7.6 Delivering Accessibility Improvements

This section describes accessibility initiatives generated from the findings of the Social Exclusion Unit in its Making the Connections report and subsequent DfT guidance on Accessibility Planning. Several Priority Action Plans are now in place to address the high level problems identified in the analysis of the 'Making the Connections Lancashire' workshops, whilst further Action Plans are in their initial stages. The table below shows the relationship of the Action Plans to the issues identified in the accessibility needs assessment.

Table 7.6 Action Plan Issues

	Action Plan	Main High Level Problems to be Addressed
Priority Action Plans	East Lancashire Hospitals Trust Clinical Services Review	Location Timing
	Optimum2 European Project	Information Timing
	ELEVATE East Lancashire - Community Impact Assessments	Location Restricted Choice
	Lancashire County Communicator Guide Service	Restricted Choice Safety
Emerging Action Plans	Lancashire Older People Strategy	Restricted Choice Location
	Jobcentre Plus	Restricted Choice Information
	Local Area Agreement; Economic Development	Timing Information
	Supported Bus Services	Cost/Funding Location
	West Lancashire Primary Care Trust Public Health Improvement Plan	Restricted Choice Information
	Hyndburn & Ribble Valley Primary Care Trust Access to Healthy Food Project	Location Cost/Funding
	Lancashire Rural Delivery Pathfinder	Location Cost/Funding
	Chorley Pathfinder	Local data collection and analysis still ongoing

In addition to the Emerging Action Plans, it is anticipated that many more Action Plans will be developed as the strategy matures, as there are other accessibility issues already identified and partners who recognise the potential benefits of accessibility planning for their service who are keen to become involved. A number of Action Plans, in particular the Hyndburn Primary Care Trust Access to Healthy Food initiative and the Chorley Pathfinder, will be piloted in specific locations then extended across the county in the future as their value becomes more evident.

Priority Action Plans

7.6.1 East Lancashire Hospitals Trust Clinical Services Review

Introduction

A major review of acute health services delivered in East Lancashire is underway.  This covers not only the principal hospitals but also delivery in the community (in patients' own homes, clinics and health centres) and in primary care (provided by GPs, dentists, pharmacists and opticians).

There are no firm proposals for change at this stage, although there are five broad options.  At the heart of the proposals will be a substantial reorganisation of the clinical services offered at the Queens Park Hospital in Blackburn and Burnley General Hospital, along with the imminent closure of Blackburn Royal Infirmary.  It is expected that many specialisms will be offered at only one site in a change to current practice.

Objectives

The Review is being undertaken in response to enormous change in health care and the changing needs of patients. The aim is to place patients at the heart of flexible and responsive health and social care. It is about ensuring local health services are safe, practical and affordable and that they continue to meet the needs of local people for years to come.
The County Council wishes to ensure that any changes are carried out in such a way that people, especially those at risk of exclusion, have the best possible access to health services.

Partners

The transport implications of the review are being assessed by a Travel SubGroup:

• East Lancashire Hospitals NHS Trust staff (ELHT)
• Lancashire Ambulance Service NHS Trust
• Lancashire County Council
• Blackburn with Darwen Borough Council
• Capita Symonds
• Patient and Public Involvement Forum representatives

Process

This has highlighted areas where special consideration needs to be given to ensuring good levels of accessibility. To assess the travel issues raised by the review, the existing East Lancashire Hospitals Trust Travel Plan Steering Group Meeting has been extended and given the responsibility for this task.  The County Council is taking a leading role in this group.  The steering group will allow partners to guide the Clinical Services Review to give proper consideration to the accessibility needs of health service users and staff.  Consideration is to be given to providing some outpatient services remotely from the main hospitals, and these options will be considered by the steering group.

7.6.2 Staff travel plans are also being investigated with the help of the County Council.

Evidence Base

We have initially used Accession mapping to carry out an accessibility audit of the various options from a patient travel perspective.  ELHT have provided comprehensive data on the impact of the options on patient destinations by clinical need.  Particular consideration can therefore be given to specific areas where many users of Health Services live and to those Super Output Areas that tend to have greater numbers of people for whom travelling to hospital may be difficult.  Detailed mapping is not included here due to the confidential nature of the data.

