LITHERLAND and FORD – a Discussion on Improving Your Local Health Services

APPENDIX 5

October 2004

LITHERLAND AND FORD – a discussion on improving your local health services

South Sefton PCT aims to deliver modern local health services for local people. We wish to continually improve the standard of health services and facilities for all our local communities in line with their needs. Therefore we have produced this and four other Local Health Development Reports, based around the five Area Committee boundaries in South Sefton. This document aims to:

• give the reader information on local health needs, services and estate in this area; • explore what options and opportunities the PCT has to develop the estate to meet needs; and • request feedback and discussion from local stakeholders to help highlight further local health needs and any estate or partnership opportunities to meet them.

Particular issues for Litherland and Ford are that:

• both Litherland and Ford wards are amongst the most deprived 10% in the country; • health in Litherland and Ford is poor compared to South Sefton and England as a whole; and • development has already started to improve the existing estate, however work must continue in order to respond to the needs of the community.

The PCT is sharing this plan with stakeholders within the Litherland and Ford Area Committee boundary. We will use your feedback to inform the development of these into 5 Local Health Development Plans covering all of South Sefton. Therefore please send your feedback to:

Debbie Hindley, Service Development Manager, South Sefton PCT, Burlington House, Crosby Road North, Waterloo, L22 0QB. Telephone 0151 920 5056, email [email protected]. By Wednesday 15 th December, 2004.

**A feedback form is attached at the end of the document, although any form of response or contribution will be welcome and noted.**

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CONTENTS ...... LITHERLAND AND FORD – a discussion on improving your local health services...... 1

1. INTRODUCTION AND BACKGROUND ...... 3 1.1 The role of the PCT ...... 3 1.2 This document...... 4

2. VISION AND PRINCIPLES FOR DEVELOPMENT ...... 4 2.1 North Mersey Model of Care ...... 4 2.2 South Sefton Principles for Estate/Capital Development...... 4

3. NATIONAL CONTEXT...... 5 3.1 NHS Plan...... 5 3.2 New Contracts...... 5 3.3 Choice in Primary Care ...... 6

4. ‘WHERE ARE WE NOW?’ ...... 6 4.1 Community Profile ...... 6 4.2 Deprivation ...... 6 4.3 Limiting Long Term Illness (LLTI) ...... 7 4.4 Mortality Rates ...... 7 4.4 Existing Estate...... 7 4.5 Access to South Sefton-wide Services...... 8

5. LOCAL ISSUES...... 8 5.1 Local General Practice Issues...... 8

6. OUR OPTIONS FOR WAYS TO ACHIEVE IMPROVEMENTS ...... 9 6.1 LIFT (Local Improvement Finance Trust) ...... 9 6.2 New GMS Flexibilities...... 9

7. OPPORTUNITIES AND AFFORDABILITY ...... 9 7.1 Joint Working Opportunities ...... 9 7.2 Sefton Road Clinic...... 9

8. CONSTRAINTS ...... 9

9.STAKEHOLDER SUPPORT AND OPPORTUNITY FOR DISCUSSION...... 10

10. NEXT STEPS...... 10

FEEDBACK FORM...... 11

Appendix 1 – Comparative health needs in South Sefton...... 12 Appendix 2 – Current primary and community health services in Litherland and Ford .... 13

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1. INTRODUCTION AND BACKGROUND

1.1 The role of the PCT

South Sefton PCT has a duty to work towards:

• Improving the health of the people of South Sefton and reducing health inequalities within and between local communities; • Providing high quality primary care services; and • Commissioning high quality hospital and specialist services for our local population.

The Government has given the NHS, including PCTs, clear specific targets to achieve on the following four areas 1:

• Improving the public’s health – e.g. halting the rise in obesity • Improving access to GP and hospital services – e.g. a maximum wait in A&E of 4 hours • Improving care for people with long term conditions – e.g. diabetes and heart disease • Making the NHS a more personalised service – e.g. ensuring Choice for patients needing operations

We therefore have a responsibility to plan to achieve these across the whole of South Sefton and invest our resources accordingly.

1 We can provide further detail on the current NHS targets on request, or via www.doh.gov.uk

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1.2 This document

Therefore we have produced this and four other Local Health Development Reports, based around the five Area Committee boundaries in South Sefton. This document aims to:

Each of the five reports has the following framework:

q Vision and Principles for Development q National Context q Demographic Overview -‘Where are we now?’ q Local Issues q Approach to Achieving Change q Opportunities for Development q Constraints q Stakeholder Support and Opportunity for Discussion q Next steps

In summary key issues for the Litherland and Ford area are:

At the back of this document two appendices describe the health needs of this area compared with the rest of South Sefton and the range of services already in place in Litherland and Ford.

