1.1 Introduction

This chapter aims to draw together some of the changes to geographical boundaries that are likely to impact on our understanding of health services in 2006 and beyond. National initiatives to redefine the geographical extent of health organisations will change the way health statistics are prepared and disseminated. Initiatives by the NHS Health & Social Care Information Centre to provide wider access to Ordnance Survey map data in the NHS will provide new ways to disseminate health information.

Electoral ward boundary changes in the metropolitan districts of the West Midlands became statute in 2004 and may need to be considered when responding to requests for data by our local authority partners.

1.2 Reorganisation of Health Services

During 2005 Department of Health (DH) launched a number of consultation exercises under “Commissioning a Patient-led NHS” to examine future configurations of Strategic Health Authorities (SHAs), Primary Care Trusts (PCTs) and NHS Ambulance Trusts in England. As of April 2006 SHAs have become co-terminous with the regional offices of the DH each appointing a single Director of Public Health. The exception to this model is South East region which will have a South Central SHA and a South East SHA and two Directors of Public Health. This reduces the number of SHAs from 28 to 10 (Statutory Instrument (SI) No.1408).

Consultation on Primary Care and Ambulance Trust configurations closed 22nd March 2006 with the agreed configuration published 16th May 2006. Despite plans for NHS Ambulance Trusts to become co-terminous with their SHAs on 1st July 2006 they reduced in number from 29 to 11; two Ambulance Trusts being provided for in the South West region. Although the West Midlands region has been identified as supporting one Ambulance Trust strong local opposition to the proposals to merge Staffordshire Ambulance with the West Midlands service has resulted in a partnership arrangement between the two Ambulance Trusts in the immediate term. The new West Midlands NHS Ambulance Trust was created by the dissolution of the West Midlands, the Hereford & Worcester and the Coventry & Warwickshire Ambulance Trusts (SI No.1626).

From 1st October 2006 PCTs in England will be reduced in number from 303 to 152 many of the mergers reflecting current shared service arrangements. In the West Midlands the number of PCTs in will be reduced from 30 to 17. Based on the DH schema published 16th May West Midlands Health GIS have produced a provisional geographical boundary set for the new PCTs available to share with holders of HMSO Click-Use Licence on request. Actual boundaries will be established by Statutory Instrument.

Figure 1.01: New PCT configuration

Figure 1.01: New PCT configuration

1.3 Access to Ordnance Survey map data by NHS organisations

The NHS Health & Social Care Information Centre (HSC IC) became a Special Health Authority under the NHS umbrella 1st April 2005. Formerly part of the Department of Health it had benefited from Ordnance Survey (OS) licensing under the Pan Government Agreement (PGA). As part of NHS it would, like other NHS organisations, be required to pay full business rates for OS data. This is clearly not a desirable nor sustainable way for the NHS to base improvements in its information provision. On 8th November 2005 HSC IC and OS announced that they had brokered an agreement to provide all NHS Trusts, Primary Care Trusts, Strategic Health Authorities and Cancer Registries access to the national mapping agency’ archive. Ambulance Trusts had negotiated an OS Service Level Agreement (SLA) at the time of the PGA; they continued to be covered by this prior agreement until 1st April 2006 when they too joined with the rest of the NHS under the new arrangements. Common access to OS data under an SLA means NHS organisations can now share geographical information more freely amongst themselves and with other public sector organisations with whom they work.

The OS NHS Pilot agreement identifies a range of OS datasets which will be available free of charge at point of use to all NHS organisations based on their geographical area and their business needs. The value of the SLA has been negotiated on the basis of a ‘tiered’ access to OS data; NHS Trusts are Tier 1 organisations; PCTs Tier 2; SHAs Tier 3; Cancer Registries Tier 4 and Ambulance Trusts Tier 5. Each will have access to OS data to cover their own geographical area. NHS Trust areas are described in terms of the PCTs to which they provide clinical services. In some OS datasets PCTs and Ambulance Trusts do have access to wider SHA or national datasets - see Table 1 for details. Where there are joint working arrangements between PCTs e.g. shared services, those contracting out services can have their own OS data delivered to another organisation. In the case of specific short-term projects NHS organisations can share their OS data with a contracted organisation for the duration of the contract.

The arrangements for accessing OS data under the SLA require that each NHS organisation register as a user on the OS website. Each application is considered by the Steering Group, made up of representatives of the HSC IC & OS, for eligibility and a decision letter is issued to the applicant. Eligible organisations must then accept the NHS Terms and nominate an OS Liaison Officer. Once the signed acceptance documents have been received by OS they will issue a ‘Portfolio of Products’ together with ‘Product Order Forms’ and a Copyright licence number.

On receipt of your ‘Product Order Forms’ OS will provide their digital data for standard geographical areas and in standard supply formats. Each organisation will be responsible for using only that portion of the data which it is entitled to use i.e. to the extent of its boundary. This means the Cancer Registries will receive data for their region but not necessarily for the entire extent of their Cancer Networks. Similarly PCTs will not necessarily have access to the geographical data for the local authority areas with whom they work in Local & Strategic Partnerships. However with PCT reorganisation it is hoped these anomalies will be reduced. It is important that where such anomalies remain they are recorded by member NHS organisations and raised at HSC IC User Group meetings and during evaluation of the pilot agreement.

