BRIEFING PAPER FOR HWBB RE: DRAFT OUTLINE BUSINESS CASE Barrow Primary Care Centre at Alfred Barrow

28TH JUNE 2015

BACKGROUND

This briefing paper is intended to give the HWBB an update on the development of the Alfred Barrow new primary care centre.

It covers:

 Why the scheme is needed: including the national and local contexts; the links between this development and the wider Better Care Together Strategy; and the current service model.  The proposed scheme: including the site, the new model of care and how the scheme will help to achieve local plans.

Information is taken from the Outline Business Case for the development which is still in draft as it has not yet been completed or submitted to NHS England. This should take place later in Summer 2015, with an indicative start date for the centre opening in Autumn 2017 (subject to the approval process).

WHY THE SCHEME IS NEEDED

This scheme is required to meet national and local drivers to improve health outcomes for the population of Barrow-in-Furness.

The scheme will vastly improve patients’ experience by enabling community-based clinical teams to provide holistic, joined-up services that are efficient and effective.

The ambitions of the clinical community go beyond the building itself. The Alfred Barrow Centre will be a hub for healthy living and community well being and a ‘vanguard’ site in Barrow to lead the way in out-of-hospital care.

THE NATIONAL CONTEXT

The scheme addresses national drivers for change as set out in the table below:

National drivers for change and how the scheme addresses these

NATIONAL DRIVER HOW THE SCHEME ADDRESSES THIS NHS Constitution 1. Codified the rights and responsibilities of NHS patients This scheme will: and staff  Provide services for individuals in the local 2. Established the following basic principles and values population of Barrow-in-Furness, as is their right guiding every aspect of the NHS:  Improve access to NHS services a. The NHS provides a comprehensive service available to all  Improve the existing accommodation and models of b. Access to NHS services is based on clinical care to provide the people of Barrow-in-Furness with needs, not an individual’s ability to pay 21st Century health care c. The NHS aspires to the highest standards  Respond to problems identified in patient experience of excellence and professionalism surveys d. The NHS services must reflect the needs  Develop partnership working across organisational and preferences of patients, their families and their carers boundaries

1 NATIONAL DRIVER HOW THE SCHEME ADDRESSES THIS 3. Reiterates that the NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population.

Everyone Counts: This scheme focuses on: Planning for Patients 2013/14 to 2018/19  Listening to patients as part of the Better Care Together The key principles are: consultation and meeting their desire to have care 1. Listening to patients delivered as close to home as possible 2. Focusing on outcomes  Improving health care outcomes and life expectancy for 3. Rewarding excellence people living in Barrow-in-Furness 4. Improving knowledge and data  Improving knowledge and data through improved and integrated IM and T for health care providers NHS England Five Year Forward View - October 2014 This scheme will deliver the strategic objectives in NHS The strategic objectives of the five-year forward review include: England’s Five Year Forward View - October 2014 – for the local  Better prevention of ill health populations of Barrow-in-Furness as follows:  Empowering patients  Prevention of ill health – the scheme will improve  Engaging diverse communities access to Primary Care, reduce hospital admissions  Development of new models of care and increase life expectancy  Empower patients – the model of care will wrap The five year plan includes: services around individual patients 1. Sets out a clear direction for the NHS indicating why  Engaging diverse communities – the scheme will change is needed and what it will look like. engage all communities 2. Some actions require new partnerships with local  Development of new models of care – a new Out of communities, local authorities and employers. Hospital model of care has been designed and 3. Some critical decisions are required re investment to piloted for the PCC and a project plan is being implemented to introduce the model of care improve public health and on local service changes.  Integration of GPs, community services, mental These will need explicit support from the next health services, children’s services and social care to government. provide a Primary Care Community 4. The first argument in Forward View is that the future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health. Twelve years ago Derek Wanless’ health review warned that unless the country took prevention seriously we would be faced with a sharply rising burden of avoidable illness. That warning has not been heeded – and the NHS is on the hook for the consequences. 5. One new option identified is to permit groups of GPs to combine with nurses, other community health services, hospital specialists and perhaps mental health and social care to create integrated out-of- hospital care – the Multispecialty Community Provider.

