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North Coast SUMMARY PUBLIC CONSULTATION DOCUMENT

North Coast () redesign

This three month public consultation will run from 25th July 2016 to 25th October 2016

YOUR CHANCE TO COMMENT Please submit your views no later than 25th October 2016 This document summarises proposals to modernise health and social care services including residential and nursing care. You are invited to respond with your views

If you would like this information in large print or audio form, require any assistance with responding to the consultation or would like to request a meeting please get in touch. Contact details are available on the back page. northcoastsummary.qxp_Layout 1 08/07/2016 17:09 Page 2

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Changes to some social care and health services are being proposed for the North Coast (Sutherland)

A steering group, drawing together local The proposal, if implemented, would mean people, staff, councillors and agencies has NHS would no longer provide reviewed services in the area. The review residential care home services from Talmine covered from Scourie to the west; (Caladh Sona) and Melvich Community Care to the east and including Altnaharra and Unit (Melvich). Strath Halladale. Throughout this Both properties which are owned by the document this area will often be referred to Highland Council, however, could be as “the scoping area” or “the area in scope”. available for future community use including under the provisions of The Community The group has identified a proposed new Empowerment Act () 2015 which model of service and location. If their introduces a suite of measures to support recommendation was implemented NHS communities to improve outcomes in their Highland would run services in a new community. purpose built facility in the Kyle of Tongue area.

Development of the new facility would also allow greater co-location of health and social care services in the area and some investment in community services.

By reducing some of the challenges required to staff and maintain two smaller units it could offer a more sustainable model.

These developments would not be possible under the current arrangements.

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Why are the changes being Reasons changes are being proposed now? proposed Across the country health and social care Challenges to recruit to staff in the services need to change to make sure they north meet the future needs of the population. Need to change the model of care The north coast of Sutherland is no home provision exception. By far the biggest challenge is how to provide care to scattered Community staff based across several communities with fewer people of working sites age and a high percentage who are 75 or Caladh Sona does not meet Care over. Inspectorate Standards On top of this there are general challenges Melvich Community Care Unit is short around recruitment. Although this redesign on space does not specifically include primary care Location of both facilities do not lend some forward planning will be required in relation to the future delivery of general themselves to co-location of other practice services. services and agencies

Three practices fall into the scoping area and are served by five GPs. There is also a vacancy for a GP in the Scourie, Kinlochbervie and Practice. It is terms of common living area space, office likely that there will be further changes as a accommodation and other supportive result of anticipated retirements from one facilities. or all of the practices in the next few years. The medical model, therefore, will have to Access to both buildings is difficult with evolve and change. Therefore the current poor parking close to the building. proposed redesign of services must complement predicted future The announcement by the Highland Council circumstances. to release capital funds to replace Caladh Sona provided the opportunity to give wider One immediate concern is that Caladh Sona consideration as to how to best meet the and Melvich Community Care Unit are needs of the area as a whole. One of the converted Sheltered Housing properties and key challenges is around being able to staff are not in good condition. Caladh Sona does two small units. not meet Care Inspectorate standards on room sizes. The kitchen, sluice area, toilets, Having significant resources tied up in both utility areas, staff offices are of poor quality units also means there is less money to and generally cramped. invest in wider community services which could benefit many more local people. Melvich Community Care Unit enjoys better resident accommodation but is poor in

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Overview of health and social care services in the area

GP Practices/Health Centres Clean Bees is an independently run organisation also providing care at home There are four GP Practices in north and with the majority of their staff based in the west Sutherland three of which are in scope: area. Armadale, Tongue and Scourie, Kinlochbervie & Durness. There are health Day Care Services centres in Armadale, Tongue, Durness, Kinlochbervie and Scourie. Melvich Community Care Unit provides a registered day care service operating from Each practice covers its own on-call during 9:00am – 5:00pm, Monday to Friday. It can the out of hours period from Monday to accommodate up to eight service users per Thursday (6:00pm to 8:00am). From Friday day and currently has seven service users. (6:00pm) to Monday (8:00am) out of hours The Kyle Centre (currently under care is provided via the NHS Highland Hub refurbishment) is a community lunch club in Inverness. and drop-in centre and when complete will be able to accommodate up to 16 clients Integrated Team each day that the lunch club operates The North & West Sutherland Integrated (currently three days per week). Similarly the Team includes community nursing, Ceilidh House in Kinlochbervie is a community mental health, learning community lunch club and drop-in centre. It disabilities, physiotherapy, podiatry, operates three days per week and can occupational therapy and social work. The accommodate between 20 and 25 people. team is accessed through a single point of Further details are provided in the full contact Monday to Friday from 9am until consultation document. 5pm. Residential Care Speech and Language Therapy input is also Residential Care is provided at Caladh Sona available and is provided by the Highland (Talmine) and Melvich Community Care Council. Units. Both homes have six beds (five permanent and one respite/bluebell bed) and Care at Home and Respite provide accommodation, meals and personal NHS Highland has teams of care at home care. No nursing care is currently provided. workers serving the area in scope but they do not work from a fixed base. Emergency services

