Chorley and South Ribble LDF Health Impact Assessment - Final Version 2015

Health Impact Assessment
City Deal and the Local Development

Frameworks for Chorley and South Ribble
Tony Roberts and Kim Bickerdike
Public Health Department,
Lancashire County Council
Final Version For Circulation
Feb 2015
The most significant risk is that, when the

proposals are implemented, the health
and social inequalities in Chorley and
South Ribble could increase
Health Impact Assessment, Final Version
Acknowledgements
Many thanks to those who have contributed to and helped to review this report.
Lancashire County Council Public Health
Dr Anthony Sudell, Sakthi Karanunithi, Gulab Singh, Andrew Ascroft,
Jenny Paul, Matthew Stanton, Paula Cooper, Anna Bailey, Karen
Thompson, Hajra Sardar, Zainab Ali, Heather Collins, Helen Wilkinson,
Clare Platt, Mike Leaf, Debbie Thompson, Sarah Palmer
Lancashire County Council City Deal Infrastructure Group
Phil Barrett, Sarah Parry, Marcus Hudson, Phil Wilson, Lynn Mappin,
Lynn MacDonald, David Allen, Beckie Joyce, Natalie Corless, Suzy
Jeffrey, Dave Ainscough, David Allen
South Ribble and Chorley Borough Councils
Denise Johnson, Mark Gaffney, Howard Anthony, Howerd Booth, Cllr
Phil Smith, Frances Walker, Jennifer Clough, Mark Hodges, Helen
Hockenhull, Simon Clarke, Sarah James, Cllr Beverley Murray, Jennifer
Mullin
Chorley and South Ribble CCG
Jan Ledwood, Gora Bangi, Damian Nelson, Louise Giles, Andrea

Trafford, Joanne Cooper, Richard Kelsall, Amanda Hughes, Alison
Hewitt
Local Groups and Associations
Extended Partners and Stakeholders

Donna Hussain Chorley VCSF Network
Jackie Heywood Clayton Brook Community House
Linda Chivers Age Concern Central Lancashire
Iain Pearson Age Concern Central Lancashire
Ann Djordjevic Orvia Property
Ann Holcroft Orvia Enterprise
Howard Davidson Lancashire Association of Local Councils
Andrew Richardson Preston College
Ashley Ritchie Preston College
Adrian Roscoe Runshaw College
Amanda Jakeman Department of Work and Pensions
Sharon Riding Department of Work and Pensions
Margaret Hope Lancashire Care Foundation Trust
Emma Foster - Lancashire Care Foundation Trust
Craig Barratt - Lancashire Care Foundation Trust
Nicholas Steven - Lancashire Care Foundation Trust
Jeannie Stirling VCFS
Carole Spencer Lancashire Teaching Hospitals
Karen Partington Lancashire Teaching Hospitals
Plus over 20 local residents from across Chorley and South Ribble
Buckshaw Business Hub, Clayton Brook Community House, Buckshaw

Parents and Toddlers Group, Buckshaw Village Community Association
Contents
One Page Summary
Part 1 Background
Introduction
Scoping Health Impacts
Methodology
Predicting Future Demand
References
5
6-13
7
8
9-10
12
13
Part 2 Local Area Profile
14-20
Part 3 Impact on Inequalities
21-115
3.1 Give Every Child The Best Start in Life

Analysis and Recommendations
References
3.2 Maximise Control
References
22-27
28
29
30-47
48
49
3.3 Fair Employment for All

References
3.4 Healthy Standard of Living
References
3.5 Healthy and Sustainable Communities
References
3.6 Ill Health Prevention
References
50-59
60
61
62-67
68
69
70-82
83
84
85-113
114
115
Part 4 Recommendations
116-123
One Page Summary

The Chorley and South Ribble Local
Development Frameworks and the
City Deal set out proposals to
improve the housing, economy and
infrastructure of the local area.
The main part of the plans is for 12,000 new
homes, new and better roads and over 250
hectares of land set aside for economic
development.
Purpose of Health Impact Assessment
This Health Impact Assessment (HIA) was
requested by the Chorley and South Ribble
Health and Wellbeing Partnership to inform
how the plans could be implemented in a way
that minimises health risk and maximises
health gain.
The HIA examines the plans as a whole, rather
than as specific policies, with a particular
emphasis on their potential impact on health
and social inequalities.
Method
The HIA examined a range of evidence, from
literature, research, local knowledge and from
talking to local residents, professionals ,
planners and strategists.
Findings
The principle beneficiaries of the proposals
will be people who have good education,
work-related and professional skills, with a
decent income and aspirations
A key part of the evidence related to learning

from the experiences of building Buckshaw
Village a significant housing and economic
development that straddles the border
between the two borough councils.
People on low incomes, with few

qualifications, or work-skills and older adults
are set to benefit the least from the proposals.
Some Key Concerns

The houses to be built will largely aimed at
young and professional families, with around
one-third targeted at lower income groups.
Much of the jobs creation is expected to be
driven by high-tech industries and professional
and scientific services.
Without robust business and contingency
plans in place, the housing developments will
place significant and unsustainable burden on
education, health and social services.
There is potential that the proposals will
decrease physical activity by increasing the
need for car travel
Thus, there is a significant risk that the health

and social inequalities in Chorley and South
Ribble will increase.
Five Principle Recommendations
1. A coordinated, multi-agency approach to
reducing long-term unemployment and
for local jobs for local people
2. Innovative facilities for the delivery of
health and social care, including including
extra-care schemes, co-located services
and dementia friendly design
3. Teaching children enterprise skills from an
early age through to adulthood
4. Local provision of school places
5. Increasing physical activity for all and
measures to reduce car travel
Part 1 - Background
Introduction
Background to this Health Impact Assessment
The Health Impact Assessment

was requested in order to review
and build upon existing desktop
screening HIAs conducted in 2010
and 2012
The Chorley and South Ribble Local
Development Frameworks (LDFs) and the City
Deal for Preston, South Ribble and Lancashire
set out local plans to identify and allocate
appropriate sites for housing, infrastructure
and economic investment over the next 10-14
years. 1,2,3
In September 2013, the Chorley and South
Ribble Health and Wellbeing Partnership
formally requested the local Public Health team
at Lancashire County Council to conduct a
Health Impact Assessment (HIA) of the
development plans (The HIA refers to these
combined plans as the proposal) 4, 5
It is not the intention of this HIA to review or

expand upon previous desktop HIAs, which
examined the different policies of the LDF and
the Transport Masterplan. 6,7,8,9
The aim of the HIA is to consider the health
impacts of the proposals upon a broad and
interconnected range of health determinants,
and to identify areas in which the proposals
could have positive or negative impacts on
health inequalities.
Of particular interest in this HIA is differential
health impact - the notion that a given proposal
may disproportionately impact on one group of
the population more than another.
The City Deal and LDF proposals are currently at

a strategic level and cover topics as diverse as
urban planning, social inclusion, access to
employment and the quality of the local
environment.
These topics are so interdependent that it

makes sense to explore their collective impact,
rather than as a set of individual policies.
Therefore, this HIA is conducted at a whole-plan
level, across the total geographic area covered
by the two district authorities. It explores the
relationship between the different aspects of
the proposals and the determinants of health.
Detailed, site-specific or district specific issues
will not be considered in this HIA for two
reasons:
the plans for developing specific sites are not
detailed enough
there are insufficient resources available to
conduct both broad whole-plan HIA and sitespecific HIA.
Therefore, site- district-and policy-specific HIAs
will need to be led and owned by local delivery
teams, including construction partners.
Scoping Health Impacts

Health is influenced by a range of factors, many of which are beyond the control
of individual citizens
Some individuals and groups of
people experience systematically
better, or worse, health than
others.
This is referred to as health inequalities and
reflects the differential exposure across the life
span to risks associated a range of
circumstances and influences.
Social and community influences
Social support and integration

Social exclusion
Community spirit
Community involvement in public policy
decision-making
Employment (eg, availability, quality)
Education/training (eg, availability, quality,
affordability)
Individual lifestyle factors

Personal behaviours (eg diet, activity,
smoking, alcohol consumption, drug misuse)
Personal safety
Employment status
Educational attainment
Income, including disposable income
Self-esteem and confidence
Attitudes, beliefs - 'locus of control'
Living and working conditions

Housing (eg conditions, availability)
Working conditions (eg exposure to
hazards)
Quality of air, water, soil
Noise
Waste disposal
Energy use and sustainability of resources
Land use
Biodiversity
Accessibility to people, places, products
Socio-economic, cultural and

environmental conditions
International, national and local public
policies (eg economic, health, employment,
education, defence, transport, housing,
foreign, immigration, welfare policies)
International, national and local
public/population-based services (eg,
emergency services, policing, health and
social care, immigration, education,
transport, welfare, child care, leisure)
Expressed/perceived social/cultural values
and norms (eg discrimination, fear of
discrimination, attitudes to different
population groups, equity and fairness)
Relationship between state and citizen
Methodology Differential Impact

Reducing inequalities and improving life chances
In exploring the relationship between the

proposals and inequalities, the HIA will be
framed by the objectives of the Marmot review
of health and social inequalities Fairer
Society, Healthier Lives. 10
Fair Society Healthy Lives
In 2010, Professor Sir Michael Marmot
proposed the most effective evidence-based
strategies for reducing health inequalities in
England. The final report, 'Fair Society Healthy
Lives concluded that reducing health
inequalities would require action on six policy
objectives.
These policy objectives have been embraced
locally by both district councils, Lancashire
County Council and NHS partners as a
framework for guiding local policy.
1. Give Every Child the Best Start

in Life
2. Enable all to Maximise
Abilities and Control
3. Create Fair Employment for
all
4. Ensure Healthy Standard of
Living for all
5. Create Healthy, Sustainable
Communities
6. Strengthen Ill-Health
Prevention
Methodology Stages of HIA

The Six Stages of HIA
Purpose 11, 12, 13
Summary of Activity
1. Screening
Determine whether a detailed

Health Impact Assessment is
appropriate and required
Review of literature see references for details

Review of existing HIAs
Review of LDFs and City Deal implementation plans
2. Scoping
Set out the parameters of the

Health Impact Assessment
Report published Nov 2013, which concluded that this would be an Intermediate HIA, looking at
a broad range of topics that address the impact of the proposals at a community level.
3. Identification
Develop population profile and

collect information to identify
potential health impacts
Review existing health impact assessments and LDF/City Deal documentation

Review of local evidence and population data JSNA, Public Health Intelligence, NHS data
1 x Multi-agency workshop - report published December 2013
1 x workshop with public health colleagues
Facebook discussion with Buckshaw residents group
Online discussion on Buckshaw Village Community Association (BVCA) web forum
4. Assessment
Analyse and critically assess the

data and information in order to
prioritise health impacts
2 x Focus Groups with Buckshaw residents

1 x Focus Group with BVCA members
1 x Focus Group with Clayton Brook residents
1 x Presentation and group discussion with Buckshaw Business Hub members
1 x Meeting with Buckshaw Business Hub
1 x narrative interview with Buckshaw resident
Professional discussions and meetings with partners, including councils officers, CCG officers,
voluntary sector staff, Chorley VCSF network members
2 x attendances at City Deal Infrastructure Delivery Group
5. Recommendations
Make a set of final

recommendations for acting on
the HIA findings
This report sets out recommendations for maximising health benefit and minimising health risk
across the social gradient of inequalities. The recommendations are set out in the body of the
document and compiled at the end, presented by likely responsible agency
6. Evaluation and FollowUp
Evaluate the HIA and ensure

follow up through monitoring
and health impact management
plan.
The report makes suggestions about future implementation of the recommendations, next steps
and governance arrangements for monitoring.
10
Summary of Proposals
The LDFs and City Deal propose major investment over the next 10-14 years
City Deal will accelerate the plans by delivering the infrastructure that is necessary for the developments to take place
Housing and Economic Development
Health and Wellbeing
Environment and Climate Change
Build over 12,500 new homes across Chorley and

South Ribble, including major sites at:
Improve the wellbeing of all residents,

reduce health inequalities and improve
access to facilities that promote health
Protecting existing open space, sport and
recreational facilities
New and improved health and community
facilities including co-location of services
Improving access to healthy food
Making facilities accessible by public
transport, walking and cycling
Protect and enhance the quality of local built

and natural environment, including:
Transport
Protection of existing allotments and

provision of new allotment sites
Buckshaw
1538 homes
Pickerings Farm
1350 homes
Moss Side Test Track
750 homes
Clayton Le Woods
699 homes
Heatherleigh
600 homes
Eaves Lane
419 homes
New building will increase housing stock across both
areas by around 14% in next 10-14 years.
Allocate over 250 hectares of lands for economic,
business and retail use, including a number of
strategically significant sites:
Cuerden
Salmesbury Enterprise Zone
Lancashire Business Park
Botany Bay/Great Knowley
Buckshaw
Clayton Le Woods
North of Euxton Lane
65 ha
53 ha
33.5 ha
32.5 ha
27.5 ha
20 ha
13.1 ha
Enable easier journeys, manage car use,

improve road infrastructure and increase use of
sustainable travel. Includes:
Cross Borough Link Road from A6 to A582
Dualling A582, building Penwortham Bypass
Improving transport corridors
Improving roads, interchanges and signage
New rail stations at Midge Hall and Copull
Improve bus services, bus lanes and ticketing
New and improved cycleways, footpaths and
bridleways
Protection of Green Belt, Sites of Special

Scientific Interest (SSSIs) and Conservation
Areas
Central Park and Areas of Separation
Protecting and enhancing biodiversity
Increasing cycling and walking provision
Protection of heritage assets
Enhancing recreational value of local parks

Reduce energy use, increase renewable and
low carbon energy,
Manage flood risk, protect water resources,
Minimize pollution, reduce carbon emissions
Improve air quality
11

Aligning future service planning with housing developments will require coordination
The process of completing housing
developments to a specific timescale
is not an exact science. The variables
involved will cause challenges for the
future planning of health and
community services.
The experience from Buckshaw Village has
been that many of new residents tended to
arrive from either within the existing borough
area or from a neighbouring area. As the
houses they vacate will fill up over time, it is
reasonable to assume that the developments
will lead to a net growth in the population of
Chorley and South Ribble.
The current average occupancy rate in the area

is 2.3 persons per household. If we assume this
rate applies to new developments, and add on
predicted population increase due to
demographics, the estimated population
growth is as on the table opposite.
However, predicting where and when that

population will change at a community level is
open to many variables, which make it difficult
to predict how the population will change.
The timelines for developers taking over land
The timelines for drawing up planning
applications
The timelines for approving master-plans
The rate of house building
The rate of sales and take up of occupancy
The demographics of the people moving in
Where those people will come from
What health conditions they may bring with
them
The rate they have children
Many of these variables are beyond the control
of service planners, such as health and
education. Effective planning of future services
will require careful and sustained coordination
between all partners.
Chorley
South
Ribble
Totals
Current
Population
(2014 est)
110,800
109,800
220,600
Anticipated
rise due to
demographics
(2014-2026)
9,500
5,100
14,600
(+6.6%)
Increase due to
housing
developments
(2014-2026)
13,000
16,000
29,000
(+13.1%)
Estimated Total
Population by
2026
133,300
130,900
264,200
(+19.7%)
Estimated population change 2014-2026 14
12
References Introduction
1. Chorley Local Plan 2012-2026, Site Allocations and Development Management Policies
Development Plan Document (DPD) September 2012
2. South Ribble Site Allocations and Development Management Policies Development Plan
Document (DPD) July 2012
3. Preston, South Ribble and Lancashire City Deal, 2013
4. Report of Chorley and South Ribble Health and Wellbeing Partnership (Sept 2013)
https://democracy.chorley.gov.uk/ieListDocuments.aspx?CId=590&MID=3632#AI30248
5. Roberts, T. (2013) Chorley and South Ribble Local Development Frameworks Health Impact
Assessment - Scoping Report Draft V1.0: October 2013, Lancashire County Council
https://democracy.chorley.gov.uk/documents/s40599/Report%20HIA.pdf
6. Chorley Borough Council, Chorley Local Plan 2012-2026, Site Allocations and Development
Management Policies Development Plan Document, Health Impact Assessment, September
2012
7. South Ribble Borough Council, Site Allocations Development Plan Document Publication
Version Health Impact Assessment July 2012.
8. Lancashire County Council, Central Lancashire Highways and Transport Masterplan, March
2013
9. Lancashire County Council, Local Transport Plan 2011-2021 Central Lancashire Highways
and Transport Masterplan, Environmental Report Addendum, March 2013
10 Marmot Review (2010) Fair society, healthy lives: Strategic review of health inequalities in
England post-2010, London: The Marmot Review.
11. Health Development Agency (2002) Introducing health impact assessment (HIA)
informing the decision-making process; Health Development Agency, London
12 Lehto, J., Ritsatakis, A., (1999) Health Impact Assessment as a tool for inter-sectoral health
policy: a discussion paper for a seminar at Gothenburg, Sweden. Brussels: ECHP, WHO.
13 IMPACT (2004) European Policy Health Impact Assessment A Guide, ISBN 1 874038 75 9,
University of Liverpool
14 Public Health Data, Lancashire County Council.
13
Part 2 Local Area Profile
14
A Prime Strategic Location

