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.

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).

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. In particular the operational unit feels there is a need to see if any evidence can be identified which would provide confidence that the Kyle of Tongue area can provide a sustainable workforce.

Further work

35. Regardless of location further work would also be required around determining the number of beds, full financial appraisal and staffing establishments.

36. There would be a requirement for the Business Case process to be followed, in accordance with the Scottish Capital Investment Manual Guidance. This Business Case would be progressed jointly with the Highland Council who would be responsible for the investing in the capital components of any new build.

1 Background

1.1 Introduction

On 31st May 2016 the board of NHS Highland considered that the proposal to redesign some services for the North Coast (Sutherland), constituted major service change.

The community councils covered by the consultation are Scourie, Kinlochbervie, Durness, Tongue (incl. Melness & Skerray), Bettyhill, Strathnaver and Altnaharra, Strathy and Armadale and Melvich (Map1).

Map 1 North Coast (Sutherland) Redesign Community Council Areas

The paper to board set out a description of the local services, some of the drivers for change and the informal engagement with local stakeholders.

The board also endorsed the pre-consultation work including the options appraisal process and approved the draft consultation materials in readiness to move to a formal public consultation.

In coming to this view members were made aware that the Scottish Health Council had endorsed the engagement and options appraisal process to date (Appendix 1). Copies of the consultation papers are available on the board website http://www.nhshighland.scot.nhs.uk/news/publicconsultation/northcoastredesign/pag es/welcome.aspx

7 This report specifically covers the formal three month public consultation (25th July until 25th October 2016). It describes how the consultation was promoted, the range of ways that views were gathered and a summary of the main feedback including from NHS Highland’s consultation survey.

The internal assurance mechanisms of NHS Highland are described and feed-back on the consultation process by the Scottish Health Council is also included (Appendix 2).

Based on an assessment of all the supporting information a recommendation to the Board is made on model of service and location. The report also sets out some further work that would be required should the preferred model of service be implemented.

1.2.1 NHS Highland Leadership and Management Support

The public consultation was led by the director of operations for north and west and, once in post in July 2016 the new area manager for Caithness and Sutherland . They were supported in the design and delivery of the consultation and public engagement by a small core team (Box 1).

Box 1 Members of NHS Highland core team and their lead responsibilities Name Designation Responsibilities Christian Quality Improvement • Project management Nicolson Lead (North and West) • Preparation of consultation materials • Point of contact for Steering Group • Attend meetings and respond to queries Penny Manager • Attend meetings and respond to queries Gardner Caladh Sona & • Point of contact for residents and families Melvich • Advice on staffing matters Maimie Head of Public • Lead on public consultation process Thompson Relations and • Preparation of consultation materials Engagement • Advice on service change process • Overview of communications • Attend meetings and respond to queries • Review of all feed-back • Point of contact for Board, Scottish Government, Scottish Health Council and local steering group Lorraine District Manager • Attend meetings and respond to queries Coe (Sutherland) • Link to District Partnership • Link to North West Management Team

The consultation process was actively managed. Only staff involved in attending meetings or responsible for responding to queries communicated directly with participants in the consultation and the steering group.

In situations where there was no initial response to requests to meet (e.g. Durness, Scourie, Kinlochbervie) a member of the project team actively followed this up to check contact details and to take any required actions to remedy any gaps, including discussing with local elected members.

Usually two or three members of the core team were in attendance at the events and meetings. The core team members were also responsible for providing responses to any correspondence and for providing thematic analysis on the feed-back from meetings and correspondence.

Staff in NHS Highland’s clinical governance team provided advice with the design of the consultation questionnaire (Appendix 4) carried out the analysis and wrote up the report on the findings from the survey (Appendix 5).

Helen Sikora (Principal Officer) provided support and advice in developing the person centred planning template HERE and Ian Douglas (Senior Health Intelligence Specialist) prepared a map illustrating the consultation responses by area.

1.3 NHS Highland Governance of Process

Update reports were considered by Highland Health and Social Care Committee via the North West’s Director of Operations Report. The board was also provided with brief updates on 27 September 2016 and 29 November 2016 as part of the Chief Executive’s Report.

A draft of this full consultation report was considered by the north and west senior leadership team on 21st December 2016 and will also be considered by the the Highland Health and Social Care Committee on 11th January 2017.

1.4 External Governance

The Redesign has been a standing item on the agenda of the Sutherland District Partnership with regular presentations and updates.

The Scottish Health Council has provided guidance and carried out a survey with stakeholders on the consultation process.

