Epidemiology & Health Science Team
Analysis of responses to the
public consultation survey on
proposed health and social care
change in Caithness
December 2018
Publication produced and published by NHS Highland Public Health
About the Epidemiology & Health Science Team
As part of the NHS Highland Directorate of Public Health, the Epidemiology &
Health Science team provide specialist skills in the areas of:
Epidemiology, Evaluation, and Evidence base for Public Health functions
01463 704813
Epidemiology and Health Science Team Directorate of Public Health
NHS Highland
Larch House Stoneyfield Business Park
Inverness IV2 7PA
Author(s): Carolyn Hunter-Rowe
Acknowledgements: Sara Huc, Noelle O’Neill, Cameron Stark, Maimie Thompson
If you require this document in an alternative format, such as large print or on a coloured background, please contact us to discuss your needs.
CONTENTS
Executive Summary 2 1. Introduction 3 2. Methods 3 3. Who responded to the consultation survey? 3 4. Preferred option 7 5. Awareness of consultation methods 15 6. Summary and Conclusions 17 References 18 Appendix 1 19 Appendix 2 20
Epidemiology & Health Science Team, Public Health 1
Executive Summary
Epidemiology & Health Science Team, Public Health 2
1. Introduction
The purpose of this report is to present the results of a public feedback survey on proposed major service change in Caithness. The survey is part of the NHS Highland formal public consultation on proposed changes to adult health and social care services in Caithness held between August and November 2018.
The proposals under consultation include developing a Care Hub and Care Village in Thurso (located on Dunbar Hospital site, the only site considered in Thurso) and one in Wick (located at either Pulteney House or Town and County). The proposals were co-produced with local people, and form part of a number of proposed improvements to local health and social care services.
The consultation documents presented a number of options for feedback and comment as follows: 1. No change – current arrangements continue 2. Care Hub/Care Village at Dunbar Hospital site (Thurso) and Town & County site (Wick) 3. Care Hub/Care Village at Dunbar Hospital site (Thurso) and Pulteney House (Wick) 4. No preference 5. Other
The feedback survey aimed to ascertain the views of the public on the proposed changes and future solutions. Respondents were invited to select their preferred option as well as to comment on any aspect of the proposed options. Further information on the options under consideration is available in the full1 and summary2 public consultation documents available on the NHS Highland website.
The Epidemiology and Health Science team, part of the Directorate of Public Health and Health Policy, were asked to analyse the responses to the consultation feedback survey and report the key findings. This report provides an impartial analysis of the responses received to the survey.
2. Methods
2.1. Survey design
The public consultation survey was developed by the Head of Public Relations and Engagement for NHS Highland. Advice was also sought from the NHS Highland Clinical Governance team and the Scottish Health Council. The Scottish Health Council have an independent quality assurance role in supporting work carried out by NHS Boards to involve people in decisions about local health services.
The survey was designed to capture feedback on the options for proposed changes to adult health and social care services in Caithness. The survey also included some standard questions to capture information about who responded to support equality and diversity monitoring and sensitivity analysis, for instance, where people lived. Two questions were also included to gather feedback on consultation awareness and information sources.
Epidemiology & Health Science Team, Public Health 3
2.2. Data collection and management
Formal public consultation took place over a three month period from 20 August 2018 to 23 November 2018. The public consultation survey and consultation documents were made available on the NHS Highland website from 20 August 2018. Responses to the survey could be completed electronically or by returning a paper copy (freepost address provided). The feedback survey was distributed to all 14,529 postal addresses in Caithness using an address list provided by Royal Mail. Survey forms were also available at public meetings during the formal consultation period and promoted on the NHS Highland website, social media and local media releases.
Completed paper survey forms received by NHS Highland were reviewed and manually entered into the survey database by the Head of Public Relations and Engagement (Maimie Thompson). Forms with large amounts of text were transcribed verbatim by the Project Administrator and input to the database. Eight forms had free text comments that contained personal identifiable information (responder, individual patients or staff); these comments were excluded from the survey database. Survey forms were accepted and entered until 30 November 2018. Five forms were excluded that arrived after this date. A final data extract of the survey was downloaded on 3 December 2018 and sent to the Directorate of Public Health for analysis. The survey analysis does not include feedback on the public consultation received by email or letter.
