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CAITHNESS Summary Document - Public Consultation Proposals to redesign health and social care services in

Changes to NHS health and social care services are being proposed for Caithness. It offers the potential to attract up to £30m of investment to enhance and improve local services.

This public consultation will run from Monday 20th August to Friday 23rd November 2018

YOUR CHANCE TO COMMENT Please submit your views no later than 23rd November 2018 This document summarises some of the exciting proposals developed with local people, explains why changes are felt necessary, and encourages you to respond with your views.

If you would like this information in large print, audio form, another language, or require any assistance with responding to the consultation please get in touch.

You can find out how to make your views known including contact details on the back page. www.nhshighland.scot.nhs.uk www.nhshighland.scot.nhs.uk

“It was good to take part in something that will be great for the future of Health Care Care in Caithness” Village – Feed-back from local person, June 2018 Assisted Community Housing Pharmacy All this would be brought together in a Care Introduction business case where NHS Highland would look to secure an additional investment of GP Hub NHS Highland is proposing to develop two around £30m for Caithness from Scottish GP/Primary Community Beds Care Hub/ Care Villages: one in Care Services Transport Services Government and other funders. (located on Dunbar Hospital site, Page 6) Health & Wellbeing Hubs and one in Wick (located at Pulteney House 24/7 These exciting proposals have been or Town and County, Pages 8 & 10), as part Adult Day Palliative developed after lengthy discussions with Care Care of a number of improvements to local Outpatients local people who took part in developing services. future solutions.

Co-locate Mobile Library Community Ambulance + Fire Rapid In Summary Garden Response Modern Apprenticeship The Care Hubs/ Care Village would support more services to be moved beside each “It’s been a really other, across fewer sites and in improved Befrienders h Hairdresser/ facilities. thorough and fair process c a Beautician e r where everyone has had a t Services provided from GP Practices would u O Training & - stay in their current towns and villages. In chance to have their say. I Development h Wick and Thurso, however, some would c a e move into the Care Hubs. feel together we have a r n shaped our future services I Palliative care would continue to be delivered in Caithness across a range of and have arrived at a settings including at home and in community beds. good outcome. Everyone recognises there is a long The plans would also include: a multi-million pound upgrade for way to go but we are on Caithness General Hospital the right road now” investment in community services, and funding to improve a number of our health and care facilities which are not Thurso GP Dr Alison Brooks, who

fit for purpose. attended all of the workshops Caithness General Hospital

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Summary of short list of options Need to know The three short-listed options being considered and how they scored are shown below. There are no plans to change any GP services as part of this consultation.

Options which will be considered as part of public consultation

Option Description Score (out of 1000) Current and future locations of GP Practices

1 No change – current arrangements continue 277 (baseline) GP Practice Current Future 2 Care Hub/Village located at Dunbar Hospital site 683 (alternative) (Thurso) and Town & County Hospital site (Wick) Castletown and Canisbay Practice Canisbay Canisbay 3 Care Hub/Village located at Dunbar Hospital site 783 (preferred) Castletown and Canisbay Practice Castletown Castletown (Thurso) and Pulteney House Care Home site (Wick) Dunbeath Health Centre Dunbeath Dunbeath Thurso & Halkirk Medical Practice Halkirk Halkirk Lybster Medical Practice Lybster Lybster Care Hub / Care Village Riverbank Medical Practice Thurso Thurso Care Hub, (Dunbar Hospital site) Janet Street Dunbar Thurso & Halkirk Medical Practice Thurso Thurso Care Hub, Princes Street Dunbar (Potential) Pearson Practice Wick Medical Centre, Practice decision Care Hub / Care Village Martha Terrace (Pulteney House or Wick Riverview Practice Wick Medical Centre, Wick Care Hub THURSO Town and County). Martha Terrace Upgrade to Caithness General

WICK

“The independent facilitator was excellent and included everyone who wanted to be involved. He got engagement in a respectful manner from all.”

– Feed-back from local person, June 2018

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Thurso | West Caithness Care Hub / Care Village Thurso | Summary of current versus proposed future service provision

