Friday, 1 October 2010

Great Harwood Health Centre - constituents letter & PCT report

Hi Graham, thanks for your email and article.

There are grave concerns regarding the whole health economy in the Hyndburn area and the ability of the health services to manage both the prevention and treatment of a range of issues given the scope of health inequalities in the borough.

Great Harwood Health Centre is extremely busy and  I am sure that the practices based there have  presented evidence of need which if aligned with the local health needs analysis should be compelling evidence for a more appropriate health centre.

Should the development not go ahead then I fear we will be in a hiatus as the transition arrangements around the dissolution of the PCT's and move to GP consortia and the relationship with Public Health which will probably sit in Local Authorities (in this case LCC) etc become clear and fall into place.

However I am not clear at the moment where commissioning of capital projects will sit in the new arrangements - you may have more information.

I hope that there may still be a positive outcome regarding the development of a suitable health centre - if not then I will be interested to see what potential opportunities there will be for the site.

Concerned Resident



30 September 2010


1              Introduction

1.1          In March 2010 the Board received a report titled ‘Community Development Programme’ that explained the difficult economic position facing the Primary Care Trust in relation to service development and investment. The report also referenced a range of work taking place across the Primary Care Trust to try and focus planning on a locality basis. The recommendations that were approved by the Board were:

·         Decisions regarding major infrastructure projects cannot be taken until both the Community Development Strategy work has progressed and the financial forecast for the PCT in future years is more detailed and precise.

·         A detailed progress report should be made available to the September 2010 meeting of the Board.

1.2       Between March 2010 and the timing of this report the PCT has implemented a revised management structure to both reduce costs and prepare the organisation to plan and develop with a renewed focus on locality health.

2              Impact of NHS White Paper – Equity and Excellence, Liberating the NHS

2.1          In July 2010 the NHS White Paper – Equity and Excellence, Liberating the NHS was published for consultation. Some of the main changes the white paper proposes are:
·         The establishment of GP Commissioning Consortia that will have responsibility for commissioning NHS services.  The white paper states that  GPs collectively will lead a bottom-up design of services with commissioning support;
·         the extension of ‘personal budgets’, giving patients with long-term conditions more choices about their care;
·         giving local authorities the power to agree local strategies to bring the NHS, public health and social care together;
·         reduction of management costs and the phasing out of Strategic Health Authorities and PCT’s by April 2013.
2.2          Cost pressures in the NHS remain and the QIPP (Quality Improvement Performance and Productivity) programme of work across the North West continues.  Against this background it became important to:

·         Look at the proposed work associated with the Community Development Programme and check it’s validity in terms of priority and integrity.
·         Develop options for major infrastructure projects that can be discussed with emerging GP consortia, commissioning and localities.
·         Begin to consider what ‘development legacy’ will look like for successor organisations to the PCT post 2013 both in terms of infrastructure and funding for future development of services.

2.3          It is also important to note that any proposed service reconfiguration must now pass four tests as prescribed by the current Health Secretary. These tests were set out in the Revised Operating Framework for 2010/11 and in addition to current business case guidance require existing and future reconfiguration proposals to demonstrate:

·         support from GP commissioners;
·         strengthened public and patient engagement
·         clarity on the clinical evidence base; and
·         consistency with current and prospective patient choice.

2.4       There is no doubt that the current environment is challenging.  In negotiating the changes proposed over the next three years and managing the costs pressures there is a need to ensure that planning to continually improve health and access to health services continues.

3          From Community Development Strategy to Locality Development Programme

3.1          Members will recall that the Community Development Strategy was described as emergent, hub and spoke with the major acute hospitals as hubs and a number of community facilities as spokes. This is underpinned by the following principles:

·         A stronger local area focus recognising the specific needs of different populations based on their incidence of ill health, social care environment and distance from major acute hospitals.
·         Targeting investment in areas where it has been identified that there is inequity of access to services and inequity in health outcomes.
·         Sustainable development looking across health and social care and across organisational boundaries. This may mean that in future more services are co-located and there is potential for development of shared information management systems.
·         Best use of available resources, be that land, buildings or staff. This means that we will look for innovate ways to release resources to help develop services. A good example is ensuring full utilisation of buildings which are subject to lengthy lease contracts without break clauses (such as LIFT and PFI) so that there is greater potential to release other NHS or Social Care owned  property/land  for disposal or cease short term leases.
·         A stronger emphasis on performance assurance throughout the local health and social care system.