Supporting statement from East Lancashire Hospitals NHS Trust

East Lancashire Hospitals NHS Trust, working in collaboration with its health and social care partners, has embarked on a detailed review of its clinical services. A 16 week period of formal public consultation will commence in late March 2006.

As many of the “long list” of options initially presented would require changes in the locations where certain services are delivered, accessibility has been raised as a significant issue. As a result a Transport Sub-group was established and has focused on three key areas:-

• Emergency access (ambulance services)
• Private Transport
• Public Transport

Lancashire County Council are key members of the Transport sub-group and have taken the lead on producing public transport travel time analysis, using the Accession software. Support has also been provided for the private transport journey time modelling.

There is an agreement that joint working will continue in this area and once the outcome of the Clinical Services Review is known, that joint action plans will be confirmed with a view to attempting to address some of the key issues identified.

As part of the development process, Lancashire County Council have been approached for advice and assistance in the field of staff and patient travel plans and it is hoped that this work will develop through the spring and summer of 2006.

7.6.3 Outcomes

The first outcome from this action plan is the establishment of a free shuttle bus service between the two main hospital sites.  This service will be run by the Trust, initially using leased vehicles to enable the service to be operational by April 2006.  Three minibuses will be used to provide a half-hourly service between the hours of 7am and 6 pm.  Although only available to staff to start with, the intention is to allow patients and vistors to use the service once dedicated DDA compliant vehicles have been purchased.

Funding for the shuttle bus operation will primarily come from substantial savings in inter site staff travel cost expenses claims.

7.6.4 Optimum2 European Project

Introduction

Optimum2 is a pan-European project, based in Holland and the UK, with the objective of improving accessibility to hospital for all patients, especially for outpatients.

Chorley and South Ribble District Hospital has amalgamated with Royal Preston Hospital to form Lancashire Teaching Hospitals NHS Trust (LTHT). This has had the effect of changing in-patient travel patterns for patients, staff and visitors.  Health services are being encouraged to provide non-intrusive care more locally, not just in the main hospitals. This, and the increase in outpatient numbers, will have a profound effect on health accessibility.

The report on Transport and Social Exclusion found that 31% of people without a car have difficulties travelling to their local hospital compared to 17% who have a car. This may account for some of the 11% of appointments that are missed at the Trust.

Partners

The project involves partners from Holland and the UK.  In Lancashire the active partners are;

• Lancashire County Council
• Lancashire Teaching Hospitals Trust
• Lancashire Ambulance Service
• Preston PCT
• Chorley and South Ribble PCT
• Preston City Council.

Lancashire County Council will carry out the financial management of the project. In addition a number of organisations in the NHS and in Local Authorities operate the North West NHS Travel Group, which is organised and led by the County Council.

Evidence Base

An initial survey at CSR recorded that 50% of the patients lived within 4 miles of the hospital and that more than 60% were aged over 50. The increased life expectancy will increase the numbers of patients visiting the sites and the other Healthcare providers.

A recent survey of patient travel to RPH showed that 83% of outpatients arrived by car and only 13% stated that there was no alternative. Over 50% of the patients reported that it took them more than 5 minutes to find a parking space and almost all of the patients (93%) travelled from their home.  However, 55% claimed that they did not know where to find the information to help them use an alternative travel method. Targeted marketing is a priority to ensure that the objective of improving accessibility will be fully met, as 48% of the respondents would consider using the bus as an alternative to the car, whereas only 7% currently do so.

Process

The project has a 5-pillar approach to ensuring that accessibility is integrated into the planning and development process at the earliest possible stage;

1. The approach must be user-orientated
2. Mobility Management measures must be introduced as early as possible with any new development and ideally at the planning stage
3. Effective communication and information is vital if a Mobility Management measure is to succeed
4. Effective marketing and promotion activities are essential ingredients
5. Mobility Management measures need to be enforced.

The Lancashire Project is centred upon the development of a pro-active Travel Management System (TMS).  This will offer patients alternatives to the use of a car for visits to hospital and will effectively market the service to all end users. Initially, this system will be used by LTHT but the system is expandable to include all providers.

The system is designed to operate in the following ways;

1. By a web based Travel to Health travel planner at the address www.travel2health.co.uk
2. By a telephone contact number for patients who do not have access to the internet
3. By a pro-active personal plan that will be distributed with the appointment letter to first time patients. The personal travel plan will show the means of access to the site other than by car, including Community and Public Transport. The ownership of the plan will be with the appointment generator.

