Chorley East Health Centre

Health Profile
Tony Roberts Senior Public Health Coordinator
Lancashire County Council
February 2015

Introduction
A new health centre for East Chorley has been considered for over 10 years

This paper provides public

health data and analysis to
inform decision making for
the development of a new
health centre in East
Chorley.
A paper to the Chorley and South
Ribble Clinical Senate describes the
development:
In Chorley East, there is a real lack
of high quality healthcare facilities
and services for the local community.
A need to develop a fit for purpose
facility in one of the most deprived
neighbourhoods in Chorley has been
around for over 10 years. These
conditions are unlikely to change
without a different approach to the
delivery of services to the local
population.

Through a true partnership

approach, there is a unique chance
to make the change required with an
opportunity to finance and develop a
purpose built health centre in this
area. Lancashire Care Foundation
Trust have been working with
Chorley Council and Chorley and
South Ribble Clinical Commissioning
Group to develop the plans for this
centre.
The proposed centre will see
services that are currently delivered
in poor quality premises relocated to
new a facility together with a range of
services currently delivered in a
hospital setting. It will provide a
modern, fit for purpose environment
for the delivery of 21st century
healthcare to the local population of
Chorley east and the wider Chorley
area.

The vision of the partners is to create

a new local centre drawing upon the
experience of other areas of the
country where the investment in new
facilities has:
enabled the migration of services
from acute to a community setting
increased the capacity and
capability of local GPs to deliver a
wider range of services and
provided the patient with the
convenience of accessing a wider
range of services in an accessible
location.

The overall aim is to deliver services

more efficiently, reduce hospital
admissions and ensure that people
have less need to access acute
services with a consequential
improvement in health outcomes.

Introduction
Current facilities are outdated,
cramped and do not meet the
expectations of clinicians and
patients or the flexibility
required for the future delivery
of services in Chorley.
The purpose-built facility will provide
more services closer to peoples
homes, reducing the need for patients
to travel out of the area to major
hospitals and the number of inpatient
hospital admissions
The new facility will reflect the
increasing expectations of health and
social care professionals, patients and
the general public and the
opportunities offered by social,
political, economic and technical
change.

Service Type

Specific Servcies

Primary Care

Co-location of 3 GP practices
Including paediatric services

Community Care

Hospital Services

Services for people with long term conditions

(including chronic kidney disease and some mental
health assessment services)
Diagnostics and out-patient services
Possible IV and Chemotherapy suite

Pharmacy Services

100m2 pharmacy

Council and 3rd Sector

Services

To be developed

Additional Facilities

Space for exercise and peer group support

especially for people with Long Term Conditions
(LTCs).
Space to facilitate multi-disciplinary team meetings
supporting integrated care.

Relocation of services from :

18 Euxton Lane
16 Euxton Lane
Chorley Health Centre
Oakfield Unit

Introduction
This development takes
place in the context of
deprivation, aging facilities,
new ways of working, public
sector austerity and local
housing developments that
will place increased pressure
on health and care services.
In order to inform the developments,
this health profile considers the
different factors that may impact
upon how successful it is in
achieving its aims. These are:

Population Profiles
Review of Evidence
The Perspectives of Citizens
Co-Working with Community
Organisations

Population Profiles consideration

of the needs of both the local
resident population and GP list
populations. To include data on
age/gender, demographics,
deprivation, disease prevalence for
priority conditions (e.g. respiratory
disease, mental health, dementia
and diabetes) and determinants of
health (e.g. deprivation, employment,
lifestyle etc)
Review of Evidence Base of
models for integrated delivery of
primary and secorndary health and
care services. Where available, to
include a review of the effectiveness
on factors such as hospital
admissions, service outcomes,
safety, access, satisfaction etc.

Perspectives of citizens the CCG

has conducted insight work with
patients with a range of conditions
and characteristics. This report will
draw on this existing work exploring
citizen views around accessing
services, quality of care and dignity.
It will also propose additional insight
work that will contribute to the design
of the centre.
Co-working with VCFS The local
voluntary and community sector has
a lot to offer the care and support of
people with a range of health needs.
This paper explores how local VCFS
organisations and groups could be
useful partners and consultees in
taking the project forward.

