Geography Reference
In-Depth Information
The need for a wider range of community-based services, offering patients choice, conve-
nience, fairness and a much better experience of the NHS. The White Paper also focuses on
prevention and the need for the NHS to work in partnership with local authorities, voluntary
agencies and local people so we are all working to build the foundations for better health in
local communities. (LPCT
2007
, p. ii)
The result was a model in which more community care was envisaged, given the
fact that many are living longer, but often with debilitating illnesses that need local
and home care, not hospital stays. Also a new type of participation was proposed
to create more transparency and openness to discuss issues of public concern. It
also anticipated capacity-building in the population, by improving their knowledge
of the issues and encouraging their contribution to the debates, a process in which
their opinions were carefully evaluated. This led to what was described in Liver-
pool as 'The Big Debates' about health care. They revealed that a major concern of
many people was about their limited access to health care. This is a problem found
in many cities, as decisions about the locations of both the offices of doctors or
hospitals were usually made without effective public consultation. Indeed at a more
general level it is remarkable how many hospitals in the developed world seem to
be located close to wealthy areas, or have limited rapid public transport access since
they are in inaccessible locations, while physician's offices are few and far between
in poor areas, illustrating a failure of the market to serve all the population. Indeed
few countries have adopted the Dutch model of planning which ensures that the ma-
jor facilities that serve the public, or have large public use, such as hospitals, have to
be located on major transit routes to maximize their accessibility.
The health surveys in Liverpool showed that people were prepared to accept the
emerging trend of the increasing concentration of specialized medical facilities so
long as basic facilities were locally available within a short travel time. Research re-
sults in a major report showed the locations of various health facilities and mapped
the travel distances and times to these facilities from various points in the city. Geo-
graphically, it demonstrated that many residential areas had either few health care
facilities or limited access to them. Incorporation of these results into discussions
on how to solve these problems of access led to a new and comprehensive approach
for health care in the region, with the subtitle the 'Outside of Hospital Strategy',
which has created a four tiered system of health care in the metropolitan area (LPCT
2007
). At the local level are the General Practices, with single or multiple doctors
serving 1800-18,000 patients. Above these, 20-25 Neighbourhood Heath Centres
are planned to serve populations of 20,000-25,000 and are located in places that
could be reached by public transport in 15 min. These centres are anchored by doc-
tors and health care professionals but also contain other social and community ser-
vices. The third level consists of NHS Treatment Centres serving up 100-150,000
people that are located so they can be reached within 30 min by public transport.
These provide primary and secondary care, such as minor surgeries, diagnostic tests,
counselling and therapies, as well as outpatient clinics. The fourth level consists of
the main hospitals serving 300-500,00 people that carry out major surgeries and
other specialised medical procedures and care, in which some facilities concentrate
on particular medical areas, such children's care or mental problems. This four-
