3.1 Introduction

This chapter looks at access to a range of health services, extending work previously reported in Key Health Data¹, as well as other data sources on accessibility (such as the Core National Accessibility Indicators², CRC’s Access to Services³ and the Indices of Deprivation4) which tend to focus on local health services such as GP practices, dental practices, pharmacies and opticians.

The types of service chosen for analysis are: breast screening units (all static and mobile sites), colposcopy clinics, and genitourinary medicine (GUM) clinics.

These services are more widely dispersed throughout the region and it is therefore less likely that people would choose to walk to these services. The measure of access in this analysis is: ‘how long it takes to drive to the closest breast screening unit, colposcopy clinic and GUM clinic’.

A road network within the West Midlands, based on Ordnance Survey Integrated Transport Network (ITN) Layer, has been configured with average speeds reflecting increased congestion in more dense urban areas5. Isochrone polygons (areas of equal time from a location) are produced for each type of health services. These are then used to calculate how many people live within a 5, 10, 15 or 20 minute drive of each type of service and those living more than a 20 minute drive away Counts of population are based on 2006 LSOA mid-year population estimates. Where applicable the population counts will only count those in the target population, i.e. females aged 25-64 in the cervical screening programme and females aged 50-70 in the breast screening programme.

The drive times produced by the analysis assume a starting vehicle speed as that of the speed allocated to the road and does not include time taken to get in/out of a vehicle, nor does it factor for the acceleration or deceleration of a vehicle. In practice several minutes would need to be added to gain a realistic ‘door-to-door’ journey time.

Some services which are close to but beyond the region boundary are included, although this has been less successful for services in Wales, where the road network is not currently licensed by Department of Health.

The analysis has been performed on the following three primary care trusts in the region:

Sandwell, part of the West Midlands conurbation, is a densely populated and highly urbanised area. It is one of the most deprived PCTs in the West Midlands.

Warwickshire covers a large area and is recognised as consisting of a mixed proportion of urban and rural areas6. It is the least deprived PCT in the West Midlands.

Herefordshire is one of the most rural and least populated counties in England covering a vast land area with a relatively small population. In terms of deprivation, whilst it performs relatively well in some domains, it performs far less well in other domains; most notably the Barriers to Housing & Services domain.

These PCTs have been selected to compare access across varyingly urban and rural areas, and with contrasting socio-economic conditions:

Table 3.1: Summary of selected Primary Care Trusts

(*Note: The exact age range in the breast screening programme is those aged 50 - 70. However, population statistics are only available at LSOA level for 5-year age groups. Populations are based on LSOA annual estimates, 2006.)

The findings of the drive-time analysis are presented below and summarised accordingly for each health service and PCT.

3.2 GUM Clinics

3.2.1 Herefordshire PCT

Map 3.1: GUM Clinics drive time analysis for Herefordshire PCT

GUM Clinics drive time analysis for Herefordshire PCT

• Hereford Sexual Health is the only clinic in the PCT and is the nearest for 97% of the population; with the remaining 3% have their nearest clinic located in neighbouring Worcester.
• A quarter of its population are within a 5 minute drive of their nearest clinic.
• This increases to 37% within a 10-minute drive and 47% within a 15 minute drive.
• A significant proportion (48%) of the population is more than a 20 minute drive from their nearest GUM clinic.
• Approximately half of the most deprived population (those in the bottom quintile for the West Midlands) are within a five-minute drive, whilst the remaining half reside more than 20 minutes away. However it should be taken into account that Herefordshire has only two LSOAs in this quintile.

3.2.2 Sandwell PCT

Map 3.2: GUM Clinics drive time analysis for Sandwell PCT

GUM Clinics drive time analysis for Sandwell PCT

• The nearest clinic for just over half (51%) of the population is the Dartmouth clinic located within Sandwell, whilst the next nearest for 35% of the population is located within Dudley, whilst smaller proportions have their nearest clinic located within Walsall (8%) and Birmingham (6%).
• Only 6.5% of the total population are within a five-minute drive of a GUM clinic, although this rises sharply to 43% for those within a 10 minute drive.
• 97% of the population are within a 20 minute drive, leaving just 3% more than a 20 minute drive away. These are located in the southern areas of the PCT.
• The majority of the most deprived population (57%) live more than a 10 minute drive, but all of this group are within a 20 minute drive.

3.2.3 Warwickshire PCT

Map 3.3: GUM Clinics drive time analysis for Warwickshire PCT

GUM Clinics drive time analysis for Warwickshire PCT

• For the large majority of the resident population, their nearest clinics are located within the PCT at Nuneaton George Eliot (29%) Warwick Hospital (29%), Rugby Hospital St Cross (19%) and Stratford Hathaway Clinic (13%).
• Smaller proportions of the population have their nearest clinics located outside the PCT in Redditch (4%), Tamworth (7%), and a very small proportion (1%) outside of the West Midlands region in Banbury.
• 29% of the population are within a 5 minute drive of their nearest GUM clinic with this increasing to 67% within a 10 minute drive.
• 90% of the population are within a 15 minute drive and just 1% of its total population live more than a 20 minute drive.
• All of the most deprived population are within 15 minute drive.

