POOLE PRIMARY CARE TRUST
LOCAL HEALTH PLAN
2005/06–2007/08
May 2005

PREFACE

During 2005/06 and beyond, Poole Primary Care Trust will continue to work to improve the health of the population served by the Primary Care Trust and to deliver high quality, accessible health services. The Local Health Plan 2005/06-2007/08 (which incorporates the Local Delivery Plan) sets out the Primary Care Trust’s plans for meeting local and national priorities as follows:
  • primary care contractor services:
general practice;
NHS dental services;
community pharmacy services;
primary care out of hours services;
  • improve access for emergency care and planned care;
  • cancer;
  • long term conditions;
  • coronary heart disease;
  • diabetes;
  • improving the patient experience;
  • older people;
  • mental health;
  • reducing substance misuse;
  • children’s services;
  • public health and health inequalities;
  • quality and effectiveness;
  • workforce;
  • information management and technology;
  • physical facilities;
The Plan also includes the financial framework for delivering these services.

LOCAL HEALTH PLAN 2005/06-2007/08

TABLE OF CONTENTS

PREFACE

TABLE OF CONTENTS

1.INTRODUCTION

The National Context...... 1

The Planning Process...... 3

Poole and its Population...... 4

Service Development...... 8

Securing Delivery...... 9

2.THE VISION FOR POOLE...... 10

3. FINANCIAL FRAMEWORK...... 19

chapter one

INTRODUCTION

LOCAL HEALTH PLAN 2005/06-2007/08

SECTION 1: INTRODUCTION

THE NATIONAL CONTEXT

oThe key priorities for health and social services during the period 2005/06 to 2007/08 are contained in “The NHS Improvement Plan” and “National Standards, Local Action”. These documents update the vision of The NHS Plan, where services are designed around the needs of patients, and health outcomes are improved, particularly for the most disadvantaged. Social care will aim to promote independence, well-being and support for the most vulnerable in the community.

o“National Standards, Local Action” sets out four national priority areas in health and social care:

health and wellbeing of the population, covering health promotion and ill-health prevention so that people are kept out of the care system wherever appropriate;

long-term conditions, promoting better self-care and treatment in the community or people’s homes in order to avoid hospitalisation wherever possible;

access to services, ensuring prompt access and minimal waiting lists;

patient/user experience, promoting maximum information and choice, consumer-focused provision and positive patient experience.

oDevelopments over the period are likely to include:

expansion of choice for patients and service users;

a focus on services tailored to the individual needs of users;

full implementation of payment by results in the NHS;

an increased focus on local priorities and locally agreed targets;

further incentives to provide appropriate services for older people and those with long-term conditions outside hospital;

redesign of services to maximise performance, as reflected by the ten ‘high impact’ changes identified as best practice, and the opportunities for staff to work differently;

an increased focus on public health, the prevention of illness and the reduction of health inequalities;

an increased use of information technology for booking, transfer of records, prescribing and online patient information;

varying degrees of practice based budget holding and commissioning;

increasing freedom for the best performing organisations.

oThe existing priorities for service development remain the basis for improving local health services, including:

improving access to all services through better emergency care, reduced waiting, increased booking of appointments and admissions, and more choice for patients;

focussing on improving services and outcomes in:

cancer;
coronary heart disease;
mental health;
older people;
life chances for children;

improving the overall experience of patients, including those with long-term conditions;

improving public health and reducing health inequalities;

contributing to the cross-government drive to reduce drug misuse.

oTargets are set in all the above areas which require close working between health, social services and other partners. In 2005/06 to 2007/08 there will be an increasing emphasis on setting local targets in agreement with these partners. These local targets will reflect local health needs, addressing gaps in services and reducing inequalities in access to care. They will be informed by the results of health equity audits and evidence of effectiveness and value for money.

o“National Standards, Local Action” includes both core and developmental standards in seven areas, all of which are incorporated into the developments proposed in the Local Health Plan 2005/06-2007/08. The seven areas are:

safety; this domain requires the minimisation of all risks to patients, staff and the public, including in respect of the transfer of patients between organisations responsible for their care;

clinical and cost effectiveness, ensuring best practice is employed in patient care and treatment, individual needs and preferences are taken into account, and services are seamless and evidence-based. Clinicians’ skills and techniques will be continuously improved, and regular audits and service reviews will be undertaken;

governance, both clinical and corporate, including systematic risk assessment and management, sound financial management, support for staff to raise genuine concerns, high standards of records management and employment practices, effective clinical and managerial leadership, processes to ensure continuous quality improvement and staff training and development;

patient focus; this domain requires health care to be provided in partnership with patients, carers and the relevant care organisations in a way which treats all with dignity and respect. Information will be provided to patients in a variety of appropriate formats to enable them to exercise choice, give feedback on their care and treatment and be fully involved in the planning and delivery of their care;

accessible and responsive care, including providing patients and carers with opportunities to contribute to service planning and delivery. Patients are entitled to appropriate and prompt care which meets their individual needs and offers them choice and convenience;

care environment and amenities, where care is provided safely, and privacy and confidentiality are respected and the risk of infection minimised;

public health, including the reduction of health inequalities.