The proposed location for the Care Hub/ Need to know Village in Thurso would be on the Dunbar Services (*) Current Future Hospital site (the only site considered in Bayview House is on three floors Thurso). and is not ideal for people with A&E • Caithness General Hospital, • Caithness General Hospital Emergency Department Emergency Department walking difficulties. Owned by the An expanded range of services currently Assisted Living • No adapted housing • Housing to be developed as delivered from a number of sites in Thurso Highland Council it would be freed part of Dunbar Care Hub/Village would all move to the Care Hub (see the up for future use Caithness General • 42 inpatient beds, three high • Same range of services but Box ‘On the move’). dependency proposed multi-million pound • Two theatres, endoscopy, refurbishment to achieve 50% This would include building a new care outpatient, day-case, rehabilitation single rooms and expand home in the Hub. It would be dual services and renal Emergency Department , On the move Outpatients and day-case registered to provide nursing and surgery residential care with 24/7 community beds, The following services would all move Care at Home • Provided by NHS Highland and • Additional Investment palliative, end-of-life, respite and day care to be part of the Care Hub Independent sector providers services. Care Home • Bayview (23 beds) • Dual Registration as part of • GPs, Nurses, staff, clinics and services Care Hub/ Village (from Riverbank Medical Practice and Another positive development would be to Community • Dunbar Hospital, mostly long stay • As part of Care Hub/Village possibly Thurso & Halkirk Princes build a new Health Centre to provide Beds (**) patients (six beds) including palliative end of life Street) • One palliative room care beds Primary Care including GP services. • Integrated team (from Community Community • Dunbar, old outpatient department • As part of Care Hub/Village Mental Health Out-patients, NHS Near Me, X-ray, Health Centre, Davidson’s Lane) Community • Thurso Community Health Centre, • As part of Care Hub/Village physiotherapy, dental services, Minor Injury • Learning disabilities and day services nursing Davidson’s Lane, Thurso and Out of Hours, and base for the (from Thor House) Day Services • Bayview • As part of Care Hub /Village integrated team (community nurses, mental • Thor House, Learning Disabilities • Stepping Stones health and social workers etc) would all be • Residential, day and respite care • Stepping Stones located in the Care Hub. (from Bayview care Home) Medical Practices • Riverbank Medical Practice • As part of a Care Hub/Village • Thurso & Halkirk • Potential for Care Hub/Village As part of the Care Village some Assisted Minor Injuries • Dunbar Hospital • As part of Care Hub/Village Living Units would be built. These are Out of Hours • Dunbar Hospital • As part of Care Hub/Village houses or flats designed to help people live Need to know Outpatients • Dunbar Hospital • Dunbar Hospital independently for longer and with support. (Caithness) • Caithness General • Caithness General All three hospital inpatient facilities • NHS Near Me (at Caithness • NHS Near Me as part of Care General Hospital) Hub/Village A more detailed appraisal of the site and in Caithness don’t meet modern Palliative and End • At home and in Care Homes, • At home, community beds buildings would determine exactly where clinical standards. of Life Care Dunbar, Wick Town & County and and Caithness General each service would be located in the future. Caithness General Respite Care • Bayview Care Home • As part of Care Hub/Village

For a summary of current versus proposed (*) – For further details and descriptions see the Full Consultation Document future services see page 7. (**) – The number of community beds has still to be calculated.

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Wick | East Caithness Care Hub / Care Village Wick | Summary of current versus proposed future service provision

In Wick three possible locations for the On the move Care Hub/ Care Village were considered: Services (*) Current Future The following services would all move • Pulteney House Care Home (preferred to be part of the Care Hub A&E • Caithness General Hospital, • Caithness General Hospital option) Emergency Department Emergency Department • Town and County Hospital (alternative • GPs, Nurses, staff, clinics and services Assisted Living • No adapted housing • Caberfeidh Court Housing as option) (from Riverview Medical Practice) part of Pulteney House Care Hub/Village • Caithness General Hospital (rejected as a • Integrated team (from Old Wick Caithness General • 42 inpatient beds, three high • Same range of services but non workable option). Medical Centre) dependency proposed multi-million pound • Two theatres, endoscopy, refurbishment to achieve 50% Pulteney House (Option 3, scored 783 out • Community beds including palliative outpatient, day-case, rehabilitation single rooms and expand services and renal Emergency Department , of 1,000) - Preferred care (from Town and County) Outpatients and day-case surgery An expanded range of services currently Care at Home • Provided by NHS Highland and • Additional Investment delivered from a number of sites in Wick Independent sector providers would move to the Care Hub (See the Box Care Home • Pulteney House (18 beds) • Dual Registration as part of ‘On the move’). Care Hub/ Village Community • Town & County, mostly long stay • As part of Care Hub/Village A new build element as part of the existing Beds (**) patients (six beds) including new extension to • Palliative care (two ensuite) Pulteney House Care Home would be part of the proposals. It would be dual registered to provide Community • Old Wick Medical Centre • Wick Town & County or part of Mental Health Care Hub/Village nursing and residential care with 24 /7 Community • Medical Centre, Martha Terrace • As part of Care Hub /Village community beds, palliative, end of life care, nursing respite care and day services. Day Services • Laurandy (Third sector) • Laurandy • Haven Mental Health • Haven Mental Health Another positive development would be a “I started this process with great • As part of Care Hub/Village new Health Centre to provide Primary Care Medical Practices • Riverbank Medical Practice • As part of Care Hub /Village including GP services and NHS Near Me as trepidation as did many community • Pearson Medical Practice • Practice decision if wish to be part of Care Hub part of the Care Hub. reps. However, communication and Minor Injuries • Caithness General Hospital • Caithness General ED facilitation were both excellent and A unique element is that nearby Caberfeidh Out of Hours • Caithness General Hospital • Caithness General ED Court would be immediately available to the mood palpably changed to one Outpatients • Caithness General Hospital • Caithness General Hospital (Caithness) • NHS Near Me • NHS Near Me as part of Care support Assisted Living Accommodation. of positivity. I asked NHS Highland Hub/Village There would be potential for more to give us a positive vision and they Palliative and End • At home and in Care Homes, • At home, community beds accommodation to be developed in the of Life Care Wick Town & County and and Caithness General future with opportunities for inter- did. This changed the dynamic Caithness General Hospital generational activities. Respite Care • Pulteney House Care Home • Pulteney House Care Home as significantly” part of Care Hub/Village For a summary of current versus proposed – Feed-back from local person, June 2018 future services see page 9. (*) – For further details and descriptions see the Full Consultation Document (**) – The number of community beds has still to be calculated.

