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Home , Ashingdon, Canewdon, Castle Point, Great Wakering, Hockley, Rawreth

Castle Point &

Locality Estates Strategy Introduction

July 2018 V9GB-040718

V9 140318 Table of Contents

1 Overview ...... 2 2 Strategic context ...... 3 National Drivers for Change ...... 3 2.1.1 Five Year Forward View 3 2.1.2 Sustainability and Transformation Plan/Partnership (STP’s) 3 Local drivers for change ...... 4 2.2.1 & Rochford CCG’s 5-year Strategy 4 2.2.2 Castle Point & Rochford CCG’s Primary Care Strategy 4 2.2.3 Sustainability and Transformation Plan/Programme 5 2.2.4 South East Strategic Estates Plan/Locality Estates Strategies 6 3 Castle Point ...... 8 Castle Point demographics ...... 8 Key health issues in Castle Point ...... 9 3.2.1 Life Expectancy 1 Population of Castle Point ...... 1 4 ...... 2 Rochford District Demographics ...... 4 Key Health Issues in Rochford District ...... 5 4.2.1 Life Expectancy 6 Population of Rochford District ...... 6 5 Summary ...... 7

V9 040718 1 1 Overview

Castle Point & Rochford Clinical Commissioning Group (CCG), , Castle Point Borough Council and Rochford District Council, together with NHS (NHSE), are responsible for the delivery and provision of primary and community health and social care across the Castle Point & Rochford area.

In partnership, the CCG and Councils have ambitious plans to bring health and social care services together to make significant improvements in how and where these services are delivered in a primary and community care setting. Together they will develop innovative ways to coordinate care around people’s needs by delivering more support at home as well as earlier treatment in the community to help people be healthier for longer. By working in a more joined-up fashion and promoting the prevention agenda, unnecessary hospital admissions can be reduced and patients can remain independent in their own home for longer.

By bringing together the collective resources of Castle Point & Rochford’s statutory, voluntary and third sector organisations, the aim is to give the area a truly integrated health and social care system, where information is shared between professionals enabling them to create a single, comprehensive care package encapsulating all of a client’s needs.

Castle Point & Rochford is located on the coast of south Essex, between and Southend-on-Sea, Rochford District has a population of 83,287 over 65 square miles and Castle Point has a population of 88,011 over 17.3 square miles. The CCG have divided the area into 4 localities;

• Rochford, including , , Hawkell, , and • Rayleigh; • Benfleet, including and Hadleigh; • .

The main providers of non-primary care healthcare services in the area are;

• Basildon and University Hospital (BTUH) – secondary care • Southend University Hospital Foundation Trust (SUHFT) – secondary care • Essex Partnership University Trust (EPUT) – community and mental health services; • Ambulance Service.

The public sector in Castle Point & Rochford owns a considerable amount of estate and land, therefore the CCG and Councils recognise the value of working together to get more out of their collective assets whether that’s for catalysing major service transformation such as health and social care integration and benefits reform; unlocking land for new homes and commercial space; or creating new opportunities to save on running costs or generate income.

This Locality Estates Strategy Introduction provides an overview of the of the whole Castle Point & Rochford area and provides the context in which the four individual Locality Strategies have been developed. Individual Locality Strategies have been developed for Rochford (and surrounding areas), Rayleigh, Benfleet (Thundersley & Hadleigh) and Canvey Island. Each Strategy is a “live” document and will continually be updated to reflect the emerging CCG and STP transformation plans. V9 040718 2 2 Strategic context

National Drivers for Change

2.1.1 Five Year Forward View

The Five Year Forward View (5YFV), published in October 2014 sets out a clear strategic framework. It sets out how the health service and its partners can meet the challenges of changing health needs, rising expectations and constrained public resources by addressing the following gaps:

• Health and wellbeing gap and the need to invest in prevention; • Care and quality gap hence the creation of the new models of care; • A funding gap of £30b nationally to be closed through efficiencies (80% - £22b nationally) and investment (20% - £8b nationally) over the next five years.

In March 2017, the “Next Steps on the NHS Five Year Forward View” was published and concentrates on what will be achieved over the next two years, and how the Forward View’s goals will be implemented. 2017 marks the third phase where the focus shifts decisively to supporting delivery and implementation of the key priorities detailed in the Plan:

• Urgent and emergency care; • Primary Care; • Cancer; • Mental Health;

To deliver these aims, commissioners and providers across the NHS and local government need to work closely together – to improve the health and wellbeing of their local population and make best use of available funding.

