Forth Valley Royal Hospital Post Project Evaluation of New Hospital Build. Health Inequalities Impact Assessment (HIIA) April 2013

Transcription

1 Forth Valley Royal Hospital Post Project Evaluation of New Hospital Build Health Inequalities Impact Assessment (HIIA) April 2013 Authors Louise E Hammell, Public Health Officer (Health Intelligence) Dr AnneMaree Wallace, Director of Public Health

2 Scoping workshop A Health Inequalities Impact Assessment (HIIA) scoping workshop for the post project evaluation was held on Wednesday 31 st October The following representatives participated in the exercise: Dr AnneMaree Wallace Jo Marwaha Debbie Sigerson Louise Hammell Tom Hart Dr Peter Murdoch Paul Fisher Alison Brown Rita Ciccu Margaret Ogston Diane Keir Tom Steele Lynn Waddell Martin Watson Lorraine Beattie Director of Public Health, NHS Forth Valley Senior Equality Officer, NHS Health Scotland Project Manager, NHS Health Scotland Public Health Officer (Health Intelligence), NHS Forth Valley Employee Director, NHS Forth Valley Consultant Geriatrician and Assistant Medical Director NHS Forth Valley Strategic consultant, Mott Macdonald Healthcare planner, NHS Forth Valley Lead nurse, NHS Forth Valley Systems and administration manager, NHS Forth Valley Theatre manager, NHS Forth Valley Director of projects and facilities, NHS Forth Valley Equality and Diversity project manager, NHS Forth Valley Forth Health Serco Apologies were given from Maureen Coyle, Helen Bauld and Mike McKay (Lorraine Beattie was in attendance for Mike McKay). 1

3 Project background NHS Forth Valley is carrying out a Post Project Evaluation of the Forth Valley Royal Hospital (FVRH). A multi-agency group was formed in June 2012 to carry this out. The purpose of the evaluation is the following; The Phase 3 Evaluation will determine if FVRH has achieved the objectives described in the Outline Business Case and will provide a record of the key facts relating to the project to date. A Health Inequalities Impact Assessment (HIIA) was carried out to contribute to the evaluation to help address two of the questions in the Outline Business Case: How has FVRH contributed to improving Forth Valley s Health? How has FVRH contributed to reducing the health gap between rich and poor? Ideally an impact assessment would have been carried out at the development stage of the project and this impact assessment would have assessed if the anticipated positive impacts had come to fruition and the negative impacts had been mitigated against. The time of the original business case for the new hospital predated common usage of HIIA; so unfortunately there was no record of an impact assessment being carried out at the initial development stage. The Outline Business Case stated that the new hospital would improve the health of the people of Forth Valley and reduce inequalities. While these are very difficult to prove, the Health Inequalities Impact Assessment looked, in a systematic way, at the impact the new hospital building has had or is having on a range of different population groups as well as the staff. Background to the Impact Assessment Impact assessment is a key way to analyse and ensure the fairness and effectiveness of policy decisions. The process seeks to define the likely positive and negative health, equality and human rights impacts of a policy (including unintended impacts) and the population groups that will bear them. The assessment considers impacts on equality groups and other potentially affected populations. Impacts on disadvantaged groups, who already suffer poorer health, are particularly important. 2

4 The process also outlines mitigating actions, should negative impacts be identified and presents an opportunity to enhance the positive intentions of a proposed policy. Impact Assessments are legislated under the Scottish Public Sector Equality Duties as part of the Equality Act Other documentation in support of the impact assessment process includes the Christie Report, NHS Healthcare Quality Strategy, Equally Well and the UK Human Rights Act The Equality Act 2010 introduced the term protected characteristics to refer to groups that are protected under the Act. These are: Age Gender Gender reassignment Disability Religion and belief Sexual orientation Race Marriage and civil partnership Pregnancy and maternity Scope of the Impact Assessment Because of the size of the project the impact assessment remained at a high level. It did not go into the detail of the impacts on different patient/staff groups, but looked at them in general terms. While the assessment was mainly retrospective, it generated a few issues which need to be taken forward. These will be fed back to the evaluation group for discussion and agreement. The scope of the impact assessment of the Forth Valley Royal Hospital is to evaluate the impacts on the population, including patients and staff as a result of the building project. Key affected groups and potential impacts Impacts were assessed in three different, but overlapping ways; by population group, including those with protected characteristics and those likely to be affected; by types of impact rooted in the social determinants of health; and by human rights characteristics. The outcome of the discussions is shown in Tables 1, 2 and 3 in Appendix 1. 3