Location of Friday Street and GP Practices

GP Practices
Eaves Lane
Dr Bamford
Cunliffe Street
Other GP Practices

Location of Friday Street

Friday Street is situated in central
Chorley, close to the town centre, in
the ward of Chorley East. It is close
to the ward boundaries of:
Chorley South East,
Chorley North West and
Chorley North East.
The three GP practices have patients
predominantly from these wards, with
Chorley South West being a short
distance away.
These five central Chorley wards are
home to a wide diversity of
neighbourhoods, including social
housing, urban terraces, suburban
semis and high concentrations of
elderly people living in poverty.

Demographics Population Pyramids

The age profiles of the three GP Practices are broadly similar

Chorley Medical Centre - Bamford

Eaves Lane Surgery

Cunliffe Medical Centre

Deprivation by Place and GP Practice

Approximate location of Friday Street

Demographics Life Expectancy

Life expectancy for the area is amongst the lowest in Chorley and South Ribble

All cause mortality is a fundamental

measure of the health status of a
population. It represents the
cumulative effect of the prevalence of
risk factors, prevalence and severity
of disease, and the effectiveness of
interventions and treatment.
Differences in levels of all-cause
mortality reflect health inequalities
between different population groups,
e.g. between genders, social classes
and ethnic groups.
The populations served by GPs in
central Chorley (including the Library
House, Gale and Regent House
practices) have some of the lowest
life expectancy in the CCG
especially for men.
Service design needs to account for
targeting interventions towards men
in their retirement years.

Employment and Health

Unemployed people have
multiple elevated health risks,
including increased rates of
limiting long-term illness, mental
illness and cardiovascular
disease. The central Chorley
wards have the highest rates of
unemployment in the borough.

This has implications for service

design and collaborative
working. People in
unemployment have
commitments to appointments,
interviews, work training etc
which underpin their income.
They are likely to prioritise these
appointments over health
appointments.
They are also more likely to be
in receipt of ill-health related
benefits

Employment and Health

Different conditions can significantly
affect someones chances of
employment.
Patients with fairly well controlled
diabetes have almost as good an
employment rate as the general
population.
However, conditions which affect a
persons presentation e.g. depression,
mental illness, speech impediment can
significantly impair their ability to enter
the job market. This compounds the
difficulties they experience with their
health.

Some priority and consideration should

be given to exploring how health
services can support people to gain
employment, maximise self-sufficiency
and improve self esteem

Income and Health

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.
The relationship can operate in both directions:
low income can lead to poor health and ill health
can result in a lower earning capacity.
The three wards with the lowest income are in
Central Chorley. Unsurprisingly, these are also
three of the 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.

Mosaic profile of Central Chorley

A Residents of isolated rural communities
B Residents of small and mid-sized
towns with strong local roots
C Wealthy people living in the most
sought after neighbourhoods

D Successful professionals living in

suburban or semi-rural homes
E Middle income families living in
moderate suburban semis
F Couples with young children in
comfortable modern housing
G Young, well-educated city dwellers
H Couples and young singles in small
modern starter homes

I Lower income workers in urban terraces

in often diverse areas
J Owner occupiers in older-style
housing in ex-industrial areas
K Residents with sufficient incomes in
right-to-buy social houses
L Active elderly people living in
pleasant retirement locations
M Elderly people reliant on state support
N Young people renting flats in high
density social housing

O Families in low-rise social housing with

high levels of benefit need
Location of Friday Street
Ward Boundaries

Key Mosaic Groups

I Lower income workers in
urban terraces in often diverse
areas

Key Features
Few qualifications
Routine occupations
Young singles and couples
Some young children
Ethnic diversity
Small homes
Crowded
Below average income
Sport

J Owner occupiers in older-style

housing in ex-industrial areas

Key Features
Traditional
Married
Below average incomes
Approaching retirement
Outgrown homes
Personal responsibility
Manufacturing industries
Careful with money
Reliant on cars
Manual skills

O Families in low-rise social

housing with high levels of benefit
needs

Key Features
Disadvantaged
Low incomes
Unemployment
Long term illness
Low rise council housing
One parent families
High TV watching
Dependent on state

GP Profiles
Obesity and smoking prevalence amongst GP patients is high.

GP Profiles
Patients of the three GP practices face significant challenges to their health

Mental Health
Insight

Patients describe frustration with the way mental

health is managed in the community:
I wait months for an appointment. By the time Ive
waited 5 months I could have gone through so many
different phases.
The longer you have to wait, the more you suffer.
GPs dont have much knowledge about mental
health.
This leads to patients seeing A&E as the only option,
even though they know it is unsuitable.