2 Raising awareness of the public consultation

2.1 Introduction

In discussion with the Scottish Health Council, Steering Group members and staff a range of approaches were identified to raise awareness about the consultation; what was being proposed, promotion of meetings and how people could make their views known.

These activities were set out in a communications and engagement plan which was regularly reviewed. The process was designed to be a responsive with capacity built in during the consultation period to meet any requests as they emerged during the consultation ore respond to any gaps.

Describing the extent and effectiveness of the communications and engagement activities is particularly important. It provides the context from which to interpret the number of attendances at the meetings and numbers responding to the consultation survey. The aim was to demonstrate that NHS Highland took reasonable steps to raise awareness and engage with the range of stakeholders, and that stakeholders had reasonable opportunities respond to the consultation.

2.2 Distribution of Consultation Materials

A total of 1,200 summary documents and feed-back forms were distributed to homes in the area. Because the Royal Mail could not do a door-to-door mail drop that was sufficiently targeted the number of homes in the area was established and local contacts were identified and they agreed to carry out the distribution locally. This got underway during the week beginning 1st August 2016 and checks were put in place to ensure this happened across all communities.

Carrying out a door-to-door exercise is not a formal requirement, nor does NHS Highland understand, is it usually carried out by other boards. The decision to take this step, however, was to provide confidence that, as far as practical, a majority of residents in the area had an equal opportunity to receive the consultation materials.

The documents (summary, full consultation document and survey forms) were also widely distributed including to:

• Caladh Sona and Sinclair Court • GP Surgeries/Health Centres (Scourie, Kinlochbervie, Durness, Tongue and Armadale) • Service Points (Bettyhill) • Mobile Library • Events and meetings.

.Partner Agencies

A number of organisations were also contacted directly about the consultation including: The Highland Council, Sutherland Partnership, The Scottish Ambulance Service, Highlands and Islands Enterprise, Police Scotland, Scottish Fire & Rescue Service, Caithness & North Sutherland Regeneration Partnership and community councils. 2.3 Wider activities

The range of initiatives which took place are summarised (Box 2) and descried further in this section.

Box 2 Summary of consultation activities Raising awareness

• Mail drop of summary consultation document to all homes • Articles in local publications • Paid adverts in local newspaper • Posters and flyers in local notice boards, shops, NHS Highland facilities and the mobile library • Regular media and social media outputs • NHS Highland website • Feedback questionnaire with freepost address and envelope • Collaboration with partner agencies

Engagement activities

• Meetings with families and relatives of residents in both care homes • Attendance community council meetings • Pre arranged and promoted drop-in events • Updates to Sutherland Community Partnership and Ward 1 Business Meetings • Session with High School pupils in Farr in Bettyhill and Kinlochbervie • Meetings with local NHS Highland staff • 1:1 communications (letters, e-mails, phone-calls and face-to-face)

2.5 Attendance at events

The detail of numbers of attendance at events and meetings is provided (Appendix 3). Attendance was variable ranging from 18 and 12 who attended drop-in events in Melness and Melvich respectively, to two drop-in events in Bettyhill and Kinlochbervie where nobody attended.

It is estimated that around 110 people attended consultation events. It is difficult, to give an exact number, however, because some people attended more than one event.

11 2.6 Face to Face meetings

2.6.1 Families of residents

The formal consultation got underway with an offer of meetings for relatives of residents. Meetings were arranged in Caladh Sona on 19th August 2016) with families of two of the four permanent residents taking up the offer. In Melvich Community Care Unit three of the families of the five permanent resends took part in a group discussion on 20th August 2016. Two of the residents attended for part of the meeting with one supported by family members.

During the consultation the Care Home Manager spoke to all family members in both homes. Family members advised that they did not wish NHS Highland to discuss the proposals with residents as they believed it could be unsettling and a likely long lead in time until any proposals implemented. Consideration was also taken around status of capacity, Power of Attorney and guardianship

2.6.2 Staff working in care homes

Two meetings were held with staff in Caladh Sona on 17th and 24th August 2016 and two in Sinclair Court on 29th and 31st August 2016 The Care Home Manager updated staff who were not able to attend these meetings.

2.6.3 Other NHS Highland staff

Two meetings were also held with community based staff. In addition GPs, staff and staff side representatives were involved in the Steering Group and a range of other activities and staff attended a number of the events.

2.6.4 Local Elected Representatives,

Elected members were either active members of the steering or were in receipt of all communication relating to the Steering Group. There was regular contact through the core team to help facilitate engagement. Meetings included attendance at the Ward 1 Business Meeting on 16th August 2016 as well as councillors being present at a number of meetings such as the Sutherland District Partnership meeting on 22nd August 2016.