Outcome

The  system can be adapted to sites of high travel patterns for both staff and customers and will be extended to all Healthcare sites on a planned basis. The TMS will utilise some of the outputs from the e-government project.  The results of the personalised travel planning service will feed into the CIVITAS programme.

The project will be monitored for effectiveness both as a piece of technology and as a marketing awareness tool. This requires base line information to be gathered on current patient travel numbers and modes and the effectiveness of the current transport marketing. This will call for a positive working partnership between the healthcare providers, the County and Borough Councils and the service providers. It will need to be flexible to cope with the expected, and unexpected, changes in the NHS.

The Optimum2 project is scheduled for completion by December 2007, with the final report due June 2008. However, the TMS is scheduled for roll-out to healthcare providers over a further 5 year period. The project timetable is;

Table 7.6.4 Project Timetable

Activity	Date
Base line data	March 2006
Demo TMS	January 2006
Beta TMS	March/April 2006
Integrated working system	October/November 2006
Final release of TMS	October 2007
Marketing strategy	March 2006
Brand and Product Marketing	From April 2006
Monitoring and Review	On-going
Alternative delivery systems	On-going

Targets

A 5% reduction, from the base year, in first time appointments arriving to site by car within 3 years of the TMS going live. The secondary target is to reduce subsequent appointment visit trips by 7-10% over a 10-year period.

7.6.5 ELEVATE East Lancashire - Community Impact Assessments

Introduction

ELEVATE East Lancashire is one of the government's nine housing market renewal pathfinder projects, charged with finding innovative solutions to the problem of low demand, negative equity, and housing market collapse in towns across East Lancashire.  The area contains some of the most deprived wards in the country.  ELEVATE is working with public and private sector partners to produce sustainable communities with improved economic prosperity, environment, community safety, cohesion, educational attainment and health.

Objectives

ELEVATE's vision is for East Lancashire to become a place of choice to live, work, relax and visit. This vision will be realised through actions delivered under five policy strands. The central strand of the strategy, and where the housing market renewal funds are being targeted, is to stablish housing choice and create sustainable communities. It is supported by four other strands;

• maximise access to high value employment
• maximise the value of the area's landscape and historic character
• build community cohesion
• develop effective neighbourhood management and service delivery.

As the communities are planned and developed, it is important that proper consideration is given to accessibility issues.  We are involved in this process to examine barriers to access to the many services offered in these communities and also those that may be more remote.  By giving consideration at an early stage to accessibility, it is hoped that the sustainability of the communities can be safeguarded.

Partners

The principal partners in ELEVATE East Lancashire are Lancashire County Council, Blackburn with Darwen Borough Council and the Borough Councils of Burnley, Hyndburn, Pendle and Rossendale, together with the Commission for Architecture and the Built Environment (CABE), Northwest Development Agency (NWDA), English Partnerships, Lancashire Economic Partnership, The Housing Corporation and Business Link East Lancashire.

A smaller group of partners are engaged in a Community Impact Assessment that will determine the effects of the housing and service changes upon the community. It is within this group that accessibility issues are being considered.The key members of this group are;

• Lancashire County Council
• Burnley Borough Council
• Lancashire Constabulary
• Burnley, Pendle and Rossendale Primary Care Trust.

Process

The mechanism through which the ELEVATE strategy is translated into local action is the Area Development Framework (ADF).  Eleven ADFs have been prepared in the first phase.  In practice, much of the emphasis of the initiative is centred around the refurbishment of some properties, the removal of others and the construction of some new dwellings.  In consequence, there will be significant changes in land use patterns and we intend to ensure that accessibility levels are improved.

The basis of the analysis underway is to gather detailed information about the location key services and their users.  Analysis can then be carried out to determine the level of accessibility to these services currently enjoyed.  It is planned to extend the analysis by giving consideration to the new levels of accessibility that would be enjoyed when the ELEVATE Masterplan proposals are implemented.  An important aspect of the Action Plan will be to carry out a very detailed assessment of any barriers to accessibility that may occur.  This may include consideration of severance caused by highways and the nature of crossing opportunities, personal security issues including street lighting and environmental issues.