The OS data and supply formats are detailed in Table 1. There remain some local cost implications to NHS users in the procurement and training in GIS mapping packages, translation of OS data to compatible mapping package formats, and staff time spent preparing new OS data. West Midlands has taken action to address the former but new methods of working might be appropriate to address the latter two issues.

Table 1.01: OS data available to NHS organisations

As a pilot agreement the HSC IC and OS will be reviewing the success of the agreement against its Key Performance Indicators during the summer 2006. Part of this review process will be a customer questionnaire distributed to all NHS organisations signed up to the pilot agreement through their OS Liaison Officer. A mechanism to contact organisations that have not signed up to the agreement is still to be agreed.

OS are working hard to support new users of OS data by providing user workshops and technical support. They are also developing case study examples of the use of their data in the NHS. They will be providing a special ‘members’ area’ to their website for registered NHS organisations at:
 http://www.ordnancesurvey.co.uk/oswebsite/business/sectors/health/index.html

1.4 2004 Electoral Ward Boundary Changes

Electoral wards are the key building block of English administrative geography and the spatial units by which local government councillors are elected in metropolitan and non-metropolitan districts, unitary authorities and the London Boroughs. To ensure the success of local democracy councillors should represent broadly similar numbers of residents within a local authority area. As land within the local authority is developed, property demolished and redeveloped so electoral ward boundaries are reviewed to ensure every resident has a broadly equal representation in both local elections and local authority decision making. Electoral ward boundaries are therefore under regular review and once agreed are usually enacted to coincide with the local government elections on the first Thursday in May each year. The Boundary Committee for England (BCFE) (www.boundary.electoralcommission.org.uk) works with local authorities to make recommendations for change. These must then be approved by the Electoral Commission. The changes are finally specified in Statutory Instrument available online at http://www.hmso.gov.uk/stat.htm

The 7 metropolitan districts of West Midlands entered into the electoral ward review process in 2001. These reviews had not reached SI ahead of 31st December 2002 deadline to be included in the definition of census output areas (COAs) for the 2001 Census. As a result 2004 electoral wards are not coterminous with census area statistical (CAS) wards in the local authority areas of Birmingham, Coventry, Dudley, Sandwell, Solihull, Walsall and Wolverhampton in 2004. In 2004 the electoral wards boundary changes were implemented 10th June when the local government elections were postponed to coincide with the European parliamentary elections. There are now 10,661 electoral wards in the UK; 7976 in England; 762 in West Midlands.

Figure 1.02: Comparison of 2001 Census and 2004 Electoral wards in Birmingham

Figure 1.02: Comparison of 2001 Census and 2004 Electoral wards in Birmingham

Figure 1.03: Comparison of 2001 Census and 2004 Electoral wards in Coventry

Figure 1.03: Comparison of 2001 Census and 2004 Electoral wards in Coventry

Figure 1.04: Comparison of 2001 Census and 2004 Electoral wards in Dudley

Figure 1.04: Comparison of 2001 Census and 2004 Electoral wards in Dudley

Figure 1.05: Comparison of 2001 Census and 2004 Electoral wards in Sandwell

Figure 1.05: Comparison of 2001 Census and 2004 Electoral wards in Sandwell

Figure 1.06: Comparison of 2001 Census and 2004 Electoral wards in Solihull

Figure 1.06: Comparison of 2001 Census and 2004 Electoral wards in Solihull

Figure 1.07: Comparison of 2001 Census and 2004 Electoral wards in Walsall

Figure 1.07: Comparison of 2001 Census and 2004 Electoral wards in Walsall

Figure 1.08: Comparison of 2001 Census and 2004 Electoral wards in Wolverhampton

Figure 1.08: Comparison of 2001 Census and 2004 Electoral wards in Wolverhampton

The result of the 2004 electoral ward boundary changes was to create one whole new ward, Sutton Trinity in north Birmingham and significantly adjust the boundaries but not change the number of wards in the remainder of the city and in the other 6 local authority districts. Although Office for National Statistics (ONS) has provided COA to electoral ward lookup tables for data aggregation purposes they are ‘best fit’ allocations which can not be used to produce definitive electoral ward boundary files. The OS Boundary-Line product is based on the Statutory Instruments and represent the official, adopted electoral ward boundaries at time of publication. Under the Ordnance Survey Pilot agreement with the NHS these ward boundaries became available to NHS ‘free of charge’ in November 2005 and are available in proprietary GIS formats for NHS organisations signing up to the Pilot agreement
see: http://www.ordnancesurvey.co.uk/oswebsite/media/news/2005/nov/nhsengland.html.

Core baseline statistics from the 2001 Census data have been published by ONS for the 2004 electoral wards based on COA geography.

See: http://www.statistics.gov.uk/census2001/census2001.asp for details.