2.1.2 Sustainability and Transformation Plan/Partnership (STP’s)

Sustainability and Transformation Plan/Partnerships (STPs) bring together primary care, acute care, mental health services and social care to keep people healthier for longer and integrate services around the patients who need it most. They reflect the recognition that more integrated models of care are required to meet the changing needs of the population. In practice, this means different parts of the NHS and social care system working together to provide more co-ordinated services to patients – for example, by GPs working more closely with hospital specialists, district nurses and social workers to improve care for people with long-term conditions.

STPs will cover the period up to March 2021 and will focus on:

• improving quality and developing new models of care • improving efficiency of services • improving health and wellbeing

V9 040718 3 Local drivers for change

2.2.1 Castle Point & Rochford CCG’s 5-year Strategy

All stakeholder organisations in the Castle Point and Rochford have developed a joint five-year plan to ensure that all organisations look at the system as a whole, from the viewpoint of its citizens. The collaboration defines a vision and values that are designed to have the best interests of the residents at its heart.

The objectives of Castle Point & Rochford’s plans are:

• Transforming the care of the vulnerable and elderly; • “Home not hospital”; • Personalised and preventative care; • Delivering care outside the Hospital; • Planned surgical care: driving higher volume through fewer centres; • Focus on children and young people; • Quality in primary care.

This will be achieved by: • Commissioning integrated health and social care management hubs in both CCG localities to improve care for the vulnerable and elderly; • Develop and implement community and acute frailty pathways including intermediate care beds and a full review of ambulatory emergency care; • Treating patients in the comfort of their own homes and tailoring care to individual patient’s needs through telemedicine and remote consultations; • Develop and deliver Joint Activity Reduction Plan in partnership with Southend CCG and SUHFT to reduce acute based activity, focus on MSK, ophthalmology and paediatric reductions; • Co-production and self-management, facilitated by technology, will be at the heart of this new model, enabling the home to safely be the location for higher acuity healthcare; • Support the review of Essex acute Hospitals and implement recommendations for sub-specialisation; • Work with partners to recommission Children’s Adolescent and Mental Health Services on an Essex wide basis; • Invest in a programme of targeted primary care development to support the delivery of the Strategy and the associated goals to reduce the variability of primary care quality and outcomes so that patients across the localities receive the same high standard of care.

2.2.2 Castle Point & Rochford CCG’s Primary Care Strategy

General practice and wider primary care services face increasingly unsustainable pressures. Castle Point & Rochford’s Primary Care Strategy identifies the need for an integrated, flexible and responsive primary care-led health system providing wider primary care at scale, with people only going to hospital where there are no other community-based options for them. The aim is that no barriers remain between primary, community, secondary and social care to allow true, integrated teams working for the benefit of patients.

V9 140318 4 The key priorities for primary care in Castle Point & Rochford can be summarised as:

• Reducing variation in the quality of primary care; • Support for preventative care, wellbeing and early diagnosis of health problems; • Integrated approaches to primary care on a 24/7 basis, supported by NHS 111 and Out of Hours; • Integrated approaches (linked to Better Care Fund) to care for the elderly and those with long-term conditions; • Personalised care-planning and self-management; • Rapid, convenient access to planned and outpatient care, with more care provided out of hospital.

The Strategy suggests “Hub and Spoke” models where services are based around localities providing a model of care designed around the needs of that population.

Castle Point & Rochford CCG member practices have established a Federation (GP Healthcare Alliance) that provides a local network to allow members to benefit from closer working relationships. GP Healthcare Alliance benefits from sharing expertise in such areas as procurement, training and education, management and business solutions which benefit the way individual GP practices are operated.

2.2.3 Sustainability and Transformation Plan/Programme

South and mid-Essex (Southend, Castle Point & Rochford, Basildon & Brentwood, Thurrock and Mid-Essex CCGs) has been identified as a health economy with challenges that would benefit from having an STP. The STP sets out how radical change is needed to sustain services into the future and improve care for patients. The overall aim is to address deep-rooted, systemic pressure and ultimately improve health and care where systems are managing financial deficits or issues of service quality or both.