Outcome

As the housing market renewal changes takes shape, a programme of measures will be implemented to address any accessibility issues that may arise.

Lancashire County Communicator Guide Service

Introduction

A Communicator Guide is a specifically trained individual who provides one-to-one support in the areas of mobility, communication and access to information to a person who has a significant dual sensory loss. A person is considered to be Deafblind or Dual Sensory Impaired where they have a significant impairment of both hearing and vision. The Communicator Guide is trained in various communication techniques, for example British Sign Language and Deaf-blind manual, as well as safe and effective guiding techniques.

This service reduces the social isolation of an individual, opening up a world of opportunities in terms of being able to utilise public and community transport systems. This enables access to medical appointments, education, access to employment opportunities and social networks. The individual can develop further independence and has an opportunity to contribute to the local community, leading to improved overall physical, mental and emotional wellbeing.

Objective

To develop a Lancashire County Communicator Guide Service for adults who are Dual Sensory Impaired. This service will;

• Enable equal access to information about public and community transport services
• Enable equal access to transport networks in Lancashire
• Enable individuals to feel safe and empowered whilst travelling
• Promote Social Inclusion for this growing group of individuals
• Improve general health and wellbeing and quality of life
• Provide the opportunity to contribute and become involved in local communities for this group of individuals.

Partners 

The development of the Scheme is being led by the Adult and Community Services Directorate of Lancashire County Council, with the support of the following partners;

• District Councils
• Dual Sensory Loss Focus Groups
• Lancashire’s Visual Impairment Forum
• Public Sector Transport providers
• SENSE (National Organisation Supporting Deafblind People)
• Lancashire County Council Accessibility Planning Group

Evidence Base

Database showing location of people with Dual Sensory Impairment

Process

Lancashire County Council Accessibility Planning Group is to provide data gathering and geographic analysis.

Outcomes

7.6.6 The scheme will develop accessible public and Community Transport services for people with Dual Sensory Impairment. It will reduce social exclusion for this group of individuals by improving their health, wellbeing and quality of life.

Targets

All individuals with a Dual Sensory Impairment to have access to a Communicator Guide service that will facilitate independent use of public and community transport by April 2007.

Emerging Action Plans

7.6.7 Lancashire Older People Strategy

Through the Lancashire Strategic Partnership, a strategy for older people is being developed.  Frequent discussions with older people consistently reveal that transport and accessibility difficulties are major concerns.  We are ensuring that accessibility issues are being embedded into the strategy development process.

The development of the strategy is being led by the Adult and Community Services Directorate of Lancashire County Council, with the support of a very extensive network organisations, interested groups and individuals. Accessibility issues are being assessed through the Officer Resource Group. This group comprises;

• Lancashire Fire and Rescue Service
• Lancashire County Council
• Lancashire Economic Partnership
• Lancashire County Developments
• Pensions Service of the Department of Work and Pensions
• District Councils
• Age Concern
• Local Strategic Partnerships
• Primary Care Trusts
• Help the Aged
• Councils for Voluntary Service
• Churches Together in Lancashire
• The Anchor Trust
• The Environment Agency
• Blackpool, Fylde and Wyre Society for the Blind.

7.6.8 Jobcentre Plus

Following discussions at the Accessibility Workshops, staff from Jobcentre Plus identified several specific transport related problems affecting employers' success in recruiting local staff.  Access to employment in Kirkham has been chosen as a case study to examine the ways in which mapping accessibility can be used to examine specific problems and the results of the analysis are shown below.

Jobcentre Plus have expressed interest in participating in a similar type of study for problems of recruitment experienced by several employers (including Matalan, Asda Distribution and Exel Comet) at the Stanley industrial site in Skelmersdale. Rapid expansion of the site is taking place, but there is no regular local bus service. As a result, local residents without their own transport cannot take advantage of these new employment opportunities.

7.6.9 Kirkham Case Study

Discussions with Jobcentre Plus have revealed that three major employers in Kirkham are having serious difficulties recruiting staff.  All of the factories have implemented continental shift patterns that require staff to be on-site by 6am.  Many of the jobs at these factories are unskilled and tend to be low paid.

