Fairer Scotland Duty Assessment

of the Monklands Hospital Refurbishment/Replacement Project (MRRP)

Mrs Elspeth Russell Assistant Health Improvement Manager, NHS Lanarkshire

Dr Tasmin Sommerfield Consultant in Public Health Medicine, NHS Lanarkshire

Background to Monklands Refurbishment/Replacement Project (MRRP)

• Outline business case produced to rebuild or refurbish University Hospital Monklands

• Option appraisal in June 2018

• Two potential sites shortlisted Potential Sites Methods

• Literature search around hospital relocation and transport • North Lanarkshire Locality Health and Wellbeing profiles • Hospital activity data (from TrakCare) • Formal consultation findings • MRRP consultation documents • Fairer Scotland Duty Stakeholder workshop • Three focus groups (two community, one low-paid staff) Results: Literature search

• No specific evidence re effects of hospital relocation on socio-economic inequalities

• Travel needs of people in deprived areas cannot be wholly met by traditional commercial public transport

• Improving public transport can have wider positive impacts on socio-economic outcomes, eg employment, leisure and social activities

• More appropriate accessibility models are needed for research into travel via public transport Locality Profiles

Locality (population1, number of IDZ’s2) Airdrie Bellshill Coatbridge North (58,621, 13) (48,627, 11) (49,542, 11) (85,761, 21) Proportions of data zones in the 15% 31.6% 23.1% 32.8% 8.1% most deprived data zones in Scotland, 2016 compared to NLC average of 23.3%3 Intermediate zones above NLC average 5/13 6/11 7/11 5/21 of 15.5% for income deprivation4 Intermediate zones above NLC average 5/13 6/11 8/11 5/21 of 13.6% for employment deprivation4 Intermediate zones above NLC average 5/13 5/11 7/11 5/21 of 15.5% for income deprivation and 13.6% for employment deprivation4 Intermediate zones where at least 20% 2/13 0/11 2/11 0/21 of population are income deprived and at least 20% of population are employment deprived4 % homes in social sector5 28% 32% 33% 20% Intermediate zones with percentage of 6/13 5/11 6/11 5/21 children in low income families higher than NLC average of 18.7%6 % of population providing unpaid care7 10.3% 10.3% 9.8% 10.2% Hospital Activity Data

• Those from more deprived areas have poorer health and more need for health care.

• Outpatient data suggests 73% of patients are from the Monklands catchment and 27% elsewhere. 25% are from Airdrie, 23% are from Coatbridge, 19% are from North and 10% are Bellshill.

• A&E attendances and admissions at Monklands are higher in Airdrie and Coatbridge than in other localities.

• The North population currently makes significant use of hospitals in Glasgow.

• DNA data shows those in areas of deprivation are more likely to miss appts.

• Achieving Excellence aims to provide more services closer to home within communities and through use of digital technologies. The current service demand cannot therefore be used as a proxy for future demand as the balance of care will shift to community. Car Travel Time Analysis

Monklands catchment NHSL catchment Within 15 mins Within 15 mins • 82% can get to • 47%canget toMonklands Monklands • 20% can get to Glenmavis • 55% can get to • 49%canget toGartcosh Glenmavis • 90%canget toGartcosh Within 25 mins Within 25 mins Everyone can get to any of the • 93%canget toMonklands sites within 25 mins • 78% can get to Glenmavis • 89%canget toGartcosh Within 35 mins • 98%canget toMonklands • 97% can get to Glenmavis • 98%canget toGartcosh Public Transport Time Analysis

Monklands catchment NHSL catchment

Within 30 mins Within 30 mins • 35% can get to Monklands • 13% can get to Monklands • 3% can get to Glenmavis • 1% can get to Glenmavis • 1% can get to Gartcosh • 1% can get to Gartcosh Within 60 mins Within 60 mins • 79% can get to Monklands • 40% can get to Monklands • 28% can get to Glenmavis • 11% can get to Glenmavis • 25% can get to Gartcosh • 11% can get to Gartcosh . Travel and Transport

• Options appraisal scored Gartcosh higher as has motorway access and a close by train station with better connections than current Monklands train station and a new link road planned.

• Gartcosh can be reached by car from a central point within each township in Lanarkshire faster than the current hospital or Glenmavis for all Lanarkshire areas except Coatbridge/Airdrie/Plains.

• Glenmavis does not have the same road access as there is no motorway access and the train station is 2.4 miles away from site. There is a Single carriageway road and a planned road upgrade will coincide with hospital building work.

• Gartcosh and Glenmavis have more space for parking and expansion

• Section 75 of planning legislation - public transport has to be at least as good as at present. Staff Residence and Staff/Patient Visitor Travel Survey

• HR data suggests 60% of Monklands hospital staff reside in the Monklands catchment and 68% of Monklands hospital staff reside in North Lanarkshire,

• A local survey of staff (385 staff, 122 patients/visitors) found:

Staff Patient/visitors

Car 86% 82%

Public transport 9% 7%

Walk 3% 6%

Taxi/cycle <1% 5% (taxi)

• No data available to allow the survey results to be reviewed by locality or SIMD Fairer Scotland Impact Assessment Workshop

• Half day workshop with key stakeholders including representatives from community, staff side, NLC and third sector

• Reviewed positive/negative impacts on a range of factors of 3 options – Rebuild on current site – New build at Glenmavis – New build at Gartcosh Fairer Scotland Checklist

Social environment Physical Access/quality of environment services  Social status  Living conditions  Healthcare  Employment  Working conditions  Transport and  Income and income  Natural space connections inequality  Unintentional injuries  Social services  Crime and fear of and public safety:  Housing quality, mix, crime  Resource allocation flexibility  Family support and  Education provision social networks  Culture, leisure and  Stress, resilience and play provision community assets  Resources allocation  Participation and social interaction  Influence and sense of control  Identity and belonging Impacts Which Generated Most Discussion

• Travel and transport

• Employment

• Sense of belonging Focus Groups

• Three groups, facilitated by researcher (two with patients/public and one with staff)

• Majority of participants from areas surrounding the current hospital but also representation from the wider catchment area.

• Three main themes emerged: – Accessibility and transport – Employment – Sense of belonging Conclusions: Positive Impacts

• Employment opportunities during the build phase • Improved healthcare due to an optimal clinical model (only possible at Gartcosh or Glenmavis sites) • Potential wider benefits of improved community transport model. • Areas of deprivation in Northern Corridor and Cumbernauld Conclusions: Negative Impacts

• Poorer access to hospital for those who reside in the Monklands area – impacts patients without access to car and low-paid staff

• Extremely strong sense of value, belonging and pride around Monklands Hospital by the local community – removing it would make impact Recommendations

• Innovative, enhanced community and public transport links

• Facilitate lower paid staff to maintain employment at the new hospital

• Facilitate training opportunities for those in the most socio-economically disadvantaged areas

• Partners should work together to ensure that should the hospital move benefits the community and seeks not just to mitigate the loss of the local asset but to decrease socio-economic inequalities

• Consider providing community healthcare facilities on the vacated site.

• Ensure that the ambitions of “Achieving Excellence”, shifting the balance of care from hospital to local communities, are fully achieved Outcomes

• FSD report considered by accountable officer (DPH) and recommendations accepted

• Scottish Government commissioned independent review which supported work undertaken through FSD assessment

• NHS Lanarkshire Board commitment to an enhanced community transport model and to retain and regenerate existing site to support reduction of health inequalities using a community development approach