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Mapping and working with healthcare geography

As mapping consultants, we are always keen to point out that effective service depends on good geographical analysis and planning. However, nowhere is this more important than in the field of healthcare provision. Location intelligence can make a vital difference to effective healthcare provision, whether you are:

  • evaluating a community’s healthcare need
  • optimising patient transport routes and hubs
  • siting a clinic in the best spot to service a community

We take a look at the factors unique to mapping and analysing the UK’s healthcare geography.

A wheelchair user being helped into an ambulance.

Changing boundaries and healthcare authority names

Existing healthcare authority boundaries are an important variable to consider in any form of geographical analysis. The boundaries themselves were imposed in an attempt to provide meaningful and efficient healthcare funding and provision catchments. As with all top-down, imposed geographies, boundaries can seem very arbitrary, and are subject to regular change.

The trend in healthcare geography seems to be that the larger geographical units and names undergo major change every 10 years or so:

  • In 2001 Primary Care Trusts (PCTs) were introduced. They replaced “GP funding” and started a trend towards consolidation of healthcare units. In 2006, these macro units were further reduced from 303 PCTs down to 152.
  • In 2013 Clinical Commissioning Groups (CCGs) replaced PCTs. At their founding, they were quite numerous with more than 200 CCGs covering the country but by the time their replacement was announced, these had been consolidated into 106.
  • 2022 is due to see the implementation of Integrated Care Systems (ICS). This brings further consolidation and the new regime is due to start with just 42 ICS.

It is important to emphasise that each major change didn’t set a fixed map of healthcare boundaries for the entire period. Both PCTs and CCGs were consolidated and changed throughout their existence so we should expect similar flux from the ICS.

Regional variation in healthcare provision

To add to the fluidity of healthcare geography, the pattern in England is not always duplicated across the United Kingdom. Taking CCGs as an example - since ICS are still not fully established:

  • Scotland has 14 Regional Health Boards with a role broadly comparable to a CCG
  • Wales has 7 Local Health Boards (LHBs) which are again comparable to CCGs
  • Northern Ireland is covered by a single Health and Social Care Board (HSCB) with a broader remit than a CCG, straying into the social services typically provided by local authorities

Changing roles and blurring healthcare boundaries

PCTs were formed to allow units to set their own healthcare budgets and priorities. Similarly, CCGs were a group of health practitioners who came together in an area to commission the hospital and community NHS services they felt best served that area.

The new ICS, have a new drive to improve overall population health and tackle larger-scale health inequalities. This will involve a more collaborative approach with local authorities to try and influence social and economic factors affecting a community’s health.

By straying into areas formerly undertaken by local authorities - such as social care - any kind of geographic analysis will now need to consider other administrative geographies.

Working with healthcare boundaries

Geographically, CCGs sit in the broad category of “Administrative Geography” - as opposed to postcode geography which is widely used in the private sector. CCGs are quite large and so, in terms of size most comparable to postcode areas (for example YO), if slightly larger (around 106 CCGs vs 90 postcode areas cover England).

Although the fundamental health geographical units are large, they are intended to service real people who are bound by the realities of locality, travel infrastructure, and journey times. So for most practical projects these larger, abstract units need to be broken down into meaningful subsets. As such, it is often necessary to overlay other geographies on to CCGs in order to undertake any meaningful analysis. For example contractors and private ambulance providers often work across CCG boundaries making postcode and road network data vital in any geographical analysis. To make matters more challenging, the boundaries of these different networks rarely match.

As we’ve seen, the healthcare landscape changes regularly, so always ensure that you are working with the latest data. The Office for National Statistics provide us with the latest health authority boundaries. They update and release the data following any changes to the network and we post it to both our Prospex GIS and MapVision online mapping tool.

The first cut of the ICS network has yet to be released at time of writing, but as soon as it is, we’ll post it to our MapVision system, so you can see how the latest healthcare boundary network looks.

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