In summary, the plan is to: • Do more to help people stay well for longer; • Join services together – physical and mental health, hospital, community and social care - to provide more care closer to people and help people avoid having to go to hospital; • Redesign the three main hospitals in mid and south Essex to meet rising demands with the right number of doctors and nurses. By working together as a group, the three hospitals in Basildon, and Southend could provide some of the best quality emergency and specialist care in the country.

The STP provides an opportunity to develop access to a stronger and better healthcare economy for the populations of Essex, including the people of south-east Essex and Castle Point & Rochford. Map 1: South and Mid Essex STP

V9 040718 5 2.2.4 South East Essex Strategic Estates Plan/Locality Estates Strategies

In June 2015 CCGs were asked to develop a draft system wide Local Strategic Estates Plan. The purpose of the Strategy was to make the smartest use of our healthcare estate infrastructure and to be able to prioritise new investment where it is most needed and will drive the greatest benefits. The South-East Essex Strategic Estates Plan covers the Southend and Castle Point & Rochford CCG areas and was developed by commissioners, providers, local Councils and NHS property companies.

However, as system-wide transformation plans have developed and as the vision for truly integrated health, social, voluntary and third sector services has evolved it has been recognised that further work and more detailed strategies are required for each of the localities in the Castle Point & Rochford area:

• Rochford, including Ashingdon, Hockley, Hawkell, Hullbridge, Great Wakering and Canewdon • Rayleigh; • Benfleet, including Thundersley and Hadleigh; • Canvey Island.

The Locality Strategies cover each of the four Localities and look at the issues affecting each area with regards to health and social care need and the growing population. They set out a programme of estate change over the next 10 years so that the asset base is better able to support the demographic changes and the modernisation and integration of health and social care delivery in Castle Point & Rochford and to provide resilience and enhance the delivery of care within the local health system. The Strategies focus on the residents that live in each locality and do not cover other services that are provided for out of area clients. The Strategies make recommendations about the facilities required in order for the health and social care system to realise it’s transformation plans.

Several principles have been applied in order to develop the Strategies and to ensure that the same integrated care model is delivered to all residents of the borough whilst still recognising the unique issues and challenges in each locality. In summary, the following principles have been applied:

• Health & Social Community Care Hub; ➢ Each locality will have a Health & Social Community Care “Hub” providing integrated services including primary care, out of hospital, community, social, voluntary and third sector services; ➢ The Hub will provide services to at least 30,000 residents and must have the ability to operate 24 hours a day, seven days a week; ➢ The accommodation will be as flexible and generic as possible to allow an entire range of services to be delivered from it. There will be as little specialised clinical space as possible and dedicated space will be kept at a minimum; ➢ The precise services that are to be delivered from each Hub has yet to be defined and so, where a new facility may be required, the size of this cannot yet be determined. However, where a suitable Hub already exits, the service model may be influenced by the existing accommodation; ➢ If a suitable building already exists in a Locality that could be used as a Hub it must be identified as such providing it: o Has the capacity to accommodate existing services plus a range of integrated care services; o Is fit-for-purpose or could be made fit-for-purpose. o Any LIFT building i.e. Canvey PCC that has a long-term lease commitment must be identified as the Locality Hub.

V9 040718 6 • Spokes ➢ Each Hub will have a number of spokes, dependant on the requirements of that locality; ➢ A Spoke will deliver core services; ➢ Each Spoke should serve at least 10,000 patients; ➢ A Spoke must have at least 3 GPs (or equivalent); ➢ Each Spoke should provide 1 GP and 1 practice (or equivalent) nurse during all core hours and remain open during these hours.

• Administrative Hub ➢ It is recognised that some administration space will be required within each of the Community Hubs but a large portion of admin. would be better suited to more cost- effective office accommodation; ➢ There will be at least 1 Admin. Hub in Castle Point and Rochford. However, it should be recognised that due to the area’s geography, another Admin. Hub may be required in Canvey Island; ➢ The Admin. Hub will need to be on good transport links and have adequate parking for large numbers of peripatetic staff; ➢ The accommodation would need to offer large meeting spaces with hot desks and good access to IT systems through wifi.

• GP training practices ➢ There should be a training GP practice in each locality with more practices encouraged to become training practices during the development and implementation of the Locality Strategies.