The Forward View into action: This scheme is a fundamental part of how the local health Planning for 2015/2016 -December 2014 economy plans to deliver the Forward View in 2015 and 2016. Describes the approach for organisations to make a start in The scheme will deliver transformational change to secure 2015/16, towards fulfilling the vision set out in the Five Year sustainable high quality care with the following characteristics Forward view, whilst at the same time delivering high quality, relevant to this project: timely care that the people of England expect today.  Wider transformational primary care, provided at scale. The 2015/16 plans need to build the foundations for progressing  A modern model of integrated care centred on the the Five Year Forward View, including how the economies will patient. take forward the new models of care described within it.  Access to the highest quality urgent and emergency care. Economies are asked to consider creating new models of care

2 NATIONAL DRIVER HOW THE SCHEME ADDRESSES THIS across local and national organisations including: 1. Multispecialty community providers (MCPs) 2. Integrated primary and acute care systems (PACs) 3. Viable smaller hospitals 4. Enhanced health in care homes

THE NHS Outcome Framework 2014/15 This scheme focuses on: 1. Prevent people from dying prematurely  Listening to patients and meeting their desire to have care 2. Enhance quality of life for people with long term delivered as close to home as possible conditions  Developing a Rapid Response Service that supports people 3. Helping people to recover from episodes of ill health to get well and stay well without hospital admission or following injury 4. Ensuring that people l have a positive experience of  Improving health care outcomes and life expectancy for care people living in Barrow-in-Furness 5. Treating and caring for people in a safe environment  Improves current accommodation to a safe standard and protecting them from avoidable harm  Improving knowledge and data through improved and Some of the outcomes are aligned with Adult Social Care integrated IM&T for primary care providers Outcomes Framework (ASCOF) and/or Public Health Outcomes Framework (PHOF)

THE LOCAL CONTEXT

In 2013 Barrow-in-Furness’s population was approximately 67,800. Barrow-in-Furness was once the largest iron and steel centre in the world and a hive of shipbuilding activity. Like a number of other Northern towns and cities, Barrow-in-Furness prospered with the development of the steel and shipbuilding industries and the advent of the railway. From humble beginnings with just a few hundred inhabitants, by the late 19th century Barrow-in-Furness was booming. It was home to tens of thousands of workers, many of whom were employed by the Barrow-in-Furness Shipbuilding Company, later taken over by Vickers. But in the postwar years traditional industries dwindled and many people in mining and steel lost their jobs.

The 2013 public health profile confirmed that:  The health of people of Furness is worse than the England average  Deprivation is higher than average (39.6% of people in Barrow-in-Furness live in 20% of the most deprived areas of England)  11.8 of people in Barrow-in-Furness are in long-term unemployment per 1,000 working age population  Life expectancy is lower than the England average - 9.6 years lower for men and 6.8 years lower for women in the most deprived areas of Barrow-in-Furness in Furness.  3,285 children live in poverty.  Breastfeeding initiation is significantly lower than regional and national averages  Alcohol specific hospital stays for under 18s are significantly higher than national average  Only 51% of children achieve GCSE A*- C (including English and Mathematics) compared with a North West regional average of 59.9% and an England average of 60.8%.  For adults in Barrow-in-Furness, hospital stays for self-harm and alcohol related harm is very significantly higher than both regional and national averages (372.0 per 1,000 and 908 per 1,000 respectively).  Both recorded drug misuse and recorded diabetes are higher than regional and national averages (15.3 per 1,000 and 6.47% respectively).  Over the last ten years although all-cause mortality rates, early death rate from heart disease and strokes have fallen, these have been at lower rates than the rest of England.

3  Critically an examination of the PHOF 32 health indicators illustrates starkly that in over 50% of indicators the Furness average is significantly worse than the England average.

Health Profiles

Indicator Period England North West Barrow-in- Furness Deprivation 2013 20.4 32.8 39.6 Children in Poverty (under 16s) 2012 19.2 21.4 21.4 Statutory Homeless 2013/14 2.3 1.2 0.6 young GCSE achieved (5A*-C inc Eng & Maths) 2012/13 60.8 59.9 51.0 communities Violent Crimes (violent offences) 2013/14 11.1 11.0 16.3 people Our Long term unemployment 2013 9.9 11.2 11.8

Smoking status at time of delivery 2013/14 12.0 15.3 13.8

and Breastfeeding initiation 2013/14 73.9 64.5 51.2 Obese children (Year 6) 2013/14 19.1 19.8 20.5 Alcohol specific hospital stays (under 18) 2010-2013 44.9 71.9 113.0 Children Under 18 conceptions 2012 27.7 31.5 32.4 Smoking prevalence 2013 18.4 20.1 23.4 Percentage of physically active adults 2013 55.6 53.3 52.3 Obese adults 2012 23.0 24.3 22.7

