCGs 5 Year Plan, to a range of people across Wiltshire including Service personnel’s wives and partners, mums and their toddlers, the elderly, teenagers and students. All have been really interested in engaging and discussing accessibility to healthcare and medical facilities.

WCCG has the responsibility to provide and manage health care facilities and programmes on behalf of Wiltshire’s residents. In order to ensure that they deliver a high quality healthcare service within budget over the next 5 years they have identified 3 priorities to do this. These comprise people taking more personal responsibility for their own health and wellbeing; increased community based healthcare and medical facilities; and providing less care in hospitals and more at home and in the community. All totally commendable and realistic objectives.

The management of increasingly stretched budgets and healthcare provision must be an issue for all NHS Trusts and Clinical Commissioning Groups countrywide. It is therefore likely that the majority will be consulting on the same type of objectives as WCCG for their healthcare provision.

So where NHS Trusts and Clinical Commissioning Groups are looking to provide more community based facilities it is likely that there will be a need for a new programme of building work to accommodate this. Not just larger GP surgeries, but buildings to provide the range of facilities that are going to be required – midwifery, chiropractors, OTs, chemists, dentists, walk in centres, small ops centres. You name it they’ll need it. Whilst some areas are probably already doing well in terms of the facilities they have that are easily accessible, other areas will be lacking and will require significant investment to provide a range of community based facilities.

The difficulty is that the provision of these facilities is not a quick or cheap process.

We all know the length of time it takes to identify suitable sites for any land use, either get them allocated within the Local Plan framework or bypass this and submit and determine planning applications, discharge conditions, implement S106 Agreements, submit and secure building regs consents, highways agreements, utility providers agreements and whatever other legal requirements are necessary and then actually build the places.

Careful thought needs to be given to the locations where these facilities are best needed, are sustainably located and, in reality, where they can actually be provided. So what are the criteria for the location of these facilities – good transport links, high population centres, areas where there are existing facilities that can be expanded or areas where there are no facilities but are desperately needed, areas of deprivation or areas of wealth, areas where there are greater number of families, the elderly? The list is pretty much endless – feel a matrix solution coming to resolve this, and I don’t envy a NHS Trust or Clinical Commissioning Group having to undertake this.

As with all strategic and infrastructure related development these issues and their related land use implications have to be part of a detailed dialogue with relevant Local Authorities. An understanding must be had of what land is available in terms of the NHS Trust or Clinical Commissioning Groups land holdings, what additional land requirements would be necessary above and beyond this and whether or not this had already been identified in an emerging DPD for either health and medical related uses? Bearing in mind that the majority of Local Authorities are essentially focused on housing and employment land provision, this might not necessarily be at a sufficiently advanced stage.

Whilst the purpose of a Core Strategy is not to identify and allocate sites for specific uses, but to provide overarching land use policies, land has to be identified and allocated through other mechanisms such as Infrastructure Delivery Plans, Site Allocations DPDs, Neighbourhood Development Plans or Development Briefs. This would require the collaboration of the providers, the Local Authority, local communities and of course developers. All of which is a time consuming and lengthy process.

If land has been identified, and it happens to be outside NHS Trust or Clinical Commissioning Group ownership then there will be land ownership issues to deal with – if it’s Local Authority owned will it be available, if privately owned will landowners be willing to sell for this type of use, which will obviously be at lower land values than say open market residential or will the NHS Trust or Clinical Commissioning Group be able to JV sites to provide facilities in conjunction with other developers or organisations.

So whilst NHS Trusts and Clinical Commissioning Groups have to look at the way healthcare is provided in an area, thought also needs to be given to what facilities are required, where, when and how these can be delivered. The danger is that the provision of these facilities becomes bogged down in bureaucratic planning and land acquisition processes that move at a lumbering pace, which then delays their provision and adds to spiraling NHS costs.