2.7 MSP/MP

There has also been regular contact with constituency MSP and MP throughout the process via as well as with list MSPs.

2.8 Media releases

The media releases issued before, during and after the consultation during 2016 are summarised (Box 3) :

12 Box 3 Summary of media releases issued in 2016 Date issued Title 8th November North coast redesign consultation moves into analysis stage

7th September North coast redesign consultation reaches halfway stage

3rd August NHS Highland start North Coast public consultation

18th July Public to have their say on north coast redesign

22nd June NHS Highland to consult about north coast redesign

16th February Kyle of Tongue area proposed for new health and social care facility 26 January Board Media Briefing - North Coast Redesign

13 3 Feedback from meetings and events

Method: process for documenting and responding to feedback

Hand-written notes were taken during each meeting arranged by NHS Highland and these were then typed up and summarised as bullet points.

Any correspondence or queries raised in the survey responses were also considered and responded to whenever possible i.e. where contact details were provided.

During the consultation the core team were cautious about going too far to explore solutions to some of the issues raised. This is an important point to note as the core team were acting in a neutral facilitative capacity. Where it was possible to clarify points of detail this was done but in some cases it identified that further work or information was required.

3.1 Findings: high-level summary of the feedback from meetings

After the consultation closed the head of public relations and engagement and quality improvement lead summarised the feed-back. The information was grouped into the themes. There was consistency in the points being raised across all communities and by the end of the consultation there were no new themes emerging.

3.1.1 Existing residential care and facilities

A strong and consistent message was the support for the current level of care in both care homes. To a large extent this was attributed to the small size of the homes and the staff and the comment was made ‘bigger isn’t always better’.

It was recognised that there are limitations with the current buildings and outlook (Melvich Community Care Unit) but at the same time the most important element highlighted was the level of care and caring staff. Comments made by school pupils in Farr High School chimed with wider discussions.

“Building is not the most important thing but if you are building a new home you would look to see how you could improve.”

“Important it looks and feels like a home – not a hospital”

People sought reassurances that NHS Highland would not plan to close any facilities until any new arrangements were put in place.

3.1.2 Proposed new model

While there was general support for a proposed new model there was recognition that the detail regarding what would be in a ‘Hub’ facility was still to be determined. There was some representation around the number of beds.

Inclusion of nursing care, greater joint working and sharing of premises were also seen as positive. The reasons for proposing a new model and the importance of sustainability was debated, however, it was clear from the discussions that it was not universally accepted. There was strong support for day care services remaining in

14 their existing locations and during the consultation it was clarified that the plan was to maintain day care in Kinlochbervie, Tongue and Melvich. In many cases, how people felt about the model were heavily dependent on locations. Securing more care at home and respite were also thought to be necessary to support the model.

A number of practical considerations were raised around how residents would be transferred to a new facility.

3.2.3 Staffing, recruitment and retention

There was considerable focus on all aspects of staffing. This included what the staffing ratio would be in a proposed new facility; how would the nursing element be covered in new home and what staff groups would be based in the ‘Hub’. At most meetings it was debated whether one home would be easier to staff than two. Some of the staffing challenges were perceived to be around shift working, travel, lack of child care and lack of accommodation.

There were differing views as to whether it would be easier to staff one home (as opposed to two) and similarly mixed views as to which location would be more favourable in terms of supporting a more sustainable staffing model.

It was noted that some of the recruitment challenges are not specific to NHS Highland but that NHS Highland are an important employer in the area. There was support for promoting careers in local schools and the visits arranged as part of the consultation to Farr High School and Kinlochbervie were well received.

Some felt that current staffing challenges shouldn’t be the main driver; but rather there should be a focus on what is needed and address any barriers.

3.2.4 The ‘Hub’ facility

None of those who commented on this aspect wanted there to be less beds than are currently available (12 in total including the respite beds) but by the same token people were keen that any new facility should not be too large and loose a “home like” feel.

The number of public rooms available was questioned in particular by younger people (school pupils) who felt that people should have the opportunity to have privacy with their family without having to sit in a bedroom.

The therapeutic benefits of views and access to the outdoors were discussed and in particular by a number of families and staff. The lack of view at Melvich in particular was remarked upon and there was universal support for residents to safely access the outdoors and to fully embrace ‘My Home Life’.