Chorley and South Ribble are adjacent
district council areas in central
Lancashire that occupy a prime
strategic location. Collectively, the
authorities cover 316 square
kilometres.
The authorities are located to the south of
Preston and many thousands of residents
commute from localities such as Penwortham,
Buckshaw, Chorley North and Bamber Bridge to
work in the city. Many others use the excellent
transportation network to access jobs in other
parts of the county and beyond.
The intersection of three motorways, the rail

connections in to Manchester and easy access to
services along the West Coast Mainline together
have facilitated strong growth.
Over the past decade, there has been significant
investment in enterprise, new housing and
infrastructure.
15
Local Area Profile South Ribble

Well Connected
The borough of South Ribble is
situated in the centre of Lancashire,
immediately to the south of the
River Ribble.
It has excellent communication from its
location astride the north/south M6
motorway, and the main London to Glasgow
railway. Connections are available to the M55,
M61 and M65 motorways as well as the A6,
A49 and A59 roads.
Rail links are also available to East Lancashire,

the Fylde, Greater Manchester and
Merseyside. The borough is less than an hours
drive from the airports at Manchester and
Liverpool.
The borough has an area of 44 square miles,
with approx. 7,730 hectares of greenbelt,
68.4% of the total area.
16
Local Area Profile - Chorley

Attractive
The borough of Chorley is situated in central
Lancashire and covers around 80 square
miles.
Its eastern border lies on sparsely populated upland
rising towards the West Pennine Moors; the central spine
is more urban, containing the market town of Chorley
and settlements close to the M6, M61 and A6 that run
north-south through the borough.
In the West, the land merges into the Lancashire plain
and is dotted with villages. The borough is attractive with
a large amount of green space.
Chorley town centre is the major retail destination within

the Borough, acting as a market town centre serving the
local population.
The Borough has a wide range of natural habitats that are
important for biodiversity with areas of ancient woodland
and ecologically important river valleys, which act as
wildlife corridors.
17
Household Profile
Between 2011 and 2021 the population of Chorley is estimated to
increase by 5.9%, less than the 8.6% predicted increase for
England as a whole. In South Ribble, the predicted rise is 7.1%.
The population size of each area is very similar - In 2012, the
populations of each area were 109,100 in Chorley and 109,000 in
South Ribble. As South Ribble is geographically smaller (113sqkm,
to 203sqkm) it has nearly double the population density of
Chorley.
There are almost 94,000 dwellings in Chorley and South Ribble,
the overwhelming majority of which are owner-occupied or
privately rented (90% South Ribble, 87% Chorley) On the whole,
both districts have larger proportions of housing stock in the
higher council tax bands in comparison to the county average.
The Local Development Plans aim to increase the quantity of
housing stock by around 14% in 10 years adding around 12,000
new homes.
In 2011. both districts had around 10-10.5% of households

living in fuel poverty - below the national average. The main
factors that determine this are the energy efficiency status of the
property, the cost of energy and household income.
Both districts have overall low levels of deprivation, with some
wards amongst the least deprived in the country. However, there
are pockets of significant deprivation in both Chorley and South
Ribble (see map opposite). Unemployment, social housing, fuel
poverty and poor health status are concentrated in these areas.
Deprivation in Chorley and South Ribble
18
Population Change Age and Gender
The charts above shows the change in age distribution in context of ageing population (ONS
Population Estimates 2010 2035 by Gender). As can be seen, the proportion of adults aged over
65 in the area is set to increase significantly over the next 20 years.
19
Population Migration and Ethnicity
The charts above show the the ethnic make up of Chorley and South Ribble compared to Lancashire and the net migration of population into and out of the
boroughs. NB Migration figures solely represent flow of people, often from neighbouring districts and are not reflective of ethnicity.
20
Part 3 Impact on Inequalities
21
3.1
Give Every Child the Best Start in Life
Marmot Recommendations:
Reduce inequalities in the early development of physical and

emotional health, and cognitive, linguistic, and social skills;
Ensure high quality maternity services, parenting programmes,
childcare and early years education to meet need;
Build the resilience and well-being of young children across the
social gradient.
22
Not the Best Start for All

Providing the Best Start can be Challenging for Some Parents
A childs physical, social, and

cognitive development during the
early years strongly influences their
school-readiness and educational
attainment, economic participation
and health.1
Income
Housing Conditions
Central to enabling the best start in life is

ensuring that women have an adequate level of
income and other material support during
pregnancy to enable them to maintain a good
level of health and nutrition.3
Homes in poor condition damage the health of

those who live in them. The effects of poor
housing conditions fall disproportionately on
older people and on children .6
A childs life chances begin before birth and are

linked to the mothers health and socioeconomic status. In particular, disadvantaged
mothers are more likely to have babies of low
birth weight.
Where parents are very young, have other

difficulties in their lives or have little social
support from their family or community, they
are likely to need more support. This may relate
directly to parenting, or may be in response to
other needs material, social or emotional
related for example, to income, housing or
having access to mental health services that
recognise their needs as parents.4
Similarly, infant mortality is also linked to socioeconomic status. One quarter of all deaths
under the age of one would potentially be
avoided if all births had the same level of risk
as those to women with the lowest level of
deprivation. 2
Parental Support
Good quality maternity services are an essential

component of support for new parents and
children.5
Noise
Environmental noise has a more pronounced
effect on childrens health. Chronic exposure to
high levels of aircraft, rail and road traffic noise
can lead to attention deficits, concentration
difficulties, and poorer speech discrimination,
memory and reading ability.7
Parenting Classes
Despite the substantial increase in the
availability of parenting support in
disadvantaged areas, there remains concern
that it is still not reaching the most
disadvantaged parents in those areas.8
23
Local Profile of Young People

Overall, health outcomes for young people are good, but there
are significant inequalities
In 2012, there were around 19,900
young people aged 0 15 in each of
South Ribble and Chorley which
accounted for just over 18.2% of the
population in the two authorities. 9
Health outcomes for children and young
people in Chorley and South Ribble are
generally good.
Babies with low birth weight (<2.5kg)
decreased in both boroughs from above the
national average in 2006 to below the national
average in 2008/9. Since then the number of
low birth weight babies has increased to the
point where both boroughs are again above
the national average.10
Health issues where children are experiencing

worse health than the national average include:
Low Birth Weight
Mother smoking at delivery
Breastfeeding initiation and continuance
Tooth decay at 5 and 12 years
Obesity and in most deprived areas 11
8000
Infant mortality (deaths before first birthday) is

broadly in line with national average across both
districts.
4000
7000
6000
5000
Chorley
South Ribble
3000
2000
1000
0
0-4
5-10 11-15 16-19
Population of 0-19s in Chorley and South Ribble 12
24
A Village to Raise a Child

Belonging to a community is a key part of growing up
A childs social and cognitive

development is significantly
influenced by their relationship with
their local community.
Regular contact with positive adult role models
can help children to make positive health
choices.
If children grow up in a community where their
neighbours commit crimes are antisocial and
take up health-damaging behaviours, they will
be more likely to do these things themselves.
Conversely, if the children grow up in a
neighbourhood where most others set a good
example, the children will tend to follow that
example 13
The prevalence of smoking and drinking by

minors, as well as drug abuse and other antisocial health behaviours, are likely to be
influenced by the extent to which adults in the
community (not just the childrens parents) both
model and exercise informal social control over
such behaviours. 14
Friends, support networks,

valued social roles and positive
views on neighbourhood, reduce
the risk and severity of emotional
and behavioural disorders among
young people. 15
Resilience in adolescence is
strongly influenced by the
strength of social
relationships and has
powerful effects, including
a lower risk for
psychological problems in
adulthood and protection in
the context of continuing
disadvantage. 16
25
Buckshaw Parents and Toddlers Group

In the Absence of Local Services, Two Buckshaw Mums Set up a Parents and
Toddler Group
There was a childrens centre here
when we moved in, but it closed and
moved to Astley Village.
The Parents and Toddlers group runs in
Buckshaw Community Centre every Thursday
morning, giving local parents and their children
a chance to socialise, play and support each
other.
After it [the childrens centre] closed, me and
Julie decided to set something up. We used our
own toys, stuff, cast offs. It was just a few of us
at first. We put news out on Facebook and got
donations and other mums said theyd help out.
It costs 27.50 a week to hire the room and
everyone chips in.
Every week the group is well attended, with a

mix of parents mainly mothers from all
sections of society. The parents help keep an
eye on each others children and get to know
each other well. This community spirit amongst
mums is, according to many, one of the main
drivers of community spirit in Buckshaw.
All the mums know each other
If youre a young mum on Buckshaw, youve got
it made
I only started meeting people when I went on
maternity leave and started using the facilities
and groups
I look after my neighbours boy and take him to
school
Other amenities in Buckshaw provide

opportunities for parents and children to
socialise:
The Hub is great for coffees and the nursery is
excellent. Only problem is the really long waiting
list. You basically need to enrol your child before
you know youre going to have one!
The parks and play areas are fantastic. Its got a
really good safe feel about it
The playgrounds are well maintained not
rusty or messy
The swimming pool and Tiny Rockers
Weve now set up our own facebook page.to

ask for help, share tips, arrange childminding
26
Changing with the Times

The built environment needs to cater for and adapt to the changing needs of
young people as they grow up
The experience of Buckshaw
residents is that the local amenities
were designed primarily around the
needs of young children and families.
The needs of older children have
largely been ignored.
In Buckshaw we have excellent provision for
the very young family - in we have quite a few
parks etc. which do seem to be on the face of it
well thought out. However, for children aged
about 8 upwards there is simply nothing locally
for them. I think in future designs of
communities, and if at all possible the next
phase of this, should take provision for the
ages 8 - 18 into account.
There will be a bias of an age group in the

village due to the inevitable consequence of
expanding so quickly (most people move when
they have a growing family and so most of the
children on the village are under 8 at the
moment) but as they grow up there is a lack of
activity space locally.
I think any further parks should balance an age
range or at least stretch to slightly older with
sports areas (e.g. basketball skate area)
Older kids just wreck stuff and break bottles
I dont think theres anything for older kids.

Theyre going to be really bored and its hard for
them to get into Leyland or Chorley.
This doesnt help the image

of the teenager as this
group will end up hanging on
street corners or sitting in the
younger kids play areas
simply because there is
nothing else, despite this
being an unfortunate
stereotype that most of the
young people dont really
aspire to
Buckshaw Resident
27

Well Connected Communities are Essential for Healthy Child Development
As seen in Buckshaw, new housing

developments attract young and
expanding families.
Creating and supporting amenities that facilitate

social connectedness between children and
adults such as multi-use community centres,
play areas, sports facilities, cafes, village greens.
This creates opportunities for building good

quality relationships between parents and
between their children. Well designed local
amenities, like play areas and community
centres can facilitate a sense of community
that is essential for healthy child development.
Encouraging a strong sense of shared identity,

through signage, place naming, links to local
heritage and culture.
There is a risk that local services will not be

able to adapt to a shifting and growing
population, leaving some areas inadequately
served.
New facilities in new communities should not
exclude residents of neighbouring areas,
particularly where those areas experience high
levels of deprivation.
Provide seed funding for local community

projects that bring new residents together
such as parent and toddler groups, multigenerational projects and whole-community
events.
Social and affordable housing should have
equitable access to facilities and amenities.
These households should not be located in a
cluster in the least favourable part of the
development.
Provide support for parenting skills through

education, peer mentoring, local pre and ante
natal groups.
Ensure adequate capacity in local maternal
services for meeting the demands from newly
created neighbourhoods
Ensure that newly created communities include
amenities that are appealing to all ages.
The holistic needs of young families mothers,
babies, young children etc should be
incorporated into design of housing and
environment.
Create opportunities for physical activity
walking to school, cycle routes, use of green
spaces, including safety consideration of more
walking/cycling and traffic
28
References Best Start in Life

1. Dyson A, Hertzman C, Roberts H, Tunstill J and Vaghri Z (2009) Childhood
development, education and health inequalities. Report of task group.
2. Source: Office for National Statistics Health Statistics Quarterly82
3 Marmot Review (2010) Fair society, healthy lives: Strategic review of health
inequalities in England post-2010, London: The Marmot Review.
4 Department of Health (2009) Updated child health promotion programme
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/DH_083645
5 NICE (2007) Intrapartum care: management and delivery of care to women in labour
- http://www.nice.org.uk/CG55
6 Marmot Review (2010) As 3
7 Stansfeld, S. A., Haines, M. et al. West London Schools Study: aircraft noise at school
and child performance and health. Final Report. 2000. London, Department of the
Environment and Transport.
8 Melhuish E, Belsky J, Leyland AH et al. (2008) Effects of fully established Surestart
local programmes on 3 year old children and their families living in England: A quasiexperimental observational study. The Lancet 372(9650): 1641-1647.
9 Office of National Statistics (ONS) mid 2012 Population Estimates
10 Lancashire County Council (2013) Joint Strategic Needs Assessment (JSNA) for
Children and Young People in Lancashire 2013
11 Lancashire County Council (2013) as 10
12 Lancashire County Council (2013) JSNA Article: Lancashire-12 CYP Demographics,
Intelligence for Healthy Lancashire (JSNA)
13 Mayer S E and Jencks C. Growing up in poor neighborhoods: how much does it
matter? Science, 243 pp.1441-1445, 1989
14 Sampson R J, Stephen W et al. Neighbourhoods and violent crime: a multilevel
study of collective efficacy. Science, 277 (15th August) pp.918-924, 1997
15 Bartley, M. (2006) (ed.) Capability and Resilience: beating the odds. ESRC Human
Capability and Resilience Research Network. London: UCL Department of Epidemiology
and Public Health. Available at: www.ucl.ac.uk/capabilityandresilience
16 Bartley, M. (2006) as 15
29
3.2
Enable all to Maximise Abilities and Control
Reduce the social gradient in skills and qualifications.