2.3. Data analysis and reporting
Simple descriptive analyses were undertaken using excel and a statistical software package (SPSS v25). Percentages were calculated using the total number of responses as the denominator rather than responses to each individual question. This method is most appropriate to this particular survey design.3 Sensitivity analyses were undertaken by calculating 95% confidence intervals for the proportion reporting a preferred option. The 95% confidence intervals are used to indicate whether there was any statistical overlap in the selected options.
Responses were analysed geographically based upon answers to the question ‘Where do you live?’. Each record was assigned a consultation area using a geographical information system software package (ArcGIS). The consultation areas were defined using 2017 electoral ward boundaries for Thurso and Northwest Caithness Ward and Wick and East Caithness Ward (Appendix 1). Place names outwith the two Caithness ward boundaries were assigned the value ’Outwith’ and blank responses assigned the value ’Unknown’.
All comments and viewpoints expressed in the survey were uploaded into a qualitative analysis software package (Dedoose). Themes were summarised using a standard framework.4 This involved the identification of themes and sub-themes using sentiment analysis, where comments are coded as positive, negative or neutral.5 A second coder reviewed a sample (n=70) of comments. Once all responses were coded, the coding framework was reviewed and reorganised to enable accurate analysis of the feedback for this report (Appendix 2).
Epidemiology & Health Science Team, Public Health 2
3. Who responded to the consultation survey?
3.1. Number of responses
There were 2,017 responses to the public consultation feedback survey. Of these 1,878 responses (93%) were written responses to the survey delivered to homes, 32 (2%) were written responses from surveys available at meetings and on the website, and 107 (5%) were responses to the online questionnaire.
Respondents to the consultation survey were asked to indicate the basis upon which they were responding to the survey (Table 1). The majority of respondents indicated that they were responding to the survey as an individual (44%) or as a family or household (51%).
Where respondents indicated that they were responding on behalf of a family, household or group, 382 responses provided details of the number of people the response was on behalf of. Of these, almost three quarters (73%) reported responding on behalf of one other person. The other household and group sizes reported varied between three and eight people.
Table 1: How are you responding to this survey?
Number of % of Status of responder respondents respondents Individual 892 44.2% Family/household 1,023 50.7% Group 8 0.4% Other 0 0.0% Prefer not to say 18 0.9% Not answered 76 3.8% Total responses 2,017 100.0%
3.2. Response rate
Consultation respondents were asked to state the nearest town or village where they live, with responses assigned to one of the Highland wards in Caithness (Table 2). There were 1,046 responses (52%) received for Thurso and Northwest Caithness Ward, and 744 responses (37%) received for Wick and East Caithness Ward. There were 57 responses (3%) from outwith Caithness and 170 responses (8%) where the respondent did not provide a town or village.
The consultation survey achieved an overall response rate of 9%. The response rate for Thurso and Northwest Caithness (10%) was greater than the response rate for Wick and East Caithness (7%).
The overall response rate of 9% is higher than the 1% response rate considered ‘good’ by the Consultation Institute, and considerably higher than the average response rate (0.7%) for UK public consultations.6
Epidemiology & Health Science Team, Public Health 3
Table 2: Response rate by consultation area
Number of Responses Population Response Consultation area responses (%) aged 16 rate (%) and over1 Thurso and Northwest Caithness Ward 1,046 51.9% 10,337 10.1% Wick and East Caithness Ward 744 36.9% 11,016 6.8% Total Caithness 1,790 88.7% 21,353 8.4% Outwith 57 2.8% - - Unknown 170 8.4% - - Total responses 2,017 100.0% 21,353 9.4% Source: Caithness Public Consultation Survey 1. NRS Small Area Population Estimates (2017), best fit to Caithness Electoral Ward boundaries
The distribution of survey respondents by self-reported place of residence across the Caithness public consultation area is shown in Figure 1. The map indicates where responses from outwith the Caithness consultation area originate, but excludes those where a town or village names was not provided.
Figure 1: Distribution of survey respondents in the Caithness public consultation area
3.3. Self-declared category of responder
Consultation respondents were asked to state the category(s) that best describes who they were responding on behalf of. Three quarters of respondents (75%) indicated they were responding as a member of the public and a quarter (26%) of respondents reported being a service user, carer or relative of a service user. Just over one in ten respondents (11%) also
Epidemiology & Health Science Team, Public Health 4
indicated being a member of GP practice, Scottish Ambulance Service or NHS Highland staff.