There were differing views around whether the ‘Hub’ being busier was beneficial (‘stimulation’) versus quiet (‘calmer’). Further work around the literature and experience from elsewhere will need to be sought on this matter as well as active involvement of residents, families, staff and others.

15 3.2.5 Communications/Technology

Connectivity and better use of technology such a skype for those with family living at a distance would be welcomed.

“It’s one thing to speak and hear dad but it would be great to see him too. It would give that added reassurance that he is ok”

The increased use of Video Conferencing by consultants (geriatrician / older adult mental health psychiatry) was positive and it was recognised that it helped to avoid patients being admitted to hospital.

3.2.6 Location

The location of any proposed new ‘Hub’ was raised at every meeting. There were strong and opposing views around what would be the best location in terms of the likelihood of being able to staff a new single facility.

3.2.7 Finance

While some people felt finance was the real driver behind the proposals other accepted that there were pressing needs to make the model more sustainable in terms of a staffing model. There was general discussion on whether £1.5m capital allocation would be sufficient.

3.2.7 Local economy

There was representation that closing /relocating of facilities would have a ‘serious effect’ on the local economy.

3.2.8 Process

There was general support for the consultation process and easy access to members of the project team was appreciated. There were some legacy issues with the options appraisal work and who was involved or not involved and how were people selected. It was generally felt that the process was taking too long although it was recognised that it did need to be thorough. There were a small number of queries around the survey form and some ideas for improvement for similar exercises.

Communities expressed a desire and willingness for ongoing involvement in the process as it moves forward.

16 4 About the Consultation Survey and who responded?

4.1 Introduction

The consultation response form was agreed with the Scottish Health Council and local steering group (Appendix 4). Forms were distributed to all homes in the area with a freepost envelope.

It was made clear that people could request further forms, complete their forms on behalf of individuals, families or groups and/or submit their feed-back in any other format they preferred. The survey was also available on line.

Some standard questions were included to capture information about who responded. This is to support equality and diversity monitoring and sensitivity analysis such as age, gender, where people live, carer status and so on. Some people questioned the relevance of this.

4.2 Number of responses

262 responses were received; 19 were online and 243 were paper based. The overall response rate based on the number of people aged 16 or over was 12.7% when considered as the number of households who received a form the response rate is 20.5%

4.3 About the Respondents

The full results are provided in Appendix 5 and summarised below:

• 99% were responding on behalf of themselves • 87% described themselves as members of the community (table 1) • 68% were female • 61% were aged 60 or over • 32% were male • 29% had a long term health condition or disability • 24% had a reduced ability to carry out day to day activities described as ‘a lot’ • 5% indicated that they were carers

The most common effects of the condition or illness were related to mobility (56%); long term illness (52%) and stamina, breathing or fatigue (45%).

Table 1– Which categories best describe you

Number of % of respondents respondents Category Member of the community 209 87.1% Service user (other) 18 7.5% Staff member working in care home 14 5.8% NHS Highland staff (other) 13 5.4% Voluntary organisation 13 5.4% Carer 11 4.6% Community Council 8 3.3% Relative of resident in a care home 8 3.3% GP or GP practice staff 6 2.5% Other 8 3.3% *Note: responders could select more than one category, so these are not mutually exclusive and the percentages will not add up to 100%

4.3 Response rates by area

The location of people who responded was plotted to their community council areas (Table 2 and Map 2) and then grouped into broad areas. Area 1 = Scourie/Kinlochbervie, Durness & Kyle of Tongue and Area 2 = Bettyhill area, Strathy/Armadale & Melvich.

Overall, around one eighth (12.7%) of the population living in North West Sutherland aged 16 years & over responded to the survey (table 2).

Table 2: Response rate by geographical area of responders’ residence

No. of Population Response Consultation area responses aged 16+ rate (%) [1] Scourie/Kinlochbervie, Durness & Kyle of Tongue (Area 1: Tongue) 141 1251 11.3% Bettyhill area, Strathy/Armadale & Melvich (Area 2: Bettyhill) 88 807 10.9% Total Area 1: Tongue + Area 2: Bettyhill 229 2058 11.1% Unknown/Outwith consultation area 33 - - Total responses 262 2058 12.7% [1] Community Health Index General Practice List Population at April 2016

Where area can be assigned (n=229) the majority of responses to the survey (61.6%) came from the Area 1 as against 38.4% from Area 2.

Map 2 Number of responses by community council areas

4.4 Pattern of responses

The pattern of responses is consistent with other surveys carried out by NHS Highland where response rates were higher by females and older people. It is also a recognised characteristic of responses to larger health related surveys such as the Health Survey for Scotland.