Crossroads Caring Scotland provides home The Scottish Ambulance Service has bases in based respite care for carers and also care at Kinlochbervie and Bettyhill. There are fire home. They have staff based in stations at Scourie, Kinlochbervie, Durness, Kinlochbervie, Durness and Talmine. Tongue and Bettyhill.

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Local discussions

In April and May 2015 a series of informal various communities, staff and partner meetings took place with local community agencies was established. councils, local groups, councillors, Sutherland District Partnership, GPs and The first step was to more formally explore staff in North, West and Central Sutherland. the reasons why changes are required. This Emerging from these discussions there was was carried out over a series of workshops a good understanding around the issues with local stakeholders. It was followed up being faced and the need to consider some with several more events to develop changes. possible future models of service and to agree a set of criteria against which each During the summer of 2015 a local Steering option could be scored. Group, drawn from representatives from the

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Developing Options

Four initial events took place between flexibility and sustainability of resources August 2015 and November 2015. There improve access to services were between 25 to 44 participants at each national & local strategic fit event with approximately a third to a half best use of all available resources coming from the community. (buildings and staff) more effective service links The group agreed on a number of criteria against which to assess possible future Initially a long list of options was identified. models of service, and they were: At the fourth workshop (November 2015) a short-list of three options was confirmed by the Steering Group:

Option 1: Status quo / minimal change (i.e. current arrangements) Option 2: New build care home as part of a ‘Hub’ facility in one location to replace existing care homes (Caladh Sona and Melvich) Option 3: New build care home plus maintain one of the existing facilities (Caladh Sona and Melvich)

Appraisal of short list of options Concept of ‘Hub’ facility A fifth workshop, led by an independent 24/7 function facilitator was held in December 2015. The Shared space and base for services and staff: event was attended by around 25 people Residential & Nursing Care Beds with the purpose to: Care at Home Telecare review and rank the benefit criteria (most GP to least important) Community Nursing Physiotherapy, Occupa weight the criteria to reflect their relative tional Therapy, Speech & Language Therapy and Podiatry importance Dental Services score the options Social Work Services Scottish Ambulance Services (SAS) Further details on the options appraisal Scottish Fire & Rescue Service process including more detail on the Base for third sector partners scoring are available in the full consultation Space for training and development document. Equipment store

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Possible options for the future

Option 1 - Status Quo/Minimal Change Everything would stay the same but with some investment to look to reduce concerns around regulatory and statutory requirements around Caladh Sona.

Main disadvantages Main advantages Caladh Sona building is not fit for It is what people know and are familiar purpose with Not sustainable and does not address No service change or consultation issues of staffing two facilities required

Summary This option scored 172 (out of 1000). The low score reflects that participants agreed that there is a compelling case for the need to change.

Option 2 - New build care home as part of a ‘Hub’ facility in one location to replace existing care homes (Caladh Sona and Melvich Community Care)

Main disadvantages Main advantages Strong attachment to existing care Addresses the issues associated with home facilities and location staffing two small units Change of location for some care home Provides opportunities for further residents and staff integrated working and co-location from new modern facilities as well as opportunity for investment (eg nursing home care)

Summary This option scored 721 (out of 1000) reflecting the potential for a step change in improvement and benefits. As well as providing a purpose built facility it would also be dual registration (residential and nursing), some additional investment in community services and co-location. Having services provided from one site would also be more sustainable.

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Option 3 - New build care home plus maintain one of the existing facilities (Caladh Sona or Melvich)

Main disadvantages Main advantages Does not address issues relating to Addresses issues associated with staffing two small units physical standards in one home Would not be possible to expand Continues to have services run from service to include nursing care, ‘Hub’ two locations facility or wider community investment

Summary This option scored 508 (out of 1000) reflecting an improvement on the current arrangement but not as compelling a case for change as Option 2. It would not facilitate additional investment such as dual registration.

Conclusion of options appraisal on service model

Through the scoring process the steering group identified Option 2 as the preferred option. This does not mean a decision has been made but is included to help inform the wider public consultation. Although the appraisal was carried out using non financial criteria additional financial information has been included in the full consultation document. This is to help inform the relationship to different models and possible future investment.