Figure 7.6.9a Journey Times to Arrive by 6 am

Figure 7.6.9b Journey Times 7am to 9am

The first plot shows the areas that are accessible for residents of Lancashire to the factories in Kirkham by 6am by public transport or walking within an hour. Clearly, accessibility is limited to those who can walk to sites or catch the one train service running at this time. The second plot shows those parts of the county that are accessible by public transport between 7am and 9am, within an hour. This shows the many large residential areas, particularly around Preston and Leyland, that are accessible. Analysis of the Department of Work and Pensions Jobseekers Allowance computer records for August 2003 alongside this accessibility modelling reveals that, during the period 4am to 6am, 140 Jobseekers would be able to reach the factories by public transport or walking in an hour. Similarly, during the period between 7am and 9am, the number of Jobseekers who would be able to get to the factories in an hour rises to 4,660, a thirty three fold increase.

By overlaying the employment domain of the index of multiple deprivation it is easy to identify those areas where employment deprived people live from which it is difficult to travel to these employment opportunities.

Figure 7.6.9c

Figure 7.6.9d

This analysis provides very useful evidence of the magnitude of the difficulties and will assist discussions with partners to explore opportunities to mitigate these problems.

7.6.10 Local Area Agreement; Economic Development

The principal aims of the Lancashire Local Area Agreement (LAA) are to increase entrepreneurship and improve access to economic prosperity throughout Lancashire. An accessible Lancashire economy is based on the adoption of shared Community Cohesion, Social Inclusion and Equality and Diversity Strategies across the public sector to ensure that the under-representation of black and minority ethnic communities and people with disabilities is remedied, gender balance is achieved at all levels of the public sector in Lancashire and, access to employment and skills is improved for people from deprived and disadvantaged communities.

The LAA will aim to;

• Improve skill levels amongst people to meet demand from employers
• Return people to employment in Lancashire
• Increase environmentally, socially and economically sustainable business growth and entrepreneurship
• Improve access to public transport across Lancashire.

One proposal to help achieve these aims is to provide Jobcentre staff with travel planning information so that accessible vacancies could be offered to clients at Jobseeker interviews together with public transport information.

7.6.11 Chorley Pathfinder

The Chorley Local Strategic Partnership has been chosen to act as the Pathfinder Partnership for delivering improvements to service accessibility. The Pathfinder will aim to identify the following;

• Places where there are accessibility problems in key areas of service delivery on an evidence based approach
• Any barriers to the understanding by service providers of the relationship between the spatial organisation of services, transport provision and the accessibility needs of different sections of the population and how those barriers might be removed
• The priority areas within Chorley Borough for action
• Solutions for overcoming the identified accessibility problems and any barriers to implementing those solutions, including the ability to fund solutions from partners’ mainstream budgets.

7.6.12 Supported Bus Services

The County Council’s current policy and criteria for the support of non-commercial local bus services are being reviewed in the light of an accessibility planning framework which will seek to prioritise areas for tackling issues of social exclusion and access to key service areas such as health, employment and education.

7.6.13 West Lancashire Primary Care Trust Public Health Improvement Plan

The corporate objectives of the West Lancashire Primary Care Trust (WLPCT) include a commitment to promote, maintain and improve health and well being by ensuring quality and timely health care to the people of West Lancashire. The Trust’s objectives also include a requirement to provide equality in availability of primary and preventative healthcare and to work in partnership to achieve true integration of health and social care, particularly with respect to children, mental health, prison and older people services.

The role of accessibility in delivering these commitments has been recognised by the PCT, and its Health Promotion Department is establishing provider/stakeholder networks to work on specific aspects of accessibility. One of these networks, the West Lancashire Sport and Physical Activity Network, will have its inaugural meeting in March 2006.  Members of the group are drawn from the health, local government, voluntary and sport sectors as well as stakeholders.  The County Council will assist in the analysis of existing provision and help to facilitate the development of an Action Plan and monitoring structure.

The County Council will also have a natural involvement in another WLPCT network which takes transport as its theme, with an initial stakeholder workshop taking place in March 2006.  The workshop will follow the pattern of the ‘Making the Connections Lancashire’ events, concentrating on the themes of access to health, employment, training and leisure services. The work carried out in partnership with WLPCT, particularly with respect to access to sport and active leisure, will effectively be a pilot for future engagement across the county.

