Health Service Focus

A new vision for Liverpool

Liverpool PCT’s chief executive Gideon Ben-Tovim describes the vision for health services in the city.

The landscape for health services in Liverpool has been transformed over the past few years, taking services out of hospitals and into community health centres. The vision, a ‘New Health Service for Liverpool’ was launched in 2007 to both improve existing centres and build new facilities, changing the way that health services are delivered.

NHS spoke to Gideon Ben-Tovim, chief executive of Liverpool PCT, about the benefits of the scheme and how the human factors could be managed successfully.

He said: “We’re providing more facilities locally, whether it’s minor injuries, sexual health advice, treatment rooms, opticians, audiology, child health support or dentistry. There’s a range of services available at local level, which is helping stop so many admissions to hospital.”

Hospitals have also been receiving new estate, with top level equipment provided on a smaller scale.

Appropriate environment

The ultimate vision sees patients treated appropriately, in hospital or in the community, as is required.

“We’re trying to have the best possible hospital facilities for high quality intensive work and research,” Ben-Tovim said, but added: “There are things that don’t need to be done in hospitals, [that should be] done at the local level, particularly through neighbourhood health centres.”

The scheme has provided improved accommodation for staff, environmentally friendly buildings and a dignified environment for patients. There are even works of art on the walls, chosen and produced in collaboration with local artists. The quality of primary care infrastructure has been updated, with purpose built practices and GPs working together in partnership rather than isolation.

“We’re really transforming the face of the health service in Liverpool, whilst trying to change and improve the delivery of services by having more facilities based locally.”

This is the best way forwards, Ben-Tovim asserted, for both patients and staff. “This is what people want and it saves them going into town for a test that they could have done locally. We find that people really appreciate that and its easier for people to go to a more local health centre, prefer to be treated in a nice quality environment and we think this is very much modern, innovative thinking. People really appreciate that.”

Resistance

Ben-Tovim acknowledged that however small or beneficial it may be, there will always be initial resistance to change.

“Sometimes there was an immediate concern if they have to travel a bit further, or lose what they liked before. We know whenever you change something, people are always a bit nervous about change; there’s always that, but really we’ve had huge support and encouragement from people who have been using the services and working in them.”

This has been one of the main challenges faced by the trust as it implements the vision; working with people involved through the change process, including health professionals, patients and community.

He said: “The initial thought is, you’re used to working where you are. Even if you’re going to move into a good new building, you’ve still got to move. There’s just that natural caution, I think, that people have working through a change and the same with patients. Even if it’s moving 200 yards down the road!

“But we’ve tried to work at a reasonable pace with people, take the time to explain what we’re doing, continually have dialogue about the design of the building, what the benefits will be."

Location, location

Identifying appropriate locations for the health centres was another key challenge, and involved consulting with community, local transport officials and health professionals. The final model “came out of consensus” with these discussions to ensure the plots were accessible in every area of the city.

That was quite pioneering work and we have found very little resistance or opposition to any of our proposals over the last five or six years which I think is quite significant,” Ben- Tovim said.

Planning this location, applying for permission, and the physical site assembly has been “quite complicated”, he added. There will be 12 brand new GP practices, primary care or neighbourhood health centres in total – Everton Road, Everton; Breeze Hill, Walton; Picton Neighbourhood Health Centre, Picton; Yew Tree Neighbourhood Health Centre, Dovecot; Oriel Drive, Old Roan; Speke Neighbourhood Health Centre, Speke; South Liverpool NHS Treatment Centre at Garston; the Fiveways Neighbourhood Health Centre in Childwall; Townsend Lane Neighbourhood Health Centre in Anfield; Mere Lane Neighbourhood Health Centre in Everton; Princes Park Neighbourhood Health Centre in Toxteth and a facility is due to open in Kensington late next year.

Three additional centres have also been refurbished. The majority of these centres were delivered in partnership with the LIFTCo, which has consistently completed buildings on budget and on time to a high quality, Ben- Tovim said. Graham Pink, chief executive of the LIFTCo, Liverpool & Sefton Health Partnership Ltd, spoke to NHE about some of its successes for our September/October 2011 edition.

Ben-Tovim added that the trust has a “great relationship” with the company, and went on to say: “The fact that this has been so consistently spot on is a real tribute to the quality of the staff in the partnership. We’ve had very good engagement; good managers who work through the human caution and the understandably human resistance to change. There are some very good advocates in the community as well.”

In line with latest thinking

Since the project was designed and started so many years ago, the recent restructuring of the NHS could have posed a potential threat to the vision’s durability and relevance under government reforms. However, Ben- Tovim maintained that the transformation in Liverpool was “very much in line” with recent reforms.

He said that bringing services out of hospitals has only become more popular in the last few years – at least with trust chief executives – leaving the PCT ahead of the curve as opposed to behind.

Doctors with more of a leading role in commissioning services also fits in well with the scheme, as doctors were heavily involved in the redesign of their services and the implications this would have for patient care.

Ben-Tovim concluded: “I think we’re very much in line with latest thinking about streamlining hospital services, getting facilities out in the community, and redesigning services to meet patient need – so we’re very well placed in the evolving health service thinking.”

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