5 Strength of evidence for the Impact Assessment The Health Inequalities Impact Assessment (HIIA) was based on the knowledge of the participants most of whom have been involved over the lifetime of the building project from inception to completion. Further evidence was based on material which appears in other parts of the evaluation. The participants in the impact assessment workshop were asked to consider drawing upon three types of evidence to inform their judgements of the impacts identified, recognising that some evidence sources may straddle all three: 1. Data: profiling the characteristics of communities including business intelligence. 2. Consultation: findings from consultation on the new build (with professionals and the public) and previously conducted research e.g. community engagement and patient experience. 3. What works: research evaluations on the impacts of similar proposals and reviews of effective interventions. Examples of some of these sources are provided in Appendix 6 of the HIIA guidance document. Impacts on population groups Groups and individuals with protected characteristics A wide range of features of the FVRH building were identified which have a positive impact of groups with protected characteristics. These include for example, a higher percentage of single rooms, separate corridors for patients and visitors, separate entrances for different groups of patients and features to improve infection control. Negative features included the need for improved signage and access issues. Other groups In terms of other groups, positive impacts identified included significantly improved facilities for staff, improved security with, for example, police officers based on site and easy availability of the cashier s office and the Citizen Advice Bureau (CAB). Negative impacts included signage for those with low literacy and access for older people from remote and rural areas. 4

6 Social determinants of health Impacts on lifestyle, equality, the social environment, the physical environment and the quality of services were assessed. Positive impacts could be seen for all the areas. These include, for example; A partnership with the Forestry Commission Scotland and Central Scotland Forest Trust which seen tree planting, existing paths upgraded, the creation of new paths and cycle tracks and the appointment of a community ranger. Tai-Chi has been piloted for staff and members of the community within the hospital grounds to improve health and well-being. Vastly improved staff training facilities with a dedicated learning centre. Improved access for patients and visitors who have mobility issues with improved drop off facilities. Human Rights A number of positive impacts were identified, such as improved privacy through an increased proportion of single rooms and increased quality of care as a result of the new environment. No negative engagements with human rights were identified by the group. Conclusions A wide range of positive impacts of the FVRH build were identified, both impacts during the project and from the building as it now stands. In that sense it can be said to have improved the health and wellbeing of some of the population of Forth Valley. There has been no measure of these improvements on health outcomes. Most of the negative impacts had already been identified and were either mitigated against or in the process of being addressed. The outstanding issues identified were; Signage used in corridors, lifts and wards. Inaccessibility for disabled and those with mobility issues to the spiritual care centre. Insufficient car parking spaces for staff and visitors. 5

7 In addition many of the positive aspects continue to be developed such as the development of the hospital grounds and its use by different groups of staff, patients and the community. It was not possible to demonstrate that the FVRH had contributed to reducing the health gap between rich and poor as the positive and negative impacts of the building will apply equally to all income groups. However this exercise has systematically assessed the impacts of the FVRH for a range of groups and changes have either been made or will be made to mitigate against the identified negative impacts. 6

8 Appendix 1 Note: This is a note of discussions at the scoping workshop on 31 st October This has informed the summary in the main body of the report. Table 1: Which groups of the population protected by the Equality Act 2012 do you think will be affected by this development? Protected Population group characteristic Age Older people 1. Due to fewer acute beds care is being driven closer to home. 2. Purpose built Day Surgery Unit. 3. Patients will soon be able to park closer to the cardiology department and will be able to utilise the staff entrance. 4. Designated route to the mortuary which is important for dignity of the deceased patient. 5. Increased number of side rooms within the wards for family privacy. 6. Practical changes will be applied to issues surrounding the signage. 7. Large open space seating area is regularly used by patients, staff and visitors throughout the day. 8. Movement of patients and visitors through separate corridors has increased the dignity of care and improved infection control. 9. An increase in single occupied rooms has led to improved infection control. 10. Separate sections of the building accommodate women and children, the Renal Unit and Rehabilitation with separate entrances for all. This provides How these groups may be affected differently by the development? Positive affect Negative affect Comments 1. There are fewer acute beds which has resulted in an increased challenge on the capacity of the hospital. 2. Walking distances within the hospital pose as a problem for individuals with mobility issues as the wards/ departments cover large areas. 3. There are access issues for older people who live in rural communities. 4. The distance of the cardiology department to the front entrance is an ongoing concern. 5. Signage in corridors, lifts and wards needs to be addressed. 6. Insufficient care parking spaces for staff and visitors. 7. Anti-slip floors throughout the hospital prevent falls but can also pose as a hazard for certain patients with mobility issues. There is an increasing ageing population within Forth Valley. There was an increased demand on emergency services across all ages across Forth Valley. 7

