Sports stadiums are proving mutually attractive as shared sites for NHS health centres, and interest in such ventures is on the increase. Lynne Greenwood is your commentator
When fans of Championship football club Preston North End turn up to watch their team next season, they may well pick up useful health and lifestyle advice along with their match day programme.
Beneath the fourth and final new 3,690-seat stand of the team's Deepdale ground redevelopment will be a healthcare facility serving a much wider population than regular supporters of the club.
Central Lancashire primary care trust, which serves a population of around 450,000, has signed a 25-year lease with the club to provide a long-term conditions centre at the ground. Aimed at centralising care for patients and providing new services, the two-storey, 2,200 sq metre health centre will cater for patients with conditions including diabetes, chronic obstructive pulmonary disease, asthma and some heart and neurological conditions.
Services will also include dietetics, phlebotomy, podiatry, retinopathy and counselling, some of which are currently provided at primary, secondary and community facilities across the city.
The centre also plans to take advantage of a captive audience - the average crowd of 13,500-plus predominantly male fans who regularly watch Preston's home games - to deliver health promotion and lifestyle information which they might otherwise not access.
'I am very excited about the concept; now we have to make it work,' says PCT chief operating officer Mark Hindle.
A similar concept is already working at Warrington Wolves' Halliwell Jones stadium. The town's PCT opened a£1.3m health centre beneath a stand at the rugby league club's ground in April 2005 (see 'Teaming up for health' below). It is here that patients come for services including ophthalmology, continence, podiatry, physiotherapy, paediatric speech and language therapy and the triage of orthopaedic referrals. The centre also houses community rehabilitation and has introduced district nurse sessions.
Now other professional sports clubs are eyeing the Warrington model and weighing up opportunities to marry their own need to secure income for redevelopment with the needs of PCTs to find sites that can accommodate a range of services in the heart of a community.
That was the situation at Preston. Building started on the health centre in September in tandem with the final phase of the football ground's redevelopment, which started 11 years ago.
The club and trust came together two years ago when the former Preston PCT wanted to provide new facilities in the inner-city area of Deepdale, which has high levels of deprivation and a high percentage of minority ethnic populations. One in six people has a long-term condition.
Engage with community
There was also a desire to address the treatment provision of patients with diabetes and chronic obstructive pulmonary disease, in particular.
Mr Hindle, then director of corporate development for the former PCT, explains: 'This development was driven by public health needs in one of the city's most deprived areas. We wanted to develop services and if possible to provide a community resource out of normal hours, both of which required a new building.
'We wanted to place the new facility right in the heart of an area with its own needs, so we could engage with that community,' he adds. 'We want to help to overcome the poor take-up of screening facilities by some groups of minority ethnic women, to address the undiagnosed prevalence of diabetes in some of the population of Deepdale and encourage those patients to access care.'
A business case was developed, analysing the health needs and the size of building required to meet that need. An appraisal was made of suitable sites with good public transport links and car parking.
The initial plan was for the PCT to provide capital funding for a building programme. But in Preston, growing rapidly since it gained city status in 2002, the number of appropriate sites was limited, particularly in Deepdale.
Available land included Preston North End's former training ground, close to the football ground but no longer in use. But after it was decided this would not be appropriate, as this option would significantly diminish the number of parking spaces, Preston North End suggested the health centre could become part of its latest new stand.
As Frank Whittle Partnership, the architecture practice responsible for the stadium redevelopment, had also worked on several local projects for the NHS, it made sense for the firm to get involved once clear governance arrangements were established to ensure there was no conflict of interests.
'A detailed financial analysis was made, comparing the capital costs of the PCT buying land, building a new centre, fitting it out and maintaining it, with a 25-year lease on a building developed and fitted to our specifications by a third-party developer,' says Mr Hindle.
The third-party development model, which works in a similar way to the private finance initiative, means the football club develops and fits out the centre, with the PCT incurring no capital costs. The result was a£350,000-a-year lease, finally agreed after hugely complex and time-consuming negotiations.
Mr Hindle warns: 'Anybody going into this should not underestimate the time it will take, even before building can start. This is not building on a brownfield site, but choosing an innovative and different option, working with a football club, building clinical facilities in a different type of building and that all takes time.'
The financial appraisal and risk assessment concluded in favour of the project. Frank Whittle Partnership senior partner Martin Whittle says: 'Most new football stands at clubs outside the Premiership need to be funded by revenue income from the space beneath the stand. In this case it provides a terrific location for the PCT, with car parking.'
But ultimately, says Mr Hindle, the deciding factor was the benefit of a health facility set in partnership with a football stadium, since the venue naturally attracts a population known for its reluctance to seek out health advice.
'Where better to practise health promotion - by handing out leaflets or signposting to services - than a football club which draws 12,000-15,000 people, predominantly men, on match days? It's a huge population with whom you can make a difference. The additional health benefits, the added value of building on this site, was an overriding factor.'
Information about diet and obesity, nutrition, smoking cessation, alcohol, prostate screening and general well-being could all be made available to football fans attending matches or visiting the stadium.
Although the clinic - which will eventually have the capacity to open from 8am-8pm - will be closed to patients on match days, there is no reason why its reception area cannot be open for health promotion. Car parking is another benefit, with spaces not only for staff and visiting patients, but also for mobile breast, computerised tomography and magnetic resonance scanning units.