Ensure that schools, families and communities work in
partnership to reduce the gradient in health, well-being and
resilience of children and young people.
Improve the access and use of quality lifelong learning across the
social gradient.
30
Education and Inequalities

Poor educational attainment is bad for your health
Education is an important social

determinant of health. Many of the
root causes of inequalities in
education mirror those of health
inequalities.
Improving educational outcomes amongst the
most disadvantaged has the potential to make
a positive impact on health inequalities. In
particular, the educational level of parents can
influence child and family health related
behaviours.
At an individual level, the knowledge, personal

and social skills provided through education can
better equip individuals to access and use
information and services to maintain and
improve their own and their familys health.
The difference in life expectancy at age 25
between those with highest and those with
lowest levels of education was six years for
white men and five years for white women.1
Subsequent research has suggested a causal
effect between education and health.2
Low education level is

associated with increased
risk of death from lung
cancer, stroke,
cardiovascular disease and
infectious diseases, back
pain, diabetes, asthma,
dementia and depression. 3-11
Access to and participation in education are

prerequisites to achieving the health benefits
that education can provide.
31
Health Benefits of Education

Education drives social and health benefits to whole communities
Higher educational attainment is

associated with particular social
attitudes such as greater
understanding of diversity and
commitment to equality of
opportunities.12,13,14
All of these factors contribute to increased
levels of social capital which in turn is
associated with better health.15
Social benefits of education are not limited to
education received in childhood or
adolescence. Participation in adult learning
courses has also been shown to have a positive
impact on civic participation.16
In addition, institutions of higher education,

adult learning and professional associations can
foster networks of learning, enterprise and
voluntary initiative.16
An extensive social network can

reduce the risk of dying, increase
happiness levels and help to
maintain mental health.15,17,18
Advances in technology will require the
workforce in the future to be higher skilled, and
to be more flexible in how work is organised and
how organisations are structured.
Those with higher educational

attainment are more likely to
work in a safer environment and
report an increased likelihood of
having fulfilling, subjectively
rewarding jobs.19,20,21
Education plays a crucial role in the socialisation
process by supporting and embedding habits,
skills and values conducive to social cooperation
and increased participation in society. Those
with higher levels of education are more likely to
join voluntary associations and participate in
community activities.22,12 They are also more
likely to show greater interest in politics and
take part in political activities such as voting.13
32
Local Educational Attainment

Overall, local attainment is significantly better than the England average,
but this should not mask the difficulties that some young people face.
Educational attainment in the
boroughs is consistently higher than
the national average, giving the area
an excellent platform for securing the
economic growth that the proposals
can bring.
Education
Overall, the percentage of pupils achieving five
or more A*-C grades at GCSE or equivalent
including English and Maths in 2012/13 was
65.9% in South Ribble and 66.8% in Chorley
district - both well ahead of the average for the
14-authority Lancashire area of 60.4%.
However, for children in receipt of free school

meals in the boroughs, attainment drops to
37.2% in Chorley and 31.4% in South Ribble,
signalling significant inequalities 23
Source: Health Profiles (2007-2014), Public Health Observatory, www.healthprofiles.info
33
Access to School Places

The planning and timing of school places in new developments is essential, both for
the education of children, and the community as a whole.
The creation of 12,000 new homes
over 10-12 years will place very
significant challenges on school
places.
The effects of school places not being available

when they are needed are felt throughout the
community and include:
As described on page 11, the variables involved

in predicting the demand for new school places
are complex and include:
Rate of building houses

Rate of purchase of houses
The demographic and timing of people
moving to the area
The subsequent rate of child-birth
Under-estimating demand will lead to excess

applications for very limited places, potentially
overwhelming the local education system.
Over-estimating demand risks creating excess
school capacity that is not financially viable.
Fragmentation of families whose children

go to different schools
Excess pressure on existing schools
Significant variation in house value,
depending on proximity to school
Increased car travel, fuel use and carbon
emissions
Changes to admission policies excluding
children who would have previously been
able to access a school place
Fewer opportunities for spontaneous
community interaction
Reduced physical activity, walking and
cycling
Increased resentment over allocation of
school places
I'm also very concerned by the

number of places at Trinity
school. Given where we live, I
very much doubt we will get in,
despite living here for 5 years
and moving here for the school
(amongst other things) it seems
that other residents could beat
us to it as proximity to the
school is the only admission
criteria.
Buckshaw mother
34
One School Is Not Enough

The impact of inadequate school places is felt by the whole community
In Buckshaw, the most frequent

complaint by residents about life in
the village was regarding access to
school places:
One school certainly isn't big enough for a
development the size of Buckshaw
The catchment area or the school need to be
bigger
For many residents, the main reason for moving

to Buckshaw was to bring up a family.
the village has a great, safe and homely feel
about it. It's a wonderful place for a young
family to live with great motorway and transport
links
There are lots of young families buying their
first home
The pre planning in relation to the primary

school was evidently poor.
In Sept 2014, the intake to reception at Trinity

school will be 60 places. There were 137
applications, which were prioritised mainly
according to the distance the child lived from
the school.
There are studies coming out of our ears about

family sizes, pop density and school figures. The
oversight on school size is another factor that
infuriates rate paying residents.
Many of the houses closest to the school are

brand-new, desirable, four-five bedroom
detached houses, which now command a
premium value because of their location.
My concern is what about high school? Will

there be enough space locally for the kids?
Families living in houses built several years ago

on the other side of the village have no access to
places at the local school.
In addition to the negative impact on the value
of their home, they face significant additional
burden of car journeys and expenses taking their
children to schools elsewhere.
Going to schools in another area

means well all miss out on lots of
shared events and friends and
activities
The annotated maps and narrative on the
following pages show the real-world impact of
inadequate school places on one family.
35
Number 87 out of 60
One Buckshaw mother describes how school places have left her looking at moving home
He starts in September. We were too far away
from the Buckshaw School, from Trinity . I think
he was placed at number 87 and the last place
was given to a child at 60 . So there's no way we
would even get in to Buckshaw which is silly, its
0.3 miles away.
They have been allocated a school 2 miles away
We looked into schools in this area and applied
for schools which were easy to get to with only
having 1 car such as Primrose Hill in Euxton,
which is less than a mile for us to get to and it's
on the same sort of route we would normally
take for work . But we've been given this school
in Leyland which is fine, I really, really love the
school, but it's now meaning that I'm going to
have to get a car because bus routes and stuff
like thats it's not easily accessible.
The logistics of getting him to school and then
to work mean public transport is not an option
We would have to get on the bus at 7.10 in the

morning for him to get to the before-school club
for 7.30 . I start work at 8am, so Id then have to
get on the bus at 7.58am to get back to here
and it only goes to the Bay Horse in Euxton as
well coz its a different route coming back. Then
I'd have to walk from there up to the GA
buildings. So, I'm never gonna get to work for 8
o'clock if we do that, so yeh we'll have to get a
car which isn't ideal.
The situation has left them thinking about
moving out of Buckshaw
It was the trigger, it was a trigger for us
thinking about maybe leaving. As much as I do
love Buckshaw, with the whole school situation
and the fact that we are now going to be
getting a car we are looking at other places to
move to and not necessarily staying in
Buckshaw Village, just because we don't need to
you know if we've got a car, we don't have to
stay here anymore coz it's just as convenient to
live anywhere else.
We wanted to save a bit of money and reduce

our carbon footprint and all that, not any
more.
The school admissions policy left no room for
personal circumstances
They don't think about those sorts of things, in
fact the lady at the council told me they don't
consider the parents circumstances at all.
The planning of school places for Buckshaw is
incomprehensible to many local families
I think for a village this size for them to have
not planned to put a second school into the
place is just ridiculous, they knew how many
houses were going to be built and they knew
the target market
The difficulties faced by education planners is

highlighted in the Introduction page on
36
Map of car journey
37
Map of car journey
38
Schools around SE and Central Leyland

Pickerings Farm and
Heatherleigh
1950 homes
The developments around Moss

Side, Heatherleigh and Altcar Lane
will add around 1830 homes to
east and south Leyland.

750 homes
The area is served mainly by four primary

and two secondary schools, which will be
under the most direct pressure for places.
Slightly further afield are six more primary
and two more secondary schools, although
these will also be facing pressure from
developments in Clayton-le-Woods and
Buckshaw, as shown on subsequent pages.
Dunkirk Lane
82 homes
Altcar Lane/Shaw Brook Road

430 homes
Further to the north, Pickerings Farm adds

an additional pressure of 1350 new homes.
39
Schools around Pickerings Farm

Lostock Hall (various sites)
794 homes
Pickerings Farm is the largest

single development in South Ribble,
adding 1350 homes.
To the north east, over the railway line, are a
number of sites around Lostock Hall.
Collectively, all these sites will add 2,144
new homes less than a mile away from five
primary schools.
There is significant potential for these
schools to be overwhelmed with new
applications. If capacity does not meet
demand, then the demand will go further
afield into Leyland, where schools will be
facing increasing pressure from
developments such as Moss Side Test Track
and Heatherleigh.
Pickerings Farm
1350 homes
40
Schools around Buckshaw Village

Clayton Le Woods
700 homes
Whittle le Woods (various sites)

423 homes
Trinity School
430 homes
Buckshaw (various sites)

1538 homes
In 2014, Trinity School in Buckshaw

Village received 137 applications for
60 places in reception.
As can be seen on the map, Trinity School is
the only school currently serving the
Buckshaw area, which will continue to add
new residential housing over coming years
Unaccepted children face lengthy commutes
to schools over 1.5 miles away. These schools
will also be experiencing increased pressure
on places due to housing developments being
undertaken in Whittle-le-Woods, Clayton-leWoods, south and east Leyland and central
Chorley.
The Chorley LDF (EP10) states that land is
reserved in Buckshaw for a second primary
school.
41
Schools around Clayton Le Woods
Clayton Le Woods
700 homes
Clayton le Woods is surrounded by

six primary schools, all within a mile
of the boundary of the site.
However, four of those schools are over the
motorway, with limited pedestrian access.
Therefore, much of the pressure will be
placed on the two nearest schools Lancaster
Lane and Clayton Le Woods CofE.
Of those, Lancaster Lane will also be
experiencing overspill pressure from
Buckshaw Village.
42
Schools around South/Central Chorley

Lex Auto Site
154 homes
Duke Street
70 homes
Gillibrand
46 homes
South and Central Chorley is served

by five primary and three secondary
schools.
Carr Lane
194 homes
Collectively, new housing developments in the

area will add nearly 900 new homes.
The two primary schools in Coppull may also

experience pressure from the development at
Eaves Green if schools in Chorley cannot meet
demand.
Eaves Green
419 homes
43
Life Long Learning

A changing economic landscape needs a different kind of skills
As the economy shifts towards more

knowledge-based and technologydriven industries, there is a need for
the skills of local residents to match
the needs of new and emerging
employers.
The table opposite examines an apparent mismatch between the skills people are learning
and the requirements of the labour market.
By comparing numbers of qualifications gained
against numbers of new vacancies, it suggests
that people in particular 16-18 year olds - are
over-training for work in automotive industries,
creative & cultural industries; hair & beauty; and
hospitality, leisure, travel & tourism.
Conversely, people are under-training in areas

such as fashion, marketing and sales, security
and supporting teaching and learning in schools.
The Marmot report suggests that life-long

learning can reduce inequalities by:
(i) Providing easily accessible support and
advice for 16-25 year olds on life skills, training
and employment opportunities
(ii) Providing work-based learning for young
people and those changing jobs/careers,
including apprenticeships
(iii) Increasing availability of non-vocational
life-long learning across the life course
For those who leave school at 16, further
support is vital in the form of skills
development for work and training,
management of relationships, and advice on
substance misuse, debt, continuing education,
housing concerns and pregnancy and
parenting.
Sector
All ages
16-18
Automotive
2.4
3.8
Building services
1.8
5.6
Construction
1.6
4.3
Creative and Cultural
0.7
1.0
Fashion and Textiles
13.7
70.2
Hair and Beauty
0.2
0.4
Health and Safety
0.4
3.7
Hospitality and tourism
0.4
0.8
Land-based environmental
1.8
3.1
Marketing and Sales
165.6
2235.1
Security
3.4
76.4
Teaching and Learning
0.8
44.0
North West New Vacancies per FE and Skills Achievement (2010/11)
44
Resilient by Design
Using Asset-Based Approaches to Maximise Community Resilience
Assets approaches value the

capacity, skills, knowledge,
connections and potential in a
community.
It doesnt only see the problems that need
fixing and the gaps that need filling.
The more familiar deficit approach focuses on
the problems, needs and deficiencies in a
community such as deprivation, illness and
health-damaging behaviours.
The deficits approach designs services to fill the
gaps and fix the problems. As a result, a
community can feel disempowered and
dependent; people can become passive
recipients of services rather than active agents
in their own and their families lives.
Assets approaches are a set of values, principles

and a way of thinking about the world, which:
identify and make visible the life chanceenhancing assets in a community

see citizens and communities as the coproducers of quality of life, rather than the
recipients of services
promote community networks,
relationships and friendships that can
provide caring, mutual help and value
what works well in an area
support individuals health and well-being
through self esteem, coping strategies,
resilience skills, relationships, develop
friendships, knowledge and personal
resources
empower communities to control their
futures and create tangible resources such
as services, funds and buildings.
Asset-Based Approaches can be

embedded in a wide range of
applications, including:
Community development
Social Return on Investment
Commissioning for Social

Value
Community-level budgets
Local procurement
Employing local people
45
Types of Assets
The ingredients of a healthy, vibrant community
Physical Assets
Collective Assets
Places to go, meeting points, shared spaces

and the local environment. Includes play
areas, school gates, cafes, pubs, sports
centres, peoples houses, community
centres, shared gardens, allotments etc
The networks and connections known as

social capital in a community, including
friendships and neighbourliness; and the
effectiveness of local community and
voluntary associations etc
Institutional Assets
Economic Assets
The resources of the public, private and third

sector to support a community. Includes
local businesses, local authorities, NHS,
schools, sponsorship of local activities,
provision of professional advice and support,
volunteer coordination, small grant schemes
The economic resources of a place that

enhance well-being, including the potential
of local businesses, employment and
educational opportunities, funding and
commissioning including responsible
commissioning and local procurement etc.
Individual Assets
Cultural Assets
The practical skills, capacity, passion,

interests and knowledge of local residents.
Includes maximising peoples local
knowledge, networks, connections,
professional and organisational skills etc.
The opportunities for shared creative and

cultural activity. Includes churches and
places of worship, local nightlife, museums,
libraries, heritage trails, concerts, comedy
nights, theatre, festivals, sporting events etc.
Building assets into the design

of neighbourhoods enhances
feelings of belonging and
shared identity, which is a key
component of resilience.
The following page shows
how physical, institutional and
economic assets in Buckshaw
enhance the local community
by providing places for people
to meet, share activities,
engage in cultural events and
live together.
46
Mapping Buckshaws Assets

Mapping assets shows the ingredients of a successful, healthy and vibrant community
Business Area
Natural Spaces
The Buckshaw Business

Hub is really good for
networking local businesses
Its great to get away for an

hour or so, clear your head
Sports Pitches
Motorway
Well used, but pricey. Not sure

the kids could afford them
The links to the M6, M61

and M65 really open up my
catchment area for work
Play Areas
Safe places for young kids to
play. Really well designed
Pharmacy
Natural Space
Golf Course
Lovely walk, shame

about the dog dirt
Community Centre
Theres always things going on
clubs, classes, toddlers,
comedy nights
The Hub
Great caf, nursery,
swimming pool
Primary School
Meet up with mums at the
school gates and go for a brew
GP Health Centre
Its a really good service,
really pays attention to
what you need
Business Area
I can walk to work from
home
Runshaw Adult
Education College
Railway to Manchester
Local Shops and Tesco
Takes no time to get into

Manchester. Really good
links elsewhere too
Shops are getting better

Subway and now a chippy!
47

A coordinated approach to education and skills is required between all agencies
Education and the development of
social networks are essential factors
of resilience and control.
People in more deprived areas can become
locked into a cycle of poor control and
resilience through isolation, lack of skills and a
perpetual focus on deficits, rather than
strengths and opportunities.
The lack of easily accessible, local school places
can have negative impact on both individual
families and the rest of the community.
The skills needed by todays young people for

tomorrows workplace will be radically different
to traditional work-skills and programmes of
enterprise learning need to start early.
Further education should start within
communities, tailored to their needs.
Investment in soft infrastructure, such as

community schemes that bring people together,
resident associations, multi-generational groups.
Proving one-off set-up costs for community
groups to purchase shared resources, such as
storage facilities, IT equipment, marquees, PA
equipment etc that can be used for community
events and activities.
Conduct a retrospective demographic analysis of
population growth in Buckshaw Village, by oneyear age band.
Deliver Community Learning schemes within

local communities, bringing the knowledge and
skills of community members together with
professional educators to train, support and
inspire their neighbours.
Embed learning about Enterprise Skills into
school education at an early age and continue
through to early adulthood.
There should be an analysis of the expected

future demands within the labour market so
that training can be targeted at key population
groups in good time ahead of the need for
trained employees
Relationships should be built between
businesses and school to support young people
with work-based and enterprise learning.
There should be asset-mapping activities

conducted within local communities to establish
their strengths and aspirations.
Careful consideration should be given to
capacity planning in primary and secondary
education.
Risk-sharing agreements should be established
to mitigate the cost of over-estimation of
demand for school places.
48
References Maximise control