3.2.4 GUM Clinic Summary

The main findings for the GUM clinic analysis are identified in the table below:

Table 3.2: Summary of GUM clinic drive times analysis by population (%)

Whilst the more rural PCTs of Herefordshire and Warwickshire have noticeably greater catchments within a five-minute drive, the incremental increase in proportion of populations reduces thereafter, especially for Herefordshire.

Contrastingly, Sandwell sees its catchment population increase rapidly. Both Sandwell and Warwickshire have near complete coverage within 20 minutes, whilst Herefordshire barely sees half of its population covered.

3.3 Breast Screening Units

3.3.1 Herefordshire PCT

Map 3.4: Breast Screening Units drive time analysis for Herefordshire PCT

Breast Screening Units drive time analysis for Herefordshire PCT

• There are 7 breast screening units located within Herefordshire PCT (this equates to an average of 3 units per 100,00 of the target age group).
• 43% of females aged 50-69 are within a five minute drive of their nearest breast screening service location.
• This proportion increases to 76% within 10 minutes, and 91% within 15 minutes.
• 3% of the target population reside more than a 20 minute drive from their nearest unit, with many of these located near the Welsh borders.
• In terms of deprivation all of those females in Herefordshire, who are in the most deprived regional quintile, are within a five-minute drive.

3.3.2 Sandwell PCT

Map 3.5: Breast Screening Units drive time analysis for Sandwell PCT

Breast Screening Units drive time analysis for Sandwell PCT

• There are six breast screening units located within Sandwell PCT (an average of 2 units per 10,000 of the target age group).
• Only 31% of Sandwell females aged 50-69 are within a five minute drive to their nearest unit, although this increases rapidly to cover most of the population (93%) within a 10 minute drive.
• There is a complete coverage of the target population within 15 minutes.
• Of those Sandwell females aged 50-69 who are in the most deprived quintile, a similar pattern is observed – albeit with a slightly improved coverage – 34% are within 5 minutes, and 99% are within 10 minutes drive.

3.3.3 Warwickshire PCT

Map 3.6: Breast Screening Units drive time analysis for Warwickshire PCT

Breast Screening Units drive time analysis for Warwickshire PCT

• There are 18 breast screening units located within the PCT, meaning it has by far the greatest number of any PCT within the region (an average of 2.8 per 10,000 of the target age group).
• Over half of females aged 50-69 (56%) are within a five minute drive to their nearest unit, and this increases to 92% within 10 minutes.
• At 15 minute drive time there is complete coverage for all the target population.
• Of those females in the most deprived quintile, 88% are within 5 minutes and there is complete coverage by 10 minutes drive time.

3.3.4 Breast Screening Units Summary

The main findings for the breast screening units analysis are identified in the table below:

Table 3.3: Summary of breast screening units drive times analysis by population (%)

Whilst Sandwell and Warwickshire see total coverage at 15 minutes drive time (and indeed near total coverage within 10 minutes), Herefordshire is unable to gain complete coverage within 20 minutes, with a small proportion of women residing more than 20 minutes from their nearest breast screening unit.

3.4 Colposcopy Clinics

3.4.1 Herefordshire PCT

Map 3.7: Colposcopy clinics drive time analysis for Herefordshire PCT

Colposcopy clinics drive time analysis for Herefordshire PCT

• Herefordshire County Hospital is the only colposcopy clinic located within the PCT, and for 97% of females aged 25-64 it is their nearest clinic (the nearest for the remaining 3% is located in Worcestershire).
• A fifth of the female target population are within a 5 minute drive of their nearest clinic, with this rising to 37% within 10 minutes.
• Just over half (52%) of the population are within a 20 minute drive, and just under half (48%) are more than 20 minutes.
• Half (51%) of those females aged 25-64 in the most deprived quintile are within 10 minute drive to their nearest clinic, with the remaining half residing more than 20 minutes.

3.4.2 Sandwell PCT

Map 3.8: Colposcopy clinics drive time analysis for Sandwell PCT

Colposcopy clinics drive time analysis for Sandwell PCT

• There is only one clinic located within Sandwell, at Sandwell General Hospital, which is the nearest for 58% of the target population.
• Other clinics in neighbouring PCTs provide the nearest clinic for significant proportions of the remaining target population: Dudley (15%), Birmingham (11%), and Walsall (9%).
• Only 4% of women are located within five minute drive to their nearest clinic although this increases to 30% within 10 minutes and 70% within 15 minutes.
• All but 2% of the target population are within a 20 minute drive.
• For those in the most deprived quintile, an almost identical pattern to the whole population is observed.