Special docking stations to accommodate the units are being incorporated into the car park, as this is seen as a venue more likely to persuade some of the population to attend breast screening than alternative hospital locations or sites further afield. Vital clinical input and support has come from a 10-strong multidisciplinary team which assessed everything from health needs building design to the services it should provide.
Consultant diabetologist Simon Howell, who has been involved in the project for over three years, says: 'Having a centre with the potential for closer working between primary and secondary care is a distinct advantage. With lifestyle change - diet adjustment and exercise - being a cornerstone of diabetes treatment, the location at a sports ground is also good.'
Dr Howell believes the centre will serve those patients who require more treatment than is available at their GP surgery, but not enough to require a hospital visit. However, he cautions that the centre cannot replace the secondary care required by many people with diabetes.
Other reservations have been expressed. Although the site is well served by bus routes, there were some complaints during the public consultation process - partly conducted through the city's Muslim forum - that the 80 or 200 metres from the nearest bus stops was too far.
Then there are the financial implications, one of the two main areas of concern in the early negotiation stage, when not everyone was convinced about the plans. Concerns centred on the risk of going into partnership with a football club and the implications for local secondary care services. 'There was a nervousness about the balance sheets of football clubs and what would happen if Preston North End were to go out of business,' Mr Hindle explains.
'People asked what would happen if we invested capital - NHS money - and the club folded. Yet the club has been there for 140 years and how many other businesses in Preston can say that? And paying through a third party developer lease significantly minimises the financial risk to public money.'
Much of the doubt was countered by strong arguments that the new facility is in line with the Department of Health's Our Health, Our Care, Our Say policy - it will create services near to where people live, or relocate them from other providers' sites, such as hospitals.
With the co-operation of Lancashire Teaching Hospitals foundation trust, in a debate focused on clinical rather than financial needs, Mr Hindle is confident of the outcome: 'We appreciate that it may have a significant impact on the income of the foundation trust and we need to resolve the funds flow issue.
'It's our job as managers to sort out the money and we are not letting payment by results as an example stand in the way of doing the right thing. We are not in conflict but it is an important issue which needs to be resolved.'
Preston North End chair and the man behind the ground redevelopment Derek Shaw is equally enthusiastic: 'The partnership with the PCT is fantastic for the city, for the football club and for the people of Preston; especially those who live in Deepdale.
'We would have been unable to raise the funding for the fourth new stand to complete our ground without such an agreement. It is something which similar clubs to ourselves - in the Championship or League One - will be looking at enviously.'
Mr Shaw is keen to stress that the PCT will have the club's full support for any health promotional activities they want to carry out on match days with their fans. 'That work can only benefit everyone,' he says.
The health centre entails design challenges such as creating enough natural light and ventilation in a building beneath a football stand. It is 'designed to make a statement about health' with a large, welcoming reception area which will house a cyber cafŽ and health information on screen.
Frank Whittle Partnership associate partner Phil Nealen liaises with the PCT. He says the front of the building will be glazed, with a 'street' running through the building, from which will lead four glazed extra-wide corridors housing 'consulting clusters'. The first floor will be office space, with a 'hot desk' area for visiting staff.
Mr Nealen believes that although Frank Whittle Partnership's experience of working in both sports stadia and health is important, it is essential that a different architect is responsible for each element of the redevelopment.
'It would have been almost impossible to have two separate architectural practices working on the stadium and the health centre and yet it is important that they are under the control of two different people,' he says.
The club expects the stand to be ready for the new season. Although the health centre structure will also be complete, the more complex fitting out of the building is expected to take another three months, with an opening scheduled before the end of 2008.
Teaming up for health
The Preston scheme is one of a number of partnerships planned between primary care trusts and local sport clubs.
Warrington Wolves were pioneers in taking the link between health and sport further. Its healthcare centre opened in April 2005.
The Wolves initiative has allowed Warrington PCT to redesign services in an enhanced clinical environment. A recent patient survey showed 99 per cent of patients were very or fairly satisfied.
Acting director and chief operating officer of the community services unit Carole Hugall says: 'The initiative has enabled the PCT and community services unit to improve patient care and, two years on, it is clear the benefits to patients are being realised.'
West Hertfordshire Hospitals trust is hoping to set up a PFI partnership with Watford football club, to build a new hospital as part of a development which includes a new stadium.
A planning application for the Watford health campus encompasses a£270m private finance initiative acute hospital, primary care facilities, a redeveloped stadium, affordable housing, hotel and conference centre and small business units.
Trust chief executive David Law says the development will make the trust even more competitive in the era of patient choice. But at Oldham, where phase one of a major£80m redevelopment of Oldham Athletic's football ground is expected to start this month, an approach by the football club to work with Oldham PCT and Pennine Acute Hospitals trust has been rejected.
Football club director Ian Hill is responsible for the redevelopment. He visited the Warrington scheme and says that as Royal Oldham Hospital is close to the football ground - and uses some of the club's parking facilities already - it seemed to him that a new partnership might be appropriate.
'We are planning to build some housing as part of our development and would be happy to include some properties for key workers at the hospital if it is needed,' he says.
But both trusts say they have no plans to take space in the new stadium.
Blackpool PCT and Blackpool council's social services are now based in the new stand at Blackpool football club's Bloomfield Road ground, overlooking the pitch, but there are no clinical facilities on the site.