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NHS England Travel Assessment : Hightown Surgery
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NHS England
Travel Assessment for Hightown Village Surgery
April 2017
Strategic Transport Planning & Investment Sefton Council
NHS England Travel Assessment : Hightown Surgery
2
NHS England
Travel Assessment for Hightown Village Surgery
1 Introduction and Background NHS England is currently undertaking a consultation exercise regarding future provision of primary medical services to patients registered at Hightown Village surgery. Sefton Council has been asked to undertake an assessment of the travel arrangements and the likely impact on patients should the patient list be dispersed and the patients need to assess an alternative surgery. The alternative surgeries that have been identified are The Village Surgery, The Hollies Surgery and Chapel Lane Surgery, all in Formby, and Crosby Village Surgery. The journeys involved in travelling to the alternative surgeries will be assessed. The assessment will in the main:
a. consider all likely transport methods such as private car, bus, taxi, bicycle, train etc.
b. include a consideration of levels of access to cars and vans by residents of Hightown, levels of disability and health, deprivation etc.
c. indicate expected journey duration, routes, distance travelled and cost of fare if applicable.
d. include access to parking facilities at or nearby to the proposed practices and whether a fee is charged. If a fee is charged, how much is the fee per hour?
e. include details of what difficulties patients at the practice are likely to face should the practice close.
f. have regard to patients with protected characteristic i.e. age, disability, gender reassignment, race, pregnancy and maternity, religion and belief, sex, sexual orientation.
2 Patient Information – Surgery / Ward Profile Information on the total number of patients at the surgery, a list of postcodes and some social and demographic data was provided by NHS England for the assessment. No medical data, patient names or information that could be identifiable to an individual was provided. Hightown Village Surgery currently has 1988 patients, the postcodes of which have been used for the assessment (see Appendix A). Of the 1988 patients, 8 have been discounted from the assessment for the following reasons:
L38 0BZ (x1) terminated by post office 2001
L38 6JN (x3) terminated by post office 1994
WR11 2GD (x2) Evesham, Worcestershire – too far to consider
WN7 5JF (x1) Leigh, Wigan – too far to consider
L3 4ER (x1) Quebec Quay, Liverpool – too far to consider
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This left 1980 patients to consider, the large majority of which (1794) live in the area of Hightown and Crosby, covered by the following four wards:
Victoria
Church
Manor
Blundellsands (See Appendix B) Of the 1794 patients, 396 already live in Crosby and we have therefore assumed that the journey to Crosby Village Surgery will be quicker and easier than the current journey to Hightown Village Surgery. These patients have therefore been excluded from the journey planning part of the assessment. The travel assessment has concentrated on the 1398 patients who live in Hightown. Data from the 2011 census was obtained to provide information about the demographic and other characteristics of the local population. Census data are available at different geographical levels, mainly based around units of population called Super Output Areas (SOA). Data are also available at ward level. SOAs are further broken down into Lower Super Output Areas (LSOA). For the Hightown area, all of Hightown is covered by a single LSOA (Sefton 021D), so the data for this LSOA have been used to provide an overview of the characteristics of the local population. The census data and the information provided by NHS England was used to address items (b), (e) and (f) in the scope of work described above. Specifically, four main characteristics from the census data were used for the assessment :
Age profile of residents – specifically, the percentage of the population aged between 0 and 4, between 65 and 74 and aged 75 and over.
Incidence of activity limiting health conditions – those people who report that their activities are limited by a health condition.
Vehicle availability – specifically, the proportion of households that do not have access to a car or van
Economic activity – the proportion of individuals that are economically active or inactive
The data for the Hightown LSOA and comparable data for the whole of Sefton, for NW England and for England as a whole are provided in Appendix C. 3 Scope and Method of Travel Assessment A travel assessment for the journeys to the alternative surgeries was used to address items (a), (c), (d) and (e) in the scope of work described above. The three alternative surgeries in Formby are all located next to each other, so they have been considered together, as a single journey destination. The assessment is divided into two parts, the first part involved undertaking a desk study looking at the information available via on-line journey planning tools. The second part of the assessment took place on site when the ease or difficulty of each of the different journeys was assessed, including any obstacles the patients may face when undertaking the journey.