There was no sampling undertaken in this survey i.e. all residents in the areas were potential responders (regardless of whether their characteristics made them more or less likely to actually respond). In this situation, it would, therefore, not be appropriate to adjust to the total population by weighting responses.

5. Feedback on aspects of the proposal and service model options

5.1 Introduction

People were given an opportunity to feedback on aspects of the proposal as well as by responding to 17 questions (Appendix 4. The results are provided in full (Appendix 5) and summarised below:

5.2 Comments on proposed general elements of the redesign

The responders were asked to rate the importance to them of four aspect of proposed redesign of services. The majority of respondents rated each aspect as important, ranging from 80% to 96% (table 3). There were some differences by area table 4).

Table 3: Percentage ratings of impacts of the proposed redesign

Impact of proposed plan n= Rating (percentage of respondents) Important Neutral / Not Unsure / No opinion important Don’t know Better joint working across 242 84.3% 11.2% 2.5% 2.1% professions and services More efficient use of 243 79.8% 16.0% 2.9% 1.2% resources (staff, buildings) Retaining locations of GP 251 95.6% 2.8% 1.2% 0.4% Practices Providing more care-at- 222 89.9% 8.9% 0.0% 1.2% home (carer services)

Table 4: Percentage of respondents rating impacts as important, by area

Impact of proposed plan Area 1: Area 2: Tongue Bettyhill Better joint working across professions and services 87.5% 80.8% More efficient use of resources (staff, buildings) 85.4% 73.1% Retaining locations of GP practices 97.1% 95.2% Providing more care-at-home (carer services 90.5% 92.6%

5.3 Comments on specific aspects of the proposed redesign

The responders were asked how they felt about some specific aspects of local services (table 5). The majority of respondents were pleased / positive about the following: • Retaining day services in Tongue (85%) • Providing dual registration (residential and nursing care) in the new care home and ‘Hub’ facility (75.8%) • Developing a new purpose built care home and ‘Hub’ facility (74%) • Retaining day services in Melvich (68%) • Retaining day services in Kinlochbervie (60%)

Table 5: Percentage of respondents by reactions to what the proposed plan will enable / require

The proposed plan will n= Rating (percentage of respondents) enable / require ... Pleased Neutral / Unhappy Unsure / No opinion Don’t know Developing a new purpose 232 74.1% 10.3% 11.2% 4.3% built care home and ‘Hub’ facility Providing dual registration 227 75.8% 14.1% 5.3% 4.8% (residential and nursing care) in the new care home and ‘Hub’ facility Retaining day services in 211 59.7% 35.1% 0.5% 4.7% Kinlochbervie Retaining day services in 225 84.9% 12.4% 0.4% 2.2% Tongue Retaining day services in 223 67.7% 28.3% 1.3% 2.7% Melvich Closing residential care at 224 20.1% 37.9% 33.9% 8.0% Caladh Sona Closing residential care at 225 19.1% 41.3% 30.7% 8.9% Sinclair Court

The two requirements that the majority of respondents were not pleased about were closing residential care at Caladh Sona and Sinclair Court (34% and 31% unhappy, respectively). This is considered further in this section to explain the apparent contradictory nature of the responses i.e supportive of new facility but not supportive of closing existing facilities.

5.4 Preferred model of service

The majority of respondents to this question (56.4%) selected Option B - the new build care home as part of ‘Hub’ facility in one location to replace existing care homes Caladh Sona (Melness) and Melvich Community Care Unit (table 6).

The ratio of those selecting Option B versus those selecting Option C New-build care home plus maintain one of the existing care homes – Caladh Sona (Melness) or Melvich Community Care Unit) was approximately 2:1.

Notably support for Option A Do minimum (current arrangements) being very much lower at 6.2%. 1.2% of respondents stated that they did not have a preference (table 6).

Table 6: Percentage preferred option for all survey respondents

Preferred option: No. of Percent responses Option B – New-build care home as part of ‘Hub’ 145 56.4% facility in one location to replace existing care homes Caladh Sona (Melness) & Sinclair Court (Melvich) Option C – New-build care home plus maintain one of 87 33.9% the existing care homes – Caladh Sona (Melness) or Sinclair Court (Melvich) Option A – Do minimum (current arrangements) 16 6.2% I do not have a preference 3 1.2% Other 6 2.3% Total 257 100.0%

5.4.1 Preferred model of service by location of responders

Option B was also selected by the majority of respondents from Area 1: Scourie / Kinlochbervie, Durness & Kyle of Tongue (69%), table 7.