1 Bartley, M. (2006) (ed.) Capability and Resilience: beating the odds. ESRC Human Capability and Resilience Research Network. London: UCL Department of Epidemiology and Public Health. Available at:
www.ucl.ac.uk/capabilityandresilience
2 Waddell G & Burton AK (2007) Is Work Good For Your Health & Well-Being? London: Independent Review for DWP, DoH, HSE London
3 Edgar Cahn in Stephens, L., Ryan-Collins, J. et al (2008) Co production: a manifesto for growing the core economy. London: New Economics Foundation. Available at: http://www.
neweconomics.org/gen/z_sys_publicationdetail.aspx?pid=257
4 Livingston, M., Bailey, N. et al (2008) Peoples attachment to place: the influence of neighbourhood deprivation, pg 3. Coventry: Chartered Institute of Housing.
5 Curtice, J., Ellaway, A., Robertson C et al (2005) Environment Group Research Findings No. 25/2005 Public Attitudes and Environmental Justice in Scotland. Available at: http://www.scotland.gov.uk/
Publications/2005/10/1395043/50440
6 Cooper R, Boyko C, Codinhoto R, (2008) Mental Capital and Well-being: Making the most of ourselves in the 21st century. State-of- Science Review: SR-DR2 The Effect of the Physical Environment on Mental
Well-being. Foresight Mental Capital and Well-being Project. Available at: http://www.foresight.gov.uk/OurWork/ActiveProjects/ Mental%20Capital/ProjectOutputs.asp
7 Clark C, Candy B, Stansfield S (2006) A systematic review on the effect of the built and physical environment on mental health. Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Marys
School of Medicine and Dentistry, University of London
8 Cooper R, Boyko C, Codinhoto R, (2008) Mental Capital and Well-being: Making the most of ourselves in the 21st century. State-of- Science Review: SR-DR2 The Effect of the Physical Environment on Mental
Well-being. Foresight Mental Capital and Well-being Project. Available at: http://www.foresight.gov.uk/OurWork/ActiveProjects/ Mental%20Capital/ProjectOutputs.asp
9 Ellaway and MacIntyre reference to follow
10 Thomson H, Petticrew M, Morrison D. (2001). Health effects of housing improvement: systematic review of intervention studies. BMJ 323: 187-90.
11 Clark C, Candy B, Stansfield S (2006) A systematic review on the effect of the built and physical environment on mental health. Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Queen Marys
School of Medicine and Dentistry, University of London
12. McGill P, Morgan M. Ireland's learning poor: Adult educational disadvantage and cross-border cooperation. Armagh: Centre for Cross Border Studies 2001.
13. Green A, Preston J, Sabates R. Education, equality and social cohesion: A distribution approach. Compare: A Journal of Comparative Education 2003;33(4):453-70.
14. Programme for International Student Assessment. Literary skills for the world of tomorrow: Further results from PISA 2000. Paris: Organisation for Economic Co-operation and Development 2003.
15. Putnam RD. Bowling alone: The collapse and revival of American community. New York: Simon & Shuster 2000.
16. Feinstein L, Hammond C, Woods L, Preston J, Bynner J. The contribution of adult learning to social health capital. Research report No. 8. London: Centre for Research on the Wider Benefits of Learning 2003.
17. Fratiglioni L, Wang H, Ericsson K, Maytan M, Winblad B. Influence of social network on occurrence of dementia: A community-based longitudinal study. The Lancet 000;355(9212):1315-9.
18 Balanda K, Wilde J. Inequalities in perceived health: A report on the all-Ireland social capital & health survey. Dublin: Institute of Public Health in Ireland 2003.
19. Ross CE, Wu C-l. The links between education and health. American Sociological Review 1995;60:719-45.
20. Wolfe B, Zuvekas S. Nonmarket outcomes of schooling. International Journal of Educational Research 1997;27:491-501.
21. Reynolds JR, Ross CE. Social stratification and health: Education's benefit beyond economic status and social origins. Social Problems 1998;45(2):221-47.
22. Healy T, Cote S. The well-being of nations: The role of human and social capital. Paris:Organisation for Economic Co-operation and Development 2001.
23 QCI Learning Improvement Support Group, Lancashire County Council
49
3.3
Fair Employment for All
Improve access to good jobs and reduce long-term unemployment

across the social gradient;
Make it easier for people who are disadvantaged in the labour market
to obtain and keep work and improve quality of jobs.
50
Into Work
While the proposals present many employment opportunities, for
some people there are significant barriers to overcome
The potential employment
opportunities created by City Deal and
the LDFs will come in three waves:
1. Construction
Work to build new houses, roads, factories and
the associated infrastructure. This work includes
a significant amount of manual labour, but also
work in planning, logistics and management.
2. Industry
Work obtained in the services and industries
that are established as a result of the economic
development plans and enterprise areas. This
will include scientific, professional, support and
labour jobs.
3. Service
Work in associated service industries, supporting
new businesses with infrastructure, for example
in security, transport, maintenance, supplies,
catering etc.
People who live in areas of deprivation, who are

long-term unemployment, new into the labour
market or living with existing health problems
face significant barriers to accessing these
employment opportunities.
In order to secure the maximum number of local
jobs for local people, consideration needs to be
given to:
The cost and timely availability of public
transport
The confidence to apply for and gain
employment
Basic functional and work skills
Raising awareness of different opportunities
Financial support to retrain or gain
certification for certain jobs
Improving entrepreneurial skills needed to
take advantage of economic developments
The support and mentoring needed to
change careers or industries
51
Local Enterprise
The area has a thriving enterprise sector in industries that are key to local economic success
In 2012, there were 4,030 active
enterprises in Chorley and 3,825 in
South Ribble.
Number of Enterprises in Chorley and South Ribble by Sector (2013)
The authorities are in an excellent business

location at the heart of the intersection of
three motorways that will be further enhanced
by developments such as the 65 hectare
enterprise site at Cuerden, the 128 acre
Revolution logistics and industrial park that
forms part of the Buckshaw Village site and the
Enterprise Zone at Samlesbury.
In addition, Walton Summit, SouthRings and
the Lancashire Business Park are very
significant locations of commercial activity.
As well as the 75 major enterprises, employing
over 100 people each, there are over 6,000
small and micro enterprises employing fewer
than 10 people.
In 2012, the 5-year survival rate for active
enterprises set up in 2007 was 46.2% in
Chorley and 42.5% in South Ribble against a
Lancashire average of 43.2%.
52
Local Employment Trends

Both district areas have employment rates that are consistently above the
national and regional rates.
The trends in employment rates over
the past decade - averaging 73.8% for
Chorley and 72.6% for South Ribble are significantly higher than the
average national rate of 66%.
Source: Nomis 2014
53
Local Employment South Ribble

At a district level, South Ribble has one of the lowest
unemployment rates in Lancashire.
The range of unemployment levels by ward is from a low of 0.7% to a

high of 3.4%. Unemployment in South Ribble is heavily concentrated in
four wards, with 30% of all unemployment claimants living in
Lowerhouse, Seven Stars, Kingsfold and Golden Hill.
Reducing unemployment in the four highest wards to the Lancashire
average would reduce the overall unemployment rate in the borough
from 1.7% to 1.5%
54
Local Employment - Chorley

Unemployment by ward in Chorley ranges from a low of
0.6% to a high of 4.1%, and is heavily concentrated in four
wards.
Around 46% of all of Chorleys unemployed citizens live in the highest

four wards.
Reducing unemployment in these four highest wards to 3.0% would
reduce the overall unemployment rate in the borough from 2.0% to 1.7%
55
Creating Fair Employment for All

Employment and Inequalities are Inextricably Linked
Patterns of employment both reflect

and reinforce the social gradient.
Unemployment is unequally
distributed across society, with those
in lower socioeconomic positions at
higher risk, thus contributing to the
social gradient in health.1
The number and type of jobs available to those
with low-level skills is becoming increasingly
restricted. The steady growth of jobs over the
past decade has been predominantly in higher
skilled employment while the number of
manufacturing and low-skilled jobs has been in
decline over a longer period.
Unemployed people have multiple elevated
health risks, including increased rates of
limiting long-term illness2, mental illness3 and
cardiovascular disease.4
The experience of unemployment has also been

consistently associated with an increase in
overall mortality, and in particular with suicide.5
The unemployed have much higher use of
medication6 and much worse prognosis and
recovery rates.7
There are three core ways in which

unemployment affects morbidity and mortality:
Unemployment has both short- and long-term

effects on health.8 The steady negative effects,
of unemployment are proportionate to the
length of unemployment.9 Therefore adverse
effects on health are greatest among those who
experience long-term unemployment.10
Second, unemployment can trigger distress,

anxiety and depression.12 Many psychosocial
stressors contribute to poor health not only
among the unemployed themselves, but also
among their partners and children.13 Loss of
work results in the loss of a core role which is
linked with ones sense of identity, as well as the
loss of rewards, social participation and support.
First, financial problems as a consequence of

unemployment result in lower living standards,
which may in turn reduce social integration and
lower self-esteem.11
Third, unemployment impacts on health

behaviours, being associated with increased
smoking and alcohol consumption and
decreased physical exercise.14
56
Unequal Opportunities
Ill health and disability dramatically affects employment rates
Patterns of employment both reflect
and reinforce the social gradient and
there are serious inequalities of access
to labour market opportunities.
Rates of unemployment are highest among
those with no or few qualifications and skills,
people with disabilities and mental ill-health,
those with caring responsibilities, lone parents,
those from some ethnic minority groups, older
workers and, in particular, young people.
When in work, these same groups are more
likely to be in low-paid, poor quality jobs with
few opportunities for advancement, often
working in conditions that are harmful to
health. Many are trapped in a cycle of lowpaid, poor quality work and unemployment.
Insecure and poor quality employment is also
associated with increased risks of poor physical
and mental health. There is a graded
relationship between a persons status at work
and how much control and support they have
there. These factors, in turn, have biological
effects and are related to increased risk of illhealth.
57
A Changing Landscape
The Local Employment Landscape Continues to Change
In Chorley and South Ribble, as in

most places, the manufacturing
sector has shed jobs over the years
whilst the service sector has grown
to become a far greater source of
employment.
Chorley has a higher rate of employment in the
service sector generally, and specifically in real
estate, professional, scientific and
administrative sector. There is a lower rate of
jobs in the manufacturing sector than the
county and nationally.
South Ribble has a similar rate of
manufacturing jobs to the county average.
Employment in the service sector is below the
county and national average.
The future trend towards sectors such as high

tech manufacturing, creative industries,
telecommunications, marketing and small,
globally connected enterprises.
Local people, and particularly young people
entering the labour market, will need a different
set of skills if they are to thrive in this
transformed labour market. They will need to be
enterprising, flexible and curious able to take
risks, work collaboratively and think creatively.
People living in areas of high unemployment are
at risk of not benefiting from the economic
development plans if these plans do not include
pro-active approaches to engagement, reskilling,
training and support.
Clayton Brook was built to

supply Walton Summit with
manual labour. But now the
manual labour jobs have
gone. Its all desk work. A lot
of people round here cant
do desk work
Clayton Brook resident
58
Workforce for Tomorrow

Employment opportunities are the top priority of local young people
The people who will be entering the

labour market in 2022 are currently
still in primary school.
The national Make Your Mark campaign and
ballot asked young people aged 13-19 to vote
on their top priorities
Across Lancashire, 15,625 young people voted
and their top 5 issues were:
1) Better work experience (1,693)
2) Living wage (1,528)
3) 16-19 Bursary fund (1,510)
4) Zero tolerance to bullying in schools (1,341)
5) Combat youth unemployment (1,237)
It is clear that, in a set of local development
proposals that will take a decade to implement,
there must, now, be a focus on the workforce
of the future.
The precise nature of that future labour market

is uncertain, but increased globalisation, an
increased automation of manufacturing and a
more knowledge-based economy mean that the
traditional employment options of previous
generations are unlikely to exist.
Case Study - Rotherham Ready
One of the problems that this can present for

young people living in areas of high
unemployment is that they are less likely to
have local role models engaged in any
employment, let alone in modern enterprise.
The scheme works in partnership between

schools, businesses, colleges, council, economic
development, NHS and other agencies to
empower young people, engage with business,
influence planning policy, connect with
communities and regenerate the town.
Persistent educational underachievement in

neighbourhoods can be driven by the young
peoples perception of the labour market and
the lack of awareness of whats out there.
Being able to connect academic learning to
economic success is a key factor in central to
their academic achievement.
The scheme has rolled out across the north of

England and has trained over 1,700 teachers
how to deliver enterprise skills as part of the
national curriculum.
Following decades of decline that resulted from

the closure of steel plants, Rotherham MBC set
up Rotherham Ready, a scheme that entitled
all young people to a grounding in enterprise
skills.
Over 200 young people have started up new

businesses with a greater than 70% survival rate.
59

Focus on Reducing Long Term Unemployment
There is a risk that the economic

developments planned for Chorley
and South Ribble will mainly benefit
those already capable of securing
good quality employment
Without an extensive programme of

community-based retraining, there is a risk that
people who are long-term unemployed,
disabled, suffering health problems or living in
areas of deprivation may become further left
behind.
Unemployment in Chorley and South Ribble is

concentrated in eight wards.
This risks widening inequalities and fuelling

resentment that the plans for economic growth
do not include them.
Targeting action to reduce unemployment in

these wards will have a positive impact on both
overall unemployment rates for the boroughs,
but also on the social and health inequalities
associated with unemployment.
The manual labour skills and labour market

that people living in these eight ward are used
to are no longer as relevant in todays
economy.
Practical measures to address this could include:

Community-based work skills and functional
skills training
Confidence and life-skills courses
Pre-selection employment pools for specific
types of labour, e.g. road and construction
Financial support for people to undergo
certification checks and gain CSCS cards
Job clubs delivered in community centres
Strategically, agencies should be exploring

joined up ways of engaging and supporting
people into employment, for example:
Analysis should be done on the employment
mix of the future workforce.
Producing regular communications on
upcoming work opportunities directly into
local communities
Networks of employment agencies,
employers and education providers
collaborating on skills training
Requiring that local contractors use locally
sourced labour
Coordinating public transport to link
residential to employment areas at
appropriate times.
Developing sustainable travel options from
residential to employment areas
60
References Fair employment

1 Kasl S and Jones A (2000) The impact of job loss and retirement on health in Berkman LF and Kawachi I (Eds.) Social epidemiology. Oxford: Oxford University Press, pp. 118-136.
2 Bartley M (2004) Health inequality: an introduction to theories, concepts and methods. Cambridge: Polity.
3 Thomas C, Benzeval M, and Stansfeld S (2005) Employment Transitions and mental health: An analysis from the British household panel survey. Journal of Epidemiology and Community Health 59:243249.
4 Gallo W, Teng H, Falba T, Kasl S, Krumholz H and Bradley E (2006) The impact of late career job loss on myocardial infarction and stroke: a 10 year follow up using the health and retirement survey.
Occupational Environment Medicine 63: 683-687
5 Voss M, Nyln L, Floderus B, Diderichsen F, Terry P D (2004)Unemployment and Early Cause-Specific Mortality: A Study Based on the Swedish Twin Registry. American Journal of Public Health 94 (12):
2155-2161.
6 Jin R, Shah CP, Svoboda TJ (1997) The impact of unemployment on health: A review of the evidence. Journal of Public Health Policy 18(3): 275-301.
7 Leslie S, Rysdale J, Lee A et al (2007) Unemployment and deprivation are associated with a poorer outcome following percutaneous coronary angioplasty. International Journal of Cardiology 122 (2);
8 Stuckler D, Basu S, Suhrcke M, Coutts, McKee M (2009) The public health effect of economic crisis and alternative policy responses in Europe: An empirical analysis. The Lancet 374(9686): 315-323;
9 Maier R, Egger A, Barth A, Winker R, Osterode W, Kundi M, Wolf C, Ruediger H (2006) Effects of short- and long-term unemployment on physical work capacity and on serum cortisol. International
Archives of Occupational and Environmental Health 79(3): 193-8;
10 Bethune A (1997) Unemployment and mortality in Drever F and Whitehead M (Eds.) Health inequalities: Decennial supplement, ONS Series DS no. 15. London: The Stationery Office: 156-167.
Archives of Occupational and Environmental Health 79(3): 193-8.
12 Voss M, Nyln L, Floderus B, Diderichsen F, Terry P D (2004) Unemployment and early cause-specific mortality: A study based on the Swedish Twin Registry. American Journal of Public Health 94 (12):
2155-2161.
13 Bartley M, Ferie J and Montgomery SM (2006) Health and labour market disadvantage: unemployment, nonemployment and job insecurity in Marmot M and Wilkinson R G (Eds.) Social determinants
of health; Second edition. Oxford: Oxford University Press.
Archives of Occupational and Environmental Health 79(3): 193-8.
61
3.4
Healthy Standard of Living
Establish a minimum income for healthy living for people of all

ages;
Reduce the social gradient in the standard of living
Reduce the cliff edges faced by people moving between benefits
and work.
62
Income Inequalities
The relationship between low income and poor health is well established.
People on low incomes refrain from

purchasing goods and services that
maintain or improve health or are
forced to purchase cheaper goods
and services that may increase
health risks.
Being on a low income also prevents people
from participating in a social life and can leave
them feeling they are less worthy or have a
lower status in society than the better-off.1
The relationship can operate in both directions:

low income can lead to poor health and ill
health can result in a lower earning capacity.
Some groups have significantly reduced

employment opportunities; they include
disabled adults, people with mental health
problems, those with caring responsibilities,
lone parents and young people. 2, 3
Many of the social and economic problems that
lone mothers are exposed to are made worse by
exclusion from paid work and lack of income.4
An increase in income leads to an

increase in psychological
wellbeing and a decrease in
anxiety and depression.5
The more debts people have, the more likely

they will have a mental disorder.6
Thirty-five per cent of people in very low-income
households (earning less than 10,000 p.a.) have
no insurance of any kind and residents of social
housing were more than twice as likely to
experience burglary as owner occupiers.7
The degree of inequality in society has a harmful
effect on health, not only of the poor, but of
society as a whole. 8
Areas marked by greater inequality have not
only worse health but a higher rate of crime and
other adverse social outcomes. Both poverty
and inequality may be important for social
cohesion, life opportunities and health.
63
Household Income South Ribble