3.2          During the period April to June 2010 a Community Development Strategy structure was devised to be implemented on completion of the PCT’s restructuring in July 2010. With the publication of the white paper this has been reviewed and revised so that the structure can tackle locality service development alongside emergent GP Consortia. It was also suggested by the Director of Public Health that a more appropriate term for this work would be Locality Development Programme and this was agreed.

3.3          Whilst implementing the governance structure for this programme has taken longer than originally intended, the work underpinning the programme has continued unabated especially in regard to infrastructure options and transitional care. The Project Initiation Document for the Locality Development Programme  which explains structure and rationale is detailed at Appendix A

3.4          The basic premise of the Locality Development Programme is that it will bring together infrastructure and logistics expertise with the locality commissioning team work that is being established following the PCT reconfiguration. This involves:

·         The continued development of revised intermediate/transitional care pathways.
·         The establishment of locality based GP consortia.
·         Work with the East Lancashire Estates Collaborative (a joint Director level forum looking at Estate across ELHT, NHS East Lancashire, NHS Blackburn with Darwen and Lancashire Care Trust)
·         The implementation of the CIAMS (Commissioning. Investment and Asset Management Strategy).
·         The continued development and implementation of the SMYL (Save a Million Years of Life) programme.

4              Infrastructure Options

4.1          There is recognition that there is public expectation around service developments in East Lancashire especially in regard to the proposed LIFT (Local Improvement Finance Trust) developments that have been deferred for Clitheroe, Colne and Great Harwood. Consequently the development of infrastructure options has concentrated initially on these localities.

4.2          A full report on the infrastructure options identified has been included at Appendix B and in summary this  indicates that:

·         Alternative solutions to the new builds originally proposed for Clitheroe, Colne and Great Harwood should be considered as the PCT no longer has a projected revenue position to support the increase in LIFT lease plus payments that these developments would bring over future years.
·         Alternative solutions could include smaller builds funded through in part or whole by land sale, refurbishment and service lease options.
·         There is a need to address the PCT owned estate around these developments to ensure maximum value for money.

4.3          Most importantly the options need to be discussed in detail with clinicians and the public in these localities to see if an agreed and sustainable way forward can be achieved. Initial discussions with GP’s in each area affected have been well received and there is both an understanding of the economic position and local needs which bodes well for the future. A particular concern of GP’s has been to try and ensure that there isn’t a commitment given to infrastructure development that is unaffordable or that will restrict service development opportunity post 2013 whilst recognising that some investment is still required.

4.4       There is also recognition of the need to build on the extremely valuable clinical needs assessment work undertaken in localities that led to the initial proposals for LIFT development. It is critical that there is an understanding that this is a continuation of service development work and not a cessation of it.  This is about how best to protect and expand services in a difficult economic environment. There are no plans to reduce or withdraw services at present.

5          Finance

5.1          In July 2010 NHS East Lancashire Director of Finance reported to the Board a forecast out-turn position for 2010/11 of a deficit between £5 and £6 million. A range of mitigating actions is taking place to try and address this position including the deferment of spending on new service developments.

5.2          Critically the estimated increase in revenue spending in future years should the three LIFT developments proceed as originally planned is £2.7 million per annum.

Proposed LIFT Scheme
Estimated Lease Plus Payment Per Annum
Estimated Savings per annum on Premises Replaced by Scheme
Estimated Net Cost Per annum


*Great Harwood

* Colne and Great Harwood had not reached business case stage and therefore lease plus costs savings estimates are based on the latest LIFT schemes that have closed. 

5.3       Given the forecasted financial position of NHS East Lancashire in 2010/11 and the known funding position for future years the proposed LIFT schemes are currently unaffordable and alternative solutions to infrastructure issues in these localities need to be found.

6              Conclusion

6.1          The financial position of the PCT and the need to review service development in the light of changes being introduced by the revised operating framework for the NHS and the White Paper mean that the three LIFT developments for Clitheroe, Colne and Great Harwood as originally planned cannot proceed.

6.2          NHS East Lancashire recognises the disappointment that people may feel in each of these localities but must stress that what is being proposed is not no investment altogether it is ‘different’ and hopefully sustainable development. In order to do this a range of options have been identified for discussion with clinicians and local people.

7              Recommendations

7.1          The Board is asked to note the progress made in developing alternative options and preparing the organisation for future changes. In addition the Board is asked to note that LIFT developments for Clitheroe, Great Harwood and Colne as originally proposed are no longer affordable and that there is a need to reconsider development in these localities as a result. In order to take service development forward in this environment the Board is asked to;

·         approve the establishment of the Locality Development Programme Board;
·         approve the commencement of engagement with stakeholders including clinicians and local people about alternative service and infrastructure development.
·         and confirm that whilst extremely disappointed that plans cannot progress as originally envisaged there are no plans to reduce or withdraw services at present.