Youve no choice but to go to A&E, but they dont

want to know you.
Ive gone into A&E saying I feel suicidal and then
been put in a broom cupboard and made to wait 5 to
12 to 18 hours.
The three GPs have the highest rates of reported
mental health problems, indicating significant potential
for collaborative working with local mental health
services. Consideration should be given to addressing
the relationship between physical and mental health,
lifestyle and deprivation.

Diabetes
Insight
The quality of information and
education was seen as poor
If youre vulnerable, illiterate or have
English as a second language, youre
just persecuted for that and youre not
going to get any real care.
Patients highlighted the benefits of
having all diabetes-related services
under one roof.

If shes going to be seen for her heart,

she might as well be seen for her
diabetes at the same time.
Podiatry is more than a key thing. It is
the essential factor. Feet care for
diabetes is critical.
If you could go to one place and get
everything done in a day I know its a
whole day, but youre all sorted.

COPD Profile
Insight
Patients want quicker diagnosis, which
could prevent future problems:
It took them months to get to the
bottom of it. I was going between
Preston and Chorley for over 18 months
before they found out what was wrong
with me.
They need to get it diagnosed earlier!
If they could have spotted that sooner
and got me sorted, I wouldnt have
developed sleep apnoea as much as I
did and therefore I wouldnt have lost
my job and everything else.

Continuity of care and dignity are

common issues
I want to see the same person,
otherwise youve no idea whats going
on.
They never listen; never ever listen.
There should be a COPD clinic in the
GP surgery.

Dementia Profile
Insight

Carers of people with dementia feel that the

system is stacked against them
Its these people [carers] I worry about. They
need help and its just not there.
Nobody could see that this gentleman [the
carer] was cracking up in front of them.
The services offered by the voluntary sector
are particularly valued
Age Concern: its fantastic what they are
doing. Its a god send. It gives us something to
look forward to.

The Alzheimer's Society is superb in every

respect, they cant do enough.
Without Genesis , Id be in hospital.

Staff in all areas of health care need to be

trained in dementia awareness.
[sufferer] went for a breast scan. It was
impossible for them to scan her because she
had to go in on her own.
Theres just no way that [sufferer] could have
an eye test. She wouldnt have a clue. She
wouldnt answer anything.
Theres a lot of GPs who dont know what to
do with dementia

Urgent Care 0-4 year old

Insight
Generally, services for children and young
people are seen more positively than
other services.

I was seen more quickly in A&E.

Doctors are open a little later.

Services ask how you feel and if the

process was ok.
The practice populations of Eaves Lane
and Banford have the highest rates of
emergency admissions for young children
in the CCG. As the data is a rate per
1000, the difference cannot be accounted
for being a result of a young population.
There is scope to consider incorporating a
minor injuries/ailments service for children
in the new Centre, as it is possible that
the admissions reflect the parents ability
to get timely access to primary care or
diagnostics. This needs further
investigation.

Asset-Based Design
Using Asset-Based Approaches to Maximise Health

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

Service Design

Commissioning for Social

Value

Community-level budgets

Local procurement

Employing local people

Local Community Assets

The map is an extract from a district-wide
community assets mapping exercise done by
Lancashire County Council in 2014.
2 Astley Village Community Centre
3 Albany Science College
6 Chorley Community Centre
7 Chorley United Reformed Church
10 Eaves Green Village Hall
11 Galloways Society for the Blind
13 Lancaster House
14 Homestart Chorley & South Ribble
18 St Marys Parish Centre
19 Tatton Community Centre
28 Chorley Gardening Club
29 Chorley Cricket Club
30 Chorley Lifestyle Centre
31 The Scout Centre
32 Highfield Childrens Centre
33 Holly Trees Resource Centre
34 Lancashire Registration Service
35 Chorley Youth Offending Team Office
36 Young People's Service
37 Woodlands - Conference Centre
The consultation exercise should incorporate these
and other local groups.

Evidence-Based Design
Access to Diagnostics

Case Management

Community Development

Diagnostics involves a variety of tests

and measurements that can be used
to determine what conditions,
diseases or syndromes a person may
currently have or is likely to develop

Overall, evidence for case

management in reducing
readmissions and costs is weak and
ambiguous.