V9 040718 7 3 Castle Point

The Borough of Castle Point is located on the coast of south Essex, between Basildon and Southend-on-Sea, with a population size of 88,011 over 17.3 square miles with the main east to west routes being the A13 and A127.

The area has been divided into 2 Localities Canvey Island and Benfleet, Thundersley and Hadleigh as shown in the map to the left

Each Locality is made up of the following Wards:

Locality Wards

• Canvey Island North • Canvey Island West Canvey Island • Canvey Island East • Canvey Island Central • Canvey Island South • Canvey Island Winter Gardens • St George • Victoria Benfleet, Hadleigh & • St Peter • Appleton Thundersley • Cedar Hall • St Mary • Boyce • St James Table 1: Castle Point Wards

Map 2: Castle Point

Castle Point demographics

Below are the key population issues facing the Borough of Castle Point:

• Between the 2001 Census and 2011 Census, the total population of Castle Point has grown by 1.6%; • Compared with the 2001 Census, the 2011 Census reports the three greatest percentage increases in population are in the 85+ year olds by 47.4% (740 additional people), 60-64-year olds by 40.9% (2,060 additional people) and the 65-69-year olds by 32.8% (1,433 additional people). • The number of residents living in the district who are aged 65 and over is expected to increase from 21,700 people to 31,600. This takes the proportion of people in this age bracket from 24.5% to 32.2% by 2034. This is a 7.7% increase the third highest percentage change of the Essex districts; • Even though the population grew between the 2001 and 2011 Census there have been some fairly large percentage decreases in populations by age such as 30-34-year olds by 28.3% (1,614 fewer people), 35-39-year olds by 17.7% (1,100 fewer people) and 50-54-year olds by 21.1% (1581 fewer people);

V9 040718 8 • For children and young people there has been a decrease in population between the 2001 and 2011 Census for 0-4-year olds by 7.8% (351 fewer people), 5-9-year olds by 18% (962 fewer people), 10-15-year olds by 3.7% (200 fewer people) and 15-19-year olds by 7.6% (521 fewer people). (Source: NOMIS and ONS)

Castle Point’s IMD score ranks it 187 out of 354 local authorities, putting it in the top half of least deprived nationally. With an IMD score of 16.63, Castle Point has low levels of deprivation compared with Essex,

however has pockets of high levels of deprivation above the national median in Canvey Island. It has 1 Lower Super Outer Areas (LSOAs), in Canvey Island East that is within the 10 per cent most deprived areas in England. However, in comparison there are 2 LSOA areas ranked in the 10% least deprived in the whole of

England.

The inequality score highlights pockets of deprivation by calculating the difference between the highest and lowest scoring SOAs within the unitary. For Castle Point, the score is low compared with national

standards, ranking in the 40% least deprived LAs on inequality.

Map 3: IMD Score, compared against Essex

Key health issues in Castle Point

The health of people in Castle Point is similar to the national picture, however diet-related indicators are worse than average, with fewer people eating healthily and an increase in obesity and diabetes. 27% of adults are classified as obese and 20.4% of children are classified as obese by the age of 11. Early death rates from heart disease and stroke are decreasing and are well below the national average, while early deaths from cancer are tracking the national trend very closely. (Source: ONS)

Fewer children live in poverty, however, children’s health is close to the national average. Teenage pregnancy and dental health in children is significantly better than average.

An annual report published by the Association of Public Health Observatories, identified the following key health issues for the Castle Point area: • Increasing older population living in their own homes • Lower life expectancies • Above average levels of smoking rate • Above average levels of obesity

V9 040718 9 3.2.1 Life Expectancy

Males: Females:

Map 4: Life Expectancy of Males (left) and Females (right) compared to the rest of Essex

The life expectancy of both males and females within Castle Point is just below average compared to the rest of Essex, with males on average living to 79.5 years (0.5 years below average) and females living to 83 years (1 year below average).

Population of Castle Point

The population in Castle Point is 88,011 (2011 census data). Below is an analysis of the population growth between the 2001 Census and 2011 Census and the projected population growth until 2031:

2001 Census 2011 Census % increase between 2001 Projected population as Projected population as % projected increase & 2011 at 2021 at 2031 between 2001 & 2031 86,604 88,011 1.6% 91,095 95,718 10.52% Table 2: Population of Castle Point (Source: NOMIS, population projections by local authority)

The table above shows that the population is expected to increase by 8.76% in Castle Point, between 2011 and 2031.