9 rapid access for patients who may have medical or mobility issues. 11. Calmer surroundings of the hospital improve mental well-being. 12.To improve the environment of the hospital Forth Valley is taking forward an innovative new art strategy ( ) as part of a collaboration between Creative Scotland and partner local authorities. The Forth Valley Art Strategy is designed to involve patients, service users and staff, focusing on three main priorities: Creating artworks for hospital waiting areas and other spaces Commissioning arts projects for major public spaces. Developing art exhibitions and events programmes. People in their middle years See also: Age: older people: positive effect: 2, 5, See also: Age: older people: negative effect: 4-7. See also: Age: older people: comments:2 Young people (under 25s) See also: Age: older people: positive effect: 2, 5, See also: Age: older people: negative effect: 4-7. See also: Age: older people: comments:2 Young children and families 1. Designated neonatal rooms for parents to stay without the parent having to be admitted to hospital. 2. Designated rooms are available within the paediatric ward for parents to stay. See also: Age: older people: negative effect: 4-7. See also: Age: older people: comments:2 8

10 Gender Men Women 3. There is reduced walking time to theatre due to the location of the ward and theatre. 4. See: Age: older people: positive effect: Children s Spaces Project: This project is currently in development to decorate FVRH s Children s wards as part of the process of creating imagery and narratives for children. 1. There are separate feeding and baby changing facilities available regardless of gender. 2. Local employment opportunities were available during the building of FVRH. 1. See also: Gender: men: positive effect: Employment opportunities were available for all female workers at the initial build construction: Design phase: There was a high percentage of female man hours involved within the design phase with 30% of the work force being female. This included senior positions including a lead architect and a building services engineer. Management Organisations: 20% of the management organisations including administration were female. 9

11 Gender reassignment Transgender Workforce: The numbers were very small at < 1% of the peak complement of 1300 workers being female. 1. All x-ray cubicles are unisex. 2. Transgender individuals are treated in their preferred gender. Disability Physical disability 1. Possibility of a coin/ token operated wheelchair access to allow visitors/family to assist friends/family who requires a wheelchair. 2. Changes identified for doorways that are currently held open or automated. 1. The number of disabled parking spaces is compliant with regulations but is still insufficient. 2. Waiting time for porters to take patients to wards who require assistance with a wheelchair. 3. No areas for adults to self-change, this is not presently within the building regulations. 4. Televisions at each bedside may be disadvantageous for access in and out of bed. 5. Public toilets are difficult to access for those who use a Zimmer frame. These individuals would have to use the disabled toilet. See also: Age: older people: negative effect: 7. Learning disability 1. Issues with signage used in corridors, lifts and wards which is not user friendly to learning disabled people. Sensory impairment 1. Designated area for guide dogs. 1. Issues with signage used in corridors, lifts and wards which is not user friendly to those with a sensory impairment. 10

12 Long-term conditions Mental health problems See also: Age: older people: positive effect: Mental Health Unit is integrated into the hospital allowing for better liaison, contingency of care and improvement in dignity. This intends to promote positive attitudes with co-location. 2. Current art projects involving mental health: The Branching out programme (Mental Health support programme) An innovative scheme which introduces people with Mental Health problems to the green space surrounding the Forth Valley Royal Hospital. This NHS and Forestry Commission Scotland partnership has recently won a RSPB Nature of Scotland award. Partners residencies (budget of approximately 110K funded by Creative Scotland, Clackmannanshire Council and NHS Forth Valley from Oct Sep 2013). Photographer in residence Lindsay Perth is working with outpatients referred by the mental health team and service users accessing Reachout with Arts in Mind (mental health arts project in Alloa). See also: Disability: physical disability: negative effect: 1-5. See also: Age: older people: negative effect: 7. 11