Jackie Hadwen
LIFT Chief Executive

Appendix A



JULY 2010







3 – 6
Why Do We Need a Locality Development Programme?
3 – 4
Programme Rationale
4 – 6



6 - 10
Programme Objectives
Programme Structure and Methodology
6 – 9
Programme Timetable






Suggested Membership Locality Development Programme Board

Suggested Membership Commissioning Development Team

Suggested Membership Infrastructure and Logistics Team

Programme – Stage 1


1.1        Why do we need a Locality Development Programme?

NHS East Lancashire needs a Locality Development Programme principally to bring together commissioning development and infrastructure review work in order to ensure that both the difficult economic situation faced by the NHS and the organisational changes occurring within the NHS do not lead to a lack of appropriate and timely service development for local communities. Regardless of the challenges NHS East Lancashire faces we acknowledge our duty to serve our local communities as the NHS and continue to develop services that are equitable, accessible and meet local health needs.

The NHS East Lancashire Board have seen and discussed a number of papers over the past 12 months indicating a shift in commissioning intention that will require changes to the health system post Meeting Patient Needs. These include:

·         Urgent Care Strategy
·         Frail and Elderly Strategy
·         Transitional Care
·         Re-ablement/Rehabilitation
·         Management of Long Term Conditions
·         Review of Locality Hospital Use
·         Locality Development Strategy

There is a now a need to bring these strands of work together into a practical programme to test what it will possible to change to support the revised commissioning intention on a locality basis in terms of:

·         Equity of access
·         Affordability
·         Infrastructure
·         Provider capacity and capability
·         Clinical support
·         Partner support
·         Public support

The Locality Development Programme is ambitious and will continue to ask many questions of local services including:

·         Is current service provision appropriate and equitable in each of our localities?
·         How can we ensure provider innovation is factored into commissioning development?
·         How can commissioning support providers to make significant changes to services without destabilising the health economy?
·         Is current infrastructure capable of supporting the services that local communities will need in future years?
·         Is it possible to save money to support agreed service development priorities?
·         How can we work in a more integrated way with other public sector bodies to get the best possible solutions for local communities?

These are just a few of the key issues that the programme will inevitably have to address. This programme implements the strategic direction identified in NHS East Lancashire’s Commissioning Investment and Asset Management Strategy (CIAMS) and will take the strategy forward to identify tangible actions at locality level.

1.2      Programme Rationale

The Locality Development Programme is simply a structured way of confirming new ways of working that build on changes to the organisational structures, the Save a Million Years of Life programme (SMYL) and world class commissioning that are already in progress. The programme rationale is that if we can implement an effective way of devolving our planning to locality level for both service and infrastructure then we can achieve a number of things:

·         Clear recognition in our planning of what needs to be the same in each locality and what needs to be different? For example; is it right that not every locality has access to the same sort of provision for minor injuries/urgent care?
·         Planning at locality level should not be radically affected by changes in NHS organisational structures. A focus on local needs should prevent planning inertia due to regional and national changes.

·         Identification of what is possible within the resources available in order to provide value for money. For example; NHS East Lancashire has deferred three proposed LIFT developments in Great Harwood, Clitheroe and Colne. The Locality Development Programme will consider what the best options are for service and infrastructure development, what’s possible?

The programme aims to provide a structure robust enough to ensure delivery of the programme objectives and yet be flexible enough to adapt to what happens in each locality. Each of our localities, Burnley, Pendle, Rossendale, Hyndburn and Ribble Valley has its own Borough Council and its own unique health and cultural characteristics. One way of working may not fit all.

In addition transparency will be very important. This is about the best solutions for services and for patient’s not about one organisation or another. Working across organisational agenda’s and budgets whilst challenging will be absolutely essential. We are likely to see a need to change and flex the programme arrangements in response to this as the programme moves through stages from planning, approvals and through to implementation.

2             TERMS OF REFERENCE

2.1        Programme Objectives

The programme objectives are to:
·         Complete an agreed Locality Development Plan for each locality; Burnley, Pendle, Rossendale, Hyndburn and Ribble Valley by 01/04/11.
·         Ensure robust clinical, provider, partner and public engagement in the planning process.
·         Embed revised ways of working at locality level within NHS East Lancashire with partner organisations, clinicians and the public.

