The Committee will receive a presentation from Chris Howlett (Programme Director) and Jane Mower (Estates Development Manager) at the North Essex Clinical Commissioning Group on plans for improving health services in North Essex, highlighting the current comprehensive approach to incorporating health into future development.
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Councillor Ellis (in respect of his spouse’s employment by the North Essex Wheelchair Service) declared a non-pecuniary interest in this item pursuant to the provisions of Meetings General Procedure Rule 7(5).
Laura Chase, Planning Policy Manager, introduced Chris Howlett (Programme Director) and Jane Mower (Estates Development Manager) at the North Essex Clinical Commissioning Group to the Committee members.
The Committee received a presentation from the Programme Director and Estates Development Manager on plans for improving health services in North Essex, highlighting the current comprehensive approach to incorporating health into future development. The health service had needed to adapt to a number of recent challenges including:
• Year on year growth in demand for services outstripping increase in funding
• Ageing population with more complex health needs
• Population growth/housing development
• Changing public expectation of service standards
• Changing health needs (obesity, diabetes, COPD, mental health, dementia)
• Workforce recruitment and retention not keeping up with demand
• Political and structural instability.
The presentation explained how these challenges were being responded to through new organisational structures and long-term strategies. In particular, the Hub and Spoke model of delivery was presented which was intended to tailor the delivery of health services to the needs of local areas.
Councillor Arnold sought clarification on the reason why there was a limit to the number of development proposals on which representatives could be made as health statutory consultees.
The Planning and Housing Manager explained that the Community Infrastructure Levy Regulations provided for a limit of five comments and that the removal of this limit had been part of a recent consultation which were now subject to the publication of secondary legislation.
Councillor Luxford Vaughan asked whether the Estates Development Manager had been involved in the submission of the response to the LUC consultation and expressed her extreme concern in relation to the remarks referring to the impact on health services being inadequately addressed and that no new primary health care facilities would be provided. She also referred to the cultural shift which would be required to move patient care to new digital solutions and how this would work in a tangible sense. She also asked about the traffic implications of the Hub and Spokes model as a consequence of people travelling further.
The Estates Development Manager explained that she co-ordinated all health-related responses in relation to the Garden Communities and Section 1 proposals. She confirmed that the three North Essex Authorities had acknowledged the health-related response to the consultation.
The Programme Director also explained that large scale development had a wider impact on health services and it was not just about providing additional primary care. He went on to explain that the Hub and Scope concept in reality would provide new facilities with a range of services in some areas but in other places there would be a reliance on existing health care practices which would need to be adapted to accommodate a range of services, dependent upon the needs of the area. He further explained the rapid growth in online care which targeted the healthy younger population who preferred to access care while on the move and around their working lives. It was envisaged that this growth in new technology solutions would free up capacity within the existing health premises for those that needed face to face consultation and even where populations were growing.
The Executive Director explained that the key part of the Sustainability Appraisal (SA) was about making places healthy first before thinking about how people would be treated. He considered that primary health was being used within the SA as a mechanism of health provision rather than an assessment of the nature of health provision going forward. He also confirmed his view that the SA could make certain assessments currently but it couldn’t take account of the significant impact of the scale of new technology going forward. He considered that the real significant change to be made was the creation of healthier places to live.
Councillor Barber welcomed the presentation, explaining his sceptical view about the Garden Communities proposals and the presentation had helped his understanding of the health-related issues. He asked what contributions the Council could make towards preventable health measures and hoped the exchange of information from the Clinical Commissioning Group would continue.
Councillor Ellis welcomed the presentation from the North Essex Clinical Commissioning Group, he hoped it may become a regular exchange of information and he was encouraged to learn that there was now a good point of contact for Local Plan related issues. He questioned the assertion that GP recruitment could be assisted as a consequence of the growth in virtual health treatment and welcomed an explanation of recruitment measures and whether sponsorship had been considered. He asked about the Urgent Treatment Service proposed to be located at the front of the hospital and questioned how this would work given the proximity of the car park which was heavily over-subscribed.
The Programme Director explained that GP recruitment remained a current problem and that a range of different initiatives were being considered to reduce the gaps, including working with practices investing in a recruitment website and training, work with NHS England with international recruitment and working on a patient navigation approach to ensure only those who need to see a GP do so, although this required a significant level of culture change to be successful. He explained that it was envisaged that the patients who currently attended the Colchester Primary Care Centre at the Walk in Centre would attend the Urgent Treatment Service and he did not consider this would create a significant impact and the hospital had introduced a range of new parking controls, improved capacity as well as the new Park and Ride bus stop provision. He also explained that the development proposals which were due to commence at the hospital included a complete re-modelling of the entrance area, including utilisation of part of the duck pond.
