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Highland Health Board NHS Highland Board 31 May 2016 Item 4.9 UPDATE ON MAJOR SERVICE REDESIGN PROJECTS Report by Gill McVicar, Director of Operations (North and West), Georgia Haire, Deputy Director of Operations (South and Mid) and Maimie Thompson (Head of PR and Engagement) on behalf of Deborah Jones, Director of Strategic Commissioning, Planning and Performance The NHS Highland Board is asked to: • Consider the proposals to redesign services for the North Coast (Sutherland), approve that the changes constitute major service change; endorse the pre- consultation work and options appraisal process and approve the draft consultation materials; • Note the update on progress with developing the business case for major redesign of services for Badenoch and Strathspey 1. Background and summary Services provided by the NHS need to change to ensure they meet the future needs of the changing population, particularly the increasing ageing population of Scotland and the number of people with long-term health conditions. There are additional challenges facing NHS Highland linked to geography, recruitment, staff retention and in some cases history. In addition there is a pressing need to develop more community services, facilitate greater community resilience and modernise and rationalise our estate. Notably at the time the major service change projects got underway in 2012/13 the backlog maintenance was some £70million. As set out in NHS Highland’s 10 year operational strategy, work is ongoing to transform models of care and services. The transformations of services we are striving to deliver are supported by a number of underpinning principles: • Reduce the length of time people spend in hospital • Reduce unnecessary attendances (A&E, out patients) • Increase choice for end of life care and more realistic medicine • Support for people to stay at home longer by increasing the age of admission to institutional care where that is required • Fewer but better care homes • Greater integration, co-location and co-ordination of care • Reduction in the use of locums • Supporting staff to work to the top of their licence • Supporting people and communities to be more independent and resilient Our 10 year strategy is backed up by The National Clinical Strategy for Scotland’, issued by the Scottish Government in February and Scotland’s Chief Medical Officer Annual Report (2014/15) ‘Realistic Medicine’ published in January. This financial year (2016/17) time will be spent continuing essential work to redesign services which have already been consulted on and are going through the business case process Badenoch & Strathspey; Skye, Lochalsh and South West Ross and Raigmore Critical Care. These won't come to fruition until 2019/20: Actions will also be required to ensure that work can get underway to ensure necessary preparation is in place to make future changes such as the re-design on the north coast of Sutherland, ongoing redesign of services in Caithness including the clinical model and Redesign of Mental Health Provision in Argyll and Bute. 1.1 Major service change and business case process The process which is required to be followed is summarised (Appendix 1). Projects which are deemed major require formal public consultation for a minimum period of three months. The public engagement and consultation around such projects are independently reviewed by the Scottish Health Council and require appropriate sign off from the board and endorsement by the Cabinet Secretary. Following public consultation, for capital projects, the Initial Agreement is the first of three documents which are required to be prepared as part of the Scottish Capital Investment Manual (SCIM) business case process. Once it has been approved projects progress to Outline Business Case (OBC) and Full Business Case (FBC). The stage of both projects is summarised: 1.2 North Coast re-design (Sutherland) The proposal for the North Coast re-design (Sutherland) has been through an informal engagement process including an options appraisal exercise with local communities. The North & West Operational Unit would now like to move to formal public consultation, subject to the board agreeing that the proposals represent major service change and they are content with the options and draft consultation materials. The Scottish Health Council has endorsed the engagement and options appraisal process to date (Appendix 2). 1.2 Badenoch and Strathspey The board approved the Initial Agreement in June 2015 and this project is progressing through the Outline Business Case Process. A brief update is provided. 2. Updates on major service change projects in Highland 2.2 North Coast (Sutherland) redesign 2.2.1 Overview The north coast of Sutherland is one of the most sparsely populated areas in Highland and when combined with its ageing population and small number of younger people it faces some unique challenges to deliver and sustain services. To put the population in context there are two secondary schools in the area: Farr in Bettyhill with 68 pupils and Kinlochbervie with 50 pupils. The scope of this redesign covers the communities between Scourie and Kinlochbervie in the West across to Melvich in the East, covering a resident population of around 2,250. In terms of primary care health services there are four GP Practices: Scourie/Kinlochbervie, Durness, Tongue and Armadale. Armadale has branch surgeries in Bettyhill and Melvich. Under the proposed new arrangements these services would still be provided from the same locations. As part of the integrated team the wider range of services include community nursing, community rehabilitation team, care at home and respite, day care services and residential care. There is no community hospital on the north coast but there are two six-bedded residential care homes (Caladh Sona in Talmine and Melvich). Both are converted sheltered homes and 2 are 29 miles apart (travel time approx 30 to 40 mins). The homes are owned by the Highland Council but since April 2012, the services are managed by NHS Highland. In December 2014 the Highland Council announced a funding commitment to provide capital to replace Caladh Sona. They own the facility but the service transferred to NHS Highland in 2012, as part of integration though the lead agency model. It has also provided the opportunity to give wider consideration as to how to meet the needs of the area as a whole (Box 1). Box 1 Three key reasons why the proposed re-design is required • The general challenges in recruiting to health and social care staff in the north and move to reflect more integrated working. • The current location of both facilities do not lend themselves to greater co-location of other services • The care homes are not purpose built and are not in good condition: Caladh Sona does not meet Care Inspectorate Standards and the Melvich Community Care Unit, while in better condition is also not ideal. 2.2.2 Major service change process and public consultation In April and May 2015 a series of informal meetings and semi-structured discussions took place with local communities, groups, councillors, GPs and staff in North, West and Central Sutherland. Emerging from these discussions was a good understanding from all areas of the issues faced and an acceptance of the need to look at all the services in the area to reflect more integrated ways of working to support people to be more independent at home. Agreement was reached to move to the next steps and the scope was the communities of Scourie, Kinlochbervie, Durness, Tongue, Bettyhill, Strathy, Armadale and Melvich, staff working in both units. Other relevant stake holders included service providers and partner agencies. The Options appraisal process has been followed including a series of workshop events identifying a long list of options which were whittled down to a short list of three options. 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) (*) Options B and C would include strengthened community, primary and emergency care services in linked teams, enhanced community resilience utilising potential for inward investment. Notably the group did not short-list having no care homes in the area as an option. This was debated at some length but participants including some clinicians, overall felt, that it would not be achievable to increase the capacity of care at home, community services or adapt housing to such an extent that more people could be cared for locally. The full description of the process is set out in the full draft consultation document (Appendix 3a). 3 Option 2 was preferred model of service and through a further Options Appraisal exercise the Kyle of Tongue area was the recommended area for the proposed new facility. The preferred model would be more sustainable by reducing some of the challenges currently required to staff and maintain two small units. The proposal, if implemented, would mean NHS Highland would no longer provide residential care home services from Caladh Sona and Melvich Community Care Unit. However, there could be possibilities for consideration around how local communities might use any properties freed up. If the board consider the proposals to represent major service change then formal consultation for a minimum period of three months would be required. 2.2.3 Time-table for proposed formal consultation and next steps If the board agree a move to formal public consultation the dates would be confirmed after the Board meeting to allow time to respond to any queries and finalise materials. Following the consultation, a recommendation would be brought to the Board 2.3 Badenoch and Strathspey In February 2015 the Cabinet Secretary for Health and Wellbeing approved NHS Highland’s proposals for the modernisation of services in Badenoch and Strathspey.
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