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Strategic planning for healthcare

30 Sep 2025

The latest National Planning Policy Framework published in December 2024, and setting out the new Labour government’s planning agenda for England, mentioned the words ‘health’ or ‘healthier’ no fewer than 39 times. In line with wider ambitions to renew the country’s ageing healthcare estate, the Framework now explicitly recognises the need for collaboration and strategic policy-making in planning for infrastructure investment; including strategic health infrastructure such as hospitals and neighbourhood health facilities. 
 
However, based upon research undertaken by Lichfields, up-to-date development plans are currently patchy, or even lacking entirely, in policies relating to either healthcare generally or the renewal of healthcare estates. This Insight Focus looks in more depth at opportunities to streamline the healthcare development process through better integration between health infrastructure investment strategies and local planning frameworks.
 
Summary of Findings
 

 

 
£4bn

  

 
  
Cash increase in the health capital budget, focused upon continuing delivery of New Hospitals Programme and estate renewal.
 
  

 

 
39

  

 
 
References to ‘health’ or ‘healthier’ within the new NPPF, which also promotes alignment between infrastructure providers such as health trusts and development plans.
  
  

 

 
63%

  

 
 
Of up-to-date local plans containing strategic policies with a high-level objective to improve health or healthcare within the local planning authority area.
 
  

 

 
26%

  

 
 
Only around a quarter of the same plans contain site-specific policies, allocations or designations for the delivery of healthcare related infrastructure projects.
 
  

 

 
2026

  

 
 
A key year for plan-making across England, as evidence bases are updated to reflect higher national development targets, and consultation is undertaken to idenitfy new local plan allocations.
 
  
   
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The Government’s 10 Year Health Plan

 
The current government was elected, in part, on a manifesto pledge for NHS reform and is now beginning to set out a number of ways in which they will seek to deliver this. Plans include substantial changes to patient care and treatment, but also new physical infrastructure, such as the roll out of neighbourhood health services and the New Hospitals Programme.
 
The government are seeking to address long-standing and widely acknowledged challenges to the country’s existing healthcare estate, as well as supporting future growth across the sector.
 
As such, the recent 2025 Spending Review included a £4 billion cash increase in the Department of Health and Social Care’s annual capital budget from 2023-24 to 2029-30 to invest in the NHS, including in new technology, hospitals and primary care. This will deliver the largest ever health capital budget, and also builds on the record capital investment to repair the NHS estate which includes:
 
  • Continuing delivery of 25 new hospitals via the New Hospitals Programme, including replacing the seven hospitals built entirely from Reinforced Autoclaved Aerated Concrete (RAAC); and
     
  • Investing £30 billion over the next five years in day-to-day maintenance and repair of the NHS estate, with over £5 billion allocated specifically to address the most critical building repairs. This will enable the government to meet its commitment to eradicate RAAC from the NHS estate entirely by 2035.
 
This is exciting news for a number of new healthcare schemes currently in the development pipeline, including major Lichfields projects such as Berwick Community Hospital (due to open in 2026), and Leeds General Infirmary (pencilled in for 2030 to 2035).
   
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The National Planning Context

 
In tandem with this investment in healthcare, the Government is also seeking to tackle current planning delays, and instead utilise the planning system as a catalyst to further their growth agenda. Fundamental to these aims are recent revisions to the National Planning Policy Framework (NPPF). The updates to the NPPF cover a wide range of sectors and planning issues. However, fundamentally, they promote more ambitious plan-making; both in terms of timescales but also the quantum of development. This applies as much to health infrastructure as any other sector.
 
Indeed, there are no fewer than 39 references to ‘health’ or ‘healthier’ within the new NPPF. Health is quite rightly identified as underpinning the social objectives of ‘sustainable development’ and, in this context, paragraph 20 of the Framework is clear that strategic policies should set out the pattern, scale and design quality of places and make sufficient provision for health infrastructure. The NPPF goes on to state at paragraph 27 that:
 
… strategic policy-making authorities should make sure that their plan policies align as fully as possible with those of other bodies where a strategic relationship exists on these matters, and take into account the relevant investment plans of infrastructure providers... their plans should ensure that: a) a consistent approach is taken to planning the delivery of major infrastructure, such as hospitals, [and] neighbourhood health facilities…
NPPF, Paragraph 27
 
This alludes to both the importance of strategic planning in securing the delivery of public infrastructure, but also the clear need for alignment between the plans of relevant bodies such as health trusts, and local planning authorities through their own development plans.
   
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Planning for Growth?

 
At Lichfields, based upon our day-to-day project work within the sector, we appreciate the extent to which the strategic infrastructure strategies and investment priorities of health trusts align with local development plan policy can vary hugely. Where development plan policy lags behind trusts’ strategic programmes, there is a likelihood that the planning process for these developments can then become more protracted and higher risk. 
  
To better understand the extent to which strategic planning policies actually help to facilitate the delivery of new healthcare infrastructure Lichfields has analysed a sample of the most recently-adopted development plans.
 
Taking as a starting point data from the Planning Inspectorate regarding the progress of development plan documents containing strategic planning policies[1], we have considered those local plans adopted since March 2020 which can arguably be considered ‘up-to-date’[2] in NPPF terms.
 