13 Media and sound artist Mark Vernon is working with service users in the Falkirk area, creating sound programmes which can be broadcast in house via the hospital radio, online and at public events. Design-led environmental project in FVRH s Mental Health Unit (budget of approx 45K funded by Creative Scotland, NHS Forth Valley, sponsored by SERCO in conjunction with the University of Stirling as an academic partner). Due to start in October Design and arts interventions which will involve artists and designers working with patients and service users within the mental health unit. Artlink Central ( independent participatory arts organisation contracted by NHS Forth Valley s Endowments Board since 1997) Ongoing arts programme with patients in the Mental Health Unit wards that are supported within the unit s Occupational Therapy programme by Artlink Central. 12

14 Arts and Crafts Circle Patients in the Mental Health Unit s elderly Wards 4 and 5 create small objects (cards, dreamcatchers, knitting, etc). There are now separate wards for those with delirium which has increased safety. Religion and belief Various faith groups 1. Spiritual care centre available. 2. Prayer rooms available. 3. Viewing rooms are available in mortuary. 1. Difficulty for people with mobility issues accessing the spiritual care centre as the door is not accessible due to the weight. Sexual orientation Lesbian, Gay, Bisexual and heterosexual people. 1. Full support for all sexual orientations is provided. Race and disability Marriage and civil partnership Non-English speakers Individuals in a marriage or civil partnership 1. Free access to televisions at patients bedsides. 2. Hospital restaurant caters for all ethnic groups. 3. All televisions have free view with limited non- English speaking channels (BBC Alba, Russia today, BBC Asian network, BBC radio Cymru). 1. Accessible signage is lacking for ethnic minority groups. Local ethnic profile identified: Polish, Russian and Hungarian populations. Around 2% of the local population is Black/ Minority Ethnic. No issues identified. Pregnancy and maternity Expectant mothers and their families No issues identified. 13

15 Table 2: Which other groups of the population do you think will be affected by this development? Population Group Staff How these groups may be affected differently by the development? Positive affect Negative affect Comments Access to beautiful and extensive grounds. Significant involvement of clinical teams in the design of units so that the work space is fit for purpose. Lack of available parking spaces for staff resulting in parking in surrounding streets. Significantly improved facilities/ work environment A partnership with the Forestry Commission Scotland and Central Scotland Forest Trust seen tree planting, existing paths upgraded, the creation of new paths and cycle tracks and the appointment of a community ranger. Socio-economic factors Cashier s office situated near to the main entrance for travel reimbursements. Citizen Advice Bureau (CAB) office is available for patients and visitors. Hospital buses are currently subsidised by NHSFV where individuals who have a train ticket receive a free bus ride to and from the hospital. 14

16 Homelessness No issues specific to this group were identified. People with low-literacy Issues with signage used in corridors, lifts and wards which is not user friendly to those with low literacy People in rural or remote areas New buses were purchased and bus routes were developed to provide easier travel access to Forth Valley Royal Hospital for patients, staff and members of the community. A new slip road has also been built which provides easier access off the M8 motorway to Forth Valley Royal Hospital. There are access issues for older people who live in rural or remote communities. Carers No issues specific to this group were identified. People involved in the criminal justice system Separate access routes are available throughout the hospital for high risk prisoners. Security staff are present throughout the hospital 24hrs a day. Two community police officers are based on the hospital site. Policies in place for pregnant female prisoners. 15

17 Table 3: What positive or negative impacts has the project had on health? Areas of impact Which populations? How impact will arise/other comments What impact will the policy have on equality? Discrimination against groups of people Promoting equality of opportunity Tackling harassment Promoting positive attitudes Promoting good relations between different groups Community capacity building Development of grounds. Older people. People in their middle years. Young people (under 25s) Young children and their families. Physical disabilities. Learning disabilities. Sensory impairments. A partnership with the Forestry Commission Scotland and Central Scotland Forest Trust seen tree planting, existing paths upgraded, the creation of new paths and cycle tracks and the appointment of a community ranger. Woodland developments at Forth Valley Royal Hospital helped Falkirk Council to win the Overall winner trophy at the Scottish Quality in Planning Awards Mental Health problems. Open Plan Office environment. Staff. Encourages team working and better communication. Very unpopular with some staff who find the environment difficult to work in Flexible IT working with privacy still available. Staff. Cost reduction on printers and faxes. 16