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For the purposes of the journey planning process, 3 representative patient postcodes were selected to work with from the main area of Hightown. The identity of the patients at those postcodes is not known. Those postcodes are from different parts of the village and are:
L38 0BU (Resident 1)
L38 9GL (Resident 2)
L38 3RJ (Resident 3) (See Appendix D) Using the 3 resident postcodes taken from across the Hightown area, we focused on 4 journeys. Those journeys were
Hightown Surgery to the Formby surgeries and the Crosby surgery
Resident 1 to the Formby surgeries and the Crosby surgery
Resident 2 to the Formby surgeries and the Crosby surgery
Resident 3 to the Formby surgeries and the Crosby surgery We looked at each of the journeys from a walking / cycling / driving / public transport and taxi perspective. The assessments do not include any allocation for waiting time for public transport or delays due to traffic congestion. Incorporating provision for waiting times or traffic delays would be potentially complex, so the travel assessment is based on the actual journey times for the public transport services and driving under free-flowing traffic conditions. 4 Travel Assessment a) Desk Based Study The results of the desk based study are included in Appendix E. All the journeys we looked at via public transport can be achieved in less than 30 minutes travel time with the exception of Resident 2 travelling to Crosby Village Surgery by train – due to the distance to the station, this journey takes 34 minutes. All journeys to the surgeries in Formby can be taken by train or by a combination of train and bus (from the station in Formby to the surgeries). In most cases, this option will reduce the walking time to be undertaken by the patient, which would be important for patients who may have difficulty walking. The bus only option has been discounted for these journeys as it would mean taking two buses and the journeys would take around an hour. The easiest and quickest way for the residents to access the surgery in Crosby is by using the bus (Service 206, Hightown to Blundellsands Circular). The longest journey of which is 24 minutes. In relation to other modes, driving and cycling journeys can both be achieved in under 25 minutes, walking would take approximately an hour and this would be discounted for most people.
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b) Site Based Study Hightown During the site based assessment, we concentrated on anything which would prove a barrier or provide difficulty for any patients undertaking the journeys.
i) Hightown Station Access The first barrier is Hightown Station, this station provides only a stepped access to either cross the railway or to move from one platform to the opposite side. There are two sets of steps – one very steep and a stepped ramp – this would cause difficulties for anyone with mobility issues.
ii) Car parking at Hightown Station For anyone wishing to drive to the station, car parking provision was looked at. On the surgery (eastern) side of the station, there is a disabled parking bay that could accommodate 2 closely parked vehicles plus plenty of on road parking. There is however limited car parking on the seaward (western) side of the railway line consisting of two spaces. There is no on street parking availability.
Hightown Station footbridge Hightown Station footbridge
Disabled parking at Hightown station Parking at Hightown – west side of railway
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The other main issue here is the dropped kerb to allow access to the pavement on the surgery side of the station. It is covered in mud and the H bracket road marking can hardly be seen.
iii) Bus Stops for access to Service 206 to Crosby There is only one main bus stop in Hightown situated on the junction of Alt Road / School Road very close to the station (see Appendix C). This bus stop has a seat and is also covered. As this is on the seaward (western) side of the station, anyone living on the surgery (eastern) side of the track would need to cross the track using the steps and the bridge to access the bus stop. Service 206 operates as a hail and ride however whilst bus stop locations are indicated on journey planning tools, there are no bus stop poles or any signs of bus stops anywhere in Hightown other than the main stop at the station. It is therefore not clear where you should be if you want to take the bus or whether it can be hailed from anywhere along the route which could be very confusing if you don’t use it regularly. Service 206 is operated by HTL Buses (Huyton Travel Ltd) using 22 seater mini bus style vehicles, but which are accessible (DDA compliant).
iv) Other issues To access the station, Resident 1 needs to cross Thornbeck Avenue at the roundabout to enter Lower Alt Road. However the road here has no pedestrian refuge and could be difficult to cross. Other legs of the roundabout have pedestrian refuges which are very new, but would mean taking the longer way round the roundabout.