Whereas nearly half of respondents from Area 2: Bettyhill, Strathy / Armadale & Melvich selected Option C (46.0%), followed by Option B (41%).

Table 7: Percentage preferred option (as per Q3) of survey respondents by area of residence

Area n= Preferred Option (% of responses) Option Option Option No pref. Other A B C Area 1: Tongue 140 2.1% 69.3% 25.7% 0.7% 2.1% Area 2: Bettyhill 87 10.3% 41.4% 46.0% 1.1% 1.1%

5.5 Other responses

The consultation survey was only way for people to provide feed-back other information is described below. There is some overlap as some people/groups were known to submit a consultation form, letter, attend feed-back at events and were members of local groups or community councils

5.5.1 Melvich Community Council

Melvich CC submitted a formal written response on 17th October (Appendix 6). They made a number of comments around the consultation process and how the original steering group was compiled. In terms of the model they recognised that the current model is not sustainable for the future.

“Melvich Community Council, therefore, fully supports the proposal to develop a new purpose built, dual registered care unit and Hun facility.

22 5.5.2 Tongue, Melness and Skerray Community Council

The Community Council submitted a consultation form favouring Option B.

5.5.3 Strathy & Armadale Community Council

Strathy and Armadale Community Council submitted a formal written response on 24th October (Appendix 7). They made a number of comments regarding travel, transport and staffing. In terms of the model, they were in favour of Option C. In particular they favoured a new build at Caladh Sona while retaining services at Melvich Community Care Unit (with modest upgrade as required).

5.5.4 North Coast Connections

This organisation is based in Tongue selected Option B in the Kyle of Tongue area.

“We do not wish to close Caladh Sona but the building should be replaced.”

5.5.5 Caladh Sona Action Group

The group is a community based organisation formed in Tongue in 2006 in order to campaign for a rebuild of CaldhSona and retain residential care services in their area. The Group completed a consultation response form favouring Option B in the Kyle of Tongue area.

In addition they submitted a letter (Appendix 8) setting out what they consider to be some of the benefits of locating the proposed ‘Hub’ in the Kyle of Tongue area. This included it being a:

‘central location’ and hosting a “vibrant third sector with voluntary organisations running a well-being hub and community transport.”

5.5.6 Friends of Caladh Sona

The charities activities including raising funds raise funds for the residents. They completed a consultation response form favouring Option 2 in the Kyle of Tongue area and commented:

“Need to maintain services in Melness”

5.6 Responses from Partner Agencies

5.6.1 Scottish Ambulance Service (SAS)

The SAS is supportive of the proposed hub model and is interested and willing to explore options for co-location. The SAS would also welcome the opportunity to work in partnership with NHS Highland to test communication technology which could for example be tested in the emergency ambulance fleet.

5.6.2 Other

No other written responses were received.

6 Feedback on location of possible new ‘Hub’

6.1 Introduction

This section of the report provides feedback on public views on possible location of any proposed new Hub facility should that go forward as the preferred option. Feed- back is summarised based on the survey plus any other relevant comments received during the consultation.

6.2 Survey responses

Respondents were asked to select their preferred location, should Option B (the Steering Group preferred option) be implemented. Broad locations were agreed by the Steering Group at an options appraisal event held in Tongue on 11th February 2016 prior to the consultation

The majority of respondents to this question and (64%) selected Kyle of Tongue as the preferred location. The ratio of those selecting this option versus those selecting Bettyhill (20%) was approximately 3:1. Support for other options was much lower (Table 8)

Table 8: Percentage preferred location for all survey respondents

Location: No. of Percent responses Kyle of Tongue (Steering Group preferred option) 153 64.3% Bettyhill 48 20.2% Melvich 23 9.7% Scourie/Kinlochbervie 5 2.1% Durness 2 0.8% Strathy/Armadale 2 0.8% I do not have a preference 2 0.8% Other 3 1.3% Total 238 100.0%

Kyle of Tongue was also selected as the preferred location by the majority of those from Area 1: Scourie / Kinlochbervie, Durness & Kyle of Tongue (89%). Over 40% respondents from Area 2: Bettyhill, Strathy / Armadale & Melvich selected Bettyhill (44%), followed by Kyle of Tongue and Melvich (both at 25%).