Table 3: Self-declared category of responder
Number of % of Category of responder respondents respondents Member of the public 1,516 75.2% Service user / carer / relative of service user 527 26.1% NHS Highland staff 150 7.4% Voluntary organisation 62 3.1% Local Business 51 2.5% GP or Practice staff 49 2.4% Local Group 43 2.1% Community Council / Councillor / Planning Partner 25 1.2% Scottish Ambulance Service 15 0.7% Other / Prefer not to say 85 4.2% Base: All (2,017) Responders could select more than one category so the percentages may not equal 100%
3.4. Demographic profile
The demographic profile of the survey respondents is shown in Table 4. Generally a higher percentage of responses were by females, 57% compared to 31% for males. This difference was similar in both Thurso and Northwest Caithness and Wick and East Caithness.
Table 4: Demographic profile by consultation area
Thurso and Wick and Characteristic Northwest East Outwith Unknown Total Caithness Caithness Females 58.2% 60.9% 49.1% 40.0% 57.4% Males 33.0% 30.4% 40.4% 16.5% 30.8%
Age 16-29 2.5% 2.6% 1.8% 1.8% 2.4% Age 30-39 5.6% 7.5% 3.5% 1.2% 5.9% Age 40-49 9.8% 9.3% 5.3% 2.4% 8.8% Age 50-59 20.6% 18.3% 19.3% 10.6% 18.8% Age 60-69 22.5% 21.5% 17.5% 10.0% 20.9% Age 70-79 18.3% 19.1% 22.8% 11.2% 18.1% Age 80+ 10.0% 6.6% 15.8% 8.8% 8.8%
White Scottish 74.9% 80.0% 57.9% 56.5% 74.7% White other British 20.7% 15.9% 36.8% 11.2% 18.6% White other white 1.1% 1.1% 1.8% 1.2% 1.1% Other ethnic groups 0.2% 0.5% 0.0% 0.0% 0.3%
Disability 17.6% 15.2% 14.0% 14.7% 16.4% Base: All (2,017) Percentages calculated include unknown/blank responses so categories shown may not equal 100%
Epidemiology & Health Science Team, Public Health 5
Table 4 also shows that a higher percentage of responses were by those in the age groups 50-59, 60-69 and 70-79 years. Similar proportions of older people responded in both Thurso and Northwest Caithness and Wick and East Caithness.
Almost all respondents that provided an ethnicity identified themselves as White Scottish (75%) or White other British (19%). One in six (16%) respondents considered themselves to have a disability.
3.5. How representative is the survey?
In order to help interpret the survey results, the demographic characteristics of survey respondents were compared against the best known estimates for the region (Figure 2). The light bars represent the people responding to the survey and the dark bars the general population.
There are some notable differences highlighted, which are consistent with other public consultation findings. Females tend to be over represented (65% in the survey compared to 51% in the general population) and males under represented (35% compared to 49%). Older people aged 60 to 79 years are also over represented; 47% compared to 29% in the general population.
The ethnicity of survey respondents is representative when compared to the estimates reported in the 2011 Census. Likewise the number of people responding to the survey who reported having a disability (16%) was similar to the 2011 Census estimate of 20%.
Figure 2: Comparison of survey respondents to best population estimates
Source: Caithness Public Consultation Survey National Records of Scotland (NRS) small area population estimates mid-2017 for gender/age best estimates Census 2011 for ethnicity/disability best estimates
Epidemiology & Health Science Team, Public Health 6
3.6. Survey response summary
The 2,017 responses received to the public consultation survey represent a response rate of 9%. Response rates were higher in Thurso and Northwest Caithness than Wick and East Caithness, 10% compared to 7%. Both exceed responses received to other similar major service change consultations. Ethnicity and disability data are in line with expectations from census data but females and older people are slightly over-represented. Most people have responded as a member of the public rather than as a member of an organisation or group.
4. Preferred option
4.1. Introduction
Proposals for where NHS Highland delivers some adult health and social care services were presented in the public consultation documents. The documentation outlined plans to develop two Care Hubs / Care Villages; one located on the Dunbar Hospital site in Thurso and one located in Wick , at either the Town & County site (option 2) or the Pulteney House site (option 3). Options for maintaining current arrangements (option 1) and no preference were also included in the consultation. Respondents were invited to indicated their preferred option or submit alternative viewpoints. Further comments on any aspect of the options were also invited.
4.2. Overall preferred option
Overall, the results of the public consultation survey demonstrate broad agreement for a case for change. Seven out of every ten respondents (70%) indicated a preference for the proposals for change outlined in option 2 and option 3. Of these, just under four out of every ten people who responded to the survey (39%) selected option 3 and three out of every ten people (32%) selected option 2 as their preferred option (Table 5).