Within this approximate five year window, 88 new plans containing strategic planning policies have been adopted. Whilst this in itself is a sobering statistic given there are over 330 local planning authorities in England[3], detailed analysis of these 88 plans reveals that 63% contain strategic policies with a high-level objective to improve health or healthcare within the local planning authority area. However, only around a quarter (26%) of the plans contain site-specific policies, allocations or designations for the delivery of specific healthcare-related infrastructure projects.
 
Fundamentally, this suggests a disconnect between healthcare infrastructure delivery and planning. For example, in overlaying the specific sites identified within the New Hospitals Programme onto this policy coverage, it is clear many sites will need to progress without any formal or up-to-date planning status through an allocation or site-specific designation.
 
Better collaboration and engagement between health and planning authorities can only smoothen the delivery of these vital new projects and facilities.
 
Proportion of up to date local plans containing health policies
 
 
 
 
Source: Lichfields analysis 
 
   
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Aligning Healthcare Infrastructure and Planning Strategies

 
In this context, there are an additional practical steps which health trusts and other institutions can take to streamline the development process.
 
Firstly, it is important to consider the detailed makeup of any masterplan for a local healthcare estate, and how the different aspects of those proposals may be best pursued through the planning system. This could involve more closely marrying the key milestones of the planning process with NHS England’s business case guidance chart for new development.[4]
 
 NHS Englands Business Case Process aligned with key planning milestones
 
 
Source: NHS England Business Case Process table and Lichfields analysis 
 
 
For example, for longer term projects (perhaps those at Strategic Outline Case stage), engagement with the local plan preparation process is key. In its simplest form, this can comprise the submission of written representations to the local planning authority’s statutory Local Plan consultations, up to the submission of visioning documents based upon the estate masterplan itself, or even attendance at the Plan's Examination in Public.
 
It can be challenging to align the long-term planning required from a development plan perspective with health trusts' development pipelines, which are inevitably dependent upon a range of factors such as the availability of funding or evolving clinical needs. However, establishing high-level policy support, and a broad awareness of the proposals and masterplan, at the local plan adoption stage is likely to yield quicker results down the line, regardless of the nature of the project.
 
In many cases this approach is also timely as, with the wider political agenda for planning reform, there is likely to be a surge of local plan consultations over the coming months, as local planning authorities seek to update their statutory development plans to account for the additional housing and development needs identified nationally by Government. In itself, this also offers an opportunity to identify and promote any potential disposal sites in or around hospital estates for alternative uses, such as housing.
  
 
As development proposals progress in more detail, for example towards Outline Business Case, they will then benefit from greater planning certainty, from both a programme and risk perspective. At Detailed Business Case, this could potentially be supplemented through the submission of a pre-application enquiry to seek the local planning authority’s views in relation to more detailed technical considerations, such as access, design, drainage and ecology.
 
At the point of Full Business Case, planning permission should ideally already have been secured, at which point the project can progress through the delivery phase and discharge of planning conditions.
   
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How Lichfields Can Help


 
To ensure faster delivery of other public service infrastructure such as health … facilities, local planning authorities should … work proactively and positively with promoters, delivery partners and statutory bodies to plan for required facilities and resolve key planning issues before applications are submitted.
NPPF para.101, December 2019 
   
With the largest ever health capital budget now established by Government, the emphasis must shift to delivery. However, there is often currently a disconnect between health infrastructure delivery strategies and local planning frameworks. Early and proactive engagement in plan-making is just one way of overcoming this. 
 
In addition, effective planning appraisal (including careful analysis of recent changes in Permitted Development Rights relating to RAAC and new hospital buildings) together with wider engagement and frontloading of key assessments (particularly, for example, Biodiversity Net Gain strategies) will also be pivotal to the delivery of health infrastructure projects.
 
Whether it is a new clinic, hospital, estate masterplan or site disposal strategy, Lichfields provides expert advice to de-risk the planning process and achieve our clients’ objectives. Our understanding of the public and private health sectors best-places us to provide planning support to health trusts, contractors, architects and developers at every stage of the process; from initial feasibility, supporting the business case process, through to securing permissions for new developments and supporting delivery.
 
Please get in touch via the contact details below to find out how we can help.
   
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Insight author

 

Robert Dibden

Planning Director

 

 

Footnotes

 
[1] https://www.gov.uk/government/publications/local-plan-monitoring-progress (snapshot taken at August 2025)

[2] National Planning Policy Framework paragraph 234, December 2024
[3] https://www.planning.data.gov.uk/dataset/local-planning-authority
[4] https://www.england.nhs.uk/wp-content/uploads/2018/10/a2p-stages-of-bc-process-table.pdf

 
Disclaimer: This publication has been written in general terms and cannot be relied on to cover specific situations. We recommend that you obtain professional advice before acting or refraining from acting on any of the contents of this publication. Lichfields accepts no duty of care or liability for any loss occasioned to any person acting or refraining from acting as a result of any material in this publication. Lichfields is the trading name of Nathaniel Lichfield & Partners Limited. Registered in England, no.2778116

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