18 What impact will the policy have on lifestyles? Diet and nutrition Exercise and physical activity Substance use: tobacco, alcohol or drugs Sexual health Learning and skills Tobacco policy CEL 01 (2012) Cycle to Work Scheme to work in operation. Varied healthy eating menus for staff and patients. All men and women. All staff. All men and women. Various faith groups. Working towards smoke free grounds by March Improved well-being. Promotion of healthy lifestyle. Resulted in a healthy living award. Health improvement information available at main reception area. Television screens also used to circulate information. Older people. People in their middle years. Young people (under 25s). Young children and their families. Physical disability. Learning disability. Patients and visitors can be directed to appointments and wards. Language line available for non- English speaking individuals. Information is constantly available for all individuals who spend time within the hospital. Sensory impairment. Long-term conditions. Mental Health problems. Non-English speakers. 17

19 Public pursuits i.e. dog walking. Specific activities using the hospital grounds to improve health and well being Dedicated ranger employed to develop the grounds and their use by the NHS and the community All men and women. Research has been undertaken between the Forestry Commission, the University of the Highlands and Islands and NHS regarding the social return and investment on green space. Tai-Chi has been piloted for staff and members of the community within the hospital grounds. To improve the environment of the hospital Forth Valley is taking forward an innovative new art strategy as part of a collaboration between Creative Scotland and partner local authorities. The Forth Valley Art Strategy is designed to involve patients, service users and staff, focusing on three main priorities: Creating artworks for hospital waiting areas and other spaces Commissioning arts projects for major public spaces. Developing art exhibitions and events programmes. 18

20 Patients with a mental health illness The Branching out programme (Mental Health support programme) is an innovative scheme which introduces people with Mental Health problems to the green space surrounding the Forth Valley Royal Hospital. This NHS and Forestry Commission Scotland partnership has recently won a RSPB Nature of Scotland award. What impact will the policy have on the social environment? Social status Employment (paid or unpaid) Income Crime and fear of crime Family support and social networks Stress, resilience and community assets Participation and inclusion Control New staff roles were developed following transition. All NHS staff policies (including Agenda for Change and terms and conditions) have been adopted and implemented by Serco (corporate responsibility for facilities management). The Retired and Senior Volunteer Programme (RSVP) is expanding to engage young and unemployed people for work experience. Local and extended populations looking for work. All staff. Socio-economic factors. Homelessness. People with low-literacy. Improved working conditions. Existing roles were modified. Improved working conditions. Work ongoing. Improved design of theatres. All men and women. Ensures that patients relatives now have better access through to theatres. 19

21 Panic Alarms now situated in hospital. All staff. Improved working conditions. Improved drop off facilities. All men and women. Improved access for patients and visitors who have mobility issues. Improved rest areas. Performance managed CCTV across site. All men and women. All staff. All men and women. All staff. Ensures that those who are unable to walk long distances throughout the hospital can stop and rest. Improved working conditions. Improved direct travel to FVRH. Police on site. All men and women. All staff. Decreases the need for private transport. Increases accessibility of the hospital for individuals without private transport. What impact will the policy have on the physical environment? Staff involvement in the design and planning of the hospital. All staff. Increased safety for staff, patients and visitors. Improved working conditions and facilities. Living conditions Working conditions Pollution or climate change (waste, energy, resource use) Unintentional injuries and public safety Transmission of infectious disease Parking for staff and visitors is an issue. All men and women. Work ongoing. Access to beautiful grounds. Access to shops, including Starbucks, M&S and WRVS. All men and women. All staff. All men and women. All staff. Increase in well-being for staff, patients and visitors. Improved working conditions. Improved access of choice for patients and visitors. 20

22 Public Transport providers offering discounts on travelling. Including a free bus ticket to the hospital if travelling by train and a 10% discount for staff when travelling with Express Taxis. Staff are no longer working across multiple sites. All men and women. All staff. Socio-economic factors. People in rural or remote areas. All staff. Improved access to the hospital. Reduction in carbon footprint. Improved working conditions. Decrease in expenses for mileage. More energy efficient building. All staff. Reduction in carbon footprint. Better facilities for recycling waste materials (excluding clinical waste). All staff. Reduction in carbon footprint. 80% recycling of segregated waste. How will the policy impact on access to and quality of services? Healthcare Transport Social services Housing services Education provision Culture and leisure services Communicating information, consultation and involvement Improved safety for staff and patients. Built in features to improve infection control Various different entrances available. All staff. All men and women. All people All men and women. All staff. People involved in the criminal justice system. Separate access for public and hospital, with a separate ambulance road for reducing unintentional injuries. Reduced infections Reduction on intrusion to public areas. 21