Of the remaining respondents, one fifth of people (19%) selected the option to maintain current arrangements (option 1). A further 5% of respondents suggested a different option and 4% indicated no preference. There were 51 survey forms (3%) where the respondent did not select an option. These results are illustrated in Figure 3.
Table 5: Feedback on overall preferred option
Option Description Number Percent Option 1 No change – current arrangements continue 385 19.1% Care Hub/Village at Dunbar Hospital site Option 2 635 31.5% (Thurso) and Town & County site (Wick) Care Hub/Village at Dunbar Hospital site Option 3 777 38.5% (Thurso) and Pulteney House (Wick) No preference No preference 76 3.8% Other Respondent could suggest a different option 93 4.6% Not given Respondent did not select an option 51 2.5% Total responses 2,017 100.0%
Epidemiology & Health Science Team, Public Health 7
Figure 3: Feedback on overall preferred option1
1 Base: All (2,017), includes responders who did not select an option
4.3. Preferred option by consultation area
Analysis of the preferred option by the respondents geographical area of residence shows that the case for change (option 2 or option 3) was supported by almost three in every four (74%) respondents from Thurso and Northwest Caithness and over two thirds (68%) of respondents from Wick and East Caithness (Table 6).
In Thurso and Northwest Caithness there was stronger support for option 3 (42%) compared to Wick and East Caithness (36%). For Wick and East Caithness residents opinion was fairly evenly divided between option 2 (33%) and option 3 (36%).
Wick and East Caithness residents were also more likely to select the status quo than those in Thurso and Northwest Caithness, 23% compared to 16%.
Table 6: Feedback on preferred option by consultation area
Total No Not Consultation area Option 1 Option 2 Option 3 Other Number of preference given Responses Thurso and 15.5% 31.5% 42.0% 3.5% 6.1% 1.3% 1,046 Northwest Caithness Wick and East 22.8% 32.9% 35.5% 3.2% 3.4% 2.2% 744 Caithness Outwith 14.0% 22.8% 50.9% 5.3% 3.5% 3.5% 57 Unknown 26.5% 27.6% 26.5% 7.1% 1.2% 11.2% 170 Total 19.1% 31.5% 38.5% 3.8% 4.6% 2.5% 2,017
Epidemiology & Health Science Team, Public Health 8
4.4. Preferred option by consultation area, Caithness only
Feedback on the preferred option for Caithness residents only is shown in Table 7 and Figure 4. These data exclude respondents from outwith Caithness and those who did not give a response. For this analysis 95% confidence intervals were also calculated for the responses to the options in order to indicate whether there is any overlap in the responses. The confidence intervals are shown as error bars in Figure 4.
In Thurso and Northwest Caithness there is a strong preference for option 3 (43%), which is significantly higher than the overall percentage preferring option 2 (32%). Wick and East Caithness residents also selected a preference for option 3 (36%) compared to option 2 (34%), although this difference was not distinct.
The overall percentage of Caithness residents preferring option 3 was 40%. This is significantly higher than the percentage selecting option 2 (33%) or option 1 (19%).
Table 7: Feedback on preferred option by consultation area, Caithness residents only1
No Total Number of Consultation area Option 1 Option 2 Option 3 Other preference Responses Thurso and 15.7% 32.0% 42.5% 3.6% 6.2% 1,032 Northwest Caithness Wick and East 23.4% 33.7% 36.3% 3.3% 3.4% 728 Caithness All Caithness 18.9% 32.7% 39.9% 3.5% 5.1% 1,760
1 Excludes responders outwith consultation area (outwith/unknown) and blank responses
Figure 4: Consultation preferred option, Caithness residents only
Base: 1,760. Excludes responders outwith consultation area (outwith/unknown) and blank responses Error bars represent 95% confidence intervals
Epidemiology & Health Science Team, Public Health 9
4.5. Summary of themes in consultation comments
There were a total of 731 comments made by respondents to the public consultation survey about the option they selected. Many views and opinions were expressed and all were analysed for key themes and issues (Figure 5). The main themes identified were associated with accessibility and transport, the model of care, site and environment, GPs, the consultation process, staffing, governance, the range of services, quality of care and technology. A more detailed summary of the identified themes is shown in Appendix 2.
