Dr Marcus Chilaka University of Salford, UK Jilla Burgess-Allen Stockport PCT, UK Integrated Health Care Centres: synergies and limitations from a health impact assessment perspective

Background One of the cardinal principles enshrined in the United Kingdom (UK) National Health Service (NHS) Improvement Plan is the establishment of Integrated Health Care Centres (IHCC) 1,2 One of the cardinal principles enshrined in the United Kingdom (UK) National Health Service (NHS) Improvement Plan is the establishment of Integrated Health Care Centres (IHCC) 1,2 Where health care would be delivered along with social services Where health care would be delivered along with social services Social care staff would work alongside General Practitioners (GPs) and other primary & community health teams. Social care staff would work alongside General Practitioners (GPs) and other primary & community health teams. A cardinal objective of the policy is to take steps to reduce health inequalities and strengthen the preventative role of the NHS A cardinal objective of the policy is to take steps to reduce health inequalities and strengthen the preventative role of the NHS

Background Objectives of the IHCC strategy include: Objectives of the IHCC strategy include: - The modernisation of GP premises, improved access - Delivery of quality services tailored to the needs of local people - New ways of working that entails more integrated and accessible services for local people, as well as the development of new one-stop primary care centres - To encourage greater participation of the private sector in the provision of health care This research examines the possible merits and limitations of the IHCC model from a Health Impact Assessment (HIA) standpoint. This research examines the possible merits and limitations of the IHCC model from a Health Impact Assessment (HIA) standpoint.

IHCC Schematic diagram Diagnostics Facilities -Ultra sound -ECG -X-RAY Outpatient clinic Specialist GP/Nurse service Extended Minor Illness Services -Nurse Practitioner -Nurse Triage GP service GP, Practice nurses, Healthcare, Assistants, Counsellors Therapy clinics Podiatry, Physiotherapy, Occupational Therapy, Speech and Language Service, Dietetics, Orthotics Education and Training Facility Pharmacy Dental Services Visiting hospital consultant clinics Treatment room Nurse Practitioner, District Nurses, Health Care Assistants Base for Specialist Nurses Health Promotion/Public Information Services Healthy Living Advice Child Health Health Visitor, School Nurses, Social Services Teams Sexual Health Services Social Services

Methods Rapid prospective Health Impact Assessments of 5 proposed IHCCs in the North West Region of England Rapid prospective Health Impact Assessments of 5 proposed IHCCs in the North West Region of England Evidence for the HIAs under consideration was collated and analysed from extensive literature reviews, expert opinion (focus groups) and local community engagement workshops 3 Evidence for the HIAs under consideration was collated and analysed from extensive literature reviews, expert opinion (focus groups) and local community engagement workshops 3

Findings: Positive impacts This model of service provision can help reach out to vulnerable groups towards reducing health inequalities This model of service provision can help reach out to vulnerable groups towards reducing health inequalities Can also provide opportunities for preventive interventions and community health education Can also provide opportunities for preventive interventions and community health education Having a range of services under one roof will make using the centres more convenient and promote better partnership working between service providers Having a range of services under one roof will make using the centres more convenient and promote better partnership working between service providers

Findings: Positive impacts There is potential to boost the local economy if local people are employed in the construction of the facilities, maintenance of the sites and when the facilities become operational, where possible There is potential to boost the local economy if local people are employed in the construction of the facilities, maintenance of the sites and when the facilities become operational, where possible Extended opening hours will also enhance convenience and increased access to health care services Extended opening hours will also enhance convenience and increased access to health care services There is the potential for improved access to general & health-specific information from the combined health, community and social services. There is the potential for improved access to general & health-specific information from the combined health, community and social services.

Findings: Positive impacts There is potential for highly sustainable building designs which are welcoming, aesthetically pleasing and easy to use. There is potential for highly sustainable building designs which are welcoming, aesthetically pleasing and easy to use. This would improve the environmental and energy efficiency of the facilities with benefits to the corporate organisations involved in the project as well as local residents This would improve the environmental and energy efficiency of the facilities with benefits to the corporate organisations involved in the project as well as local residents Overall, the integration of medical services with social & community services has enormous potential to improve health and wellbeing Overall, the integration of medical services with social & community services has enormous potential to improve health and wellbeing

Findings: Negative impacts Transportation difficulties could have negative health impacts, especially for the elderly and people with disabilities and limited mobility. Transportation difficulties could have negative health impacts, especially for the elderly and people with disabilities and limited mobility. There is the possibility of the loss of personal and individualised touch to service provision within a bigger health & social care facility There is the possibility of the loss of personal and individualised touch to service provision within a bigger health & social care facility Having a broad range of services under one roof may mean there are tensions between the needs and expectations of different service providers and user groups. Having a broad range of services under one roof may mean there are tensions between the needs and expectations of different service providers and user groups.

Findings: Negative impacts More people using the IHCCs may increase air and noise pollution and other risks, such as road traffic accidents, from increased traffic. More people using the IHCCs may increase air and noise pollution and other risks, such as road traffic accidents, from increased traffic. There is also the potential for increased nuisance to residents and businesses within the neighbourhood of the new one-stop centres; for example parking of cars within the vicinity of the residents and businesses located close by. There is also the potential for increased nuisance to residents and businesses within the neighbourhood of the new one-stop centres; for example parking of cars within the vicinity of the residents and businesses located close by.

Conclusions The IHCC model of health service provision has the potential to improve health outcomes The IHCC model of health service provision has the potential to improve health outcomes However, the programme needs to be implemented in ways that mitigate possible negative health impacts However, the programme needs to be implemented in ways that mitigate possible negative health impacts Being in its initial phase the model needs to be monitored and evaluated, especially within the context of the prevailing financial crises affecting all sectors, including healthcare Being in its initial phase the model needs to be monitored and evaluated, especially within the context of the prevailing financial crises affecting all sectors, including healthcare

References 1. Department of health (DOH) 2000: The NHS Improvement Plan: Putting People at the Heart of Public Services. The Stationery Office (TSO), London 2. Community Health Partnerships (CHP) (2009): LIFT- Enabling Integrated Services, Co-location and Partnership working. php?ob=1&id=63 (accessed 02/06/09) php?ob=1&id=63 php?ob=1&id=63 3. Scott-Samuel et al (2001) Merseyside Guidelines for Health Impact Assessment, Liverpool