Adults Excess weight in adults 2012 63.8 66.0 67.0 Incidence of malignant melanoma 2009-2011 14.8 16.5 8.8 Hospital stays for self harm 2012/13 188.0 245.3 372.9

Health Hospital stays for alcohol related harm 2012/13 637 731 908 Drug misuse 2010/11 8.6 10.7 15.3 Poor of Recorded diabetes 2013/14 6.21 6.50 6.47 death and Incidence of TB 2010-2012 15.1 11.5 5.8 All STI diagnoses (ex Chlamydia age<25) 2013 832 758 453

Disease Hip fractures in age 65 and over 2012/13 568.1 589.2 510.6

Excess winter deaths (three year) 2010-2013 17.4 17.1 12.2 Life expectancy at birth (male) 2011-2013 79.4 78.0 76.9

causes Life expectancy at birth (female) 2011-2013 83.1 81.8 81.6 &

Infant mortality 2010-2012 4.1 4.3 2.7 Smoking related deaths 2011-2013 288.7 346.7 315.7 Under 75 mortality rate – cardiovascular 2011-2013 78.2 92.8 96.9 expectancy Under 75 mortality rate - cancer 2011-2013 144.4 159.8 161.6 Life Killed and seriously injured on roads 2011-2013 39.7 39.4 20.5

NHS Cumbria Strategic Service Development Plan 2011/12 recognises that the development of improved infrastructure across Furness is an urgent and vital enabler to improving health and social care for the population of Barrow-in-Furness. Historical underfunding has resulted in out of date, poorly designed and poorly maintained buildings, which are totally inappropriate to deliver 21st century healthcare.

The Morecambe Bay health economy is overspending by approximately £30m and in Furness there are significantly high levels of non-elective and elective admissions and outpatients into acute care: whilst much of this is attributable to high levels of deprivation and health inequalities, it is also attributable to poor access to primary care.

Following the recent reviews of services, all organisations providing health and social care across Morecambe Bay have worked together to produce ‘The Better Care Together’ (BCT) programme, this

4 sets out a sustainable strategy for health services in Morecambe Bay. A cornerstone of this is updating the out of hospital and in hospital models of care in order to “right size” the hospitals. In Barrow-in-Furness in particular, there are significantly higher levels of non-elective, elective, and paediatric admission levels (all upper quartile compared to national comparators). There has been an over-reliance on hospital services in part due to the lack of capacity in primary and community services. For example, less than 20% of nursing staff in Morecambe Bay are outside hospital compared with nearly 70% in mature integrated health systems like Torbay.

Better Care Together has set out a new integrated model of out of hospital services, which looks to wrap community services around GP practices with in-reach from acute staff. This will help to keep people fit and well for longer, avoid unnecessary hospital admissions, reduce beds, consolidate acute services across Morecambe Bay and, therefore, save money. In order to deliver the new model of care ‘fit for purpose’ primary and community facilities in town centres are required.

The BCT Strategy was submitted to NHS England and Monitor on 30 June 2014 and has recently been approved. The Strategy confirmed that the Barrow Primary Care Centre, one of seven identified as needed across Morecambe Bay, is essential to deliver the Out of Hospital model in Furness and contribute to the Morecambe Bay health economy being able to deliver affordable 21st century healthcare.

LINKS BETWEEN BETTER CARE TOGETHER (BCT) AND ALFRED BARROW

The vision set out in the Better Care Together Strategy is:

“By 2025 Morecambe Bay will have a well-deserved reputation as one of the best health and care systems in the world. Promoting wellbeing and preventing ill health will be our prime purpose with mental health, children’s and older people’s services receiving equal priority with all other areas of care.”

The underpinning principle throughout the Strategy is the need for integration of services: this is at the heart of the Vanguard Expression of Interest in February 2015: which stated:

“We are working to create an Accountable Care System of Provision that will take responsibility for the whole health and care needs of our population, under a single capitated budget.”

At present, GP practices and community services are provided in Barrow from a multiplicity of buildings throughout the town, with little or no joint provision, poor building conditions and no opportunity to integrate services.

The driver behind the development of the new Alfred Barrow health centre is primarily the need to provide decent buildings so that services, especially general practice, can be provided in a safe and appropriate environment.

