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21 October 2015

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There are potential financial benefits in identifying and utilising empty space to facilitate clinical appointments outside of A&E that will help the local population seek treatment, as is being worked on in Halton

There are potential financial benefits in identifying and utilising empty space to facilitate clinical appointments outside of A&E that will help the local population seek treatment, as is being worked on in Halton

Halton Clinical Commissioning Group (CCG) was ahead of the game when the NHS Five Year Forward View (FYFV), called for more community-based care when it was published last year. Plans are well underway to reconfigure an under-used health centre in Widnes to deliver urgent care services so that local people have a real alternative to attending the nearest A&E, which is eight miles away.
The borough of Halton consists of the towns of Runcorn and Widnes that are separated by the River Mersey. At present, the towns are joined by a single bridge that is sometimes highly congested.
A second river crossing is now under construction but it is planned that both the old and new bridges will be subject to toll payments. A&E departments serving the areas are located in Warrington and St Helens (north of the river) and Chester (south of the river).
To the north of the river, A&E services provided by the two closest centres (Warrington and Whiston Hospitals) have become increasingly busy in recent years and are unable to provide sufficient capacity to meet the current demand.  
Widnes has one of the lowest levels of car ownership in the country, with the closest A&E department more than eight miles away. With NHS England’s call to help reduce pressure on the acute sector and cut A&E admissions by 15% over five years, NHS Halton CCG identified a need to provide a real primary care alternative to A&E, while also integrating services like mental health, providing wellbeing services, social activities and opportunities for evidence-based brief interventions.

Planning
Taking a strategic approach to the use of NHS estate from a commissioning perspective has been key to moving the project forward – an approach that has long been overlooked by many CCGs. Through this work with community health partnerships (CHP) and the local improvement finance trust programme (LIFT) (a public/private partnership programme) called – Renova – our eyes were really opened when we saw that taking a strategic view of estates, and making it a central part of commissioning, would mean saving money and improving patient care.
Having the right estate in place is critical to improving services and responding to the challenges the NHS is facing. That estate needs to be well-planned, well-utilised and efficiently run in order to offer good value for money and to be able to deliver the changing models of care to set out by the FYFV.

Team work
All three partners (Halton CCG, Renova and CHP) have developed a strong working relationship and a collaborative approach. Together they created an estate plan, overlaying the NHS and Halton Borough Council plans, and undertook a public consultation spanning both of the two towns making up Halton.
As part of this work, the existing Widnes Healthcare Resource Centre was identified as a key site to support commissioning plans and providing a solution to the requirement for additional urgent care services within the local community. Despite the centre being a popular and busy building, there was lots of available capacity, CHP and Renova seized the opportunity to work with us to put more services in there, get the best value and use the building to its full potential.

The product
The top floor of the centre was previously home to 25 offices that were underused and inefficient. With £850,000 of investment from the Department of Health, via CHP, this space – in addition to the space occupied by the Widnes Walk in Centre on the ground floor – has now been reconfigured for additional clinical use. Facilities now include a welcoming reception, an X-ray room on the ground floor in addition to imaging and ultrasound facilities. The additional clinical rooms will have the capacity to see approximately 43,000 patients per year.
The investment decision was influenced by prospective savings shown in estimates presented by the local health economy through:
Ceasing to manage and disposing of less suitable buildings in the Widnes area.
Reduced costs to the ambulance service of patient transport.
Savings to the A&E units operated by the hospital trusts in St Helens and Warrington where increasing pressures were judged likely to necessitate investment in the extension of facilities.
Once fully operational, it’s estimated that the project will translate to £3 million of system savings for the local health system over the next three years, as well as a 15% reduction in A&E attendances over five years, and a year on year reduction in non-elective admissions through A&E over the same period.
As part of the project, the CCG has chosen to invest in an independent centre management service to continually monitor space usage of the whole building and maximise opportunities for usage going forward. Monthly reports are sent to the CCG and CHP; and utilisation is reported based on the number of sessions available in each room and comparing how many sessions are booked with how many are actually used. As a result, the void (unused space) risk will be eliminated and future savings will result from reducing the amount the CCG pays for unused space.
Along with generating savings and reducing A&E attendances, the new NHS Widnes Urgent Care Centre will provide expert treatment with no appointment needed. The urgent care centre is run by a team of highly skilled multidisciplinary staff consisting of doctors and nurses, all of whom are experienced at diagnosing and treating minor injuries or illnesses. It is open 365 days a year, 8am till 10:30pm, with expert diagnostics including access to X-ray and specialist staff to treat children. The approach has already led to improved alliances with GPs and practices, which in turn will work together to meet seven-day NHS requirements.
Therefore, the plans to bring more services under the same roof, and return these spaces to clinical use, have presented an ideal solution to the problems of acute care provision and efficiency in the estate, avoiding the need to spend money on a new-build project.
The Widnes Urgent Care Centre is one example of how CHPs Strategic Estate Planning service is connecting NHS commissioners and service providers with wider public services, and helping to create the conditions needed to reshape the community, primary and acute care estate, driving integration and delivering better value.

Dave Sweeney, transformation lead at NHS Halton CCG and Halton Borough Council.

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