Table 9: Percentage preferred location (as per Q4) of survey respondents by area of residence

Preferred location (% of responses) Area Area 1: Area 2: Tongue Bettyhill (n=131) (n=81) Scourie / Kinlochbervie 3.8% 0.0% Durness 1.5% 2.5% Kyle of Tongue 88.5% 24.7% Bettyhill 3.1% 44.4% Strathy / Armadale 0.0% 1.2% Melvich 0.8% 24.7% No preference 0.8% 1.2% Other 1.5% 1.2%

Table 10: Percentage preferred location (as per Q4) of survey respondents by area of residence

6.3 Other feed-back

6.3.1 Melvich Community Council

“Melvich Community Council, therefore, fully supports the proposal to develop a new purpose built, dual registered care unit and Hub facility. However, we would like to affirm some of the concerns highlighted during the public consultation meetings in relation to location of this building. In particular in the recruitment and retention of both nursing and social care staff for the building; the potential impact on the wider community of the proposed 3-18 years school campus at Bettyhill and the uncertainty of GP services.

“The Community Council believes all these concerns are valid and have been identified by members of our community through the recent public consultation meetings. We therefore consider this warrants further review of an appropriate locations for the new-build care unit to ensure this change does meet the requirements of the communities health and social care needs now and in the future.”

25 6.3.2 North Coast Connections

This organisation which is based in Tongue selected Option B in the Kyle of Tongue area.

6.3.3 Caladh Sona Action Group

The group submitted a letter (Appendix 8) setting out what they consider to be some of the benefits of locating the proposed ‘Hub’ in the Kyle of Tongue area. This included it being a:

‘central location’ and hosting a “vibrant third sector with voluntary organisations running a well-being hub and community transport.”

6.3.4 Friends of Caladh Sona

The charity favoured Option B in the Kyle of Tongue area and commented “Need to maintain services in Melness”

26 7. Recommendation and Next Steps

7.1 Introduction

This report brings together all the key elements: the background, options appraisal, consultation process, feedback on options and location and some proposed next steps.

In coming to a view, the operational unit has sought to satisfy itself that majority of people were comfortable with the consultation process and that there was strong support for the service model and views around location were understood.

7.2 Recommendation

Taking everything into consideration the Unit feels there is broad support from the wide range of stakeholders for Option B - the preferred option and this is now being formally recommended to the Board for endorsement.

While the Kyle of Tongue was the preferred location for the majority of respondents (64%), significantly more people did respond to the consultation from the Tongue area.

During the consultation there was considerable discussion around which location would most likely support a sustainable staffing model. It is therefore recommended that some further evidence is gathered to reassure all concerned that the Kyle of Tongue area could support a new facility.

7.3 Next steps and decision making process

The Board of NHS Highland will consider the report and the recommendation at their meeting to be held 31 January 2016.

As the Scottish Health Council has not deemed the changes to be major should the board and the Highland Council endorse the recommendation then work would start on the Initial Agreement as part of the Business Case process

Significant work would still be required including to agree the specification of the ‘Hub’, the design and purchase of a site and detailed financial planning

The plan would be for new arrangements to be in place before any changes were made.

Appendix 1 – Scottish Health Council

Appendix 2 – Scottish Health Council

Appendix 3 - Events and stakeholder meetings including updates to committees

North (Sutherland) Coast Redesign _ Events

Date Event Location August 16/08/16 Ward 1 Business Meeting Police Station, Lairg  Two ward councillors 17/08/16 Caladh Sona staff Caladh Sona  Five members of staff 19/08/16 Families Caladh Sona 20/08/16 Families Melvich Community Care Unit 24/08/16 Caladh Sona staff Caladh Sona  Five members of staff 26/08/16 Sutherland Community Partnership Highland Council (Drummuie),  Four Highland Cllrs Golspie  Highland Council  Police Scotland  Highland Council  Voluntary Sector 29/08/16 Drop-in for staff Melvich Community Care Unit  Five members of staff 31/08/16 Drop in for staff Melvich Community Care Unit  Three members of staff 31/08/16 Drop – in (Melness) Melness Village Hall  12 members of the public  Six members of the steering group September 13/09/16 Pupil Council Farr High School  15 pupils 14/09/16 Drop-in Melvich Melvich Village Hall  12 members of the public 19/09/16 Joint Community Council meeting Strathy Hall (Bettyhill, Strathnaver & Altnaharra and Strathy & Armadale)  15 members of community council/public  One Highland Cllr 23/09/16 Staff (Community based- north side) Bettyhill Nurse base  Six members of staff 29/09/16 4th, 5th & 6th Year Kinlochbervie High School  10 pupils 29/09/16 Staff (Community based – west side) Ceilidh House, KLB  Two members of staff (provisionally) October 11/10/16 Drop-in Bettyhill Village Hall  No attendees 12/10/16 Drop-in Kinlochbervie in the Ceilidh  No attendees House

Appendix 4 – Survey Form

Appendix 5 Report on Analysis of Survey Form

Appendix 6 – Melvich Community Council

Melvich Community Council Serving the Communities of Melvich, Portskerra, Halladale and Forsinard

17th October 2016

Dear Maimie,

The following points represent the key thoughts and areas of concern of Melvich Community Council with regard to NHS Highland’s proposals for redesign of care home provision on the North Coast. This letter should be considered as the formal feedback from Melvich Community Council in the North Coast Redesign consultation process.

