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North Coast (Sutherland) Redesign NHS Highland Board 31 January 2017 Item 4.5 North Coast (Sutherland) redesign Report on formal public consultation 25th July to 25th October 2016 Michelle Johnstone (Area Manager, Caithness and Sutherland) Christian Nicholson (Quality Improvement Lead) Maimie Thompson (Head of Public Relations and Engagement) December 2016 www.nhshighland.scot.nhs.uk Contents Executive Summary 1 Background 2 Raising awareness of the public consultation 3 Feed-back from meetings and events 4 About the Consultation Survey and who responded 5 Feedback on aspects of the service and service model options 6 Feedback on location of possible new Hub 7 Recommendations and next steps Appendices 2 Executive summary Strategic overview and local context 1. Services provided by NHS Highland need to change to make sure they meet the future needs of the population. In particular this relates to the increasing ageing population, changes to health and social care and the general challenges in recruiting and retaining staff. 2. The north coast of Sutherland is one of the most sparsely populated areas in Scotland, and when combined with its ageing population, the area faces some unique challenges to sustaining local services. 3. Specifically on the north coast there are two six-bedded care homes that are not purpose built and are not in good condition: Caladh Sona in Talmine, Melness, near Tongue does not meet Care Inspectorate Standards; Melvich Community Care Unit, in Melvich, while in better condition is also not ideal in terms of space or outlook. 4. Furthermore the current locations of both facilities do not lend themselves to greater co location with other services. However both care homes are extremely valued by families, local communities and staff and receive consistently high grades from the Care Inspectorate. 5. When services were provided by Highland Council, there had been considerable discussions around the replacement of Caladh Sona and this was supported by a local campaign Group Caladh Sona Action Group. The Group remain active. 6. The Highland Council agreed to a £1.5 million capital spend in May 2014 for a replacement facility for Caladh Sona. This also provided the opportunity to look at all the buildings and resources in the area. This was to explore how best to provide services that are local, sustainable, effective and efficient for the future. 7. For these reasons it was agreed to carry out a review and re-design of health and social care services across the north coast and to look at the viability of both local care homes and possible future options in the context of a wider redesign of community services. Scope of redesign 8. The scope of this redesign covered the communities between Scourie and Kinlochbervie to the West across to Melvich in the East and including Altnaharra and Strath Halladale, with a resident population of around 2,250. The scope reflects both the location of the care home facilities and the communities who mostly use these facilities. Development of options and options appraisal 9. During 2015/16 a steering group, drawing together local people, staff, councillors and agencies reviewed services in the area. Three options were short-listed: 3 Option A – status quo/minimal change Option B – build a new care home ‘Hub’ facility in one location and replace existing facilities (Caladh Sona and Melvich Community Care Unit) Option C – build a new care home facility in one location and maintain a second facility (either Caladh Sona or Melvich Community Care Unit) 10. The model of service which scored the highest was Option B, scoring 721 out of 1000, with Option A, the status quo scoring poorly with 172 out of a possible 1000. 11. Further options appraisal work was also carried out to determine a location for the ‘Hub’ should Option B be implemented. Through this process six broad locations were determined by the steering group. The Kyle of Tongue area scored highest closely followed by Bettyhill. Service change process and public consultation 12. While the proposals don’t fall within the scope of the current service change guidance - CEL 4 (2010) which is designed around health (and not adult social care), NHS Highland, as the lead agency for older people services, believed it appropriate to follow the CEL 4 (2010) process. 13. The Scottish Health Council did not consider the proposed changes to be major but the Board of NHS Highland considered these changes to be potentially ‘major’. In doing so they endorsed using the major service change process and approved a move to formal public consultation at their meeting on 31st May 2016. They also approved the draft consultation materials. 14. The formal public consultation was launched on 25th July 2016 and ran for a period of three months to 25th October 2016. 15. NHS Highland consulted on the three short-listed options on the model of care with Option B as the preferred option and Kyle of Tongue area the preferred location should Option B be implemented. 16. Although the Scottish Health Council did not believe the proposal to be major they provided an independent overview of the process. Awareness of the consultation 17. During the consultation period 1,200 summary consultation documents and survey forms with freepost envelope were distributed to a majority homes in the area of scope. 18. Throughout the consultation there was a regular flow of information available for the public through local media, social media and direct contact from the project team. 19. Meetings were held with families of residents, staff in care homes and wider staff groups including, Community Nurses, Allie Health Professionals and local GPs. 4 20. There was active engagement from community councils, local groups, local councillors and other key local groups. There was also wider engagement with partner agencies, MSPs, local MP and others. 21. Overall some 17 meetings and events took place and all requests for meetings during the consultation period were accommodated. Feed-back from meetings, events and correspondence 22. Feed-back from the various meetings and other responses were analysed. Families of residents in both homes were very complementary around current level of care. Most but not all recognised why there was a need to consider future options. While open to possible changes they sought reassurances that high quality person centred care in a homely environment would be maintained. 23. In terms of wider views, the main themes raised consistently throughout the consultation included: the number of beds in the new unit, assurance that day care services would be maintained. People also wanted assurance that facilities would not close until any replacement was built. 24. In addition a further key concern raised both from communities and staff was around being able to staff two facilities, and if one facility, which location would be more viable. There were opposing views around where any staffing challenges would be more likely to be overcome. 25. In advance of the consultation a petition with around 100 signatures was received to ‘keep the care home in Melness’. 26. During the informal engagement stage letters were also received from pupils in Tongue Primary School supporting a replacement for Caladh Sona to remain in Melness/Tongue area. Responses to the consultation survey 27. 262 people completed survey forms giving a response rate of around 13% of adults aged over 16. There are around 1214 (occupied) homes in the area giving an approximate response rate of 22% per homes in the area. In general one form was completed per household. 28. A majority (56%) of respondents selected Option B while (34%) supported Option C. The status quo (Option A) received 6%, with 4% suggesting other options. However there was a general caveat around while those who responded accepted the case for change they weren’t necessarily ‘happy’ about it. This was borne out by the percentage who stated they were ‘unhappy’ about the proposed closure of Caladh Sona (34%) and Melvich Community Care Unit (31%).. 29. Tongue, Melness and Skerray Community Council and Melvich Community Council supported Option B. Strathy and Armadale Community Council supported Option C. Written responses were not received from the other Community Councils (Scourie, Kinlochbervie and Durness). 5 30. Kyle of Tongue area was the preferred location for the majority of respondents (64%), followed by Bettyhill (20%). Generally speaking people’s choice on location matched where they lived or neighboured. 31. Specifically in their formal response Melvich Community Council requested a “further review of an appropriate location for the new build care unit to ensure this change does meet the requirements of our communities health and social care needs now and in the future.” 32. The Scottish Health Council carried out a survey which showed that people felt there had been a reasonable effort to consult people about the proposals. There were positive comments about it being a thorough and open process and that NHS Highland staff answered people’s questions. There were some negative comments about the scope, one comment about a decision already being made and that the process was slow. Recommendation 33. Taking everything into consideration there appears to broad support and understanding for the case for change from the wide range of stakeholders for Option B - the preferred option - and this is now being formally recommended to the Board for endorsement. 34. However, while the Kyle of Tongue was the preferred location for proposed new ‘Hub’ for the majority of respondents (64%), significantly more people did respond to the consultation from the Tongue area. In addition during the consultation there was also considerable concern raised around which location would most likely support a sustainable staffing model. 35. Should the proposal get the necessary approval from the board it is recommended that some further work is carried out, to look in more detail at the staffing challenges and ways of improving recruitment.
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