The planning process

oPoole Primary Care Trust is the lead organisation for planning local health services. As a Primary Care Trust it has three main functions;

improving the health of the local population;

securing the provision of high quality services;

integrating health and social care.

oPlanning for improving health and social care is increasingly a collaborative activity and the Primary Care Trust, in leading local health improvement planning, is working to develop partnerships and make increasing use of Health Act Flexibilities such as pooled budgets and joint working.

oThe Poole health and social care community is the partnership of organisations which together contribute to the development of the health improvement and social care agenda. The principle organisations and agencies involved include:

Poole Primary Care Trust;

local general practices and other primary care providers;

Dorset and Somerset Strategic Health Authority;

NHS Trusts (Poole Hospital NHS Trust, The Royal Bournemouth and Christchurch Hospitals NHS Trust and Dorset HealthCare NHS Trust);

the Borough of Poole, including Social Services, education, leisure services, housing, transportation, planning, economic development, community development, cultural services, environmental health and consumer protection;

other local authorities, particularly Bournemouth Borough Council and Dorset County Council;

a range of voluntary and independent sector organisations including user and carer groups.

oConsultation with these organisations, with relevant working groups such as the Local Implementation Teams for the National Service Frameworks and with the public is undertaken at the appropriate stages of the planning process in order to ensure ownership and compatibility between the plans of different bodies and sectors. It is particularly important that, where local priorities are put forward in addition to national priorities, these are agreed between all parties and reflected in the relevant plans of each organisation.

poole and its population

oPoole is a busy resort and commercial town forming a conurbation with Bournemouth on the south coast. The Borough covers an area of about 25 square miles with a rich and diverse environment, which includes 7 kilometres of beaches, Poole Harbour and lowland heathland surrounding the town. Poole is a relatively affluent and growing community, but has some pockets of deprivation.

oThe population of the Borough of Poole increased markedly during the 1990s and stood at 137,500 in 2004. The population served by Poole Primary Care Trust is approximately 173,000. Some 30,000 of the Primary Care Trust population lives in areas covered by Dorset County Council and Bournemouth Borough Council. The age structure of the Primary Care Trust is different from the average for England and Wales, with proportionally:

fewer pre-school and school-aged children;

few younger adults aged 20-24 and fewer people of working age;

more people post-retirement age, particularly those aged 75+ and very elderly residents aged 90+.

Figure 1:Population of the Poole PCT as at December 2004 (E&W mid-2003 population estimate from Office for National Statistics)

oThe population of the Borough of Poole is set to increase further with a projected population of 138,400 by 2011 and 143,000 by 2021. This expansion will not be even across all age groups and the numbers of elderly and very elderly residents will continue to grow faster than in other parts of England and Wales. It is estimated that Poole’s post-retirement population will increase by 15% between 2003 and 2011, compared with a national increase of approximately 10%. Pre-school and school-age children numbers are set to fall slightly to 2011, then remain static. The total numbers of working age adults will remain similar between 2003 and 2011, but with workers becoming more concentrated in the 4564 age group.

oThe population of the Borough of Poole is predominantly white; 2001 Census data shows that 1.8% of the population of Poole is from a non-white ethnic group, including mixed race.

oThe projected rise in the population will lead to growth in the number of new households of approximately 6,400 by 2011, putting enormous pressure on the demand for housing and the demand for local authority and health services. There will be more single, elderly people living in Poole. Lone pensioners already occupy 16% of households and 23% of people aged over 75 in Poole live alone.

oThere are housing implications of the projected population growth in Poole. There is limited land available for housing development within the town because of its geographical location. Land values are very high and the cost of housing has risen sharply, outstripping the increase in household incomes. The lack of affordable housing locally will have an impact on the health and social well-being of the population. There may be growth in homelessness and overcrowding as people live with friends or family. More people may move out of the town but commute to Poole for work and leisure, adding to congestion and environmental damage. Some firms are likely to find it difficult to fill vacancies for skilled staff. This could have the effect of constraining the local economy and wealth of the town and make it harder to provide the required level of health and social care because of a lack of available staff.

oAs people get older, particularly in their 80s and 90s, their need for health and social care increases and it is likely, therefore, that there will be an increased demand for health and social care services in the next decade. There will also be an impact from more single person households being created as there will be fewer people who have family living with them to provide informal care and support.

oPoole has experienced significant employment growth and, according to official figures, could be said to be operating at or very near full employment. In November 2004, unemployment, as measured by claimant rate in the resident population of working age, stood at 0.9%. Unemployment is concentrated amongst groups who are disadvantaged in some way, either because of age, lack of skills or length of time out of work. Unemployment is concentrated in a few wards (Hamworthy and Harbour). People with a disability are more likely to be unemployed than those without a disability. Work undertaken for the Welfare to Work Joint Investment Plan 2002-04 suggested that about 800 disabled people would like to move into employment if they could.

