Speeches by Beales.

“What is your judgment about the benefits of the lower cost of public borrowing that generally could be secured compared to private resource borrowing, versus other financial considerations such as the speed of delivery and inflationary pressures, particularly in the construction sector? Do you have any sense from the e…”

“I take that caveat that it did certainly move projects forward that would not have moved forward. Even if you had set the barrier at planning permission—and not conception or design of projects—to finish and completion and handover, is there any data comparing public sector funded projects versus PPP projects on that, …”

“If the system were able to use some of that capital funding to switch to provide security in terms of revenue-based pressures over a set lease term, would that help in the system? At the moment, technically CIL is capital funding, but there are examples of some being used to subsidise revenue pressures in other service…”

“Does anyone else on the panel have any thoughts about how that might be better unlocked?”

“Very few contracts or funding pots in any Government areas give funding security for 20 years. Spending review periods are three years. This is not a unique challenge. Why is the health system so hesitant and cautious in this space, where perhaps others in the public sector are not?”

“Does that take into account the time delivery of public sector projects? With the new hospital programme, 40 hospitals pledged by the last Government, I think one was built and maybe a handful of others are slightly in the process of delivery. My own hospital did not even have a business case signed off after 14 years.…”

“Turning to section 106 and CIL, Martin, do you have a sense as an organisation of how much CIL and section 106 that can be utilised for healthcare at the moment is unspent?”

“Something close to school place planning.”

“One of the frustrations in my own community is unmet GP need and investment in the primary care estate. I have met pharmacists who want investment in order to have consulting rooms, and hundreds of thousands of pounds of health section 106 is unspent at the civic centre in the same community. It feels like there is a m…”

“The problem might be that the timescales that the local authority is working towards in planning and decision making, and the NHS and your decisions, are quite unaligned.”

“I appreciate that. Do you think there should be more formal engagement in the local plan process for health?”

“Do you think ICBs and NHS Property Services more generally have a clear and articulated outline of their health needs in each local plan area? If I was a planning authority, would there be one document I could go to which would suggest the investment needs for health in that place?”

“Do you have any thoughts about how you can better align those processes?”

“Does it align with the local plan period?”

“Ruth, I think your report highlighted a misalignment in NHS, developer and local authority agreements. I do not know whether you have any comments or thoughts about what might need to change to address that misalignment.”

“Do you think there is enough transparency on section 106 and CIL funding, what is available and the conditions under which it could be allocated?”

“One of the challenges from local authorities is that, often in the planning process, they do secure provision and sites, but the NHS is moving at such a different pace and scale that those sites are lost. New health centres and GP centres are secured in developments as section 106 gains, but the NHS is not able to move…”

“Do there need to be more formal arrangements that bring together the planning authority and NHS decision makers in this space?”

“The information we have received suggests that £148 million for health and social care infrastructure in the system is currently unspent. That is not insignificant. You talk about £60 million being accessed, but bearing in mind the level of unmet capital investment need and the ambitions about neighbourhood health, it …”

“Your model comparing borrowing costs looks very much at private sector borrowing based on a repayment model over time. There are obviously other types of public-private finance initiatives or partnerships in the development sector, some of which use asset exchanges. On large hospital sites or large public sector sites,…”