2. VISION AND PRINCIPLES FOR DEVELOPMENT

2.1 North Mersey Model of Care The North Mersey Future Healthcare Project supports a whole system approach to healthcare and in particular a strategic shift of secondary care services towards a team based local care delivery via strengthened primary care services.

2.2 South Sefton Principles for Estate/Capital Development South Sefton PCT would like to create a modern, flexible healthcare system with opportunities to provide a fully integrated service with local accessibility. In order to deliver this, the PCT will assess any new estate/capital developments against the following weighted criteria, shown in priority order:

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ü supports GP practices to deliver core services ü support the shift of secondary care services to primary care ü enables health premises to meet statutory requirements ü provides value for money ü contributes to the reduction in health inequalities ü is acceptable to the public and professionals ü accessible for patients ü allows future flexibility ü reflects modern infrastructure e.g. Information Technology, Clinical Effectiveness ü supports recruitment and retention ü contributes to regeneration and partnership working

Dependant on the needs of the population and the current services and estate, service improvements are likely to be achieved in different ways in each area.

2.3 A Primary Care Strategy Following the success of the first stage of the bid for £1.2 billion by the North Mersey Future Healthcare Programme that offers a future vision of modern health services, a strategy is currently being developed for the strategic shift of services into primary care. This and the other four Local Health Development Reports will be informed by this work in early November and it will contribute to the wider primary care strategy for South Sefton.

3. NATIONAL CONTEXT

3.1 NHS Plan The NHS Plan details a vision for developing the NHS and in particular, for Primary Care. It describes access to a comprehensive range of services in a community setting. National targets clearly suggest that development of premises in the community is vital in order that the vision becomes a reality.

3.2 New Contracts A new Personal Medical Services (PMS) contract for General Practitioners was implemented in 1997, which encouraged GPs to deliver services that met the needs of their population. In April 2004 the new General Medical Services (nGMS) contract was launched. The new contract gives the PCT an opportunity to commission enhanced services 2 in a primary care setting.

National negotiations are on-going to introduce a new Dental Contract. Early discussions see the integration of dentistry with Primary Care. From April 2005, PCTs will have new responsibilities to provide or secure through local commissioning, NHS Primary Dental Services.

In addition, national contract negotiations are still underway to accept a new pharmacy contract, which is likely to be introduced in April 2005. This could encourage pharmacists to work closer with primary care around the prevention of chronic disease and so provide additional resource to support the delivery of primary care services. Locally, work with optometrists has seen a number of new initiatives set up to support primary care.

2 Enhanced services are essential or additional services delivered to a higher specified standard or not provided through essential or additional services e.g. specialist services provided by GPs or health professionals with a specialist interest.

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3.3 Choice in Primary Care The Department of Health document “Building on the Best -Choice, Responsiveness and Equity in the NHS” (December 2003) broadly sets out how the Government will make NHS services more responsive to patients, by offering more choice across the spectrum of healthcare. It’s main aim is to improve patient and user experience and build new partnerships between those who use health and social care and those who work in them.

One of the priority areas is to increase choice of access to a wider range of services in primary care, encouraging innovative new providers, particularly in deprived areas where primary care has traditionally been weak, and extending more flexible ways for people to access care.

4. ‘WHERE ARE WE NOW?’

4.1 Community Profile Litherland and Ford Area Committee covers Litherland and Ford and from the 2001 census, has a population of 24,889. The diagram below indicates the age profile of those residents as a percentage and makes a comparison with the average in England.

Litherland & Ford Area Committee Percentage of total population by age band compared to England (Census Resident Population 2001) Source: Census 2001 St andard Tables for Wards Table 001 - Crown Copyright material is reproduced wit h the permission of the Controller of Her Majest y's Stat ionery Of fice (HMSO) and Nort h West Small Area Dat abase 2004

Excess Litherland & Ford AC 85+ 80-84 Excess England 75-79 70-74 65-69 MALES 60-64 FEMALES 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 12% 10% 8% 6% 4% 2% 0% 2% 4% 6% 8% 10% 12% Percentage of total population

The diagram above indicates that there is a high percentage of 0-19 year olds residing in the area, which is above the average for England.

4.2 Deprivation An index of multiple deprivation, developed by the Department of Environment, Transport and Regions (DETR) in 2000, scores wards on the basis of income, employment, health and disability, education skills and training, barriers to housing and services, living

Page 6 Litherland and Ford Local Health Development Report APPENDIX 5 environment and crime. Both Litherland and Ford wards are amongst the most deprived 10% in the country on at least one or more of the domains.