Average earnings in South Ribble
were slightly higher in 2013 when
measured by place of residence in
comparison to place of work.
At the ward level, variations in income levels
between the most and least affluent wards in the
district are quite apparent. Lowerhouse ward
recorded the lowest average income in either
authority.
Four wards have average household incomes lower
than both the England and the Lancashire average.
Unsurprisingly, these are also the four wards with
the highest levels of unemployment.
Improving the income of people living in these areas
will require attention to:
Access to affordable transport, which limits

the scope of their employment options and,
hence, their income capacity.
The relative cost of essential goods, services

and utilities compared to income leaves no
spare capacity for investing in education
The lack of transferrable and specialist skills

to access jobs in a changing labour market
The lack of functional numeracy and literacy

skills needed for effective budgeting and
personal finance management.
64
Household Income Chorley

Average earnings in Chorley are
noticeably higher when measured by
place of residence in comparison to
place of work.
There is a net outflow of commuters to
Manchester and other areas, in particular of
those people who have higher academic
qualifications.
At the ward level, Pennine ward consistently
records one of the highest average income
figures in the broader Lancashire area. The
majority of other Chorley wards have average
income figures that are above the county
average.
Four wards have average household incomes
lower than both the England and the
Lancashire average. Unsurprisingly, these are
also four of the wards with the highest levels of
unemployment.
The people in these wards face the same
barriers to improving their income as shown on
the previous page.
65
Fuel Poverty and Affordable Warmth

There are effective, practical measures for reducing fuel poverty
There are around 8,800 households

in Chorley and South Ribble that are
in fuel poverty.
Diseases which are known to be affected by
the cold account for almost three quarters
(73%) of excess winter deaths. These are
diseases of the circulation (40%) and
respiratory illnesses (33% of deaths) 9
Further significant impact of cold homes
includes respiratory health, mental health
including anxiety depression and stress, 10
Children in cold homes are more than twice as
likely to suffer from respiratory problems as
the warmest homes 11
Significant gains can be made in respiratory

health for children following improvements to
cold damp homes, for example in one study
nocturnal cough and missed school days fell
from 9.3 /100 to 1.4 / 100 12
Interventions cited in evidence reviews typically

include physical measures such as heating
repairs, replacement, draft proofing insulation,
income maximisation, and energy advice.
Some smaller studies looking at direct costs and

health service usage following interventions in
an estate East London found post intervention
residents had average health costs of 72 vs
512 compared to a similar non improved area,
another study showed 50% higher costs
associated with cold homes. 13
Interventions to improve flats in Glasgow found

a drop in blood pressure, reduction in use of
medication and hospital admissions
'The Cochrane Collaborative' looked at 39

separate studies to assess the health and social
impact of physical improvements to housing,
found that health benefits did result from
housing improvements, this effect was most
significant when targeted at individuals with
poor health and inadequate housing 'in
particular inadequate warmth', as opposed to
general area based neighbourhood renewal
schemes, where health improvements were less
clear 14
66
Case Study - ReachOut

Addressing Income Inequalities Requires Innovative Thinking about the Lives of
People in Most Need
The ReachOut programme aims to
reduce income inequalities by
focusing on the people who need
support the most.
It offers support on a range of issues, such as
finance, employment, housing, training
opportunities and accessing services.
The project seeks to address the wider
determinants of health, such as low income,
poor housing, low education, training or
employment opportunities.
In North East Essex, the Tendring ReachOut
project helps people receive advice and
assistance in deprived areas.
Instead of waiting for people to come to

Jobcentres or ask for advice (as in traditional
CAB programmes), ReachOut provides advice
and support by knocking on doors, meeting
people in the street and at local community
venues.
The Wirral ReachOut programme has,

in three years, knocked on over 83,000
doors, engaged over 160,000 clients
on the doorstep, referred 6,000 clients
and had over 2,000 people start jobs.
In Derbyshire more than half of GP surgeries
have regular CAB sessions and in one year, they
helped more than 2,050 clients to secure over
2 million in additional benefits. Derbyshire NHS
estimates for every 1 invested, the project
secured 6.50 in additional income.
These programmes recognise that the tax and

benefits systems are complex and those in most
need require additional help both to secure
benefits and to get back into work.
Many of these programmes are offered on a
project by project basis and receive short-term
funding.
Few financial support interventions are
mainstreamed into NHS or local authority
budgets yet many are consistently effective in
improving incomes and reducing debt.
Maximising the economic impact of the

LDF/City Deal proposals will depend on
finding ways to mainstream innovative
schemes that effectively target those with
the most benefit to gain.
67

Poor living standards is both a cause and a consequence of inequalities
There are a number of practical and strategic

measures that can help improve healthy living
standards.
Pro-active case finding, initiated by NHS and

social care providers, but carried out by the
voluntary sector.
It is no surprise that the wards with the lowest

incomes are also those with the highest
unemployment and fewest qualifications.
Data sharing between agencies so that

vulnerable NHS and social service patients are
referred to advice and support for their standard
of living
Ensuring that new build properties adhere to, or

exceed, standards on energy efficiency.
There is a risk that people in the most deprived

areas do not benefit from improved access to
training, employment or new amenities that
could improve their standard of living and
quality of housing.
Provision of advice and support in GP surgeries,

health centres, community centres and other
places more frequently used by people on low
incomes.
Practical, community-based training in

household management, cooking, maintenance
etc to enable people to be more self-sufficient
Addressing healthy living standards requires

coordinated action on behalf of local
authorities, NHS services, social services,
employment agencies and the voluntary sector.
Programmes to properly insulate, damp proof,

dry and efficiently heat the homes of people
who are most vulnerable especially those with
cardio-vascular or respiratory disease, older
adults and children.
The relationship between healthy

living standards, employment and
skills is significant.
Practical numeracy and budgeting skills training

for people in areas of deprivation
Responsible trader schemes to give people the

confidence that home repair staff are properly
trained, ethical, approved and responsible
68
References Standard of Living

1 Marmot M (2004) Social Causes of Social Inequalities in Health in Anand S, Fabienne P and Sen A (Eds.) Public health, ethics, and equity. Oxford:
Oxford University Press pp. 37-6
2 Berthoud R (2006) Employment Rates of Disabled People. London: Department for Work and Pensions;
3 Marwaha S and Johnson S (2004) Schizophrenia and employment: A review. Social Psychiatry and Psychiatric Epidemiology 39(5): 337-349;
4 Ford R and Millar J (1998) Private Lives and Public Responses. Lone Parenthood and Future Policy in the UK. London: Policy Studies Institute; Millar
J and Rowlingson K (2001) Lone parents, employment and social policy: Crossnational comparisons. Bristol: The Policy Press; Millar J, Ridge T (2009)
Relationships of care: Working lone mothers, their children and employment sustainability. Journal of Social Policy 38(1): 103121.
5 Taylor M, Sacker A and Jenkins S (2009) Financial capability and wellbeing: Evidence from the BHPS. Financial Services Authority.
6 Fitch C, Hamilton S, Basset P and Davey R (2009) Debt and Mental Health. London: Royal College Psychiatrists.
7 Association of British Insurers (2009) Access for all: Extending the reach of insurance protection.
8 Wilkinson R and Pickett K (2009) The Spirit Level: Why more equal societies almost always do better. London: Allen Lane
9. Chief Medical Officer report 2009
10 Warm Front Better Health Health Impact Evaluation of Warm Front Scheme Geoff Green, Jan Gilbertson 2008
11 Housing and health: does installing heating in their homes improve the health of children with asthma? M Somerville I Mackenzie P Owen D
Miles 200
12 The Health Impacts of Cold Homes and Fuel Poverty Written by the Marmot Review Team for Friends of the Earth 2011
13 Fuel Poverty and Health A guide for primary care organisations, and public health and primary care professionals Produced by the National Heart
Forum, the Eaga Partnership Charitable Trust, the Faculty of Public Health Medicine, Help the Aged and the Met Office 2003
14 Housing improvement for health and associated socioeconomic outcomes (Review) The Cochrane Collaboration 2013
69
3.5
Healthy and Sustainable Communities
Develop common policies to reduce the scale and impact of

climate change and health inequalities;
Improve community capital and reduce social isolation across the
social gradient.
70
Inclusive by Design
Inequalities in social inclusion can be mitigated by good design
Regeneration which benefits the

majority of the population may also
cause the displacement of excluded
groups, moving them to the edge or
out of the community, to their further
disadvantage.
The provision of physical facilities does not of
itself constitute, or develop, social capital.1
Supportive social networks can be encouraged
by strategies such as fostering established
networks to actively encourage newcomers to
get involved; providing a range of meeting
places; paying close attention to equitable
distribution of resources; reducing tension
between different groups.2
People living with the highest level of street

level incivilities are twice as likely to report
anxiety and 1.8 times more likely to report
depression.3
Designing streets which protect or create

distinctive characteristics and encourage social
integration will result in places where people
want to live and work.
Crowding, graffiti, abandoned buildings,

vandalism, street litter, poor maintenance of
buildings, traffic, parking, lack of places to stop
and chat, lack of recreation facilities and green
spaces, and noise all predict distress and
depression.4
Civilised street design7 can help to;

Engage with local communities and nurture a
sense of community by making it safe to
walk, cycle, play and congregate by reducing
the speeds and dominance of motor vehicles.
Encourage good civilised behaviour where
road users consider the needs of people who
are more vulnerable
Discourage anti-social behaviour through
good design and natural surveillance.
Provide people with better access to
employment opportunities and services.
Protect distinctive street environments
Neighbourhoods where residents make high use

of local amenities are associated with more
walking.5
Reducing traffic levels and traffic speed can
increase play, social interaction between
residents and quality of life.6
71
Transport Health and Access

Access to employment and services is not equitable
Transport accounts for around 29 per

cent of the UKs carbon dioxide
emissions8 and contributes
significantly to some of todays
greatest challenges to public health
in England.
These challenges include road traffic injuries,
physical inactivity, the adverse effect of traffic
on social cohesiveness and the impact of
outdoor air and noise pollution.
However, the relationships between transport

and health are multiple, complex, and
socioeconomically patterned.
Transport also enables access to work,

education, social networks and services that can
improve peoples opportunities.9
These groups find their access is reduced to

services such as shops and health care and they
spend a higher proportion of their resources on
transport.10
However, access to private transport is

disproportionately enjoyed by people on good
incomes. Public transport has become less
affordable over the past 20 years and the
limitations on routes and times make it
unsuitable for many purposes.
Employment opportunities and social activities

are often severely restricted by the availability
of transport and there is often reduced provision
in the evenings and at weekends.
Lack of access to transport is experienced

disproportionately by women, children and
disabled people, people from minority ethnic
groups, older people and people with low socioeconomic status.
Transport helps people connect to and access a

range of local services, shops, employment,
learning and facilities further a field. By
providing people with the opportunity to access
these services, streets can help stimulate local
economies.
72
Transport - Trends
To be successful, local proposals to reduce car travel will need to buck national trends
The number of licensed vehicles in

Great Britain has increased every
year since the end of the Second
World War, except 1991.
Whilst the number of trips taken by all modes of

private transport has also reduced nationally,
there has been a sharper decrease for
sustainable forms of transport, including walking
and cycling.
At the end of March 2014 there were

35.3million vehicles licensed for use on the
road in Great Britain.
2.72 million new vehicles were registered in
Great Britain in 2013, 10 per cent up on the
previous year. Of these, 84.4% were cars.
In contrast, the total number of buses and

coaches fell by 1.2% compared with quarter 1
2013, and new registrations have decreased by
15.6% over the same period, continuing an
eight year decline. There are now 8% fewer
buses than in 2005. Outside London, the
number of trips made by bus has decreased by
18% since 1995.
73
Transport - Challenges
Efforts to increase sustainable travel need to be specifically targeted
The proposals seek to increase take

up of sustainable travel and public
transport.
The evidence suggests that the proposals will
be most effective where they address very
specific journeys and types of journeys.
As shown opposite, cars remain the dominant
mode of transport for all journeys over 1 mile.
Taken as a whole, the area has the highest rate
of car driving to work and the lowest rate of
walking or cycling to work in Lancashire.
Over the past decade, car use for commuting
has increased in South Ribble, whilst cycling
has reduced in both council districts.
In contrast, the number of buses and coaches
fell by 1.2% compared with quarter 1 2013,
Source: Census 2001; 2011
74
Physical Activity
Increasing physical activity will play a key role in ill-health prevention
Physical activity can reduce the risk

of most preventable diseases and
improve outcomes - including cardiovascular disease, stroke, mental
health, dementia and respiratory
diseases
People in the area report being physically
active on more days a month than elsewhere
in the county.
There is a strong correlation between physical
activity and income deprivation, as shown by
the graph opposite, which shows the amount
of time spent being physically active for
schoolchildren in different income bands.
75
Leyland Community Health Loop

The Community Health Loop is a
proposed multi-use community
health facility that encourages
healthy lifestyle, sustainable
transport and the natural
environment around Leyland and
Farrington
When completed, the ten-mile long Loop
will feature way-stations at kilometre
intervals with facilities for dog walking, poo
bins, picnic areas, exercise activities, local
information, litter bins and recycling and
signposts to local amenities and attractions.
The proposed route will connect areas such

as Wade Hall, Heatherleigh, Clayton le
Woods and Altcar Lane to employment sites
at Lancashire Business Park and Buckshaw
Village with Leyland.
The benefits of the Loop include:

Health & wellbeing
Exercise facilities, encouraging healthy
lifestyle in outdoor environment, cleaner
environment, community involvement,
reaching a large urban population
Transport & accessibility

Linking major employment and housing
areas, complements City Deal, signposts local
shops and amenities
Environment
Improved air quality, cleaner local
environment, and wildlife corridor.
Culture
Providing heritage information, art points for
schools or art groups to display work, hand
crafted wooden animal sculpture trail
76
Access to Green Space

Incorporating green space into the design of new neighbourhoods has many
heath-related benefits.
Impact on Coping Skills
Impact on Physical Health
Impact on Mental Health.
Residents living in buildings without trees and

grass have reported more procrastination in
dealing with their problems. They felt their
problems were more severe than residents
living in greener environments.11
Populations exposed to the greenest

environments (parks, woodlands, open spaces)
had 25% lower all cause death rates and 30%
lower circulatory disease death rates compared
to those in areas with low green environment
after controlling for deprivation.13
The mental health benefits of activities in a

natural environment17 include:
Impact on Community Safety

the greener a buildings surroundings were the
fewer crimes (property and violent) reported.
Dense vegetation has been linked to the fear of
crime, lower perceived security.12 View
distance is important as vegetation provides
potential cover for criminal activity.
Impact on Income Inequality

Populations exposed to the greenest
environments (parks, woodlands, open spaces)
also have lowest levels of income-related
inequality in health.13
Impact on Social Connectedness

the use of green outdoor common spaces
predicted the strength of neighbourhood social
ties and sense of community.14
Impact on Economy
The natural environment underpins our
economy, providing an enormous range of
products and services worth many billions of
pounds to local, regional and national
economies.15 Improved access helps to reduce
sick days, increasing business productivity and
staff retention.16
Social, emotional, creative and cognitive

development of children and young people
Quality of life and relaxation
Recovery from stress
Relief of symptoms
Therapeutic and healing; spiritual
Physical activity; sport; adventure; challenge
Learning; intellectual and creative
development
Sense of meaning/purpose/perspective
Social contact; cohesion; belonging; identity
Volunteering; conservation; giving
something back".
77
Designed for Walking

Levels of motor traffic on residential
streets are associated both with poor
health and weakened social
cohesion.
The average resident on a busy street has less
than one quarter of local friends compared
with those living on a similar street with little
traffic.18
In light traffic streets, the home territory i.e.
the area over which people feel a sense of
responsibility is far broader than in heavy
traffic areas and included three times the
number of gathering spots. This impacts
particularly on children and the elderly.
People living in walkable, mixed use
neighbourhoods with pedestrian-friendly
design are more likely to know their
neighbours, participate politically, trust others
and be socially engaged, compared with those
living in car-oriented suburbs.19
The survival of older people increases where
there is more space for walking near their
home, with nearby parks and tree-lined
streets. (Marmot)
Pedestrian-friendly design in Buckshaw
78
Climate Change and Inequalities