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Wick | East Caithness Care Hub / Care Village Wick | Summary of current versus proposed Town and County option?

Town and County (Option 2, scored 683 On the move out of 1,000) – Alternative Services (*) Current Future The following services would all move An expanded range of services currently from current locations to be part of the A&E • Caithness General Hospital, • Caithness General Hospital Emergency Department Emergency Department delivered from a number of sites in Wick Care Hub would all move to the Care Hub (See the Assisted Living • No adapted housing • To be developed as part of Box ‘On the move’) • Residential and respite care (from Wick Town & Country Care Pulteney House) Hub/Village Caithness General • 42 inpatient beds, three high • Same range of services but As part of the proposals a new care home • GPs, nurses, staff, clinics and services dependency proposed multi-million pound would be built in the Care Hub. It would be (from Riverview Medical Practice) • Two theatres, endoscopy, refurbishment to achieve 50% dual registered to provide nursing and outpatient, day-case, rehabilitation single rooms and expand residential care with 24/7 community beds, • Integrated team including services and renal Emergency Department , community mental health services Outpatients and day-case palliative, end- of-life care, respite care and surgery (from Old Wick Medical Centre) day services. Care at Home • Provided by NHS Highland and • Additional Investment Independent sector providers Another positive development would be to Care Home • Pulteney House (18 residential • Dual Registration as part of build a new Health Centre to provide Need to know beds) Care Hub/ Village Primary Care including GP services and Community • Town & Country, mostly long stay • To be developed as part of Care NHS Near Me. In this option the existing buildings Beds (**) patients (six beds) Hub/Village • Palliative care (two ensuite) and gardens on the Town and As part of the Care Village some Assisted Community • Old Wick Medical Centre • As part of Care Hub/Village County site would almost certainly Mental Health Living Units would also be built. need to be demolished to build Community • Medical Centre, Martha Terrace • As part of Care Hub/Village nursing For a summary of current versus proposed the new facilities. It would also see Day Services • Laurandy (Third sector) • Laurandy future services see page 11. the transfer of residents from their • Haven Mental Health • Haven Mental Health • As part of Care Hub/Village home in Pulteney House to the Medical Practices • Riverbank Medical Practice • As part of a Care Hub/Village Care Hub • Pearson Medical Practice • Practice decision if wish to be part of Care Hub Minor Injuries • Caithness General Hospital • Caithness General ED Out of Hours • Caithness General Hospital • Caithness General ED Outpatients • Caithness General Hospital • Caithness General (Caithness) • NHS Near Me • NHS Near Me as part of Care Hub/Village Palliative and End • At home and in Care Homes, • At home, community beds as of Life Care Wick Town & County and part of Care Hub/Village and Caithness General Hospital Caithness General Respite Care • Pulteney House Care Home • As part of Care Hub/Village

(*) – For further details and descriptions see the Full Consultation Document (**) – The number of community beds has still to be calculated.