Community development and

engagement programmes can
contribute significantly to improving
health and patient experience. To be
effective, they should consider:

Some 75% of clinical decisions are

based on a diagnostic test
Improving efficiency of testing, speed
and accuracy of diagnosis can
provide a substantial contribution to
savings
For patients: early detection and
diagnosis can prevent unnecessary
pain and suffering as well as
potentially reducing scale / cost of
treatment
There is a large body of research
links early diagnosis to measurable
health gains (improved survival rates /
lower treatment costs)

It has been shown to improve patient

experience, prevent ill-health and
promote health.
What works:
Hospital-initiated case
management,
GP-led community case
management
Well integrated health and social
care teams providing support in
patients home
Targeting case management for
frail elderly
Comprehensive, multi-disciplinary
shared assessments

Community workshops contribute

to a sustainable healthy community
Peer mentors can be effective in
delivering health promotion
Community development takes
time years, not weeks.
Community involvement improves
planning and delivery of services

Training staff and community

members in community
development approaches
Consultation events are not
effective and lead to fatigue in
community groups

Evidence-Based Design
Seven Day Opening

Self Management

Expert Patient Programmes

Admission at the weekend is

associated with increased risk of
subsequent death within 30 days of
admission.

The evidence shows that the following are

achievable with self management:

A case study with an expert patient

programme published in the journal
Self Care showed that for every 1
invested up to 6 was returned in
wider social benefits such as:

Case study findings into seven day

opening are overwhelmingly positive,
particularly with regard to waiting
times and patient "flow", but there are
also interesting figures relating to
improved recovery time and patient
experience.

The literature seems to suggest that

the main issue is not whether or not to
implement 7 day access, but how to
implement and to what level.
A seven day working programme
should be tailored to the needs and
expectations of targeted population,
specific to the patient diagnosis
group.

Arthritis: a 12% reduction in pain and a

7% reduction in disability, as well as
improvements in coping skills.

Diabetes: reduction in levels of HbA1c,

improvements in diet and in the amount
of exercise taken.
Hypertension: blood pressure was
lowered
Asthma: patients had greater
confidence in managing their symptoms
and more appropriate use of their
medication; increased adherence to
preventative medication; lower use of
reliever medicines

Increased volunteering
Return to work or increase in hours

Return to training, higher education

Engagement in community
Involvement in services design etc

Other savings included:

GP visit savings 7%
Nurse visit savings 7%
A & E Visit savings 10%

Arthritis: supported self-management

significantly reduced GP visits and sick
days by 52%

Inpatient activity savings 15%

CHD: 50-85% reduction in admissions

and follow-up visits

Medication savings 5%

Outpatient visit savings 7%

Summary and Recommendations

Summary

Recommendations

The population served by the three

GP practices faces significant
challenges to maintaining their health.

The initial evidence shows that there are

compelling reasons to explore the
development of Chorley Health Centre

Unemployment is high, as is income

deprivation. Health-impacting lifestyle
issues such as smoking and obesity
are widespread.

The development should be supported

by robust consultation, engagement and
co-design with service users, carers and
providers, being mindful of the most
effective means of engaging people in
different mosaic profile types.

Levels of health need are great

across most conditions, highlighting
potential gains to be made by colocation of services.
Patient satisfaction with issues such
as diagnostics, dignity and continuity
are low, again signifying potential
gains to be made from co-location.
There is a robust evidence base
supporting innovative, new models of
care delivery, including seven day
access, self-management and access
to diagnostics.

Further exploration should be done

regarding why two of the practices have
high child admissions to urgent care.
The voluntary sector has much to offer
people with different and multiple health
problems in Chorley and should be fully
engaged in the design of the facility. The
Chorley VCFS Network Coordinator can
support this engagement.
Consideration should be given to
integrating the delivery of services, not
just to co-location of services. This
needs to be considered throughout the
design phase.

Access for people on low incomes,

with language and sensory
impairment and with specific health
conditions needs to be carefully
thought through. The consultation and
design should include this as a
specific topic and it should be
continually refined as the service gets
going.
There should be collaboration
between the CCG, providers and
Chorley Borough Council regarding
the provision of public leisure services
on site e.g. gym
The decision on which services
should be co-located on site should
be based on population need, rather
than on the operational parameters of
the services e.g. men in retirement
Consideration should be given to how
the facility may both promote and
destabilise the local voluntary and
community sector; and into how they
can be effective delivery partners.