Those on the lowest incomes will be most affected by the impact of climate change
Climate change presents

unprecedented and potentially
catastrophic risks to health and wellbeing.20
Climate change will also have long-term, less

direct impacts such as the effects on mental
health of flooding and other climate-related
events, which could cause anxiety and
depression.23
Climate change is predicted to result in an

increase in deaths, disability and injury from
extreme temperature and weather conditions,
heatwaves, floods and storms including health
hazards from chemical and sewage pollution.21
Those likely to be most vulnerable to

the impacts of climate change are
those already deprived by their level
of income, quality of homes, and their
health.24
It is estimated there will be an increase in

respiratory problems from the damaging
effects of surface ozone during the summer as
well as an increase in skin cancers and
cataracts.22
Although low-income areas will suffer most

acutely, risks associated with climate change will
fall disproportionately on the urban poor, the
elderly and children, 25
People on low incomes in the UK are more likely

to live in urban areas which will be warmer, and
therefore to be at risk of heat stroke.25
They are more likely to live in homes that are
less well protected26 and in areas that are more
exposed to weather extremes and flooding.27
They are less likely to have access to insurance
against risks associated with climate change
such as storm and flood damage.28
Measures to mitigate the inequalities of climate
change include increasing active travel across
the social gradient; improving access and
quality of open and green spaces available
across the social gradient; and improving local
food environments across the social gradient.
79
Coming to Buckshaw Village

Residents describe what attracted them to Buckshaw Village
From: Clayton le Woods
I outgrew my house in Clayton
and there was lots of choice on
Buckshaw
From: Lytham
Lytham was too expensive.
Here, its a dead central
location, the train is good for
getting to work in Salford
From: Bolton
The commute is great, links to
the motorways. Really easy to
get to work
From: Euxton
Always lived around here.
Wanted a bigger house now
weve got a daughter. Its great
for motorways and public
transport
From: Darwen
Everything is convenient
doctors, shops, school. Its safe
and clean no rough areas
From: Manchester
Travel links to Manchester
M6, M61, train. I like it, but
theres not much to do. I miss
the nightlife in Manchester
From: Bamber Bridge

I have friends who moved to
Buckshaw. They really liked it.
There are lots of young
families.
From: Singapore
I lived with my husbands
parents in Whittle and found
Buckshaw just by wandering
around
From: Ribble Valley

The houses were cheaper here
and you could get a bigger
house for the same money
From: Liverpool
Im originally from Astley
Village. I moved to Liverpool,
but outgrew my house and
wanted to come back home so
moved to Buckshaw
From: Accrington
Wanted somewhere we could
bring up the kids, where they
can play out and be safe. I want
to see them through school
From: Chorley
Properties had new kitchen,
bathroom etc. and didn't need
any work doing to them. Could
move straight in
80
Buckshaw Village
Comments from Buckshaw Residents about what works in Buckshaw Village
We have a fantastic community
feel here, I know I can ask
anybody for anything and get
some help, day or night, rain or
shine!!
I think there is a good
community spirit, although
people do sometimes look at me
strange when I say Hi on the
street!
Very social media savvy some posts

on Facebook have 2.5k views in one
day and 7.5k in a week
New residents now receive a
Buckshaw welcome pack with a map of
the village and details about the BVCA
The community association has been

set up for 6 or 7 years. The association
holds really good events which are free
for residents, sponsored by local
businesses and very well attended
(over 1,000 people at Christmas
event)
'Buckshaw' has its own identity

There is a good sense of space,
with lots of sky. Buckshaw feels
like being on holiday
There are very definitive
boundaries on Buckshaw
Really good community spirit.
Lots of help with looking after
each other's kids
Its not added on to another

place. Its a place in its own right
81
Frustration on Buckshaw
Residents describe the features of Buckshaw that cause them frustration and, in some
cases, make them want to leave.
Its soul destroying
walking to Charnock
Farm looking at bushes
full of bags of dog mess
just hanging there like
baubles on a Christmas
tree
The mobile phone signal is

awful. No 3G on the village
Not being able to get a school place. I

only moved here so we could walk to
school. Whats the point of living here if
Ive got to drive to another school 2
miles away? I might as well live there
Very few grit bins on the village and

some are used as litter bins
Allowing a village to be built

with a pre-war telecoms
infrastructure is pure lunacy.
there has been a noticeable
increase in commercial vehicles
scattered across the village.
Roads need to be adopted and
brought up to scratch quicker
Drainage on paths and

roads is very poor
feeling like
we are being
ripped off by
cost cutting
companies
and councils
the centre
has no
storage space
for groups to
use
Parking and its going to get

worse as kids get older
Sunningdale Drive is a car

crash waiting to happen it is
sooooo dangerous
Our postcodes
still arent on
sat-nav so we
cant get
deliveries. The
drivers just give
up trying to
find us.
cars abandoned on
the grass and all over
the pavements
General inconsiderate abandonment
82

Inclusive by Design
There are practical ideas and
solutions that can improve the
sustainability of local communities
Travel and Transport

Designing the layout of community to encourage
the use of sustainable travel e.g. from home to
school, workplace, facilities etc
Social Inclusion
Road layout and physical features can cut
communities into separate entities "this side
of the road, that side of the road
Accessible public transport consider bus routes

through a new development to account for
people most likely to be using public transport
Risk of segmenting housing mix to create "nice

areas", "old people areas", "poor people areas"
segregating communities
Consider range of housing to attract mixed
population manual workers, professionals,
managerial, young and old to increase
community and social assets
Incorporate dementia friendly design features
into planning
Linking public transport routes and timings with

employment sites
Access to Amenities
Incorporate services and businesses into local
community shops, caf, hairdressers etc.
Consider accessibility across social gradient.
Consider innovate solutions to parking, based on
how people actually live their lives, not on how
planners think people should live their lives.
Housing Design
Whole-life design houses able to
accommodate changes in peoples' needs same
people, same houses, different needs - for
example wheelchairs, stair-lifts, easy steps, level
showers etc
Ecological and energy efficient housing design
Consider different options for occupancy cohabitation, shared facilities etc

Impact on existing communities
Ensure that the new developments do not
impact negatively on other areas outside of
Chorley and South Ribble
Ensure new developments positively impact on
on community heritage and on the relationship
between existing and new centres
83
References Sustainable Communities

1. Campbell, C., Wood, R. et al. Social capital and health. London, Health Education
Authority. 1999.
2. Cattell, V. and Evans, M. Neighbourhood images in East London: social capital and
social networks on two East London estates. York, YPS for the Joseph Rowntree
Foundation. 1999: 1-61.
3 Curtice, J., Ellaway, A., Robertson C et al (2005) Environment Group Research Findings
No. 25/2005 Public Attitudes and Environmental Justice in Scotland.
4 Cooper R, Boyko C, Codinhoto R, (2008) Mental Capital and Well-being: Making the
most of ourselves in the 21st century. State-of- Science Review: SR-DR2 The Effect of the
Physical Environment on Mental Well-being. Foresight Mental Capital and Well-being
Project.
5 McCormack G, Giles-Corti B, Lange A (2004) An update of recent evidence of the
relationship between objective and self-measures of the physical environment and
physical activity behaviours. Journal of Science, Sport and Medicine, 7(1 Supplement), 8192.
6 Hart, J. (2009). No Friends? Blame the traffic... Living Streets/ Street Life, Winter, 6-7.
7 Lancashire County Councils Traffic & Safety Policy Group, Creating Civilised Streets;
Policy and Design Guidance, Feb 2010, revised June 2010, Lancashire County Council
8 Environment Agency. Addressing Environmental Inequalities. www.environmentagency.gov.uk/research/library/position/41189.aspx
9 Department of the Environment, Transport and the Regions (2004) Social exclusion and
the provision of public transport.
10. Acheson, D., Barker, D. et al. Independent inquiry into inequalities in health: report.
pp.1-164. 1998. London, The Stationery Office.
11 Kaplan S. "Mental fatigue and the designed environment" in Public Environments eds.
Harvey J and Henning D Washington DC, Environmental Design Research Association.
1987
12 Kuo F E and Sullivan W C. Environment and crime in the inner city: Does vegetation
reduce crime? Environment and Behavior, 33 (3) pp.343-367, 2001
13 Sullivan WC, Kuo FE and Depooter SF (2004) The fruit of urban nature: Vital
neighbourhood space. Environment and Behaviour 36(5): 678-700
14 Mitchell, R. and Popham, F. (2008) Effect of exposure to natural environment on
health inequalities: an observational population study. The Lancet, 372(9650), pp.1655
1660.
15 T. Sunderland (2012) Microeconomic Evidence for the Benefits of Investment in the

Environment Review. Natural England Research Report 033. Sheffield: Natural England.
16 Sustrans (2008) Active Travel and Healthy Workplaces. Sustrans Active Travel Information
Sheet FH06. Bristol: Sustrans.
17 Mitchell, R. and Shaw, R. (2008) Health impacts of the John Muir Award. Glasgow:
University of Glasgow.
18 Hart, J. (2008) Driven to excess: impacts of motor vehicle traffic on residential quality of life
in Bristol. Bristol: University of West of England. Available at:
http://www.2shared.com/file/3788304/ f7ea0c6c/DrivenToExcess.html
19 Leyden, K. (2003) Social capital and the built environment: The Importance of Walkable
Neighbourhoods. American Journal of Public Health, 93(9)
20 Porritt J, Colin-Thom D, Coote A, Friel S, Kjellstrom T and Wilkinson P (2009) Sustainable
development task group report: Health impacts of climate change.
21 NHS Confederation (2007) Taking the temperature: Towards an NHS response to global
warming; Department of Health and Health Protection Agency (2008) The Health Effects of
Climate Change in the UK.
22 IPCC (2007) Climate change 2007: Synthesis report of 4th assessment. Geneva:
Intergovernmental Panel on Climate Change. pp.53.
23 Costello A, Abbas M, Allen A et al (2009) Managing the health effects of climate change.
The Lancet 373(9676): 1693-1733.
24 Power A, Davis J, Plant P and Kjellstrom T (2009) The built environment and health
inequalities. Task group submission to the Marmot Review.
25 IPCC (2007) Climate Change 2007: Impacts, Adaptation and Vulnerability. Contribution of
Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate
Change.
26 Stern N (2006) The economics of climate change: The Stern Review. Cabinet Office and HM
Treasury.
27 Environment Agency (2006) Addressing environmental inequalities: Flood risk. Bristol:
Environment Agency.
28 Pitt M (2008) The Pitt review: Lessons learned from the 2007 floods. London: The Cabinet
Office; Chapter 2.
84
3.6
Strengthen Ill-Health Prevention
Prioritise prevention and early detection of those conditions most

strongly related to health inequalities;
Increase availability of long-term and sustainable funding in ill
health prevention across the social gradient.
85
The Role of Preventing Ill-Health

Everything is going to change.
Ill health prevention and health

promotion are not the sole domain
of the NHS, so it is not the only
player in addressing health
inequalities.
Similarly, public health departments should not
be solely responsible for tackling health
inequalities.
Reducing health inequalities is a responsibility
shared between a range of different sectors
and services,
Decisions made in schools, the workplace, at
home and in government as well as across the
NHS, all have the potential to help or hinder ill
health prevention.
An aging population and increased demands on

health and social care mean that services which
are already at capacity are at risk of being
overwhelmed.
The housing developments proposed in the
proposals will exacerbate demand in Chorley
and South Ribble by importing residents from
elsewhere and moving residents around the
boroughs. It will be very difficult to predict
exactly how and where these population shifts
will occur.
Coupled with the financial constraints imposed
by recent public service budgets, all services
must now be looking at not simply being more
efficient, but being more connected and more
focused on prevention and early intervention
targeting the most vulnerable as a priority.
This will place significant challenges on service

providers, who will need to develop flexible
approaches in order to respond to both the
changing demographics and the shifting location
of residents.
There are excellent opportunities within the

proposals for embedding innovative new
service models into the developments,
including extra care schemes, retirement
villages, co-located health and social care
services and hubs for community activity.
Likewise, as seen previously in this HIA, joined
up working between health, social care,
employment, welfare, housing and other
agencies will enable citizens to maximise the
control they have over their lives and be
healthier, for longer as a result.
86
Preventing Ill Health Priorities
The data opposite is from the

Chorley and South Ribble CCG
profile, which shows that there are
areas of ill health prevention that
require attention 1
Significantly better than England
For many preventable

diseases, the citizens of
Chorley and South Ribble
fare somewhat better than
the national average.
Significantly worse than England
Chorley
% Mothers smoking in pregnancy

% Mothers initiating breast feeding
Incidence of malignant melanoma
Hospital stays for self-harm
Life expectancy (females)
Rate of road injuries and deaths
Hip fracture in 65s and over
% of people living in most deprived quintile in

England
% children (under 16) in families receiving
means-tested benefits & low income
The level of GCSE attainment
The estimated level of adult physical activity
Incidence of acute sexually transmitted
infections
Estimated users of opiate and/or crack
cocaine aged 15-64
South Ribble
% Mothers smoking in pregnancy

% Mothers initiating breast feeding
Rate of road injuries and deaths
Hospital stays for alcohol related harm
Alcohol-specific hospital stays (persons <18
years admitted to hospital due to alcohol
specific conditions)
% of people living in most deprived quintile in

England
Long term unemployment
children (under 16) in families receiving
means-tested benefits & low income
Life expectancy (males)
Estimated percentage of obese adults
Incidence of acute sexually transmitted
infections
Estimated users of opiate and/or crack cocaine
aged 15-64
87
Trajectory of Health Outcomes

How Health Outcomes in Chorley and South Ribble are changing, compared to national
trend
Improving locally but are still significantly worse than
England 2
Getting worse locally and the deterioration appears to
Female life expectancy - Chorley

People killed or seriously injured on roads
Alcohol-specific hospital stays in <18 year olds South
Ribble
Hospital stays for self-harm Chorley
Improving locally and bucking the national trend
Life expectancy in South Ribble males
In South Ribble early deaths from all cancers in ages <75

years
Drug abuse
Overweight or obese 10-11 year old children - Chorley
Acute sexually transmitted infections
Smoking prevalence in adults Chorley
be at a faster rate than England 2
Overweight or obese children (% children in year 6)

South Ribble
Incidence of malignant melanoma in under 75 year olds
(Chorley)
Getting worse locally against a national picture of

improvement
Deaths from all cancers in ages <75 years - Chorley

Infant mortality - South Ribble
Hip fracture in ages 65 and over South Ribble
New cases of tuberculosis
Suicide rate South Ribble
Adult smoking prevalence South Ribble
Smoking in pregnancy
88
Older adults
Approximately one in five older people lives in poverty. 3
In Chorley and South Ribble, the
over 65 population is expected to
increase significantly over the next
10 years
We are living longer but we can expect to

live without good health for many of those
additional years. More of our older people
are therefore living with one or more
disabilities alongside chronic health issues.
There are disparities between older people
in low and high socioeconomic groups , with
people in the lowest quintile of income
reporting poorer general health, lower levels
of fruit and vegetable consumption and
higher degrees of mobility problems and
lower-limb impairment.4
Similarly, the prevalence of ischemic heart
disease among older people is higher in the
most deprived areas. Diabetes prevalence
and uncontrolled hypertension are also
inversely related to income. 4
The Extra Care and Specialist Housing

Strategy for Lancashire states:
We simply cannot afford to continue to

provide services for our older people in the
way the we have historically and in terms of
outcomes for our older people, we should
not aspire to. The historic models of care
provision and associated accommodation are
out of date and many are not fit for purpose.
Our housing stock does not meet the needs
of many older people and hence investment
is required to transform the way in which we
provide for our older people. 5
Services that promote the health, well being
and independence of older people prevent
or delay the need for more intensive or
institutional care, and make a significant
contribution to ameliorating health
inequalities. 6
89
Older adults
We need a new approach to accommodation for older people 7
The model for provision of
accommodation and care for older
people needs to change to reflect
the change in demand and
changes in expectations.
Dementia is placing increasing demands on
services and residential care is moving
increasingly towards a higher dependency
model and in many cases becoming more
about end of life care.
There is a need to promote and to make
investments in accommodation for older
people across all forms of tenure and across
the spectrum of dependency and affluence.
However, these investments need to be
made with careful planning and with a focus
on the needs of specific localities and the
needs of the target population.
There is evidence to support consistent

revenue savings through promoting extra
care rather than defaulting to residential or
nursing care.
If a genuine range of choices can be offered,
older people will then need support in
making choices which are right for them.
Lancashire County Council has estimated an

immediate need for an additional 988 units
of extra care across the county against a
current provision of around 350. This level of
provision could enable Lancashire to reduce
its current reliance of residential care.
A more ambitious target of around 2,600
units has been identified which is predicted
to grow to 3,725 by 2033 along with a
growth in demand for all types of
accommodation for older people.
In the locality, this would translate to around
500-700 additional units by 2033.
There are sites available in the LDFs that

would be suitable for extra care. There are
no insurmountable barriers from a town
planning perspective to delivering a step
change in extra care provision.
Any programme for investment in extra care
however, can only deliver to its potential
with strong partnership working between
County Council, District Council, NHS Clinical
Commissioning Groups and willing providers
and operators.
There is potential to co-locate other
appropriate services within extra care
developments such as GP surgeries or other
public services.
The ability of well designed extra care
facilities to contribute towards regeneration
and place should not be under-estimated
and there is strong evidence to support
highly positive contributions of such schemes
in this regard.
90
Designed Around People

The design and delivery of new, relocated or remodelled services needs to ensure
accessibility for all and be based on the experiences of the people most in need
Case Study - Michelle
Michelle lives in Clayton Brook. Her
experience of taking her daughter
for a Child and Adolescent Mental
Health Service (CAMHS)
appointment in Leyland illustrates
how any new, relocated or
remodelled service needs to be
mindful of the lived experiences of
the people it serves. This is
particularly with a view to ensuring
that the service is accessible to those
who need it the most and who find it
hardest to access, especially when
access is across authority
boundaries.
The appointment was at ten oclock, in Leyland.