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Conclusion | Pulteney House or Town and County? Option 1 | No change = current arrangements (scored 277 out of 1000) Did you know? Local people who took part in developing Having the Care Hub / Care Village located ? Between 2017 and 2037 the total ? the options scored Pulteney House (783) at Town and County would be a significant This option has to be included in any public higher than Town and County (683) as the improvement on the current arrangements population in Caithness is predicted consultation as the baseline to compare the location for the Care Hub/Care Village (Option 1) but it throws up a number to decrease by 14 per cent, roughly other two options. The low score reflects challenges which may not be easy to going from 26,000 to 22,000. The that participants felt that this option does They highlighted some unique advantages overcome. not address current or future challenges. In over 85 age group will increase by of locating the Care Hub/Village at Pulteney particular having 24/7 services across five 136 per cent: from 700 to 1,700. House: • would almost certainly result in the NHS sites: demolition of the existing buildings and Already half of NHS staff in • Would not need to move residents from gardens Caithness are aged 50 or over. • Dunbar Hospital and Bayview Care their home in Pulteney House. • makes poor use of existing buildings Home in Thurso • Makes the best use of existing buildings that are in good condition • Caithness General Hospital, Town and that are in good condition • no assisted living accommodation County and Pulteney Care Home in Wick. • Assisted living accommodation already • would be the most complex option and available nearby slower to deliver • Easier and quicker to deliver • Town and County buildings and garden could be safeguarded for future use Overall for these reasons They also felt there was a unique Pulteney House is, therefore, the disadvantage of the preferred option: preferred option for the Care • Likely opposition to change in use for Hub and Care Village in Wick Wick Town & County Hospital

“Everyone was made to feel involved and valued” – Participant, June 2018

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Full consultation materials Why do we need to change services? The full consultation documents provide Did you know? further details on everything covered in this Existing and increasing staff shortages mean ? NHS Near Me is a new NHS ? leaflet plus additional information. it would become very difficult to keep some Highland service which aims to local services running. This would result in provide consultations as close as You can find out more on the background unpredictable closures of services, often to why changes are needed, a summary of possible to patients’ homes. It uses with little or no notice. Buildings which are video consultations supported by new current and proposed future services, not fit to deliver modern clinical and care technology. assessment of buildings and how local standards may be closed with no alternative It is currently available in Caithness people have been involved in developing services in place. and appraisal of options. General Hospital and in the future will also be available in the Care Hubs. We also need to plan ahead to meet the There are also sections on how potential growing pressures linked to requirements of impacts would be addressed, what would our ageing population (See box below). happen to any buildings that might become vacant, and the business case “I have been doing video “Very thankful not to process to secure funding. consultations for four years. have to travel to The Near-Me technology is a for a 10

Why we need to plan services for the future? huge improvement. Still some minute consultation. patients prefer face-to-face It’s a first class idea, • There will be more people to care for with fewer people to provide the care consultations but the vast very well organised.” • Investment in community services and housing would allow more people to be looked after at home for longer majority love its ease and – Patient feed-back • Half the current NHS staff in Caithness are over 50 accessibility. It cannot be • Only one-in-three nursing jobs are recruited when first advertised rolled out fast enough for me.” • Too many people are having to travel for out-patient appointments – Consultant feed-back • Some staff and services are not beside each other when it would be more sensible if they were

• All three hospital in-patient facilities don’t meet modern standards

• Bayview House Care Home in Thurso is on three floors and is difficult to access if people need help walking

• Caithness General Hospital needs significant investment to expand the Emergency and Out-patient departments and develop better facilities for the community maternity unit

13 14 Tell us what you think

The consultation feed-back form sets out everything that we are looking to get your views on. Please complete the form and return it in the Freepost Envelope. Alternatively you can go to the NHS Highland site and complete the survey on line.

How to find out more

NHS Highland staff and community representatives who took part in developing the options will attend meetings of community councils, local groups, and public meetings. There will be a range of other opportunities to meet the public, service users and staff to answer any questions and explain the proposals in more detail.

These meetings and events will be advertised locally including through the media, social media, local groups, websites and local venues.

Further details are provided in the full consultation document available on the NHS Highland website and locally in GP Practices, Libraries, Post Offices and other local venues.

If you want further information from NHS Highland, please get in touch with:

Michelle Johnstone Dr Alison Brooks Maimie Thompson Area Manager (North) GP Cluster Lead (Caithness) Head of PR & Engagement T: 07973 747688 T: 01847 895986 T: 07814 618591 E: [email protected] E: [email protected] E: [email protected]

Christian Nicolson Eric Green Quality Improvement Lead Head of Estates T: 07870 513114 T: 07903 883244 E: [email protected] E: [email protected]

Making decisions

The board of NHS Highland will consider responses to the consultation on all the options that have been considered to date. They will also give consideration to any alternative suggestions that are put forward as a result of the consultation.

Other factors such as technical issues associated with sites and buildings will be studied. The independent report by Scottish Health Council on the public consultation process will also be an important consideration.

Any new or changing circumstances will be reviewed.