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Options appraisal to determine the location of “Hub” facility

An independently facilitated sixth workshop was held to specifically carry out an Option Appraisal on a possible location, should it be decided to build a new 'Hub' facility as part of the preferred option. The Group agreed six possible areas:

Scourie / Kinlochbervie Durness Kyle of Tongue Bettyhill Strathy / Armadale Melvich

Benefits Criteria

Participants also agreed on eight criteria as being the most important to determine location. Each of the criteria were ranked and weighted to reflect participants views on their relative importance:

1. Recruitment and retention of staff 2. Geographical centre 3. Infrastructure 4. Suitability for development of “Hub” 5. Social impact / community resilience 6. Economic impact 7. Access to care homes / residential care outwith area 8. Ease of acquisition of land

While the specific site and outlook of the Care Home would be very important, it was felt this would be best considered later on in the process. If it was progressed it would involve service users, visitors and staff.

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Scoring

The group were asked to score the agreed locations against the agreed criteria. Combining the scores and the weighting the results were: Location Scores (out of 1000) Scourie / Kinlochbervie 334 Durness 347 Kyle of Tongue 754 Bettyhill 630 Strathy / Armadale 430 Melvich 501

Options appraisal on location of new build residential care home ‘Hub’

The stakeholders scored Kyle of Tongue area as their preferred option closely followed by Bettyhill. Please note this does not mean a decision has been made on the preferred model of service or location. The purpose of the consultation is to seek wider views and other considerations.

A full copy of the independent consultants report on the Options Appraisal process is available on NHS Highland website or on request.

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Addressing potential impacts and other considerations

If option two was implemented there could be potential impacts for some services users and staff especially through the closure of both units.

A small number of residents would be directly impacted during any transitions phase. Since 2009, there were 11 permanent residents in Caladh Sona and 18 in the Melvich Unit. The number of new admissions per year to each home is usually one or two.

Residents come from a range of communities across the north coast as well out of area. Most people (families, visitors) already have to travel to visit residents. Further details are provided in the full consultation document.

Going into the future there would be implications for some staff roles and responsibilities, including where staff will work from. This would be considered as part of the Impact Assessment and onwards through NHS Highland’s organisational change process and the policy surrounding “Change of Base”.

Other considerations

If option two was progressed further, detailed work would still be required to determine the exact specification of the facility and the design as well as to identify a site.

Service users, members of the public and relevant experts will be invited to be involved in this work. The outlook of the proposed new facility would require careful consideration, balancing having a desired outlook with co-location or proximity to other services and the community in general.

My Home Life is a UK-wide initiative to promote quality and delivers positive change in care homes for older people. It is a social movement that seeks to “make a difference” for those living, dying, visiting and working in care homes. The findings and recommendations from ‘My Home Life’ would be built into how the services would be provided.

Freeing up buildings

Any building no longer required (Caladh Sona and/or Melvich Community Care Unit) could be available for alternative use or disposal.

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How to find out more

Further details are provided in the full consultation document. NHS Highland will attend meetings of community councils, district partnership and other local groups. These will be advertised locally and in the media or you can find out from the various secretaries of community councils or visit the NHS Highland website.

We will also be pleased to meet or speak with any individuals, groups or staff on request, if at all possible. If you require any further information, please get in touch with:

Gill McVicar Maimie Thompson Christian Nicolson Director of Operations Head of PR and Engagement Quality Improvement Lead NHS Highland NHS Highland NHS Highland Larachan House Assynt House Lawson Memorial Hospital Dochcarty Road Beechwood Park Golspie Dingwall Inverness Sutherland IV15 9UG IV2 3BW KW10 6SS T: 01349 868221 T: 01463 704722 T: 01408 664078 [email protected] [email protected] [email protected]

Tell us what you think

A public consultation form with Freepost envelope will be available locally. If you would like to be sent a copy, please get in touch with Christian or Maimie. Alternatively you can complete an on-line version of the form which you will find on the NHS Highland website. Whatever method you choose please only complete one form.

Making decisions

The board of NHS Highland reviewed the process carried out to date and the changes being proposed at their board meeting held on 31st May 2016. They considered it appropriate to move to public consultation.

The board of NHS Highland will consider all the feed-back on options and locations. They will also assess other considerations such as an independent report by Scottish Health Council on the public consultation process, affordability, practical issues or any changing circumstances. It is likely that the board would consider the findings at their meeting scheduled for 29th November 2016.