The Health Scrutiny Committee for Lincolnshire has called on Government for greater clarity over how developer contributions can support the healthcare infrastructure needed as communities grow.
The Committee has written to the Government following its consideration of the pressures that population change and planned housing growth can place on NHS services and infrastructure across Lincolnshire. The representation follows the Committee's consideration of NHS planning in response to demographic change at its meeting on 1 July 2026.
Lincolnshire faces particular challenges arising from an ageing population, increased frailty, long-term health conditions, health inequalities and the rural nature of the county. Alongside these existing pressures, significant planned housing growth has the potential to generate additional demand for primary, community, neighbourhood, urgent and emergency, and acute healthcare services.
The Committee's concern centres on Section 106 planning obligations, through which developers can be required to contribute towards infrastructure needed as a consequence of development and it is asking Government to clarify how the planning framework can recognise the cumulative impact of housing growth, particularly where the combined effect of several developments creates a clear need for additional healthcare capacity, but no individual development would, on its own, justify a major infrastructure project.
A particular issue for Lincolnshire
The Committee believes the question has particular significance for Lincolnshire because of the way the county's population is distributed.
Its letter highlights that nine of Lincolnshire's ten largest settlements have populations between 18,000 and 48,000, and states that Local Plan housing allocations for many of these settlements appear substantial enough to require a step-change in locally available secondary and urgent care.
The Committee's concern is therefore not simply about individual housing developments. It is about ensuring that the combined effect of planned growth across a community can be properly considered when longer-term healthcare infrastructure is planned.
Asking Government for clarification
The Committee has asked Government to consider seven areas, including:
- how cumulative healthcare infrastructure requirements associated with planned housing growth can be identified and addressed while individual Section 106 obligations continue to satisfy the statutory tests;
- what evidence and methodology should be used to demonstrate the relationship between residential development and additional demand for different types of healthcare infrastructure;
- how Section 106 and the Community Infrastructure Levy should work together where infrastructure responds to the combined effects of several developments;
- when contributions might support new, extended, refurbished, repurposed or shared premises delivering NHS-funded services;
- whether directly related infrastructure such as access or parking can be supported where necessary to mitigate development-related demand;
- whether national guidance should be reviewed to reflect changing neighbourhood and community-based models of healthcare; and
- whether Government will work with NHS bodies, local planning authorities and local government to develop a more consistent national approach.
The Committee has offered to contribute Lincolnshire evidence to any future Government review or policy-development work.
Councillor Richard Cleaver, Chairman of the Health Scrutiny Committee for Lincolnshire, said:
“Housing growth cannot be considered in isolation from the services and infrastructure that growing communities need. New homes bring new residents, and that inevitably has implications for local healthcare provision.
“The difficulty we are highlighting is that healthcare pressures do not always arise neatly from one development at a time. Several developments within a town may collectively create a need for additional healthcare capacity, even though no single development would justify that investment on its own.
“We fully recognise the importance of the safeguards governing Section 106 contributions and we are not asking for those safeguards to be removed. What we are asking for is greater clarity about how the cumulative effects of planned housing growth can be recognised and how proportionate contributions can support the healthcare infrastructure those communities will need.
“This is particularly important as the NHS develops more neighbourhood and community-based models of care. Healthcare infrastructure is no longer simply a choice between a GP surgery and a hospital. It can involve extending, refurbishing, repurposing or sharing facilities so that services are provided closer to people's homes.
“We hope Government will look carefully at the questions we have raised and work with local authorities and the NHS to develop a clearer and more consistent approach. Ultimately, our objective is straightforward: where substantial housing growth is planned, the healthcare infrastructure needed to support that growth should be planned alongside it.”