Figure 5: Summary of themes identified in public consultation survey comments
Base: 731, multiple themes and comments per respondent, negative and positive sentiments expressed
4.5.1. Access and transport
A range of comments were made concerning the accessibility of all sites included in the options. Concerns were raised about the further distance to travel for people using services, particularly older people and people with mobility difficulties. Comments related to the public transport infrastructure and provision of bus services, taxi costs and parking capacity for staff, patients and visitors. Concerns also related to equity of access to services for people living in more rural locations.
“The hubs are only going to work and be of benefit to visitors and patients if there is regular, sufficient reliable, low cost (or free) transport. This is a key point that needs to be a major part of this consultation”. Respondent 1588, Thurso
“I am concerned about the locations suggested for the Wick sites – neither are central or accessible”. Respondent 1718, Wick
“Ultimately having care on both sides of the county is vital.” Respondent 1873, Thurso
Epidemiology & Health Science Team, Public Health 10
4.5.2. Model of Care
There were mixed comments regarding the concept of care hubs / care villages in the public consultation, with co-location of services seen as both an advantage and disadvantage. Issues raised include the provision of a range of district general hospital services, in particular outpatient appointments and maternity care.
“Makes sense to bring everything together in a Hub built for our needs in the future.” Respondent 1708, Thurso
“We feel that a purpose built 21st Century care hub/care village is the preferred option giving vulnerable and elderly people in the community the best we can. All services under the one roof assisted living, day care, warden et c.” Respondent 825, Wick
“There is no advantage to patients in care hub. We have all the services at the present time. Why would the elderly in a care home like the extra hustle and bustle of traffic and people all day long? This would also apply to palliative care patients.” Respondent 1601, Wick
“Caithness General, as the name implies, is the Hub in Caithness. Prioritise bringing the hospital up to standard which is lacking at the moment.” Respondent 262, Wick
“As a family we cannot understand why this re-design is being considered without the inclusion of the return of full maternity services to Caithness.” Respondent 2014, Thurso
4.5.3. Site and environment
Comments made about the local environment of sites, include concerns made about the physical space of site, future proofing and room for expansion. Some people commented upon the use of empty buildings and that better use could be made of existing resources. Some respondents had concerns about the potential loss of the gardens at Town and County hospital site. Specific issues for Pulteney House regarded the exposed location and perceived safety issues regarding the physical environment.
“Don't think the two chosen sites are suitable. I hope a more suitable site to accommodate the services will be found rather than settle for either of the two (Wick) chosen - both are not large enough.” Respondent 1969, Wick
“What is to happen to the property vacated by the services transferring to the Hubs?” Respondent 890, Thurso
“What would happen to the beautiful gardens created at Town and County with voluntary members of the public and donations from public organisations and families?” Respondent 890, Wick
“Location of Pulteney house is a risk factor for patients who have dementia and are prone to walking with purpose. The location is also close to a built-up area of housing.” Respondent 1577, Thurso
4.5.4. Medical Centres
A range of issues focused on GP practices and the location of medical centres was commented upon. The majority of viewpoints expressed were in favour of GP practices
Epidemiology & Health Science Team, Public Health 11
remaining central with few respondents commenting upon the benefits of co-location. There were concerns raised about the closure of rural practices, availability of appointments and current services.
“My main concern is the medical centre. I feel it is well situated at the moment and central for everyone to access.” Respondent 1742, Wick
“Unhappy about relocating GP Practices away from Town Centre.” Respondent 1696, Thurso
“Doctor in Halkirk for decades and to lose this service would be a major step back.” Respondent 1604, Thurso
“I would have thought the supply of doctors more important than premises. As you never see the same doctor twice [with] days waiting for appointment.[] Switching premises isn't going to improve performance plus it will take surgery away from centre of the town.” Respondent 233, Unknown
4.5.5. Consultation Process
A range of comments were made about the consultation process. Whilst some people felt that the consultation documents were very good, others reported a lack of detail about the plans, bed numbers and what would happen to empty buildings. Respondents also had concerns about contributing to decisions that would not affect them, for instance, Thurso residents selecting Wick options. A number of responses also raised concerns about whether decisions had already been made.
“I do not feel that the summary document provides enough information to be able to make an informed choice. [ ] There is no mention of bed numbers or what age ranges respite will cover. No proposed plan drawings to help visualise each choice.” Respondent 1573, Wick
“Living in Thurso I would prefer more weight to be given to residents in the Wick area when it comes to a choice between option 2 and option 3.” Respondent 607, Thurso
“Felt that decision already made and this is only a paper exercise!” Respondent 1852, Wick
4.5.6. Staffing
Staffing comments included issues regarding the importance attracting staff to work in Caithness, the sustainability of the future workforce, and concerns about the cost of locums to maintain services. Some people noted the importance of staff over and above the building infrastructure.