oAverage full-time weekly earnings in 2003 of those working in Poole were slightly above the national average (£499 in Poole compared with £476 nationally). However those living in Poole earned less (£441). The differential between the highest 10% and the lowest 10% is greater than nationally and has increased over time. In 1998, 16.8% of Poole’s population lived in households that were in receipt of benefit (Income Support, Job Seeker’s Allowance, Family Credit, Disabled Workers Allowance or Council Tax benefit).

oPoole is a relatively prosperous town in terms of overall deprivation statistics. The 2004 Index of Multiple Deprivation ranks Poole 225th out of 354 districts (when the district ranked 1st has the highest deprivation). The 2004 Index is based on Super Output Areas (of which there are 91 in the Borough of Poole) rather than on wards as previously, and it contains seven domains rather than the previous five. These domains are:

income;

 employment;

health deprivation and disability;

education skills and training deprivation;

barriers to housing and services;

living environment;

crime.

oThere are also two supplementary indices reflecting income deprivation among children and older people. On the overall income domain Poole ranks 144th, and on employment 166th, out of 354 districts. Poole has no Super Output Areas in the worst 10% in the country, but four within the worst 25%: Hamworthy West (Turlin Moor), Alderney (Melbury Avenue/Arne Avenue area and Bedford Road/Belbin Avenue area) and Poole Town Centre. More than a third of Poole’s Super Output Areas are among the 25% least deprived in England.

oIn the health deprivation and disability domain Poole has one Super Output Area in the worst 10% in the country (Poole Town – Lagland Street/New Orchard area) and a further three in the worst 25% (parts of Turlin Moor, Alderney and Canford Heath East).

oResearch undertaken by Bournemouth University and the Alderney Public Health Action Area found that:

37.8% of households in the survey area (Alderney ward) experienced problems in finding enough money for food;

17.1% of respondents reported that there was sometimes not enough to eat;

money was seen as a major factor in eating a healthy diet.

oThe Children in Need Census 2002 indicated that in the Borough of Poole there were 23.0 children in need per 1,000 of the 0-18 population. The figure for England was 19.2. The child poverty index for 2000 showed the percentage of children living in households claiming means-tested benefits. In Alderney the figure was 46.15% and in Hamworthy 36.83%.

oPoole has a low mortality rate. In 2002 the standardised mortality rate (SMR) for Poole was 91. A figure of less than 100 indicates a low mortality rate in comparison with England and Wales. Since 1990 mortality has declined, that is the health status of local residents has improved. Mortality in Poole is lower than in Europe and in England and Wales. Comparing Poole with Dorset neighbours, mortality is lower than in Bournemouth and in Weymouth and Portland, but higher than Christchurch, East Dorset, North Dorset, Purbeck and West Dorset. However this masks differences between electoral wards.

oFigures published in 2004 showed that males in Poole had a life expectancy of 78.2 (77.4 in the South West and 76.2 in England as a whole) while females had a life expectancy of 82.1 (81.8 in the South West and 80.7 in England).

oInfant mortality is lower in Poole than the UK average. Figures for 2000-2002 show an infant mortality rate (for children below the age of 1) of 3.7 per 1,000 live births, lower than the national rate of 5.4.

oOverall the rate of deaths due to coronary heart disease is lower than England and Wales, an SMR of 84 in 2001-2002. In Poole, for both males and females aged less than 65 years and those aged between 65 and 74 years, mortality is significantly lower than in England and Wales.

oFor cancer, figures for 2001-2002 show that Poole residents had a mortality rate of 164.26 per 100,000, which is significantly lower than England and Wales (187.52).

oRegistration rates for malignant melanoma (skin cancer) are still higher than for England and Wales. Indirectly standardised skin cancer death ratios for 2001-2002 were 163 for Poole against 100 nationally.

oThe Dorset Joint Mental Health Strategy for 2002/03 indicated that 1,604 people registered with a GP practice in Poole would be expected to suffer from major mental health problems at some time in their lives. Of these:

443 would be expected to suffer from schizophrenia;

52 would be expected to suffer from mania and all major depressions;

631 would be expected to suffer from all other disorders excluding substance misuse.

oHospital admission rates per 100,000 population aged 15-74 associated with schizophrenia are higher in Poole than for England (89.84 compared with 76.46 in 2001/02). The rate for mortality from suicide and undetermined injury in Poole is higher than that for England, being 10.91 and 8.72 respectively per 100,000 all ages in 2001-2002.

oDeath rates from accidents in females aged 85 and over are significantly high, and increasing, in Poole at 657.94 per 100,000 (England 270.88). Admissions following serious accidental injury for females aged 85 and over in 2002/03 were similarly significantly high at 7577 (5609 in England).