V9 040718 1 4 Rochford District

Map 5: Rochford District

Rochford District is located on the coast of South Essex, between Basildon and Southend-on-Sea, with a population size of 83,287 over 65 square miles. The District has two main routes in and around its boundary, being the A130 and A127.

The area covered is often divided into four tiers of settlement; 1. Rayleigh; Rochford/Ashingdon; Hockley/: Of the first-tier settlements, Rayleigh has the best access to services within the District. Rochford and Hockley contain local town centres catering for local need. 2. Hullbridge; Great Wakering: The second- tier settlements have a more limited range of services and access to public transport is relatively poor. 3. Canewdon: The third-tier settlement has few services and public transport provision is generally poor. 4. All other settlements: The remaining rural settlements, are located within the Green Belt. There are little or no services and access to facilities relies on residents own transport.

V9 040718 2 The CCG has divided the area into 2 Localities; Rayleigh and Rochford and its surrounding areas as shown in the map below;

R Rochfo

Map 6: Rochford Localities

Each Locality is made up of the following Wards:

Locality Wards

• Grange • Lodge • Rayleigh Central Rayleigh • Wheatley • Trinity • Sweyne Park • Whitehouse • Downhall & • Rochford • Hawkwell North • Hockley North • • • Rochford Hullbridge Hawkwell West Hockley Central • Ashingdon & Canewdon • Hawkwell South • Hockley West • Barling & Sutton • Foulness & Great Wakering Table 3: Rochford District Wards

V9 040718 3 Rochford District Demographics

The key population issues facing Rochford District: are;

• Between the 2001 Census and 2011 Census, the total population of Rochford District has grown by 6.1%; • The District has an ageing population with a higher proportion of people aged 65 or over than can be seen nationally; the number of people over the age of 65 is expected to increase from 18,800 people to 27,700 by 2035. This takes the proportion of people in this age bracket from 22.3% to 29.4% by 203, a 7.1% increase. • Compared with the 2001 Census, the 2011 Census reports the three largest percentage increases in the population of Rochford are the 60-64-year olds by 40.7% (1,765 additional people), 85+ year olds by 37.7% (575 additional people) and 80-8- year olds by 29.9% (553 additional people). • Even though the population grew between the 2001 and 2011 there have also been some significant decreases in population between the 2001 and 2011 census for children and young people; for 0-4 year olds there has been a decrease by 2.3% (103 fewer people) and 5-9-year olds by 14% (714 fewer people). (Source: NOMIS, ONS)

Rochford District score ranks it 285 out of 354 local authorities, putting it in the top 20% least deprived nationally. With an IMD score of 11.03, Rochford District has low levels of deprivation compared with Essex. It has no Lower Super Outer Areas (LSOAs), within the 10 per cent most deprived areas in England. However, in comparison there are 9 LSOA areas ranked in the 10% least deprived in the whole of England.

The inequality score highlights pockets of deprivation by calculating the difference between the highest and lowest scoring SOAs within the unitary. For Rochford District, the score is low compared with national standards, ranking in the 40% least deprived LAs on inequality.

Map 7: IMD Score, compared against Essex

V9 040718 4 Key Health Issues in Rochford District

The health of people in Rochford District is generally better than the national average however; diet-related indicators are worse than average, with fewer people eating healthily and an increase in obesity. It has been published that 28.1% of adults within the District are classified as obese and 14.4% of children are classified as obese by the age of 11. Early death rates from heart disease and stroke are decreasing and are well below the national average, while early deaths from cancer are tracking the national trend very closely. (Source: ONS).

Rochford District has the fourth highest rate of diabetes within Essex county and has a poor wellbeing amongst some adults; but does have a lower than average percentage of the population with mental health problems. The District is seeing an increase in the number of people with dementia, which tracks the increase of ageing population. Overall fewer children live in poverty compared to the national average; however, children’s health is close to the national average. Teenage pregnancy and dental health in children is significantly better than average.