Thornbeck Avenue at roundabout showing
lack of pedestrian refuge
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The footways between the station and Resident 3 are very uneven due to tree roots and are also covered in moss, which could be a slip/trip hazard. Arrival in Formby
i) Formby Station Access Formby Railway Station is accessible via steps from the platform, but it also has a lift. Formby is generally a lot busier than Hightown with much more traffic around. Some patients may be discouraged from walking due to the amount of traffic.
ii) Bus Stops for access to Formby Circulars
On arrival at Formby Station, the Formby Circulars can be picked up at the bus stop on the bridge just outside the station. The bus stop does not have a seat or a shelter. These buses stop in Sumner Road which is a couple of minutes’ walk from the surgeries, this bus stop has available seating and a shelter. Alternatively the buses also stop on Chapel Lane and Elbow Lane although these bus stops are posts only and do not have seats or shelters.
iii) Car parking at Surgeries When driving to the surgeries in Formby, parking at the rear of Chapel Lane is a private pay and display car park (The Cloisters) – charges here are 20p for 1 hour / 40p for 2 hours with a maximum charge of £1.00. Alternatively, Sumner Road car park is a pay and display car park. Charges are up to 30 mins 30p / up to 2 hours £1.00. Both The Village Surgery and The Hollies have limited amounts of free patient car parking. Arrival in Crosby
i) Blundellsands and Crosby Station Access Blundellsands & Crosby Railway Station is fully accessible and has both an underpass for crossing the line and a ramped access for leaving and entering the station.
Tree roots cause an uneven surface Footway covered in moss
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ii) Crosby Village Surgery Crosby Village Surgery may be difficult to locate on a first visit as the building has no sign, just an A4 piece of paper in the window.
iii) Car parking for surgery The surgery has no car park however parking is available in the Sefton Council Car park in the village centre (The Green) with prices starting at 30p for 30 minutes going up to a maximum of £3.80 for over 4 hours.
Blundellsands and Crosby station
Crosby Village Surgery
Aerial view of Crosby village showing location of
surgery (ringed) and Council car park
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iv) Bus Stops
The bus stop for returning to Hightown is located on Islington and has seats and a shelter. 5 Issues affecting ability to travel In addition to an assessment of the actual journey involved in travelling to alternative surgery locations, patient profile and area based census data have been used to provide an indication of the proportion of people that may have difficulties travelling to an alternative surgery. It is important to note that these issues are very likely to be affecting people’s ability to travel to their current surgery as well. The ability of people to make the journey to the surgery has been considered in terms of likely level of mobility, access to a private vehicle, declared levels of disability and affordability. In accordance with discrimination legislation, the potential impacts on patients with protected characteristics has been considered. The protected characteristics that are likely to be affected by changes to travel requirements are age, disability and pregnancy and maternity. Other protected characteristics would be equally affected and there would be no differential impact. a) Age profile The proportion of very young children is used as an indicator of the proportion of people who would be travelling with a pram or buggy. The proportion of people with mobility difficulties is higher among the older age groups, so the proportion of older people, particularly those 75 years and over, gives an indication of the proportion of people who may find difficulties with a longer or more complex journey to the GP surgery. The percentage of young children in the Hightown area is lower than in the Borough as a whole and only about half the national average. For older age groups, however, Sefton as a whole has a much higher percentage of older people than the national average. In Hightown, the 65 to 74 age group has a higher proportion than the Sefton average, but the 75 and over group is similar to or slightly below the Sefton average. Based on the age profile and taking account of both very young ages and the older age groups, there are probably about 20% of patients in the Hightown surgery who may have mobility issues associated with age. b) Disability Hightown Village Practice has 5% of registered patients receiving Disability Living Allowance, which is similar to the national average. The DLA figures, however, relate only to those people who have claimed and qualify for DLA, so will be an under representation of the proportion of people who have a reduced level of mobility. In