2.2        Programme Structure and Methodology

The programme structure has two principal strands Commissioning and Infrastructure and Logistics. Both strands will report to a Programme Board chaired by the Programme Director, Jackie Hadwen, LIFT Chief Executive. It is proposed that the Programme Board will report to both the NHS East Lancashire Board and QIPP Level 3 Board.

For each locality it will be important to both link with existing forums and develop new ones to ensure the opportunities for option appraisal and engagement are fully realised.

Locality Development Programme Board
The purpose of the Locality Development Programme Board is to:
·         Provide leadership to and governance for all aspects of the programme.
·         To ensure that programme progress is maintained.
·         To ensure that the programme has adequate resources to deliver the programme objectives effectively, on time and within budget.
·         To be able to escalate any programme issues requiring resolution at Executive Board level to NHS East Lancashire Board and/or Level 3 QIPP Board.

Suggested membership of the Locality Development Programme Board is detailed at Appendix A.

Commissioning Development Team

The purpose of the Commissioning Development Team is to agree and implement revised locality based working arrangements together with confirmation of commissioning priorities in each locality. Several strands of commissioning development will be progressed including:

·         Locality Based GP Commissioning Consortia
·         Urgent Care Strategy
·         Frail and Elderly Strategy
·         Transitional Care
·         Re-ablement/Rehabilitation
·         Management of Long Term Conditions

Suggested membership of the Commissioning Development Team is detailed at Appendix B.

Infrastructure and Logistics Team

The purpose of the Infrastructure and Logistics Team is to work alongside the Commissioning Development Team and seek to put in place the information and tools that will be needed to support option appraisals, approvals and implementation. The Infrastructure and Logistics Team will include Finance, Estates, IT, Human Resources and Provider Representatives’. Suggested membership of the Infrastructure and Logistics Team is detailed at Appendix C.

Links to Existing Forums

Wherever possible links to existing forums will be utilised to both monitor and progress work for example:

·         The East Lancashire NHS Estates Collaborative which is a meeting of Directors of Finance and Estates leads for NHS East Lancashire, NHS Blackburn with Darwen, East Lancashire Hospitals NHS Trust and Lancashire Care Trust is currently working to identify potential estate rationalisation opportunities.
·         The Commissioning Board will naturally oversee the work of the Commissioning Development Team.
·         Local Medical Committee’s
·         Neighbourhood Boards
·         Early involvement of Staff Side representatives.
·         Early involvement of Public representatives.

Locality Teams

The development of locality teams is paramount to the success of the programme in order to ensure that:

·         Clear service priorities for each locality are agreed.
·         A clear understanding of infrastructure, finance and logistics issues in each locality is realised.

Initially and until new government policy emerges to change or confirm the directives around joint public sector working  this will be centred around the principles of ‘Total Place’.  ‘Total Place’ is a government initiative being piloted in a number of area’s to look at the way in which best value can be delivered from public sector sites and services in a discreet area. The suggested membership of locality teams is:

Locality Commissioner
Locality Infrastructure/Logistics Lead
Local Authority Representative/s
Provider Representative/s
Other Public Sector Representatives eg: Police/Fire/Ambulance

This may vary depending upon existing meeting structures in each locality and the appetite of other public sector partners to participate. One of the biggest programme challenges will be to devolve planning to locality level without fragmenting the overall aim of delivering best value equitable care for all.

2.3      Programme Timetable
The work is divided into three broad stages:

Programme Planning
  • Programme structure and governance for planning stage
  • Informal clinical and partner engagement
  • Information  and data gathering/ testing

June – September 2010
  • Project Initiation Document – July 2010
  • Report to September 2010 Board confirming project scope and plan.
  • Initial option appraisal.
  • Programme structure and governance for engagement stage
  • Formal engagement
  • Business Case Production
September 2010 – April 2011
  • Project Execution Plan
  • Business Case
  • Programme structure and governance for implementation stage
  • Continued engagement
  • Transition Planning
April 2011  onwards
  • Agreed transition plan overall and for each locality
  • Changes successfully implemented.


