Committee publication · Correspondence · 8 July 2026

Correspondence from NHS Cornwall and Isles of Scilly and NHS Devon- Cornwall Visit

Summary

NHS Cornwall and Isles of Scilly and NHS Devon write to Layla Moran MP following her committee visit, detailing structural barriers to NHS estate and infrastructure development. They outline challenges in NHS-local authority collaboration, capital allocation rigidity, Section 106 planning contributions, and primary care funding mechanisms, proposing policy reforms to enable delivery of neighbourhood health centres.

Key findings

NHS-local authority estate collaboration is limited to administrative co-location; joint capital investment for patient-facing services is blocked by governance and regulatory barriers, with new NHS community assets taking 5–10 years from planning to completion.
Multi-year NHS capital settlements are welcomed but remain hampered by within-year accounting requirements and regional finance team processes that force projects to slip between financial years, creating competing priorities and administrative burden.
Capital Departmental Expenditure Limits (CDEL) regulation has caused multiple project collapses when NHS providers lack sufficient coverage for leases or capital, disincentivising new community facility development.
Section 106 planning contributions lack national standardisation and consistent methodology; healthcare infrastructure is inconsistently prioritised relative to education and transport, and timescales do not align with NHS capital planning cycles, risking fund forfeiture.
Primary care estate funding mechanism ties rental reimbursement to District Valuer assessments; construction inflation since 2020 and higher interest rates mean developers cannot achieve project viability, forcing exceptions to standard commissioning processes. NHS spends £160,000 annually on Section 106 application staffing for Devon and Cornwall.

Tone

Critical

Topics

public-financehealth-infrastructureplanning-regulationprimary-carecapital-allocation

Key actors

Layla Moran MP, Mark Hackett, NHS Cornwall and Isles of Scilly, NHS Devon, Mat Chetwynd, Health and Social Care Committee

Notable line

“… it is not uncommon for new NHS community assets to take 5-10 years from planning to practical completion which makes local authority partnerships difficult to establish from either a tenant …”

Key Quotes

“The barriers to delivery span across multiple governance and regulatory framework areas which makes the NHS an especially difficult partner to work with or invest in …”
— Mark Hackett · NHS-local authority estate collaboration challenges

“It is very common for projects to slip in time scales due to reasons relating to delays, statutory planning applications or community interests wanting to escalate changes in service provision to a scrutiny committee for example.”
— Mark Hackett · Capital allocation and administrative process burdens

“We have unfortunately had multiple projects collapse due to an NHS provider organisation failing to hold enough coverage within either its capital 3 or lease CDEL thresholds for the project due to competing priorities of other investments required.”
— Mark Hackett · Capital Departmental Expenditure Limits impact

“… there is no consistent or mandated approach across local planning authorities (LPAs) in how NHS infrastructure is prioritised relative to other demands such as education, transport, and affordable housing.”
— Mark Hackett · Section 106 planning contributions inconsistency

“… construction inflation has been significant and developers in many of our schemes are unable to achieve the project delivery at a cost which would result in the rental yield being in line with the District Valuers assessment and therefore a project …”
— Mark Hackett · Primary care estate payment mechanism viability challenges

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Source · parliament.uk record ↗