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the census data, 20% of residents of Hightown report that their day to day activities are limited in some way (9% limited a lot and 11 % limited a little). This is slightly lower than for Sefton as a whole. Based on the census data for levels of activity, there are probably about 20% of patients in the Hightown surgery who may have mobility issues associated with health related conditions and disability. c) Access to vehicles People’s access to a car or van is reported in the census. In Hightown, access to a car or van is very high, with only 8.1% reporting that there were no cars or vans in the household. This is much lower than for Sefton as a whole, where 28.5% of households do not have a car or van. Based on the census data for access to vehicles, there are only about 8% of patients in the Hightown surgery who may have mobility issues associated with lack of access to a private vehicle. d) Affordability Transport costs can be substantial, depending on the nature and frequency of the journey and affordability can affect people’s willingness and ability to travel. Census data on levels of economic activity have been used as an indicator of the proportion of people who may have issues with affording transport (e.g. public transport or taxis). Levels of unemployment are very low in Hightown, 1.2% compared to 3.8% across Sefton as a whole. The proportion of retired people in Hightown is high, 34.5%, higher than in Sefton as a whole, but there are very few people not working due to long-term sickness or disability, 1.1%, compared to 5% across Sefton as a whole. Based on the census data for economic activity, there are probably no more than about 5-10% of patients in the Hightown surgery who may have mobility issues associated with affordability.
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6 Conclusions Patients currently registered at Hightown Village Surgery are mainly resident in Hightown itself or in Crosby, with small numbers of patients in other areas, such as Formby and Ince Blundell (see Appendix A). The travel related implications of transferring patients to alternative surgeries will primarily affect the patients resident in Hightown and the travel assessment has therefore concentrated on those residents. For the purposes of this assessment, a travel time of 30 minutes has been used as the maximum acceptable travel time. Journeys of longer than 30 minutes have been assumed to be unduly long and therefore inconvenient for the individual concerned. Journeys from the different parts of Hightown by a range of alternative means of travel have been assessed. Details are reported in Appendix E. Travel to the alternative surgery locations in both Formby and Crosby from Hightown is feasible. Travel by private car or taxi is relatively simple and there are public transport options available. For most of the area of Hightown, the journeys to the alternative surgeries can be made in less than 30 minutes travel time (excluding possible waiting times for public transport or delays due to traffic congestion). Travel from the southern end of Hightown by train may take more than 30 minutes because of the distance of that part of the village from the railway station. Although travel to the alternative surgeries is feasible, the assessment has identified some issues that would affect the ability of some patients to make the journeys. These are :
Travel to the alternative surgeries in either Formby or Crosby for residents of Hightown inevitably takes longer than the existing journey to the Hightown village surgery and will also incur additional costs, whether for public transport fares, parking charges or fuel costs for private vehicles.
The conditions of the footway and the provision for crossing the roads on some of the routes to the railway station is not ideal and may cause problems for patients with mobility difficulties.
The main issue affecting patients with mobility difficulties is the Hightown railway station access. There are no lifts at the station and the existing bridge has a stepped ramp and/or steps. This makes it very difficult to access both sides of the railway, which would be a significant barrier for anyone with mobility difficulties who wished to use the train to travel to either Formby or Crosby.
Based on the age profile of the Hightown population and the proportion of people who report that their day to day activities are limited, there are probably about 20% of the patients in the Hightown surgery who have mobility difficulties and who would find it difficult to walk any distance or to use the railway given the issues with the station footbridge.
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