4.3 Limiting Long Term Illness (LLTI) Based on a self-assessment of whether or not a person has a limiting long-term-illness, health problem or disability which limits their daily activities or the work they can do, including problems that are due to old age. The 2001 census indicated that 45.3% of households in Litherland and Ford have one or more people with a LLTI compared with 42.7% in South Sefton and 33.6% in England. Health in Litherland and Ford is poor compared to South Sefton PCT and England as a whole.

4.4 Causes of Mortality In Litherland and Ford there are high levels of morbidity relating to a range of diseases. In particular 26% of deaths in the area have been cancer related. It is recognised that primary care services in the area must be accessible and of the highest standard if real health gain is to be achieved. The chart below indicates the main causes of death in the Litherland and Ford area across all age groups.

Litherland & Ford Area Committee Main Causes of Death for Persons of all ages, 2000-2002

Coronary Heart Disease 18%

Other Causes 35% Stroke 5%

Lung Cancer 9%

Injury and Poisoning 3% Other cancer 17% Respiratory Disease 13%

4.4 Existing Estate There are 36 GP practices in South Sefton of which 5 are situated within the Litherland and Ford wards. In addition there is a health clinic (Sefton Road) providing a range of community services and is the base for out of hours services in South Sefton including GP, Dental and District Nursing.

A baseline survey undertaken on the above premises looked at 9 key areas as follows:

• Physical Condition • Functional Suitability

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• Space Utilisation • Quality • Compliance with Fire and Health & Safety Requirements • Environmental Management (Energy Performance) • Development Capacity • Location • Service Capacity

This survey indicated that all 5 GP practices are reaching capacity in terms of space utilisation. Plans already exist to relocate two of the practices into the proposed Local NHS Centre on the site if the Litherland Town Hall and another practice has just completed a substantial extension to enable their training practice to accommodate another trainee GP. Relocation to the new centre will present possible service development opportunities in the existing Sefton Road Clinic.

In general, development has already started to improve the existing estate and it is recognised that work must continue in order to respond to the needs of the community and to meet local and national targets.

4.5 Access to South Sefton-wide Services All South Sefton residents can access services at the May Logan Centre in Bootle. The May Logan Centre is a healthy living centre with additional services such as; § An enhanced family planning service § Walk in treatment service § Community midwifery § Minor surgery

The future development of the Litherland Town Hall will see all Out of Hours services on one site, integrated with a nurse led treatment service and a model of care that supports the management of chronic conditions such as Diabetes, Coronary Heart Disease and Respiratory Disease. All South Sefton residents can access these services and the PCT are currently working with Merseytravel to develop a travel plan for the centre and to look at where improvement in transport routes are required across the borough.

It is important that the PCT works with the Local Authority to use opportunities to plan and run seamless services for clients. For example, there are potential opportunities to extend this way of working for services for children in the coming months and years.

5. LOCAL ISSUES

5.1 Local General Practice Issues • All 5 GP practices in the Litherland and Ford area are currently reaching capacity in terms of space utilisation. Plans to relocate two of those practices into the new Litherland Centre are progressing. • A contributing factor to recruitment difficulties is sometimes around GP partners buying into existing surgery premises. GPs often own their own premises, a number of premises are suffering from negative equity and therefore are not an attractive option for newly qualified GPs.

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6. OUR OPTIONS FOR WAYS TO ACHIEVE IMPROVEMENTS

There are a number of mechanisms available to the PCT in order to implement any required service improvements, these include:

6.1 LIFT (Local Improvement Finance Trust) The LIFT initiative is a mechanism to attract capital funding to invest in the primary care estate. South Sefton PCT is part of a LIFT initiative, involving the five Primary Care Trusts across Liverpool and Sefton. It has recently been successful in procuring a private sector partner and is now a partner in the newly formed LIFT company known as the ‘Liverpool and Sefton Health Partnership’. This has enabled the planned development in Litherland. The LIFT Company is currently inviting proposals for a second wave of developments across Sefton and Liverpool.

6.2 New GMS Flexibilities The new GP Contract set out a range of flexibilities to be introduced. The new and revised payment arrangements will enable capital investment in the primary care estate and better target revenue support for GPs.

7. OPPORTUNITIES AND AFFORDABILITY

7.1 Joint Working Opportunities There has been a lot of development recently in the Litherland and Ford area, with a major new Local NHS Centre being developed on the Litherland Town Hall site with a range of services being planned. This new development is due for completion in July 2005. In addition the PCT has invested in the Litherland Sports Park development, led by Sefton Leisure Services, providing community cardiac and pulmonary rehabilitation. The PCT will continue to work with the Local Authority and other organisations to identify any further opportunities, especially around delivering an integrated health and social care model.

7.2 Sefton Road Clinic In addition to the considerable service development opportunities that will be realised following the completion of the Local NHS Centre in Litherland, a range of services will also be relocated from the existing Sefton Road Clinic. Subsequently there is an opportunity to develop other services at Sefton Road that will support and complement the needs of the community.