Firstly, Melvich Community Council would like to thank NHS Highland for recognising their concerns as not being part of the steering group scoring days on the proposed option and location. We fully understand the process of such change is very challenging. We are very appreciative of the additional meetings and flexibility of these meetings by Maimie Thompson and Christian Nicolson to ensure our community had adequate opportunities to engage in the Public Consultation process. We also appreciate the involvement of Penny Gardner in this process who has been very fair and impartial between the two existing units.

Our only comment for future processes would be for NHS Highland to consider the process when compiling a steering group. It has been commented at several of the public meetings that the steering group was heavily made up (more than half) of groups specific to one community across the Scourie to Melvich area identified. By considering the criteria for future community steering groups we would hope that would provide a fairer engagement and prevent some of the divides experienced within our small, close communities.

Melvich Community Council welcomes NHS Highland’s acknowledgement of the community’s concerns regarding day care services and their commitment to ensure day care services will continue to be run locally in the village as well as strengthening the care at home services within the community, that will help community members remain at home as long as possible, promote their independence and keep them in their local communities. We are aware that some local opinion has outlined the wish to attain the Melvich unit and have a new build further west. We recognise through this process, the public consultation and the national media coverage that this model is unsustainable for the future health and social needs of our community.

Melvich Community Council therefore fully supports the proposal to develop a new purpose-built, dual registered care unit and Hub facility. However, we would like to affirm some of the concerns highlighted during the public consultation meetings in relation to the location of this building. In particular in the recruitment and retention of both nursing and social care staffing for the building; the potential impact on the wider community of the proposed 3-18 years school campus at Bettyhill and the uncertainty of G.P. services, specifically given the recent media coverage on the removal of G.P. services based in our community at weekends.

33 The Community Council believe all these concerns are valid and have been identified by members of our community through the recent public consultation meetings. We therefore consider this warrants 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 needs now and in the future.

Should you require any further clarification of any points raised in this letter then please do let us know.

Yours sincerely,

Tina Wrighton Chair, Melvich Community Council

Appendix 7 – Strathy & Armadale Community Council

Strathy & Armadale Community Council

NHS (North Coast) Sutherland; Service Change Feedback (October 2016)

• Our CC is in full support of retaining services at the Melvich Care Centre in Sinclair Court and of modest upgrading and extending where required. • We are also in support of Caladh Sona being renovated to keep services at that side of the coast. • It is so important to have “care “within the community” and not miles away even if it is in a new build. • Day Care is very important to the health and welfare of senior citizens. • Travelling 40 or more miles over difficult roads in bad weather is a non starter. • Mobile phone and Broadband signals are poor or nonexistent in the Tongue area. • Roadside telephone kiosks have been or are presently being removed. • We don’t have adequate transport, bus or taxi services to enable convenient travel along the coast. • Centralising all services to a new “hub “is only of use to those living close to it and would spoil what is at present available in our local Doctors surgeries. • Workers from the Melvich side very often cover shifts at Melness due to lack of staff there. • Nursing Staff mostly live in Caithness where cover is more readily available but they have no wish to travel the distance to Tongue. • We have lost several highly qualified nurses because of all this uncertainty. • How do you propose to staff a new build if it were in the Tongue area? • How many staff will be required? • Are there plans in progress for Staff training? • Are there plans to build housing for staff in the area? • To help with staffing will child care be part of the project? • We are struggling to understand how this new arrangement would provide a better and more reliable homecare service in the area. • The new proposal for “Out of Hours Primary Care” adds to the whole frightening prospect for the welfare of everyone who lives in North Sutherland. • Thurso are struggling to cover their own responsibilities so how can they add us to their rota?

This response is on behalf of Strathy & Armadale Community Council. We discussed the matter at our council meeting on 3rd October 2016

Janette Mackay Chairperson: Strathy & Armadale Community Council. 01641 541275

Appendix 8 Caladh Sona Action Group