Councillor Ellis was of the view that a more sensible solution would have been to move the hospital within close proximity to the A12 and asked if this had been explored. He also about a reference to new Essex Design Guide principles and whether this version had been adopted by this Council. He went on to confirm he would be very pleased to receive further updates from the North Essex Clinical Commissioning Group and was very encouraged that positive working relationships had now been developed with health service representatives.
The Programme Director explained that Colchester Hospital was built in 1985 and it was apparent early on that the site would become constrained due to housing development. The Trust had looked at the feasibility of developing a new hospital under a Public Funding Initiative (PFI) but this had been rejected because of the costs. He further explained that large capital sums were no longer available due to the long-term viability concerns associated with PFI projects and projects involving the building of ‘super’ hospitals had problems in themselves such as accessibility problems and public consultation protests.
The Planning Policy Manager confirmed that the Essex Design Guide was an online document which was subject to changes and updating over time and, as such, was no longer a document which was subject to formal adoption.
The Estates Development Manager confirmed that Laura Taylor Green at Essex County Council and part of the Strategic Planning Group was able to provide an excellent presentation on the Essex Design Guide should the Panel members be interested.
Councillor Warnes was of the view that the discussion had confirmed his support for an infrastructure led approach whilst also acknowledging the difficulties for people currently trying to access health services. He supported innovative and creative solutions but delivery was subject to delivery on the ground. He referred to Colchester’s long time acknowledged aging population and associated funding issues. He also referred to areas of deprivation in the Borough and the importance of preventative health measures as well as the importance of adequate social and primary care funding. He supported the use of new technology in terms of assistive and adaptive innovations, however, he advocated a more widespread fibre broadband network solution in order to deliver these innovations. He also referred to his varying experiences of GP surgeries and the impact of restricted appointment access leading to people considering self-care as an easier option. He supported the need to build healthy places to live.
The Programme Director explained that the fibre broadband revolution was only a part of the solution to improved health services due to the mix in ability to use IT. He acknowledged that older people can use IT effectively in order to access healthcare but this was not the case for all. He also explained that many people would be accessing healthcare from their mobile phones rather than using broadband, although he accepted that health services were investing heavily in broadband infrastructure and were also improving IT practices to provide access from any health care building for any type of worker to improve portability and access to information. He also responded to comments about current access problems associated with growth in demand and the environmental impact on a person’s health and wellbeing, such as whether they have company, transport etc. He advocated a collective approach to address inequalities together with a multi-facetted approach to enable that to happen.
Councillor Cope also welcomed the presentation. He referred to the amalgamation of GP practices and whether this was a welcome way forward as well as healthy environments in terms of the need for new housing for young families to provide gardens larger than the minimum area to achieve policy compliance. He strongly advocated the need for larger gardens to benefit the health of young children and asked how this could addressed given current policy restrictions.
Councillor Warnes also referred to the Government’s recent initiative to extend permitted development in respect of the change of use of office space to residential use and the problems associated with lack of amenity space as a consequence. He also lamented the lack of control that the Local Authority had in relation to this practice.
The Programme Director explained that the amalgamation of hospitals had produced some successes but not in all cases. The Ipswich and Colchester amalgamation was in its early years and it remained to be seen whether the merger would produce patient benefit, cost savings and efficiencies. In terms of GP practices, a new Government initiative had recently been implemented providing for all GP practices to join a primary care network which would lead to more sharing of resources across practices and it remained to be seen whether this arrangement would prove to be successful. He explained that he worked closely with public health colleagues to provide for healthy spaces in new developments through the Essex Design Guide.
The Planning Policy Manager explained that the Council had recently been awarded £250,000 to undertake an air quality project, which was one of a range on initiatives which would come forward.
The Planning and Housing Manager explained that minimum garden sizes were specified in the Essex Design Guide but these minimum standards weren’t prescriptive, dependent upon location. There were also local policies which might be different to the Essex Design Guide, which had not been adopted in its entirety, rather, elements of which were utilised according to what was considered appropriate for Colchester.
The Chairman referred to the Lifetime Homes provisions within the Essex Design Guide and his experience of external ramps for wheelchair users being constructed with unsafe gradients and the need for those involved in implementing and designing dwellings for people with disabilities to have actual experience of living as a disabled person.
The Estates Development Manager acknowledged the concerns expressed in relation to design and implementation of Lifetime Homes and the need for people from the local community to be involved in the design of community infrastructure. She was also of the view that the Garden Communities projects would provide opportunities to involve local people in the master planning of the homes and to have patients involved in health care decision making.
RESOLVED that the contents of the presentation be noted and Chris Howlett and Jane Mower be thanked for their very informative attendance.