7.6.14 Hyndburn & Ribble Valley Primary Care Trust Access to Healthy Food Project

The corporate objectives of Hyndburn & Ribble Valley Primary Care Trust  (H&RVPCT) include commitments to;

• Work actively to reduce health inequalities
• Increase knowledge and awareness of health inequalities through training and development
• Implement the Health Inequalities Action Plan
• Model resource and investment across Hyndburn and Ribble Valley
• Focus support for lifestyle health inequalities where needed.

To help it fulfil these commitments, the Trust has commissioned the East Lancashire Public Health Network (ELPHN), which provides public health expertise and support to the three Primary Care Trusts of East Lancashire, to carry out a study of access to food in Hyndburn.  ELPHN has been working with the County Council to establish the location of existing food shops and the type of food they stock.  Lancashire’s Trading Standards Department has supplied data on retail shops in the county, which has allowed specific types of shop, such as greengrocers, butchers and supermarkets, to be considered. Accession software has been used with Ordnance Survey ITN data to map access to these shops by walking.

The analysis is currently with the H&RVPCT.  It is anticipated that a working party will be convened in late Spring 2006 to move the project forward to full Action Plan status.

7.6.15 Lancashire Rural Delivery Pathfinder

The Lancashire Economic Partnership is leading the rural delivery Pathfinder in the North West. Each region in the UK will have common issues to face in the allocation of fair access to rural services; but under unique circumstances. As set out in the Lancashire Rural Pathfinder Business Plan of March 2005, Lancashire has a complex ‘rurality’. Increasingly, the cities, towns and villages, along with dispersed settlements which characterise the Lancashire rural space, cannot be seen as separate entities. Accessibility rather than proximity to markets, employment, health, leisure and education is the key to a successful regional and sub regional economy.

Providing cost efficient and equitable access to rural services is extremely challenging in transport terms. One in four households (25.1%) in Lancashire does not have access to a car or van, and nearly one in two (45.3%) only has access to one car or van. As around 60% of trips are made by car, many people therefore do not have access to a car during the week (Source Rural Innovation 2005). Against this background, the provision of rural public transport in Lancashire is under considerable pressure. This project is therefore aimed at informing investment and prioritisation decisions in the County, as well as improving the evidence base to support policy and delivery mechanism improvements in the national context.

Transport is one of the thematic work streams being progressed within the Pathfinder Action Plans in parallel with Enterprise, Housing, Environment and Access to Services (Rural Proofing). The Lancashire Economic Partnership is shortly to undertake a research project in West Lancashire and the Forest of Bowland with the following key aims to;

• provide an assessment of Lancashire evidence to support the contention that rural transport services offer non-transport benefits/value in terms of the economy, landscape, biodiversity, sub regional GVA and enhanced quality of life and also inform the development of the Local Transport Plan outputs and processes
• provide evidence, where possible, towards the monetary evaluation for the availability of transport opportunities for rural residents differentiated by journey purpose at different times of day and where possible by age
• link the above evidence with other workstreams being carried out within the Pathfinder Programmes and to influence, where appropriate and possible, the TAG appraisal guidance in the evaluation frameworks applied to mainstream transport funding
• improve understanding by service providers, including social healthcare, education and business, of the relationship between the spatial organisation of services, transport provision and availability and accessibility of different sections of the rural population. The accessibility modelling work currently being carried out will be augmented with additional accessibility modelling to improve the understanding of this relationship
• relate the research work to the Local Transport Plan and Accessibility Strategy.

7.6.16 Future developments

Other accessibility issues have already been identified and have partners who are keen to become involved in accessibility planning. We anticipate that work will begin on these and other projects in the next two years. They include;

• working with young people not in education, employment or training (NEETs) through the Learning and Skills Council
• the resettlement of ex-offenders, working with the Governor of Lancaster Prison
• provision of access to sports facilities operated by District Councils in Private Public Partnerships
• provision of transport for students with Special Educational Needs.

Accessibility Improvements in the LTP Programme

The delivery of many strategies during the period of the first LTP has greatly assisted accessibility to amenities and services. Similarly, the cross-cutting nature of the strategies within our second LTP will result in many more accessibility improvements. The LTP programme will consist of some measures that are advanced through the Accessibility Strategy, with the principal purpose of improving social inclusion. Other measures that are promoted through the programme appraisal process will also have a primary objective of enhancing accessibility, if not with the principal objective of improving social inclusion.

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