Programme deliverables are those items which will need to be delivered in order to progress the programme to timetable. The table below outlines the deliverables for Stage 1 of the programme. These are not totally inclusive and may be added to as the programme is established:





Confirm Locality Based Commissioning arrangements in line with revised commissioning structure.
Associate Director of Commissioning
Confirm Commissioning Locality Leads
Associate Director of Commissioning
Establish Commissioning Development Team
Associate Director of Commissioning
Infrastructure and Logistics
Establish Infrastructure and Logistics Team
Programme Director
Infrastructure and Logistics
Complete discussions with Local Authorities regarding infrastructure planning forums re Total Place
Programme Director
Establish Locality Development Programme Board
Programme Director
Confirm key service development  issues to be addressed in each locality
Associate Director of Commissioning
Infrastructure and Logistics
Develop and implement communications plan for Stage 1
Programme Director
Commissioning and Infrastructure and Logistics
Deliver locality based workshops to consider initial option appraisal and future working arrangements
Programme Director
Develop and implement programme risk register
Programme Director
Infrastructure and Logistics
Confirm key infrastructure issues to be addressed in each locality.
Programme Director

Appendix A

Suggested Membership Locality Development Programme Board

Job Title
Suggested Locality Development Programme Board Role
NHS East Lancashire Director of Commissioning
Lead Executive Director for the programme and Commissioning governance.
NHS East Lancashire Director of Corporate Services and Public Affairs
Programme governance. Communications and engagement governance.

NHS east Lancashire Director of Public Health
Health Planning Priorities
NHS East Lancashire Director of Finance
Financial governance.
Programme governance.

PEC Chair

Clinical governance.

LIFT Chief Executive

Programme Director and Chair
LCC Representative

Social services and education links for all Boroughs.
Provider Representatives x 2
Links to principal local providers. Nominated representatives from East Lancashire Hospitals NHS Trust and NHS East Lancashire Provider Services Unit.
NHS Blackburn with Darwen Representative
Links for Pennine Lancashire
NHS East Lancashire Associate Director of Commissioning
Chair of Commissioning Development Team

Appendix B
Suggested Membership Commissioning Development Team
Job Title

Suggested Commissioning Development Team Role
NHS East Lancashire Associate Director of Commissioning
NHS East Lancashire Director of Commissioning
Lead Executive Director for the programme and Commissioning governance.
LIFT Chief Executive

Programme Director
PEC Member
Clinical Lead
Senior Commissioning Managers x 3

Lead Managers for Commissioning Workstreams
GP Consortia Leads
Consortia development

Appendix C

Suggested Membership Infrastructure and Logistics Team

Job Title
Suggested Infrastructure and Logistics Team Role

LIFT Chief Executive

Programme Director and Chair
NHS East Lancashire Associate Director of Corporate Services and Public Affairs
Communications and engagement planning.
NHS East Lancashire Associate Director of Finance
Financial information and planning.
NHS East Lancashire Associate Director of Estates and Facilities
Estate and facilities information and planning.
Eric Wright Group Representative (LIFT)
Commercial development and property planning support.
PCT Informatics Unit Representative

Information Technology planning.
NHS East Lancashire HR Representative
Workforce planning.
Provider Representatives (ELHT and PCTs)
Provider planning.

Appendix B

Alternative Options for Development in Respect of Clitheroe Community Hospital, Great Harwood Health Centre and Colne Health Centre.

1          Introduction

1.1       NHS East Lancashire’s CIAMS (commissioning Investment and asset management strategy) sought to consolidate up to date estates information in a way that supports commissioners to align their future service strategies, to the quality, location and accessibility of their existing estate and identify area’s for development. 

1.2       The announcement of the QIPP (quality, improvement, performance and productivity) agenda, and more recently, the NHS White Paper, Liberating the NHS has accelerated the need to work collaboratively across the health economy and maximise any commercial leverage from 3rd party developments, housing opportunities, co-location and land disposal.

1.3       This paper identifies potential options for NHS East Lancashire in regard to the deferred LIFT developments for Clitheroe, Colne and Great Harwood.  

1.4       It should be noted that there has been insufficient activity within the commercial land and property market over the past two years to provide any degree of price certainty, therefore the figures and information quoted in this report air on the side of caution, but remain an opinion.  In all instances of negotiation, selling with the benefit of planning consent remains the best possible option for maximising land value.

2          Clitheroe Hospital


Gross area                              1.91 ha or 4.74 acres
Net developable area              1.49 ha or 3.7 acres

(the above figures include (gross) & exclude (net) the front land with mature lime trees - which Ribble Valley Borough Council favour retaining.

Adjacent field site                     1.13 ha or 2.8 acres. 

Total developable area 6.5 acres 

2.1       The original proposal for a LIFT development on the Clitheroe Hospital site was to build a new development of 6500 sq.m at a build cost of approximately £12 million on land adjacent to the existing hospital. Following the transfer of services the existing hospital site would then be sold. Planning permission for the new hospital development was received in 2008.