8. CONSTRAINTS

The major constraints for the PCT relate to the following:

• Workforce- there is a national shortage of GPs and nurses and this has effected recruitment and retention locally. More services mean more staff! • Affordability – the PCT has a fixed budget for both capital investment and revenue and has to rely on other sources of funding to develop the estate. Schemes will need to be prioritised

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• Information Technology – the current software and equipment is insufficient to support wider developments. Any new premises/service developments will need to include costs for IT • Availability of land or buildings – opportunities to develop buildings that will be suitable to deliver existing services efficiently and have scope to support the level of development required to deliver the ‘model of care,’ are scarce and often not affordable. • Value for money – the PCT is subject to public accountability.

9.STAKEHOLDER SUPPORT AND OPPORTUNITY FOR DISCUSSION

The purpose of this discussion is to help the PCT to identify and prioritise local health needs whilst also helping to identify any further potential facilities/development sites for future services across the 5 areas in South Sefton. The PCT intend to circulate this and the other four Local Health Development Reports for discussion, to the community and professionals working to deliver services within the respective Area Committee boundaries.

A feedback form is attached for any comments on the document, although any form of response will be welcome and noted.

10. NEXT STEPS

This discussion will run initially until mid December. A report will be presented to the PCT Board meeting in January 2005. The PCT will take decisions informed by the responses from this process. It must also be recognised that in addition we will respond to events outwith this discussion such as unforeseen site availability opportunities. We will provide feedback to stakeholders by April 2005. This is part of our strategy to increase local public involvement in ‘your NHS’, therefore we intend to maintain an ongoing dialogue with the people of South Sefton throughout this process and beyond.

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FEEDBACK FORM

LITHERLAND AND FORD LOCAL HEALTH DEVELOPMENT REPORT - Autumn 2004

Any comments or additional information provided will be used to contribute to this and wider plans across South Sefton. It is important that you supply contact details to enable the PCT to clarify or confirm any facts.

1. Are you or your organisation aware of specific health needs in your area, which are currently not being met?

2. Are you or your organisation aware of any opportunities for premises/facilities that might enable the PCT to further develop the provision of health services locally?

3. Are you or your organisation aware of any opportunities for partnership working that might enable the PCT to further develop the provision of health services locally?

4. Do you have any other comments on the document?

Please add your contact details below: Name: ______Organisation: ______

Telephone Number: ______E-mail Address: ______

Please return to Debbie Hindley, Service Development Manager, Freepost LV 3391 (no need for a stamp) South Sefton PCT, Burlington House, Crosby Road North, Waterloo, Liverpool L22 0QB. Alternatively you can contact Debbie by email on debbie.hindley@southsefton- pct.nhs.uk or by phone on 0151 920 5056. Please reply by Wednesday 15th December ,2004.

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Appendix 1 – Comparative health needs in South Sefton

Indicator Litherland & South Sefton England Ford Population 24,927 Population 167,626 Population 49,138,331 (2001 census) (2001 census) (2001 census) Ethnicity (% non-white) 1.2 1.4 9.1

Births 2002 281 1573 546,823

% Low Birth Weight 7.1 7.1 8.0

Benefits: – Attendance Allowance% 18.3 16.6 13.2 Disability Living Allowance % 9.1 7.8 4.2 (total claimants)

LLTI 3 % of Households 45.3 42.7 33.6

Unemployment % economically active who are 5.7 4.6 3.3 employed

Lone parent households% 13.5 9.3 6.4

Availability of childcare (no of places/100 children) 50 83 120

Housing tenure % rented 42.8 30.9 31.3

Levels of poor literacy % 32.6 26.2 27.1 ∗

Levels of poor numeracy % 36.9 27.8 28.9 ∗

Education % with no qualifications 40.9 34.5 28.9

Transport % with no car 45.3 35.7 26.8

3 LLTI –Limiting Long Term Illness is based on a self-assessment of whether or not a person has a limiting long-term-illness, health problem or disability which limits their daily activities or the work they can do, including problems that are due to old age ∗ Based on percentage in Merseyside ∗ Based on percentage in Merseyside

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Appendix 2 – Current primary and community health services in Litherland and Ford

General Practices 5

District Nursing Teams Health Visiting School Nursing Practice Nursing Health Clinic Services with clinic = phlebotomy, leg ulcer services, chiropody, dressing clinic

Dental Practices 3 Community Pharmacists 3

Services which work across all Area Committee areas:

• Out of Hours/Emergency Response Team/Unplanned Care • Cardiac Team • Diabetes Team • Actrite/COPD team • IMPACT • Occupational Therapy team • Physiotherapy team • SPOT (children) • Continence Team

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