3.4.3 Warwickshire PCT

Map 3.9: Colposcopy clinics drive time analysis for Warwickshire PCT

Colposcopy clinics drive time analysis for Warwickshire PCT

• There are three clinics located within the PCT, and these are the nearest for 62% of the target population.
• Small proportions have their nearest clinic located outside the PCT in Coventry, Solihull, South Staffordshire, Worcestershire, and Birmingham East & North.
• Almost a quarter of women (24%) are within a 5 minute drive of their nearest clinic, with this increasing significantly to 61% within 10 minutes.
• There is near complete coverage (96%) attained within 20 minutes.

3.4.4 Colposcopy Summary

The main findings for the colposcopy clinics analysis are identified in the table below:

Table 3.4: Summary of breast screening units drive times analysis

Sandwell and Warwickshire again are shown to have the greatest coverage, with near total coverage of the target population within 20 minutes.

Although Herefordshire sees a fifth of its target population being within five minutes, it only sees approx. half of the population covered within 20 minutes.

3.5 Summary and Conclusions

The analysis has shown that there are variations in drive times to health services according to type of health service and the PCTs in this analysis.

Figure 3.1, below, summarises the proportions of populations of the three PCTs within a 10 and 20 minute of each of the services:

Figure 3.1: Summary of PCTs to all services: populations (%) within 10 and 20 minute drive times

Summary of PCTs to all services: populations (%) within 10 and 20 minute drive times

In terms of health services, the breast screening units have complete coverage within a 20-minute drive, with the exception of Herefordshire, which is just short of this. All PCTs have relatively high proportions within 10 minutes.

The pattern for GUM and colposcopy clinics is almost identical where there is almost complete coverage within 20 minutes for both Sandwell and Warwickshire, but Herefordshire has only half of its population covered within 20 minutes. Sandwell and Herefordshire both experience similar proportions, under half their populations, within a 10-minute drive.

Herefordshire, the most rural of PCTs in the analysis, is the only PCT not to have full coverage of its population for any service within 20 minutes. The rural nature of the PCT combined with its dispersed population and fewer services perhaps makes this inevitable.

It is interesting, however, to see that in Herefordshire the catchment for those within 5 minutes is often considerably more than that of Sandwell and comparable when within 10 minutes. This suggests that those living within the main towns are covered well, but there remain isolated communities.

The isochrone polygons generated in Sandwell are much smaller in area, and this can be seen as a direct effect of urban traffic congestion affecting travel times. Despite this, Sandwell still sees the majority of its population are within 15 minutes drive of the services investigated.

Warwickshire has overall seen a very good coverage of its population for all the services analysed, with over half of its population covered within 10 minutes for all the services. This is perhaps due to the presence of a high number of services across a large area combined with the large towns (such as Nuneaton, Warwick, Bedworth, Leamington Spa) and also its proximity to Coventry.

In terms of deprivation some of the results found in this analysis may not be too robust due to the relative low levels of deprivation in Herefordshire and Warwickshire, however the analysis does suggest that there is a greater proportion of the most deprived group within shorter drive times to health services:

Figure 3.2: Summary of PCTs to all services by deprivation: populations (%) within 10 minute drive times

Summary of PCTs to all services by deprivation: populations (%) within 10minute drive times

This is most likely due to the fact that, generally speaking, there are higher levels of deprivation found in urban areas and more services are located in urban centres. Further analysis in Birmingham has also shown that the most deprived group are within shorter journey times compared to the least deprived group.

Such analysis can not only help identify gaps in services provision but help assist in scenario planning and in helping health services better target their intended population groups. Reduced journey times for patients to health services may not just help increase attendance but may also help contribute toward a reduced carbon footprint.

References:

1. Key Health Data 2004/05 Chapter 6: Access to Services, Dr Richard Wilson
   
   
2. Core National Accessibility Indicators 2007 produced by Department for Transport
   
   
3. Rural Services Data Series produced by Commission for Rural Communities
   
   
4. Indices of Deprivation 2007: Barriers to Housing and Services Domain and Geographical Barriers Sub Domain, produced by Department for Communities and Local Government
   
   
5. Methodology for allocating average road speeds is based upon the Competition Commission's report on the mergers of supermarket chains, Appendix 5.2: Road speed assumptions (2003)
   
   
6. Classification of PCTs (post October 2006 boundaries) based on the Rural and Urban Area Classification system for LSOAs, produced by Association of Public Health Observatories
   
   
7. Indices of Deprivation 2007. Produced by Department of Communities and Local Government. Regional quintiles have been calculated by WMCIU using the Income Domain