At the time, the bus from Clayton Brook to
Leyland only went every couple of hours, so we
had to leave about eight in the morning.
Fortunately, a friend passed us in her car at the
bus stop and gave us a lift, which saved me
some money, but that meant we were in
Leyland really early and had to wait for over an
hour.
Then the person my daughter was due to see
was running late, and we had to wait even
longer and so by the time we got out of the
appointment and back to the bus stop, wed
missed the bus back to Clayton Brook and had to
wait another two hours for the next one.
As we got back to Clayton Brook, the school

was kicking out, so it must have been gone three
oclock.
From eight to three - thats seven hours out of

the house for a 45 minute appointment.
School werent having it. They were going
mental about her being off all day, saying it
doesnt take all day to go to one appointment in
Leyland, and Im like well, yes, actually, it does
My daughter was really hacked off, what with
school on her back about it. She said she wasnt
going to any more appointments unless they
were in Chorley or Preston. I talked to CAMHS
and they refused to move the appointments and
sent another one out for Leyland. I told them we
couldnt make it, but they wouldnt budge.
So we ended up not going and then they said

they were going to strike us off the list for not
attending. So we went to the next appointment,
only to be told that it was cancelled because the
person we were seeing was off. So, its ok for
them to miss appointments, but not us? Is that
how it works?
91
Health Provision around Pickerings Farm

Lostock Hall (various sites)
794 homes by 2026
Approx 2,400 residents
2012-2016 224 homes
2016-2021 320 homes
2021-2026 250 homes
Pickerings Farm
1,350 homes by 2026
2012-2016 300 homes
2016-2021 475 homes
2021-2026 575 homes
GP Practice
Dentist
Pharmacy
Optician`
1. Kingsfold Medical
Centre P81181
No. GPs: 2
List: 3,929
Retirement:
3-5 years = 1
5-10 years = 3
2. Lostock Hall Medical
Centre P81179
No. GPs: 2
List:3,879
Retirement: 0
3
4
3. Village Surgery
P81769
No. GPs: 1
List:1,389
Retirement:
5-10 years = 1
4. Medicare Unit
P81642
No. GPs: 1
List:2,821
Retirement:
5-10 years = 1
Data provided by Mapzone and Chorley and South Ribble Clinical Commissioning Group (2014)
92
Health Provision around Leyland

Heatherleigh
600 homes by 2026
Approx:1,600 residents by 2026
2012-16 200 homes
2016-21 200 homes
2021-26 200 homes
5
750 homes by 2026
2012-16 80 homes
2016-21 325 homes
2021-26 345 homes
6
Dunkirk Lane
82 homes by 2021
Approx:190 residents by 2026
2012-16 35 homes
2016-21 47 homes

430 homes by 2026
2012-16 170 homes
2016-21 120 homes
2021-26 140 homes
GP Practice
Dentist
Pharmacy
Optician`
1. Worden Medical
Centre P81057
No. GPs: 7
List:12,847
Retirement:
3-5 years = 1
5-10 years = 3
2. Leyland Surgery
Y03656
No. GPs: 3
List:4,200
Retirement: 0
3. Sandy Lane Surgery
P81076
No. GPs: 9 (4 salaried)
List:11,655
Retirement:
3-5 years = 2
5-10 years = 1
4. Central Park Surgery

P81117
No. GPs: 1
List:4,290
Retirement: 0
5. Station Surgery
P81741
No. GPs: 1
List:2,730
Retirement:
5-10 years = 1
6. Moss Side Medical

Centre P81186
No. GPs: 1
List: 4,375
Retirement: 0
93
Health Provision around Clayton Le Woods
Clayton Le Woods
700 homes
2012-16 193 homes
2016-21 300 homes
2021-2026 293 homes
Dentist
Pharmacy
Optician`
1. Worden Medical
Centre P81057
No. GPs: 7
List:12,847
Retirement:
3-5 years = 1
5-10 years = 3
2. Leyland Surgery
Y03656
No. GPs: 3
List:4,200
Retirement: 0
3.Sandy Lane Surgery
P81076
List:11,655
Retirement:
3-5 years = 2
5-10 years = 1
5. Station Surgery
P81741
No. GPs: 1
List:2,730
Retirement:
5-10 years = 1
6. Dr Hamad & Partner
P81701
No. GPs: 1
List: 3,439
Retirement: 0
7. Clayton Brook
Medical Centre P81180
No. GPs: 2
List:3,346
Retirement:
3-5 years = 1
4. Central Park Surgery

P81117
No. GPs: 1
List:4,290
Retirement: 0
3
1
GP Practice
94
Health Provision around Buckshaw Village

Clayton Le Woods
700 homes
(See other page)
GP Practice
Whittle le Woods (various sites)

423 homes by 2026
2012-16 132 homes
2016-21 275 homes
2021-26 16 homes
Pharmacy
Hospital
1. Euxton Medical Centre

P81171
No. GPs: 2
List:4,196
Retirement: 0
2. Buckshaw Village
Surgery Y02466
List:6,295
Retirement:
5-10 years = 1
Buckshaw (various sites)

1538 homes by 2026
2012-2016 760 homes
2016-21 471 homes
2021-26 326 homes
Dentist
3. Whittle Surgery P81143

List:8,721
Retirement:
3-5 years = 3
5-10 years =1
Euxton (Sylvesters Farm)

161 homes by 2026
Approx 400 residents
2016-21 81 homes
2021-26 80 homes
95
Health Provision around South Chorley

4,5&6
1
3
Lex Auto Site
154 homes by 2016
2012-2016 154 homes
Duke Street
70 homes by 2021
2012-2016 30 homes
2016-2021 40 homes
Gillibrand
46 homes by 2021
2012-2016 25 homes
2016-2021 21 homes
Eaves Green
419 homes by 2026
2012-2016 159 homes
2016-2021 150 homes
2021-2026 110 homes
Carr Lane
194 homes by 2021
2012-2016 124 homes
2016-2021 70 homes
GP Practice
Dentist
Pharmacy
Optician`
1. Regent House
surgery P81062
No. GPs: 5
List:8,245
Retirement:
3-5 years = 1
5-10 years = 1
4. Dr Bamford & Partners

(Chorley Health Centre)
P81038
No. GPs: 3
List: 5,420
Retirement:
3-5 years = 1
2. Library House
Surgery P81044
No. GPs: 7
List:16,520
Retirement:
3-5 years = 1
5-10 years = 1
5. Dr M Gale & Dr C Irizar

(Chorley Health Centre)
P81127
No. GPs: 2
List: 4,090
Retirement:
5-10 years = 2
3. Cunliffe Medical
Centre P81746
No. GPs: 2
List:3,246
Retirement:
3- 5 years = 1
6. Dr R B Baghdjian &
Partner (Chorley Health
Centre ) Y00347
No. GPs: 2
List:5,109
Retirement:
1-2 years = 1
96
Air Quality
Poor air quality leads to thousands of hospital admissions every year
The average adult breathes 13,000

litres of air per day; children breathe
50% more air per pound of body
weight than adults 8.
Road traffic, industry and construction are the
leading causes of poor air quality both in
terms of pollution and particulates.
Two of the main air pollutants carbon

monoxide and nitrogen dioxide - increase
deaths and CVD hospital admissions, affect
lung function and stimulate enhanced response
to allergens. The primary source for both
pollutants is road traffic.9
Particulate matter is the mixture of solid
particles and liquid droplets found in the air
and very fine particles can easily reach the
deepest recesses of the lungs. 10
Particulate matter, especially fine particles, has

been linked with significant health problems,
including:
premature death
respiratory related hospital admissions
and emergency room visits
aggravated asthma, acute respiratory
symptoms, including aggravated coughing
and difficult or painful breathing
chronic bronchitis
decreased lung function that can be
experienced as shortness of breath; and
work and school absences.198
Particulates cause tens of thousands of elderly

people to die prematurely each year and
thousands of hospital admissions each year.
Many of these hospital admissions are elderly
people suffering from lung or heart disease. 10
Approximately 60-75% of outdoor fine (or

respirable) particles enter indoors, where the
enclosed environment can create a
disproportionate impact on health. 11
Strategies to improve air quality and well-being
must therefore address:
The ways in which dwellings are ventilated

The materials used in their construction
The proximity of construction work to
occupied houses
Adequate shielding of occupied houses
from construction work
The proximity of houses to major roads
and industry 12,13
The Chorley and South Ribble CCG Profile

recommends that reducing mortality from
respiratory disease is a local priority.
97
Power Lines
Power lines are more of a nuisance and an eyesore than a health problem
Power lines cause significant concern

to local residents, despite evidence
that they pose low risk to health.
Some of the proposed housing developments
have existing high tension power lines crossing
the site. The evidence is that it is not costeffective to move these power lines. However,
their existence must be carefully considered
within the design of the site. 14
Impact on Health
There is very limited evidence to support a low
level of risk with regards to childhood
leukaemia and non-Hodgkins lymphoma.
However, there also exists robust and good
quality evidence to rule out such a link. 14
However, there remains a significant public
perception that such a health risk is high.
The scientific evidence supports the view that

precautionary measures should address solely
the possible association with childhood
leukaemia and not other more speculative
health effects. 14
Therefore, the Health Protection Agency advises
that schools should not be built in proximity to
overhead power-lines. 14
Impact on Property
The existence of high voltage overhead power
lines in a neighbourhood has a detrimental
effect on house prices, ability to get a mortgage,
neighbourhood desirability and perceived
quality of life. 15
If they can be seen, they are never considered a
visual attraction. In wet weather they can be
heard to hum or sizzle and can be concerning
to some people. 15
The visible presence of such cables could reduce

the number of potential buyers by up to 80%,
depending on the type of property concerned,
and the distance from the pylon or cable. 15
Buyers are more bothered by pylons than by the
power line cables, and more so if the pylon is in
front, rather than the rear of the property. 15
With this considered, it will be advisable to

limit the number of houses built close to the
lines. Also, architectural, street and house
design should plan around the existence of
power lines by:
Minimising sight lines to pylons from houses,

streets and public areas
Not clustering affordable houses near power
lines, as this could create undesirable
ghettos where houses will not sell.
98
Noise
Excess noise seriously impacts on health
For many community noises,

interference with rest, recreation and
watching television seem to be the
most important issues.
However, there is evidence that noise has
other effects on social behaviour: helping
behaviour is reduced by noise in excess of 80
dBA; and loud noise increases aggressive
behaviour in individuals predisposed to
aggressiveness. 16
In noisy areas, it has been observed that there
is an increased use of prescription drugs such
as tranquilizers and sleeping pills, and an
increased frequency of psychiatric symptoms
and mental hospital admissions. 16
Road traffic noise at 50 to 60 dBA intensity
increases the time taken to fall sleep and
causes sleep disturbance. 17
School children have more adverse effects than

young adults to high noise levels and long
reverberation times including helplessness,
language acquisition, making everyday errors,
performance and sleep. 16, 18
Therefore day-care centres and schools should
not be located near major noise sources, such as
highways, airports and industrial sites. 16
Conversations beyond a few metres can become
difficult when the background noise level is in
excess of 50dBA 16
However, most sensitive are the elderly and

persons with impaired hearing as it is
particularly vital for them to be able to hear
alarming and informative signals such as door
bells, telephone signals, alarm clocks, fire alarms
etc., 16
Noise related risks in the plans include:
Siting housing in proximity to busy roads,

intersections, railway lines and
manufacturing, distribution and
commercial sites
The noise of construction on the wellbeing
of existing residents of nearby areas and
of residents who move into a
development whilst it is still under
construction
The proposed site off Brindle Lane,
Bamber Bridge (Policy S, South Ribble LDF)
is between M61 and M6 and will require
extensive buffering from traffic noise, as
identified in para 7.50 of the LDF.
Buffering will also be required for
Pickerings Farm (Policy EE, South Ribble
LDF) regarding both the dualled A582 and
the proposed cross-borough link road,
which dissects the site.
99
Flooding
The risks and impact of flooding fall disproportionately on the most vulnerable
Recent flood events across Britain

have heightened the publics concern
about flood risk.
Flood risk is defined as a combination of two
components:
the chance (or probability) of a particular

flood event and
the impact (or consequence) that the

event would cause if it occurred. 19
Whilst estimations of future flood probabilities
are uncertain, all projected scenarios point to a
substantial increase . This applies to coastal,
river and localised flooding such as secondary
watercourses, sewer and drainage systems in
towns and cities being overwhelmed by sudden
downpours. 20
The risks of flooding fall disproportionately on
people on low incomes and in areas of
deprivation. 21
This is as a result of three factors:

1. Affordable, social and rented houses are more
likely to be located in areas that are vulnerable
to flooding
2. People who are renting and in the lowest
socio-economic groups are less likely to be flood
aware
3. People in lower socio-economic groups are
less likely to cope with a flood event and to
experience worse outcomes in the aftermath of
a flood.
Levels of community organisation and the
quality of community relationships can mitigate
or exacerbate the impact of a flood event.
The health effects which can result from floods
ranges from premature death, clinical problems
requiring hospitalisation or consultation with
doctors, to an increase in the use of nonprescription drugs or alcohol, depression,
insomnia, low self esteem and general feelings
of ill-health 21.
A strategic flood risk assessment carried out in

2007 22 showed that whilst flood risk exists in
areas of the District, it does not pose a
widespread and significant issue for the allocation
of development sites.
Full flood risk assessments should be carried out
wherever there is:
Sites are located in Flood Zone 2 or 3;
Sites located in Flood Zone 1, which exceed

one hectare located. Since the risk of fluvial
or tidal flooding is minimal such FRAs
should focus on the management of surface
water;
Development sites located in an area

known to have experienced flooding
problems from any flood source;
Development sites located within 8m

(water environment) of any watercourse
regardless of Flood Zone classification.
100
Flood Risk Maps

and Heatherleigh
101
Flood Risk Maps
Pickerings Farm and Lostock Hall
102
Flood Risk Maps
Buckshaw Village
103
Flood Risk Maps
Whittle Le Woods
104
Flood Risk Maps
Botany Bay
105
Flood Risk Maps
Crosse Hall Mill Farm and Froom Street
106
Flood Risk Maps
Adlington
107
Flood Risk Maps
Altcar Lane
108
Road Traffic Accidents

Reducing inequalities in road injuries is a key priority in Chorley and South Ribble
In the UK road traffic accident deaths

for children in poorest families are
more than four times greater than
those in the richest. 23,24,25
Pedestrian injuries are most common among 59 year old children and, in this age group, are
the most common cause of serious head
trauma. 26
Very few pedestrian victims escape injury,

whereas 94% of occupants of vehicles involved
in crashes are uninjured.
Some of the reasons why poorer families are
more at risk than richer families are that:
They are less likely to own a car