“I see the benefits of the care hubs it seems like a massive amount of money will be spent on buildings when I feel it would be better spent on services and staff.” Respondent 1536, Thurso
“I also wonder how the proposed changes will be staffed when NHS struggles to fill post currently.” Respondent 890, Wick
“Could money be better spent training and recruiting staff to fill vacancies, locum posts and provide additional support.” Respondent 380, Wick
Epidemiology & Health Science Team, Public Health 12
4.5.7. Governance
A range of governance issues were commented upon by survey respondents. Concerns were raised about the lack of trust and management of NHS Highland. One respondent made reference to allegations of bullying reported in the national press.7 One comment also questioned national policy about centralisation and single rooms. There were also concerns raised about funding, the cost of the proposals and the timescale for change.
“Untrustworthy track record [of the] health board.” Respondent 1972, Thurso
“I have concerns about the timescale for implementing either of the new options. I also wonder if the money is going to be enough to bring about the proposed changes.” Respondent 1559, Thurso
“Can we instead spend any allocated money on healthcare, elderly care; not unnecessary replacements of buildings etc.” Respondent 381, Wick
“Appreciate the very difficult decisions and financial constraints NHS Highland face.” Respondent 647, Thurso
4.5.8. Range of services
There were varied comments about the range of services and facilities to be included in the care hub proposals. Specific mention was made about pharmacy, respite care, day care and assisted living. The future provision of services for young people and mental health services, including learning disability and drug and alcohol, was commented upon. Several people expressed viewpoints about the co-location of ambulance and fire services.
“Whilst ever people stay in their own home and are care for by family, friends and neighbours there is a powerful need for carers to have respite.” Respondent 393, Thurso
“Sheltered housing to be well supported. No bed cuts! Strengthen mental health services.” Respondent 1842, Wick
“Not necessary to incorporate Ambulance or Fire Service into care hub.” Respondent 716, Thurso
4.5.9. Quality of care
The existing quality of care home and palliative care at sites was commented upon positively, including the value of facilities to local communities. Concerns were raised about improvements to waiting times and out of hours care.
“The Town and County is a very caring unit with a great reputation for going beyond the usual nursing care.” Respondent 1285, Wick
“T&C has a fantastic record of care and the local people do not want to see it taken away.” Respondent 1474, Wick
“Current MIU at Dunbar is inadequate and often closed due to staff shortages. As such there seems little point bringing services to one site if actual service delivery is not improved.” Respondent 159, Thurso
Epidemiology & Health Science Team, Public Health 13
4.5.10. Technology
The use of technology was commented upon by a number of respondents. Comments include increasing use of video consultations, NHS Near me and improvements to broadband and connectivity.
“Definitely would like to have more medical video consultations carried out, hopefully to prevent the lengthy trips to Inverness.” Respondent 61, Thurso
“Still unsure how the redesign will lessen the need for patient travel – this MUST be a priority in the redesign.” Respondent 1593, Thurso
“NHS Near Me is a good idea but only if it is facilitated via the hubs / GP surgeries for the foreseeable future. Although it would also be great to have access via private homes, due to the poor broadband services in the area and the challenge some groups, especially the elderly, may have with this facility, provision of the service with central support [] is essential.” Respondent 1606, Wick
The public survey comments and viewpoints are captured in the word cloud in Figure 6.
Figure 6: Caithness public survey consultation word cloud
Base: 731, top 150 words in free text comments, negative and positive sentiments expressed
4.6. Preferred option summary
Overall the public consultation survey results indicate support for the proposed changes to adult health and care services in Caithness, with 70% of respondents indicating a preference for the changes proposed in option 2 and option 3. Sensitivity analyses show that option 3 is preferred by 43% of Thurso residents. Opinion is more evenly split for Wick residents, with 36% selecting option 3 compared to 34% selecting option 2. More respondents from Wick also preferred no change. These differences are important because of concerns about people contributing to decisions that would not affect them, for instance, Thurso residents selecting Wick options, emerged from the themes. Other themes highlighted include access and transport, the concept of care hubs, site and environment and medical centres/GPs.
Epidemiology & Health Science Team, Public Health 14
5. Awareness of Consultation methods
5.1. Introduction
The formal public consultation, which took place over a three month period, comprised a series of public meetings and events, with a range of consultation materials available on the NHS Highland website. The summary consultation document was sent to every home.