23 Dedicated in-house resources for an art strategy. Older people. Mental health problems. Partners residencies (budget of approximately 110K funded by Creative Scotland, Clackmannanshire Council and NHS Forth Valley from Oct Sep 2013). Photographer in residence Lindsay Perth is working with outpatients referred by the mental health team and service users accessing Reachout with Arts in Mind (mental health arts project in Alloa). Media and sound artist Mark Vernon is working with service users in the Falkirk area, creating sound programmes which can be broadcast in house via the hospital radio, online and at public events. Design-led environmental project in FVRH s Mental Health Unit (budget of approx 45K funded by Creative Scotland, NHS Forth Valley, sponsored by SERCO in conjunction with the University of Stirling as an academic partner). 22

24 Due to start in October Design and arts interventions which will involve artists and designers working with patients and service users within the mental health unit. Artlink Central (independent participatory arts organisation contracted by NHS Forth Valley s Endowments Board since 1997) Ongoing arts programme with patients in the Mental Health Unit wards that are supported within the unit s Occupational Therapy programme by Artlink Central. Arts and Crafts Circle Patients in the Mental Health Unit s elderly Wards 4 and 5 create small objects (cards, dreamcatchers, knitting, etc). There are now separate wards for those with delirium which has increased safety. 23

25 Patient public panel All men and women. Patient Public Panel members are comprised of a group of local volunteers. It was established in 2004 with the aim of ensuring that the perspective of patients and the public is at the heart of improving patient care and experience in acute services. Panel members participate in subgroups which include: Patient experience Patient safety Person centred Staff training facilities. All staff. Vastly improved with a dedicated learning centre. Citizens Advice and Police on site. All men and women. Free legal advice for all individuals. 24

26 Table 3: Which human rights could be affected by the project? Life (Article 2, ECHR) Areas of relevance with comments Improving the quality of care with better facilities results in: improved quality of life improved end of life care improved infection control Mental health unit made a safer environment for example anti- ligature fixtures. Freedom from ill-treatment (Article 3, ECHR) Liberty (Article 5, ECHR) Fair hearing (Article 6, ECHR) Private and family life (Article 8, ECHR) Improving the quality of care with better facilities results in: security services improved end of life care service delivery Mental Health (Care and Treatment) (Scotland) Act 2003 upheld. Not interfered with. A higher proportion of single rooms have improved privacy. Improved autonomy and self-determination with friends and family able to move patients on trolleys. Family life covered (carers). Improved consent with more privacy and access to individual interview rooms. Security of access to building covers security of information and includes improved and more resilient technology. Serco use of Wi-Fi equipment for staff (porters, estates etc). Making the hospital environment homely is a challenge as the building is generically designed. 25

27 Freedom of thought, conscience and religion (Article 9, ECHR) Freedom of expression (Article 10, ECHR) Freedom of assembly and association (Article 11, ECHR) Marriage and founding a family (Article 12, ECHR) Protocol 1 (Article 1, 2 3, ECHR) Pastoral services are available for all beliefs. Catering is appropriate for all religious needs. Upheld and improved with patient panel members involved from the outset of the build. Staff can also give input both positive and negative. Discussed: no relevant issues. Discussed: no relevant issues. Discussed: no relevant issues. 26

28 Summary of negative impacts identified Following on from the above summary further actions along with timescales and responsibility for the actions were identified. Issues Actions Timescale Responsibility Signage used in corridors, lifts and wards. Post project evaluation group to consider signage use and develop an action plan. To be agreed. Alison Brown Inaccessibility for disabled and those with mobility issues to the spiritual care centre. Insufficient car parking spaces for staff and visitors. Access to self-change facilities Post project evaluation group to consider improving inaccessibility with for example the implementation of an automatic door. Post project evaluation group to review the use of existing car parking spaces with a view to providing a solution. Post project evaluation group to consider access to self-change and develop an action plan. To be agreed. To be agreed. To be agreed. Alison Brown Mark Craske