However, we also recognise that if we are to provide the integrated care set out in the BCT Out of Hospital model, we need to provide accommodation which facilitates effective integration between primary and community services with appropriate in-reach from acute specialists.

The BCT strategy sets out the direction of travel for the health economy for the next 5 years and a Delivery Plan for the next 2 years. NHS England and Monitor have welcomed the Strategy and Delivery plan and an assurance process is in place.

5 The Delivery Plan is dependent on pump priming funding which NHSE and Monitor are not able to commit to, in whole or in part, until the assurance process is completed. This will impact on the ability of the local system to deliver the outcomes in the Plan.

In summary terms, the BCT strategy depends on the following core components:

 A new out of hospital model  Consolidation of elective care across the 3 acute hospital sites  Maintenance of core ‘stakes in the ground’ for Accident & Emergency and Consultant-led Maternity services at Furness General Hospital and the Royal Lancaster Infirmary  Right sizing of the bed base in hospitals (fewer people will need to be admitted as the out of hospital model keeps people fit and well and supported closer to home) and outreach of hospital specialists to support integrated primary and community team

The Better Care Together Programme has outlined a strategy aimed at improving the clinical and financial sustainability of the Morecambe Bay economy. At its heart is a new Out of Hospital model based on integration of care across primary and community services, with acute outreach.

In order to deliver this integrated model, it is essential that GPs and community services have fit for purpose buildings, which facilitate co-location and joint working. At present the poor condition and multiplicity of buildings, particularly GP practices, means this is not the case.

THE CURRENT SERVICE

It is accepted by commissioners and service providers that it is impossible to deliver 21st century healthcare from the exsiting widely dispersed premises which are in poor condition.

An Estates Review was completed across Furness in 2012 which identified problems with the current estate and recommended the provision of a:

‘New Health Centre – Centralise all outpatient services into a new build health centre of circa 1500m2 around Barrow-in-Furness town centre. Integrate Children’s, Mental Health and primary care services into the new facility’.

Currently primary care and community services are provided in Barrow-in-Furness in 28 properties, the majority being old and unsuitable for delivering 21st century healthcare with an estimated backlog maintenance cost of £614,000.

ACCESS TO PRIMARY CARE Public feedback indicates a high level of unnecessary attendances and admissions at FGH due to poor access and capacity in primary care in Barrow-in-Furness and Millom. A recent patient experience survey provides evidence of the problems accessing primary care through the current GP services:

Accessing Primary Care Survey - two of the practices below have merged, Risedale and Hartington Street

Survey Results from Jan and July 14 returned

Got an Had to Call Didn’t Get Can’t Surveys Surveys Response Appointment Back Later Appointment Remember Sent rate

(Results released 08 Jan 15) %s Figs %s Figs %s Figs %s Figs Figs Figs %

6 Risedale 78% 59 6% 4 13% 3 3% 2 369 144 39%

Atkinson HC 76% 58 10% 8 10% 8 4% 3 323 109 34%

Hartington St 82% 35 6% 3 9% 4 3% 1 306 104 34%

Family Practice 74% 47 14% 9 7% 5 4% 3 401 115 29%

Abbey Road 68% 71 20% 21 10% 10 2% 2 306 126 41%

Liverpool House 98% 83 1% 1 1% 1 0% 0 299 107 36%

Cumbria CCG Average 77% 6388 11% 892 9% 710 3% 269 8259

The total activity shift opportunities for the OoH model are set out on page 68 of the Better Care Together Strategy volume 2. These figures have been updated and the table below sets out the Cumbria share of the resulting activity reductions, with a split of the activity between PCCs and the Rapid Response/Urgent Care Coordination Centre.

Table 10 - Cumbria CCG non-elective activity reduction across the PCCs and Rapid Response/UCCC

CCG PCC Total Cumulative Reduction Target

15/16 16/17 17/18 18/19 19/20 Alfred Barrow 411 111 184 258 358 411 Central Lakes and Grange 298 80 134 187 260 298 East Lakes 286 77 128 180 249 286 CCG Kendal 3434 92 154 215 299 343 Millom and Duddon Valley 152 41 68 96 133 152 Cumbria Barrow Town 466 125 209 293 406 466 Ulverston and Dalton 296 80 133 186 258 296 PCC Total 2253 606 1010 1414 1962 2253 UCCC and Rapid Response 1586 426 711 995 1381 1586 Total Cumbria 3839 1032 1721 2410 3344 3839 Reduction Per Week 74 20 33 46 64 74