They are more likely to be pedestrians and
have increased exposure to traffic
More disadvantaged neighbourhoods tend
to be located nearer to major roads
On Buckshaw, the roads and paths were, in the

main, felt to be well designed and safe, but
there were also issues:
Its pretty safe on the roads. Theyre quite

narrow and twisty so you cant really get up to
anything more than 20mph.
The paths are great, no cars, quiet, safe. The
connect the village together really well so you
can get from one side to the other without really
encountering any traffic
Environmental risk factors for child pedestrian

injury indicate that the likelihood of injury
increases for the following conditions:
Elderly people can find it difficult to judge the

distance and speed of oncoming traffic and
struggle to cross the road in the time given by
signalled crossings 29
Giving Sunningdale Drive only one way in or out

is just an accident waiting to happen. How will
emergency services get in if something is
blocking the street?
Cyclists are more at risk of an accident on built

up roads (91%), but nearly half of fatalities occur
on non-built up roads (45%). 30
The maps on the following pages show patterns

of road accidents over ten years in four of the
key urban areas affected by the proposals.
increase in traffic volume (x13-14)

speed limit (x6),
absence of play areas (x5.3),
poorly protected play area (x3.5)
high proportion of kerbside parking
(x3.4) 27,28.
109
Road Traffic Accidents - Leyland
Observations:
There are significantly more
pedestrian and cyclist accidents
are in and around low income
areas such as Seven Stars and
Golden Hill than there are in
higher income areas such as
Farington. Developments at
Altcar Lane and Moss Side test
track should consider the
impact of increased traffic flow
through Seven Stars.
Road Casualties 2000-2010 Source http.www.map.ipoworld.com
110
Road Traffic Accidents Lostock Hall
Observations:
There are significantly more
pedestrian accidents in the low
income area of Kingsfold than in
higher income areas such as
Penwortham. Consideration
should be given to managing
increased traffic flow in
Kingsfold resulting from the
Pickerings Farm development.
The dualling of the A582 should
alleviate congestion on the
B5254 through Lostock Hall,
reducing accident risk.
111
Road Traffic Accidents Bamber Bridge
Observations:
Accidents, injuries and fatalities
tend to follow the principle
routes and are concentrated at
junctions.
112
Road Traffic Accidents - Chorley
Observations:
Central and south west Chorley
has high concentrations of low
income households, living near
major roads. Most pedestrian
and cyclist accidents are in
these areas. There are far fewer
accidents in higher income
residential streets.
113

A coordinated approach to ill-health prevention is not desirable. Its essential
Even without the proposals of the

LDFs and City Deal, there would be
significant pressure on local services
to maximise ill-health prevention.
The proposals do, however, bring with them
existing partnerships and vehicles for securing
improved joined up working across agencies
and innovation for new models of service
design.
Chorley and South Ribble CCG, along with

partners have adopted an Integrated
Neighbourhood Team approach to delivering
community health care, based around
populations of approximately 30,000.
There are expected to be seven INTs in the
Chorley and South Ribble area. The operational
parameters of these teams needs to be flexible
enough to accommodate a shifting population.
Local GP practices and NHS England should
consider the changing nature of capacity and
demand for delivery of primary care across the
area, and in particular on major residential sites.
Service providers will need innovative models of
delivering services around the way that people
live their lives such as work based
appointment, peripatetic clinics, mobile testing
services etc.
A study should be undertaken to understand

current provision and impact of developments
on capacity/demand
Co-location of health, social care, community
and VCFS activity/services could bring increased
integration and better efficiencies but there is a
risk of siting a co-located service in a place that
is less accessible for those who need it the most,
e.g. elderly, infirm, disabled, poor etc
Extra care facilities should be considered on the
major residential sits, to incorporate
professional services and leisure amenities.
New community health centres could bring
together primary, secondary and diagnostic
services as well as fitness centres, gyms,
swimming pools etc.
114
References Ill Health Prevention

1 Lancashire County Council (2014) Public Health Profile Chorley & South Ribble CCG
2 Lancashire County Council (2014) Public Health Profile Chorley & South Ribble CCG
3 Age Concern (2006) Just above the breadline. London: Age Concern England.
4 Craig R. and Mindell J (Eds.) (2007) Health Survey for England 2005. Volumes 1-4: The
health of older people.
5 CBRE (2014) Extra Care and Specialist Housing Strategy for Lancashire, Lancashire
County Council
7 All text and data extracted from CBRS (2014)
8 Particulate matter. (2002)., National Institute for Occupational Safety and Health.
8 Transport & Health study group. Carrying out a health impact assessment of a
transport policy.Guidance from the Transport & Health study group. (2000). Faculty of
Public Health Medicine.
10 Particulate matter. (2002)., National Institute for Occupational Safety and Health.
11 Owen, M. K. and Ensor, D. S. Airborne particle sizes and sources found in indoor
air.Atmospheric Environment, 26A (12) pp.2149-2162, (1992)
12 Cave, B, Molyneux, P and Coutts, A (2004) Healthy sustainable communities: What
works?.Milton Keynes and South Midlands Health and Social Care Group.
13 Dora, C. and Phillips, M., eds. Transport, environment and health. WHO Regional
Publications,European Series No 89, WHO. (2000).
14 Stakeholder Advisory Group on ELF EMFs (SAGE) Precautionary approaches to ELF
EMFs (2007) First Interim Assessment: Power Lines and Property, Wiring in Homes, and
Electrical Equipment in Homes
15 Sims, S. and Dent, P (22005) High-voltage Overhead Power Lines and Property
Values: A Residential Study in the UK Urban Studies, vol. 42, issue 4, pages 665-694
16 Berglund, B., Lindvall, T. et al. Guidelines for community noise. (1999) World Health
Organisation.
17 Department of the Environment Transport and the Regions. Health effect noise
assessment methods: a review and feasibility study. (1997). A review by the National
Physical Laboratory and the Institute of Sound and Vibration Research for the Noise and
Nuisance Policy Unit.
18 Ng C F. Effects of building construction noise on residents: a quasi-experiment.
Journal of Environmental Psychology, 20 pp.375-385, 2000
19 Environment Agency. Flooding. (2004)
20 Office of Science and Technology. Future flooding. Executive summary. (2004). Flood
and coastal defence project of the Foresight programme.
21 Flood Hazard Research Centre. The health effects of floods: the easter 1998 floods in
England.No 3/99. (1999). Flood Hazard Research Centre Article Series.
22 Preston City Council, South Ribble Borough Council and Chorley Borough Council
(2007) Central Lancashire Strategic Flood Risk Assessment Level 1 Final Report
23 Jarvis, S., Towner, E. et al. "Accidents" in The health of our children ed. Botting, B.
London, Office of Population Censuses and Surveys, HMSO. (1995).
24 McCarthy, M. "Transport and health" in Social determinants of health eds. Marmot,
M. and Wilkinson, R. G. Oxford, Oxford University Press. (1999): pp.132-154.
25 Acheson, D., Barker, D. et al. Independent inquiry into inequalities in health: report.
pp.1-164. (1998). London, The Stationery Office.
26 Harborview Injury Prevention and Research Center. Child pedestrian injury
interventions. (2002).
27 Wazana, A., Krueger, P. et al. A review of risk factors for child pedestrian injuries: are
they modifiable? Injury Prevention, 3 (4) pp.295-304, (1997)
28 Roberts, I. Adult accompaniment and the risk of pedestrian injury on the schoolhome journey. Injury Prevention, 1 (4) pp.242-244, (1995)
30 Gardner, G. and Gray, S. A preliminary review of rural cycling. TRL Report 310. (1997)
Crowthorne, Berkshire, Transport Research Laboratory.
115
Part 4 Recommendations
The following pages compile the recommendations made throughout the report into
arrangements for action and monitoring.
The suggested monitoring authority does not have to be the delivery mechanism for the
recommendation. Rather, it should oversee and coordinate activity to implement the
recommendations.
The local Health and Wellbeing Partnership should ultimately determine which
recommendations are to be monitored by which authority, and should retain oversight of
all recommendations in this report.
116
Health and Social Care Commissioners
Monitoring
Local GP practices and NHS England should consider the changing nature of capacity and demand for
delivery of primary care across the area, and in particular on major residential sites.
CCG and NHS England
A study should be undertaken to understand current provision and impact of developments on

capacity/demand
CCG and Public Health
Extra care facilities should be considered on the major residential sits, to incorporate professional services
and leisure amenities.
New community health centres could bring together primary, secondary and diagnostic services as well as
fitness centres, gyms, swimming pools etc.
Health and Wellbeing Partnership
Co-location of health, social care, community and VCFS activity/services could bring increased integration
and better efficiencies but there is a risk of siting a co-located service in a place that is less accessible for
those who need it the most, e.g. elderly, infirm, disabled, poor etc
Health and Wellbeing Partnership
Ensure adequate capacity in local maternal services for meeting the demands from newly created
neighbourhoods
CCG and NHS England
117
Local Service Providers
Monitoring
Redesign of Services
Service providers will need innovative models of delivering services around the way that people live their lives
such as work based appointment, peripatetic clinics, mobile testing services etc.

Partnership
Co-location of health, social care, community and VCFS activity/services could bring increased integration and
better efficiencies but there is a risk of siting a co-located service in a place that is less accessible for those who
need it the most, e.g. elderly, infirm, disabled, poor etc
Support for Parents and Families

Provide support for parenting skills through education, peer mentoring, local pre and ante natal groups.
Childrens Trust
Practical numeracy and budgeting skills training for people in areas of deprivation
Practical, community-based training in household management, cooking, maintenance etc to enable people to be
more self-sufficient
Working Together
Data sharing between agencies so that vulnerable NHS and social service patients are referred to advice and
support for their standard of living

Partnership
Provision of advice and support in GP surgeries, health centres, community centres and other places more
frequently used by people on low incomes.
Pro-active case finding, initiated by NHS and social care providers, but carried out by the voluntary sector.
Practical Support
Responsible trader schemes to give people the confidence that home repair staff are properly trained, ethical,
approved and responsible
Planning Authority
Programmes to properly insulate, damp proof, dry and efficiently heat the homes of people who are most
vulnerable especially those with cardio-vascular or respiratory disease, older adults and children.
118
Developers and Planning Authorities (1)
Monitoring
Site Design
Consider how road layout and physical features can cut communities into separate entities "this side of the
road, that side of the road
Planning Authority
Minimise risk of segmenting housing mix to create "nice areas", "old people areas", "poor people areas"
Consider range of housing to attract mixed population manual workers, professionals, managerial, young and
old to increase community and social assets
Incorporate dementia friendly design features into planning
The holistic needs of young families mothers, babies, young children etc should be incorporated into design of
housing and environment.
Access to Amenities
Incorporate services and businesses into local community shops, caf, hairdressers etc. Consider accessibility
across social gradient.
Planning Authority
Ensure that newly created communities include amenities that are appealing to all ages.
Consider innovate solutions to parking, based on how people actually live their lives, not on how planners think
people should live their lives.
Create opportunities for physical activity walking to school, cycle routes, use of green spaces, including safety
consideration of more walking/cycling and traffic
119
Developers and Planning Authorities (2)
Monitoring
Create Sense of Identity

Creating and supporting amenities that facilitate social connectedness between children and adults such as
multi-use community centres, play areas, sports facilities, cafes, village greens.
Encouraging a strong sense of shared identity, through signage, place naming, links to local heritage and
culture.
Provide seed funding for local community projects that bring new residents together such as parent and
toddler groups, multi-generational projects and whole-community events.
Strategic Infrastructure
Partnership
Social and affordable housing should have equitable access to facilities and amenities. These households should
not be located in a cluster in the least favourable part of the development.
Investment in soft infrastructure, such as community schemes that bring people together, resident
associations, multi-generational groups.
Proving one-off set-up costs for community groups to purchase shared resources, such as storage facilities, IT
equipment, marquees, PA equipment etc that can be used for community events and activities.
Housing Design
Whole-life design houses able to accommodate changes in peoples' needs same people, same houses,
different needs - for example wheelchairs, stair-lifts, easy steps, level showers etc.
Planning Authority
Ecological and energy efficient housing design

Ensuring that new build properties adhere to, or exceed, standards on energy efficiency.
Consider different options for occupancy co-habitation, shared facilities etc.
Minimise Negative Impact on existing communities

Ensure that the new developments do not impact negatively on other areas outside of Chorley and South Ribble
Planning Authority
Ensure new developments positively impact on community heritage and on the relationship between existing
and new centres
120
Employment and Skills
Monitoring
Improve Employability Skills of Existing Population
Community-based work skills and functional skills training

Local Skills Partnership
Confidence and life-skills courses

Pre-selection employment pools for specific types of labour, e.g. road and construction
Financial support for people to undergo certification checks and gain CSCS cards
Job clubs delivered in community centres
Working Together
Strategically, agencies should be exploring joined up ways of engaging and supporting people into employment,
for example:
Requiring that local contractors use locally sourced labour
Producing regular communications on upcoming work opportunities directly into local communities
Local Economic Development

Partnership
Networks of employment agencies, employers and education providers collaborating on skills training
Coordinating public transport to link residential to employment areas at appropriate times.
Developing sustainable travel options from residential to employment areas
Local Jobs for Local People
Requiring that local contractors use locally sourced labour

Partnership
Linking public transport routes and timings with employment sites
121
Schools and Learning
Monitoring
School Planning
Conduct a retrospective demographic analysis of population growth in Buckshaw Village, by one-year age band to
inform the timescales for school provision in new sites.
Careful consideration should be given to capacity planning in primary and secondary education.
Risk-sharing agreements should be established to mitigate the cost of over-estimation of demand for school
places.
Enterprise in Schools
There should be an analysis of the expected future demands within the labour market so that training can be
targeted at key population groups in good time ahead of the need for trained employees
Relationships should be built between businesses and school to support young people with work-based and
enterprise learning.

Partnership
Embed learning about Enterprise Skills into school education at an early age and continue through to early
adulthood.
Community-Based Learning
Deliver Community Learning schemes within local communities, bringing the knowledge and skills of community
members together with professional educators to train, support and inspire their neighbours.

Partnership
There should be asset-mapping activities conducted within local communities to establish their strengths and
aspirations.
122
Transport and Travel
Monitoring
Accessible Amenities and Sustainable Transport
Designing the layout of community to encourage the use of sustainable travel e.g. from home to school,
workplace, facilities etc
Accessible public transport consider bus routes through a new development to account for people most likely
to be using public transport young people, older adults, low income families etc.
Links to Employment

Partnership
Linking public transport routes and timings with employment sites

Promote Physical Activity
Create opportunities for physical activity walking to school, cycle routes, use of green spaces, including safety
consideration of more walking/cycling and traffic
Planning Authority
123

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Health Impact Assessment

City Deal and the Local Development

The most significant risk is that, when the

Health Impact Assessment, Final Version

Jan Ledwood, Gora Bangi, Damian Nelson, Louise Giles, Andrea

Extended Partners and Stakeholders

Buckshaw Business Hub, Clayton Brook Community House, Buckshaw

Health Impact Assessment, Final Version

Part 2 Local Area Profile

Part 3 Impact on Inequalities

3.1 Give Every Child The Best Start in Life

3.3 Fair Employment for All

Health Impact Assessment, Final Version

One Page Summary

A key part of the evidence related to learning

People on low incomes, with few

Some Key Concerns

Health Impact Assessment, Final Version

Thus, there is a significant risk that the health

Health Impact Assessment, Final Version

The Health Impact Assessment

It is not the intention of this HIA to review or

The City Deal and LDF proposals are currently at

Health Impact Assessment, Final Version

These topics are so interdependent that it

Scoping Health Impacts

Social and community influences

Social support and integration

Individual lifestyle factors

Living and working conditions

Health Impact Assessment, Final Version

Socio-economic, cultural and

Methodology Differential Impact

In exploring the relationship between the

1. Give Every Child the Best Start

Health Impact Assessment, Final Version

Methodology Stages of HIA

Purpose 11, 12, 13

Determine whether a detailed

Review of literature see references for details

Set out the parameters of the

Develop population profile and

Review existing health impact assessments and LDF/City Deal documentation

Analyse and critically assess the

2 x Focus Groups with Buckshaw residents

Make a set of final

6. Evaluation and FollowUp

Evaluate the HIA and ensure

Health Impact Assessment, Final Version

Housing and Economic Development

Health and Wellbeing

Environment and Climate Change

Build over 12,500 new homes across Chorley and

Improve the wellbeing of all residents,

Protect and enhance the quality of local built

Protection of existing allotments and

Enable easier journeys, manage car use,

Health Impact Assessment, Final Version

Protection of Green Belt, Sites of Special

Enhancing recreational value of local parks

Predicting Future Demand

The current average occupancy rate in the area

However, predicting where and when that