5.2. Consultation awareness
Respondents were asked about their awareness of the public consultation in order to assist with future planning (Table 8). Almost half of responders (45%) indicated that they had become aware of the consultation from friends and family, and 16% indicated that they had attended a NHS Highland consultation event. Awareness of the consultation from local groups (11%) and NHS Highland staff (10%) was also indicated.
Table 8: Respondents awareness about the public consultation
Number of % of Consultation awareness respondents respondents As part of Community Council 97 4.8% Attended NHS Highland event 318 15.8% Friends and Family 915 45.4% Local Group 215 10.7% Met with NHS Highland staff 209 10.4% Other / Not given 679 33.7% Base: All (2,017) Responders could select more than one category so the percentages may not equal 100%
5.3. Consultation information source
Respondents source of information on the public consultation is shown in Table 9. Almost two thirds of responders indicated that they had sourced information from the NHS Highland consultation document (51%) and other NHS Highland materials (12%). Information from the local media (43%) and social media (27%) was also selected as a source of information. 55 respondents (3%) indicated that they were part of a group that developed the options.
Table 9: Respondents source of information about the public consultation
Number of % of Information source respondents respondents NHS Highland consultation document 1029 51% Other NHS Highland materials 239 12% Part of group that developed options 55 3% Place of work 223 11% Local media 875 43% Social media 545 27% Other 118 6% Base: All (2,017) Responders could select more than one category so the percentages may not equal 100%
Epidemiology & Health Science Team, Public Health 15
5.4. Other comments about consultation information or awareness
There were a total of 260 comments made by respondents to the public consultation survey about the consultation process. Positive and negative feedback was received about the consultation documents, consultation meetings and the transparency of the process. A summary of the themes identified is shown below:
Consultation documents The summary consultation document sent to every home was the main source of awareness and information for many respondents. Documents viewed by some as well presented, clear and concise. Others commented on lack of detail and gaps in the information. A number of respondents noted that the summary document and survey could have been sent in same mail drop. Consultation method A few respondents queried the value of bigger meetings where it is more difficult to speak, and suggested more opportunities to speak to staff in small groups or individually. Social media is seen as a valuable tool but there is a concern about the accuracy of information obtained this way. There was good use of the website, though for some this was difficult to access. Transparency and next Some respondents commented that the consultation had been steps carried out openly and transparently, whereas others felt that a decision has already been made. Respondents queried how NHS Highland will incorporate the findings of the consultation process into the plans and next steps. Updates to the community need to be part of the plans.
A sample of comments made by respondents to the public consultation survey illustrates these themes: “Well presented document which is easy to read and understand.” Respondent 30, Wick
“The leaflet is incorrect and misleading” Respondent 34, Wick
“Information and questionnaire should be sent out together or closer dispatch to each other.” Respondent 326, Thurso
“Not enough time at larger meetings for discussion.” Respondent 1565, Wick
“Very pleased with the way the NHS Highland events was facilitated.” Respondent 1783, Thurso
“Overall, this consultation is going in the right direction but maintain transparency at all costs.” Respondent 1589, Thurso
Epidemiology & Health Science Team, Public Health 16
6. Summary and Conclusions
There were 2,017 responses to the public consultation feedback survey, of which the majority (93%) were written responses to the survey delivered to homes. Most people have responded as a member of the public (individual, family or household) rather than as a member of an organisation or group.
The consultation survey achieved an overall response rate of 9%. Response rates were higher in Thurso and Northwest Caithness (10%) than Wick and East Caithness (7%). The response rates for both areas exceed those received to other similar major service change consultations. Ethnicity and disability data are in line with expectations from census data but females and older people are slightly over-represented. This means that we can be reasonably confident that the views expressed in the survey are representative of women and older people in Caithness, but less so for males and people aged 50 and below.
The survey findings suggest broad support for the proposed changes to adult health and care services in Caithness. Overall, 70% of respondents indicated a preference for the changes proposed in option 2 and option 3. A significantly higher proportion of respondents indicated a preference to option 3 (39%) compared to option 2 (32%).
The main themes and issues identified from comments survey respondents made about consultation were associated with accessibility and transport, the model of care, site and environment, GPs, the consultation process, staffing, governance, the range of services, quality of care and technology. Concerns about public transport, parking, the concept of care hubs and the provision of wider district general hospital services were raised.
