General Practice: Large Housing Developments

Theresa Villiers Excerpts

Tuesday 29th March 2022 Westminster Hall

[Andrew Selous]

I completely agree with my right hon. Friend and I defer to his expertise on education. I would add that an element of retrospection is needed, because many of those new housing estates have already been rolled out in our constituencies. The new infrastructure levy cannot be just going forward; there is an immediate deficit that we need to remedy.

The system is broken, and that is the reason I have been campaigning on the issue and have called this debate. Contributions from section 106 funding or from the community infrastructure levy often go to provide other facilities rather than for health. The guidance states:

“It is helpful if the Director of Public Health is consulted on any planning applications (including at the pre-application stage) that are likely to have a significant impact on the health and wellbeing of the local population”.

I do not think it is “helpful”—it is absolutely essential. It should be a requirement that leads to a clear outcome of additional ring-fenced health funding to employ and accommodate the necessary GPs and practice nurses that the area’s population requires.

I have good support in my request. When I put that point to the Prime Minister on 5 January this year, he replied:

“Yes...my hon. Friend…is completely right: we cannot build new homes without putting in the infrastructure to go with it.”—[Official Report, 5 January 2022; Vol. 706, c. 20.]

I can quote no higher authority, Minister.

My argument is that no new infrastructure is more important than looking after the health of the existing and new population in an area. At the moment, the system is fragmented and uncertain, in that we might be lucky and be funded through section 106 money or we might be lucky and get it from the community infrastructure levy. Again, we might be lucky and get what is needed from the housing infrastructure fund. If we are fortunate, the local authority might come to the rescue, or it could be that Treasury funding to the Department of Health and Social Care will do the job. My CCG tells me, however, that capital funding from the Treasury for new general practice capacity appears too late to be of any use in making a sensible forward plan, and disappears equally quickly.

[Theresa Villiers (Chipping Barnet) (Con)]

Does my hon. Friend agree that while developers sometimes offer to create new premises for additional GP practice, that does not resolve the problem? The shortage is of people, of qualified GPs, so even if there are brand-new premises, without the doctors to see the patients, the problem he is talking about is not solved.

[Andrew Selous]

This is the benefit of having former members of the Cabinet in a debate such as this: they know what they are talking about. My right hon. Friend is completely right. We are talking about capital and ongoing revenue funding. Those new residents come with a stream of tax revenue—their council tax, their income tax and the tax from their businesses, which they will pay—so we are not asking for anything unreasonable; it is about an equitable allocation given where people live, when there are big increases in the local population.

In my local authority, there were proposals to build four health hubs. The original commitment was that those would be built by 31 March 2020, then by 2024, and we have one being built, another progressing, and complete silence on the other two. Initially, the funding was due to come from the primary care infrastructure fund, then the primary care transformation fund, with the CCG and the local authority due to make contributions at various points—but none of those routes has led to the delivery of two much-needed health hubs in my constituency.

I propose that there should be guaranteed primary care health funding for each 1,000 new homes, allocated at the time planning permission is granted and delivered as the new residents arrive, although smaller developments must also be catered for.

The current capitation figures, based on the Office for National Statistics population figures, always lag. Therefore, the infrastructure always comes too late, leaving unacceptable strain on local primary care services. We will, in the end, pay for the primary care services needed but, instead of always doing it too late, let us get ahead of the curve and stop the anxiety and upset that our constituents and primary care staff experience as a result.

I observe that the process is often shrouded in secrecy, with very little engagement with local Members of Parliament and councillors. We are the ones who feel the anger of our residents when these facilities arrive too late, but there is limited local accountability from those taking the decisions, and a confused and uncertain national funding process. We could learn from the way education funding is allocated to accommodate significant population growth. I recommend that the Prime Minister urgently convene a Cabinet Sub-Committee between the Treasury, the Department of Health and Social Care and the Department for Levelling Up, Housing and Communities, to deal with the issue once and for all.

I repeat the point I made to my right hon. Friend the Member for Chipping Barnet (Theresa Villiers). I understand that the new infrastructure levy may come to our rescue, but if it just looks forward and does not deal with these vast new housing estates—14,000 homes being built in my constituency and many thousands in the constituencies of colleagues here—we will have let down our constituents. Our country generally does public administration well; we are better than this and can fix it. I implore the Minister to go back to his Secretary of State to have a focused, cross-Government effort, led by the Prime Minister, to get this right once and for all.

--- Later in debate ---

[Theresa Villiers (Chipping Barnet) (Con)]

It is a pleasure to serve under your chairmanship, Mr Dowd. I pay tribute to my hon. Friend the Member for South West Bedfordshire (Andrew Selous) for securing a debate on this important issue this morning.

The Mayor of London wants 2,364 new flats and houses to be built in the borough of Barnet every year for years to come. I did a rough calculation for some of the bigger developments recently built, approved or pending in the planning system in my constituency alone, and the figure is nearly 4,000 units, with another 691 rejected but liable to come back on appeal or possibly with a revised proposal. That could mean anything up to about 9,000 people trying to find a place on a GP’s list of patients. I pay tribute to all the GPs in my constituency. They are the bedrock of our NHS. We all depend on them, and they have done magnificently in so many ways during the pandemic.

It is clear that rising healthcare need is already placing great pressure on our national health service, including general practice, as we grow older as a society and as our frail elderly population gets larger. But at the same time, council planning committees are finding it harder and harder to turn down planning applications even where it is clear that the area does not have the GP capacity to service the population increase that the proposed new flats could involve. Elected councillors are increasingly advised by officers that they should not turn down an application even if it contravenes long-established planning principles on matters such as character, conservation, height, density or pressure on local services and infrastructure, because their decision could be overturned on appeal, on the grounds that housing targets are not being met. To compound the pressure, elected representatives are threatened with high costs being awarded against councils if they lose planning appeals. That is forcing councils to produce long lists of development sites to meet the requirement of a five-year land supply, many of which may be wholly inappropriate for new housing—certainly high-density new housing. Even where developers offer to build facilities for a new GP practice as part of their plan, that does not solve the problem, as I said to my hon. Friend the Member for South West Bedfordshire, because it is a shortage of doctors, not premises, that is causing the greatest pressure on primary care.

My hon. Friend clearly articulated a solution in his speech, but I would like the Minister to consider a threefold solution. First, housing targets should be advisory, not mandatory. They should not be taken into account in planning decisions or appeals. Secondly, whether or not a local authority has a five-year land supply should no longer determine planning applications. Thirdly, we need to accelerate efforts to train, recruit and retain more family doctors. The Government take the expansion of the NHS workforce very seriously, and it is a proud achievement that there are more doctors in hospitals than ever before in the long history of our national health service. The Government have ensured that there are more GPs in training than ever before, and five new medical schools have opened. That good progress is all welcome, but as the Health Secretary has admitted, plans to recruit 6,000 additional GPs by 2024 are not on track. We need to turn that situation around if we are to tackle the covid backlog and ensure that, where new homes are built, all residents—existing ones and new ones—continue to be able to access the GP appointments they need.

I hope the Minister will set out the care improvements delivered by the £250 million package announced last year to relieve immediate pressures on GP practice. I hope he will also give us the latest numbers on the recruitment of other professionals, such as nurses and pharmacists, to support GPs as part of multidisciplinary practices. Will he commit the Government to redoubling their efforts to plan effectively for the future workforce needs of our national health service?

[Peter Dowd (in the Chair)]

Thank you for your remarks and for keeping within the advisory time limit.