An annual report published by the Association of Public Health Observatories, identified the following key health issues for the Rochford District area:

• Increasing older population living in their own homes • Above average levels of smoking rate • Lower life expectancies • Above average levels of obesity

In concurrence with the key health issues identified by the Association of Public Health Observatories the Rochford District Profile has identified the following three initial priorities for the Rochford District Area;

• Dementia care and vulnerable older people • Long term chronic conditions • Adult physical activity

V9 040718 5 4.2.1 Life Expectancy

Males: Females:

Map 8: Life Expectancy of Males (left) and Females (right) compared to the rest of Essex

The life expectancy of males within Rochford District is above average compared to the rest of Essex, living on average to 80 years (0.5 years above average) and females trending the average living to 84 years.

Population of Rochford District

The population in Rochford District is 83,287 (2011 census data). Below is an analysis of the population growth between the 2001 Census and 2011 Census and the projected population growth until 2035:

2001 Census 2011 Census % increase between 2001 Projected population as Projected population as % projected increase & 2011 at 2021 at 2031 between 2001 & 2031 78,483 83,287 6.12% 87,422 92,398 17.73% Table 4: Population of Rochford District (Source: NOMIS, population projections by local authority)

The table above shows that the population will increase by 10.94% in the Rochford District area, between 2011 and 2035.

V9 040718 6 5 Summary

In summary, the Strategy identifies there is a lack of suitable, fit-for-purpose premises in the Castle Point & Rochford area and demonstrates the need for improved premises to provide a suitable infrastructure to support the demographic changes and the modernisation and integration of health and social care delivery. Therefore, an urgent solution is required to enable commissioners to deliver their Transformation Plans to provide integrated care from a Community Hub.

Given the limited growth funding in primary care budgets, commissioners will have to take a rigorous approach to prioritising potential premises developments, so that any available funding is targeted on areas of greatest need.

When reviewing premises development proposals, the overarching decision should;

• Take account of local service needs; • Be affordable and demonstrate value for money; • Be in line with the objectives of the Primary Care Strategy and those of the Strategic Estates Plan (SEP).

The following key principles should be adopted when considering premises developments;

• Investment in premises should be allocated to deliver the strategic vision to support the overall commissioner goals. • Decisions about investment and disinvestment should be fair and equitable across the system and the decision- making process should be transparent. • Work must be undertaken to eliminate “void” costs and decommission premises where they are not used to their full potential. • Optimisation of all publicly owned (or leased) estate, utilising existing infrastructure before any new building is developed.

There is no new dedicated revenue resource – all developments will need to be financed within the existing financial revenue resources of the commissioners and investment will need to be funded by releasing resources and assets. This will be challenging given the current financial position. Capital funding may be available through central routes and from developer contributions but the commissioners will need to be able to meet the ongoing revenue commitments associated with any capital schemes.

V9 040718 7 Based on the recommendations set out in each of the attached Locality Strategies for Rochford, Rayleigh, Benfleet and Canvey Island, the following estimated capital funding requirements have been identified:

Castle Point & Rochford estates projects Locality Scheme Capital requirement Potential Funding Source Rochford New Community Integrated Care Hub (Rochford) £8m 3PD/LIFT/Council/STP ns

o Primary Care Spoke (Great Wakering) £2m 3PD/GP

s Potential Primary Care Spoke (Hullbridge) £2m 3PD/GP e k/opti

r Potential Primary Care Spoke (Ashingdon) £2m 3PD/GP cas

wo Rayleigh New Community Integrated Care Hub (Central Rayleigh) £6m LIFT/3PD/GP/STP

New Primary Care Spoke (Sweyne Park, Grange or Downhall & Rawreth £4m 3PD/LIFT/GP lity i Wards) usiness Benfleet New Community Integrated Care Hub £8m 3PD/LIFT/Council/GP/STP d b feasib 2 x Primary Care Spokes 2 x £2m 3PD/GP an

l

ther Canvey Island Canvey Primary Care Centre variations (Phase 1) £2m ETTF r

u Canvey Primary Care Centre variations (Phase 2) £3m

aisa LIFT New Canvey 2 Primary Care Spoke (East Canvey) £5m 3PD/LIFT/GP t to f app r New Integrated Administrative Hub £1m

ec EPUT/3PD Castle Point & Rochford whole New Integrated Administrative Hub £1.5m EPUT/3PD ubj S TOTAL £48.5m

In summary, it is estimated that circa £48.5million of capital investment will be required in Castle Point & Rochford over the next 10 years to ensure that the estate infrastructure is in place to enable the delivery of modern, integrated care services to the population.

(Source: Maps 2-8: Grant Thornton, 2018)

V9 040718 8