Curtain up on £1bn health investment in capital of culture

Spectator leaders aside, the city of Liverpool and the wider Merseyside region are basking in relative glory just now.

Not only is the city set to receive multi-million pound investment in its infrastructure, arts and entertainment after being chosen as European Capital of Culture for 2008, but the entire North Mersey region's health service got the government nod in July to invest over£1bn in modernising the 'whole system'.

The North Mersey healthcare programme, as it is now known, is seen as one of the most ambitious NHS modernisation schemes, both in size but also in its corporate approach. Spanning the population of five primary care trusts (Knowsley, South Sefton, Central North and South Liverpool), three local authorities (Liverpool, Knowsley and Sefton) it will affect acute services accessed by a core 700,000-strong population.

Although the investment comes relatively late compared to similar projects in other major English conurbations, the project has been on the drawing board since 2001, when a major review of adult acute services began with the prime objective of winning cash to revamp facilities at Aintree Hospitals, and Royal Liverpool and Broadgreen University trusts.

Strategic reviews of services for children and women were also under way at the time.

Cheshire and Merseyside strategic health authority chief executive Chris Hannah says the creation of PCTs and SHAs in 2002 brought a different focus to what had been a cluster of individual capital development schemes.

'When the SHA set up it was commonly accepted in the local system that the process had been drifting, ' she says. 'It was very much seen as different projects run by separate organisations without any glue in it in terms of a strategic direction for the conurbation.'

The integrated, corporate capital bid that was eventually submitted to the DoH reflects how the SHA has tried to get its health economy to work as 'one NHS'.

'When the submission was made it went as one project - it all stood and fell together, which is what made it unique, ' says Ms Hannah.

'That journey has not been easy, but the system has demonstrated maturity in saying: 'let's come together'. We owe it to the local population to have modern health services delivered in modern buildings. People will not take us seriously if we had four or five strategic outline cases covering the same population - which was a very possible outcome at one point, ' she adds.

NHS and local authority agencies in Liverpool and the wider North Mersey region have a well-established reputation for tackling health improvement. The city's decision to become the first in the UK to ban smoking in public places is the latest and boldest initiative to tackle health inequalities since it joined the World Health Organisation healthy cities project in the '80s.

And more recently it won plaudits for its intervention work in the now defunct Merseyside health action zone.

However, traditional hospital services in the region are perceived to have failed to keep up with - and perhaps, hindered - modernisation.Now that is about to change.

Proposals for the£1bn healthcare programme include:

£270m to redevelop 'some of the oldest stock in the North West' at Royal Liverpool Children's trust's Alder Hey Hospital and shift a large proportion of its specialist paediatric services into primary care, perhaps by the construction ofa dedicated 'Children's Park';

A£499m redevelopment of Royal Liverpool University Hospital to take on more unplanned treatment alongside a proposal to shift more elective care to University Hospital Aintree with the£91.5m construction of a specialist centre and additional wards. Aintree Hospital trust is keen to shift all current services from its Walton Hospital site to 'free it up for alternative use as a community facility';

Mersey Care trust is proposing to use£147m to expand mental health provision in community settings and to establish a psychiatric intensive care unit.

The programme is clearly designed to shift as much care as possible out of traditional hospital sites into both specialist and general primary care centres.

'We are not talking about a major reconfiguration of where services are provided between hospitals, but a model of care that is about shifting from hospital-based care to much more care delivered through NHS centres in primary and community settings, ' says Ms Hannah.

However, whether the proposals will actually be what the 'population' want has yet to be established. Full public consultation on finalised proposals for each site is expected to begin after an 'inquiry by design' with representatives of all relevant organisations and patient groups, designed and run by the Prince's Foundation.

The week of intensive consultations takes place in January.

The timing of consultation - just months away from a general election - carries the risk of political hijack.

The turn of events in the recent Hartlepool by-election (news, page 5, 23 September) and unwanted intervention from the centre in north London a few weeks ago (news, page 4, 23 September) will be fresh in the minds of programme managers.

'Of course We are aware of the potential hazards, but I really do not think it will be a problem here, ' says Ms Hannah.

'This is seen as good news for Merseyside and I think everyone acknowledges that.

'The Inquiry by Design process is seen as very inclusive - we have three elected members on the steering group, and we will be clear about getting agreement on what goes where, and which buildings will stay open, ' she says.

Programme lead Kate Abendsten says the involvement of clinicians in the programme from the start will be crucial to its success in winning the public's hearts and minds.

'The difference is we have real clinical buy-in from the bottom level up - which usually doesn't happen in the NHS.'