RECRUITMENT AND RETENTION Primary care in Barrow in Furness is suffering significantly from problems of recruitment and retention. This is a Cumbria-wide issue but is particularly acute in Barrow-in-Furness and Millom due to the geographical position and the poor quality of the estate. For example, Millom GPs have tried unsuccessfully to replace two out of their five doctors and cite the poor quality of the building as a major factor. The inability to recruit and retain staff is having a severe negative impact on delivery of care in an area of significant deprivation and poor outcomes. 10 GPs have left the service in the last 12 months circa 20%. The crisis in recruitment is being seen positively by the GPs as an opportunity to radically transform the way they work, with a new building as a catalyst to support change.

INCREASING NEED FOR HEALTH SERVICES IN A GROWING LOCAL ECONOMY Despite its recent economic problems Barrow-in-Furness remains a manufacturing hub with an array of industries and exciting plans for the future. It is essential for the health and wellbeing of local

7 residents that the economic momentum is maintained and nurtured. In the area BAE systems, Glaxo Smith Kline, onshore and off shore wind farm and gas energy generation are thriving. In particular, the submarines built by BAE indicate the strategic significance of the work of the town and highlight the need to ensure good health care for the increasing level of workers and contractors working at the facility over the coming years. BAE estimate an increase of up to 3,000 workers at the submarine yard over the next five years, with a large number of jobs being met by contractors and workers from outside of the area. BAE are committed to this project and will lease space to provide their Occupational Health Service.

There are plans for the redevelopment of the Barrow-in-Furness dock and marina and along the west coast the nuclear hub centred on Sellafield, which is also a major international economic asset. The provision of a comprehensive transport, education and health infrastructure is key to harnessing the potential of the area. Local economic partnerships have identified the provision of appropriate health facilities as a key enabler in their vision as follows:

 The need to cater for an increasing volume of workers and their families with specific needs  The need to ensure fit for purpose health facilities are available locally to address wider economic issues facilitating the recruitment of high calibre suitably qualified workers to our area to address hi tech recruitment issues  The need to provide for specific potential health issues relating to the industries supported in the area.

The development of the Alfred Barrow School site as the new Barrow Primary Care Centre is seen as an anchor for the town’s economic renaissance. The site is of historical importance to the town and is viewed across the area as a landmark legacy scheme. Support for the development has been unequivocal from all stakeholders. It is ideally situated for both health and the wider community benefits.

THE PROPOSED SCHEME

The project will deliver a new health centre on the existing Alfred Barrow School site in Duke Street, Barrow-in-Furness. This will be one of several Primary Care Communities identified as needed in the Better Care Together (BCT) Programme for the Morecambe Bay Health Economy. Central to the BCT programme is the model of care for primary care communities (PCCS) and teams that provide services across health and social care. These services will wrap around clusters of GP practices and proactively manage patients in their own communities working to maximise functional capacity and independence.

The building is designed to provide 21st century facilities to enable the integration of community, primary and social care services to work together to provide wrap around care to the patient and treat people in their own homes or communities where possible.

The building will be occupied by:  3 GP Practices (originally this was 4 GPs, however 2 of the practices have recently merged)  Cumbria CCG  Cumbria Partnership NHS Foundation Trust  North West Ambulance Service  BAE Systems

8  Pharmacy provider

The following services will be provided in the new facility: -  General Practitioners  Services including Therapy Services, CAMHS, Community Paediatrics, School Nursing, Health Visitors, Community Nursing, Primary Mental Health Services  Mental Health Services including First Step and Community Mental Health Services  Community and specialist services including Physiotherapy, Podiatry and Specialist Nursing - Diabetes, Retinal Screening, Learning Disabilities and Autism, Neurosciences, Acquired Brain Injury  Ambulance Response Base  Occupational Health (BAE Systems)  Pharmacy dispensing and minor ailments (Third Party)  Third Sector information point

DIAGNOSTICS It is recognized that diagnostics are available at Furness General Hospital and there is no plan to increase system costs by duplicating unnecessarily the provision of ‘high-end’ diagnostics. Simple, near-patient diagnostics e.g. ECG, anticoagulation clinic, ultrasound will be undertaken in the Alfred Barrow Centre and it is important for integrated care that the GPs have provision of an electronic referral system to obtain rapid access diagnostics at FGH.