2.2       The principle of residential development on the Clitheroe Hospital site has been established with the planners, although a residential application was refused last year on the grounds of loss of the original workhouse (existing hospital building) – this objection was lodged by the Civic Society. However, it should be noted that as the building is not listed NHS East Lancashire would not require planning consent to demolish it.  

2.3       Residential land values can be influenced by a number of factors, such as market conditions, planning restrictions, affordable housing allocations, as well as requirements for Section 106 contributions.  Given the hospitals location within the Ribble Valley and a sensible view of all other factors, a significant sale receipt should be achievable with the benefit of an outline planning consent.  Selling without planning consent would restrict the value and whilst overage could protect the PCT, this is not the optimum means of sale and value realisation

The following options are available to be considered as an alternative to proceeding with the original scheme which is currently unaffordable:

1.    Sell the hospital site and develop a new health centre on the adjacent field
2.    Sell the hospital site and adj. field and develop a new facility within the town centre (subject to land availability)
3.    Sell Clitheroe Health Centre and the hospital site and develop a combined facility on the adjacent field site, which has consent for a 6000m2 health centre
4.    Sell the field owned by the PCT and invest the sale proceeds back into the hospital to alleviate back-log maintenance/refurbish
5.    Develop the hospital site with an Extra Care provider who could potentially provide a cash receipt (value unknown) as well as accommodate any health provision required by the PCT. 

2.4       Development sites are scarce within the centre of Clitheroe. Any alternative sites would require land assembly of multiple ownerships - this would inevitably add time, cost and uncertainty into any site acquisition. 

3          Land and Health Centre at Great Harwood

3.1       The original proposal for a LIFT centre in Great Harwood was for a 4500 sq.m health centre at an approximate build cost of £8 million. NHS East Lancashire purchased the Albion Mill site adjacent to the existing health centre in 2009. The current health centre is 960sq.m in constrained and unsuitable accommodation.

3.2       As an option alternative scheme has been produced which sites a 2,500 m2 health centre at the southern end of the Albion Mill site,  This scheme allows the development of a smaller health centre to take place, whilst existing services continue to operate within the current building.  Once the new development is complete, the PCT could transfer service into the new building, and the existing health centre would be demolished to provide space for the development of a larger car park.  The outline of this scheme is attached as Appendix A to this document.  In capital terms a new build of this size would cost approximately £3.25 million.

3.3          This proposal would release approximately 1.16 acres for residential development, which could yield the PCT a land receipt in the region of £500,000.  The cost of demolition and site clearance would need to be deducted from the above figures, which has previously been reported at £250,000.

3.4       A further option that could be considered for Great Harwood is to lease alternative accommodation in the Town Centre. If this could be combined with a commercial partner such as a pharmacy then it could be possible to offset lease costs.

4          Land and Health Centre at Colne

4.1       In 2009 the PCT purchased the Kwik Save store, located near Craddock Street, Colne for the development of a new health centre.  Outline planning consent was obtained on 16 February 2009 for the demolition and construction of a 4 storey health centre, including medical units, access and parking – reserved matters were held for 3 years meaning the PCT would need to complete design etc. before February 2012 to proceed under the existing permission. 

4.2       There are several options which can be considered as follows:

·         Liaise with the Council and other public sector organisations to establish whether there is any requirement for short term use and/or market the building on a short term lease. This would involve additional costs in reconnecting supplies, removing boarding up etc. but would eliminate the operational costs of rates etc  if successful.
·         Demolish the building.  This would remove almost all operational costs but would preclude future use of the building itself and remove any value in the existing building in any resale.  It is considered unlikely that any such value exists but final confirmation of this ought to be obtained before proceeding in this manner
·         Sell the site and continue to deliver services from the existing health centre, utilising the site sale proceeds for other purposes

·         Dispose of the Kwik Save site and utilise the capital receipt to invest in the existing health centre
·         Explore the opportunities for a smaller health facility as part of a joint development with other parties, either public sector or commercial, to reduce cost to PCT
·         Utilising the sale proceeds or anticipated sale proceeds of the existing health centre to contribute towards the re-development on the existing Kwik Save site

5          Conclusion

5.1       For all sites there are a range of potential options that can be developed and tested to try and achieve an affordable solution to infrastructure and service development in these localities. In order to prioritise discussion is now needed with local commissioners, clinicians and the public.

Appendix A – Example Alternative Site for Land at Great Harwood