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Highland NHS Board 2 December 2014 Item 4.1 PROPOSED

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Highland NHS Board 2 December 2014 Item 4.1 PROPOSED Highland NHS Board 2 December 2014 Item 4.1 PROPOSED REDESIGN OF SERVICES IN SKYE, LOCHALSH AND SOUTH WEST ROSS Report by Gill McVicar, Director of Operations (North and West) and Maimie Thompson, Head of Public Relations and Engagement on behalf of Deborah Jones, Chief Operating Officer The Board is asked to: Consider the detailed report on the feedback from the three month public consultation into proposed major service change. Note the feedback from the Scottish Health Council endorsing the options appraisal and consultation process. Endorse the recommendation in support of the preferred option – to develop a Community ‘Hub’ in Broadford and a ‘Spoke’ in Portree. Note the next steps and the requirement for any decision on proposed major service change to be considered by the Cabinet Secretary for Health and Wellbeing. 1 Background and Summary This paper reflects the culmination of a huge amount of work which has taken place over the past five years as part of a comprehensive engagement exercises with communities in Skye, Lochalsh and South West Ross (part of North and West Operational Unit). In particular it highlights the main findings from the formal three month public consultation exercise but touches on the earlier options appraisal process. Within Skye, Lochalsh and South West Ross, some services are not adequately resourced making them not as safe, effective or efficient as they need to be to meet future demands. In addition the two local community hospitals are not in good physical condition and not designed to meet modern standards. It is increasingly difficult to maintain and sustain the current hospital services due to the condition of the facilities, availability of staff and the cost. While it is the intention to do so for as long as possible, as demonstrated by the recent suspension of endoscopy services from Dr MacKinnon Memorial, this is increasingly challenging. Work has been ongoing to look at these issues with a view to providing sustainable solutions for the future. Through an options appraisal process a local steering group agreed a short- list of three options for potential future models of service: Option 1 – Do minimum Option 2 – Community hospital and resource centre in one town (‘Hub’) and scaled-down services in the other (‘Spoke’). Option 2a – ‘Hub’ in Broadford, ‘Spoke’ in Portree Option 2b – ‘Hub’ in Portree, ‘Spoke’ in Broadford Option 3 – Community Hospital and resource centre ‘Hub’ in a central location Do minimum scored very lowly confirming that there was significant support for a change with option 2 identified as the preferred model of service. Further work by the steering group via the options appraisal process determined that the preferred location, at this stage, would be to have the ‘Hub’ in Broadford and ‘Spoke’ in Portree. If implemented this would mean building a new community hospital and resource centre in Broadford. This would be part of a wider redesign, as well as investment and modernisation of health and social care services across the areas of Skye, Lochalsh and South West Ross. This work is already underway in the community and the plan would be for new community arrangements to be fully tested and up and running before any changes were made. The Board of NHS Highland considered these proposed changes to be ‘major’ and therefore subject to a period of formal public consultation. The Board approved the move to consultation at their meeting in April 2014 and in May 2014 the Scottish Health Council confirmed that NHS Highland was in a position to get the public consultation underway. The formal public consultation was launched on 19th May and ran for a total of 15 weeks until 31st August. NHS Highland was consulting on the range of options including option 2a as the preferred option. During the consultation period over 50 meetings and events took place and a survey response form (with free-post envelope) was delivered to every home and business. Of those who completed NHS Highland’s consultation response survey (2,273) there was wide-spread support for the case for change with only 1% of the population who responded supporting the do minimum option, and almost 86% supporting the preferred model of service. In terms of location, overall, the majority, 57%, favoured the preferred option 2a, ‘Hub in Broadford and ‘Spoke’ in Portree, whereas 29% supported Portree as the ‘Hub’ (option 2b). Positive feedback on the consultation process and the preferred option was also received from many staff, local GP Practices and partner agencies including Highland Council, Scottish Ambulance Service, Scottish Fire and Rescue Service, Highlands and Islands Enterprise and the Highland Hospice. The Scottish Health Council and the Highland Health and Social Care Committee has endorsed that the process has been in accordance with Scottish Government Guidance. This includes the options appraisal process (service model, location and sites), public consultation materials and the public consultation communications and engagement plan. Taking everything into consideration the Operational Unit can demonstrate broad support from the wide range of stakeholders for the preferred option (option 2a) and it is now being formally recommended to the Board for endorsement. As the preferred option represents major service change, should the Board endorse the recommendation, the next step would be for the proposals to be considered by the Cabinet Secretary for a final decision. It was also clear from some of the feedback NHS Highland received that there were some people who had some strong concerns about aspects of the proposed redesign (most notably in the North and Central parts of Skye), and some topics of wider general concern (for instance future services, transport, future use of buildings, bed requirements, care homes and care-at-home) requiring further consideration. The full report, therefore also sets out some of these concerns, responses and assurances as well as the next steps in meeting the guidance. It describes some of the further work that would be required should the preferred option move to implementation. Although the board and the Scottish Health Council has already endorsed the Options Appraisal process to determine the service model and location this was challenged during the public consultation including a late submission and is touched on in this paper (Section 2.4) and covered in more detail in the full report. 2 2 NHS Highland Report on the Public Consultation 2.1 Overview The full public consultation report specifically covers the three month public consultation into the proposed redesign of services across Skye, Lochalsh and South West Ross. It does, however, provide some background information to allow the findings to be understood in the wider context of the work that has taken place over the past few years including the options appraisal process. The report describes in detail how the consultation was managed, the range of ways that views were gathered, and an analysis of all the feedback. It also includes a summary of the feedback from the independent review of the consultation process by the Scottish Health Council. Based on an assessment of all the supporting information a recommendation to the board is now made on model of service and location. Early work on a potential site to support the preferred option has also been carried out by the Steering Group with appraisal criteria and weighting having been agreed. This work would be completed if there is a decision to progress to implement the preferred option in the preferred location (Broadford). The next steps in meeting the guidance are highlighted including some of the ongoing and additional work required. 2.2 Feedback on the Public Consultation Process NHS Highland has embarked on an extensive and wide-ranging public consultation exercise. The approach appears to have been generally well received. The reasons for the changes to services being proposed have been understood and the majority of the feedback suggests that the case for major service change is accepted. There was consistency in views received through the different routes and from partner agencies. By the end of the consultation no new themes or issues were being raised. Overall the vast majority of people who took part in the consultation, and who fed-back, were positive about the opportunities to engage with NHS Highland and that there was good awareness about the consultation and how to make views known. NHS Highland’s Health and Social Care Committee endorsed that the consultation process complied with Scottish Government major service change guidance. They also supported that the Operational Unit was in a position to present the full findings to NHS Board meeting to be held in December. The Scottish Health Council carried out an independent review of the process and has also endorsed the process. A link to their report is here In coming to a conclusion as to whether NHS Highland had followed the guidance, the Scottish Health Council reported: “Based on our review and feedback from local people we are satisfied that NHS Highland has followed Scottish Government guidance on involving local people in the consultation about the ’Proposed Modernisation of Health and Social Care Services in Skye, Lochalsh and South West Ross’. 3 “Overall, feedback received indicated that the majority of people had understood the reasons for change, how the proposals had been developed, and felt listened to and that there has been sufficient opportunities to take part in the consultation. Where people have requested further meetings or information NHS Highland has been responsive.” 2.3 Feedback on the Service Model and Location 2,2,73 people took the opportunity to complete the consultation survey. Of these 86% agreed with the proposal to develop a ‘Hub’ and ‘Spoke’ model with a new build community hospital and resource centre with wider development of community services.
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