This report has also highlighted a difference in viewpoint according to where people live. The sensitivity analyses show that option 3 is preferred by 43% of Thurso residents. Opinion is more evenly split for Wick residents, with 36% selecting option 3 compared to 34% selecting option 2. This difference is not significantly different. It is of note that significantly more respondents from Wick preferred no change to Thurso residents, 23% compared to 16%. These findings are important because concerns about people contributing to decisions that would not affect them, for instance, Thurso residents selecting Wick options, were identified in comments made by respondents about the consultation.
Epidemiology & Health Science Team, Public Health 17
References
1. NHS Highland. Proposals to redesign health and social care services in Caithness: Full Document – Public Consultation. NHS Highland; 2018. Available from: https://www.nhshighland.scot.nhs.uk/News/PublicConsultation/CaithnessRedesign/Docu ments/2018/Caithness_Full_Final_September_2018.pdf
2. NHS Highland. Proposals to redesign health and social care services in Caithness: Summary Document – Public Consultation. NHS Highland; 2018. Available from: https://www.nhshighland.scot.nhs.uk/News/PublicConsultation/CaithnessRedesign/Docu ments/Caithness-SummaryDocWeb.pdf
3. Groves R et al. Survey Methodology (2nd ed). New Jersey: Wiley; 2009
4. Braun V, Clarke.V. Using thematic analysis in psychology. Qualitative Research in Psychology, 2006;3,77-101X
5. Gohil S, Vuik S, Darzi A. Sentiment Analysis of Health Care Tweets: Review of the Methods Used. JMIR Public Health Surveill 2018;4(2):e43. Available from: https://publichealth.jmir.org/2018/2/e43/
6. NHS Future Fit. Future Fit Update [online]. Available from: https://www.sath.nhs.uk/wp- content/uploads/2018/08/180830-Future-Fit-Presentation.pdf [Accessed 18 December 2018]
7. NHS Highland. NHS Highland statement 2nd November 2018 [online]. Available from: https://www.nhshighland.scot.nhs.uk/News/Pages/NHSHighlandstatement2ndNovember 2018.aspx
Epidemiology & Health Science Team, Public Health 18
Appendix 1
Codes used to assign responders geographical area of residence to consultation area
Thurso and Wick and East Outwith Unknown Northwest Caithness Ward Caithness Ward Achscrabster Ackergill Aberdeen Prefer not to say Achvarasdale Auckengill Armadale Prefer not to answer Barrock Berriedale Bettyhill Wick and Thurso Bower Bilbster Brora Blank Bowermadden Canisbay Forsinard Brough Dunbeath Helmsdale Castletown East Mey Inverness Dunnet Freswick Kildonan Forss Gills Melvich Gillock Haster Newton Glengolly John o' Groats Portskerra Halkirk Keiss Skerray Lybster Latheron Strathy Lyth Latheronwheel Milton Mey Murkle Occumster Reay Papigoe Scrabster Reiss Shebster Sarclet Thurso Scarfskerray Weydale Scotscalder Spittal Staxigoe Thrumster Ulbster Watten Westerdale Wick
Epidemiology & Health Science Team, Public Health 19
Appendix 2
Caithness Public Consultation Survey: Final Themes Theme: Access and transport Theme: Medical Centres/GP Practices
Car Parking Central location Transport Rural practices Bus services Existing buildings Taxi fares Practices moving Walking Appointments Frailty/disability Concern for current services Equity of access Theme: Site and environment Theme: Range of Services/Facilities
Congestion on roads A&E / minor injuries Future proofing – room for expansion Ambulance / air ambulance Safety (cliffs) Assisted living Exposed location to weather Cafe / lounge Physical space Day care Gardens Drugs and alcohol Local environment Fire Use of empty buildings Learning disability Better use existing resources Mental health Pharmacy Respite care Theme: Quality Theme: Model of Care
Quality of care (Care Homes) Care hub / village concept Quality of care (Palliative) Co-location Waiting times Dementia care Improvements to current care District General services Maternity Out of hours services Other services (young people) Theme: Staffing Theme: Governance issues
GPs NHS Highland management Workforce Bullying Staff not buildings Trust Locum costs Funding Training for staff Cost Recruitment and retention National policy Timescale for change Waste of money Theme: Process of consultation Theme: Technology
Decisions already made NHS Near me Lack of detail Video consultations Consultation documents Broadband Decision making from outwith area Bed numbers Empty buildings
Sentiment tags: Positive, negative, neutral
Epidemiology & Health Science Team, Public Health 20