SOCIAL CARE Discussions with social care about co-location of social care services within the new Alfred Barrow development were undertaken. Unfortunately, whilst social care is an important component of integrated working for primary care communities, Cumbria County Council has recently undertaken an asset management review which aims to consolidate Council teams within as few building as possible in each of the localities in Cumbria. In Barrow, plans are too far advanced to allow for social care to be based at Alfred Barrow. However, they have been consolidated at Craven House, which is adjacent to the Alfred Barrow site and so opportunities for integration are available.

HOW THE SCHEME WILL ACHIEVE LOCAL PLANS

The providers relocating to the Barrow Health Centre acknowledge that their current premises and models of care cannot deliver the following:

1. Integration of community, primary and social care services on one site 2. Reduce the current higher than national average levels of hospital admissions 3. Improve access to primary care services 4. Increase life expectancy of the local population 5. Improve health care premises to be able to deliver 21st Century health care

The new build at Alfred Barrow School is referred to as a ‘Key enabler’ and a Key interdependency’ in the ‘The better care together (BCT) strategy, the future for health care services in Morecambe Bay, October 2014’.

9 The vision of BCT for South Cumbria by the end of the initial two-year delivery plan is to have established a network of Primary Care Communities, The Barrow Health Centre being one of these. The shape of Barrow primary care community will reflect the local community, the practice population size, and the complexity of people within each practice, patient registers and caseload. The Primary Care Community will provide a range of proactive service functions aimed at supporting patients and carers to avoid the need for a hospital setting intervention.

Primary Care Community Groups

Primary Care Community Groups Millom Alfred Barrow Barrow Town Dalton and Ulverston Central Lakes Grange and Cartmel Kendal East

This investment will achieve the Furness locality asset management strategy by: 1. Reducing the size of the estate, 2. Reducing backlog maintenance’ 3. Improving the quality of assets’ 4. Achieving efficiencies in the estate by allowing the disposal of 5417m2 of existing assets:-  GP’s 1182m2  CPFT 2207m2  Cumbria CCG 394m2  NWAS 180m2 The new accommodation required to replace the existing is proposed to be in the order of 3800m2 which delivers a reduction in estate of circa 5%, which supports NHS Property Services Business plan – July 2014 key priorities of driving efficiency, value for money and effective asset management.

THE MODEL OF CARE

Primary care communities are one part of an overall Out of Hospital model of health and social care delivery and they aim to provide services around the communities in which people live and work. The Barrow PCC will be part of an Out of Hospital integrated health and social care model.

THE SITE

The new Barrow Primary Care Centre is to be developed on the site of the former Alfred Barrow School located on Duke Street, close to Barrow town centre. The Alfred Barrow School has operated as a number of educational institutions throughout its long history. The 2 storey building with a semi-basement level was designed by JY McIntosh in a relatively ornate Renaissance style with red brick and ashlar sandstone features. The foundation stone was laid in 1888 by Lady Cavendish and the building was given a Grade 2 listing in 1993. The

10 listing details focus predominantly on the ornate exterior although there is mention of the large internal arched bays and glazed screens on both the Ground and First floors. From completion until the 1930s the building was occupied by the Barrow Higher Grade School, the only High School in the town at that time. Extensions were added to the existing building in the 1930s to create The Alfred Barrow Boys and Girls School providing separate schools for boys and girls. Further changes were undertaken both in the function and the accommodation on the site until the 1970s when the school became the Alfred Barrow Comprehensive School. This was closed in 2009 and the school subsequently acted as temporary accommodation for two separate Barrow Primary Schools whilst their buildings underwent renovation before the building was finally closed in 2013.

The development site is approximately 1.45 hectares in area with a further 0.4 hectares of former car Parking on the South side of Duke Street to be reutilised as a patient parking area for the scheme. The site is located on the Southern edge of the town centre, adjacent to a large area of residential properties on land and overlooking Buccleuch Dock to the South West.

The original school building is surrounded in 3 sides by the various extensions that were added as the School over the years and due to their generally poor condition and unsuitability for reuse these will be demolished retaining just the original Victorian school building. This will be refurbished and reconfigured to provide office facilities and support accommodation for administrative staff from various organisations including the CCG, Cumbria Partnership Foundation Trust, the 3 GP Practices and North West Ambulance Service.

Discussions have commenced with the Town Planners at Barrow Borough Council who have welcomed this proposal. Detailed information about the development of the site is available ion request.

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