North Coast () Redesign

Full public consultation document

This document covers proposals to modernise health and social care services including residential care. You are invited to respond with your views

This three month public consultation will run from 25th July 2016 to 25th October 2016

YOUR CHANCE TO COMMENT

Please submit your views no later than 25th October 2016

If you would like this information in large print or audio form, or require any assistance with responding to the consultation or would like to request a meeting please get in touch. Contact details are available on the back page.

Contents

1. Executive summary

2. Scene setting: why services need to change

3. Working with local people to develop proposals

4. Developing possible service models and appraisal of options

5. Options appraisal to determine the location of any “Hub” facility

6. Addressing potential impacts and other considerations

7. Public consultation and decision making process

All of the information about the consultation is also available on the NHS website which you can access via the home page.

www.nhshighland.scot.nhs.uk

North Sutherland Coast Redesign Full Public Consultation Document 1

1. Executive Summary

Overview

Changes to health and social care services are being considered for local communities across the North Coast of Sutherland. NHS Highland is proposing to run residential care services in a new purpose built residential care ‘Hub’ facility in the area. It comes as part of a wider re-design.

However, it would also see NHS Highland withdraw from the residential care services which are currently provided by NHS Highland in Caladh Sona and Community Care Unit. This three month consultation is an opportunity for local people, families and partner agencies to comment.

Summary

1. The north coast of Sutherland is one of the most sparsely populated areas in Highland and when combined with its ageing population the area faces some unique challenges to deliver and sustain services.

2. The scope of this redesign covers the communities between Scourie and in the West across to Melvich in the East, covering a resident population of around 2,250

3. In terms of primary care health services there are four GP Practices: Scourie/Kinlochbervie, , Tongue and Armadale. Armadale has branch surgeries in and Melvich. Under the proposed new arrangements these services would still be provided from the same locations.

4. 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 are 29 miles apart (travel time approx 45 to 50 mins). The homes are owned by the Highland Council, but since April 2012, the services are managed by NHS Highland.

5. The three key reasons why the proposed re-design is required:

. The general challenges in recruiting to health and social care staff in the north. . The current location of both facilities do not lend themselves to greater co- location with 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.

6. In April and May 2015 a series of informal meetings took place with local community councils, local groups, councillors, Sutherland District Partnership, GPs and staff in North, West and Central Sutherland. Emerging from these discussions there was a good understanding around the issues being faced and the need to consider some changes.

North Sutherland Coast Redesign Full Public Consultation Document 2 7. During the summer of 2015 a local Steering Group, drawn from representatives from the various communities, staff and partner agencies was established. Representatives from all the communities in scope were invited to participate.

8. The first step was to more formally explore the reasons why changes are required. This was carried out over a series of workshops with local stakeholders. This was followed up with several more events to develop possible future models of service and criteria against which option could be scored.

9. A long list of possible service model options was developed. These were then whittled down to a short list of three options which participants scored:

. 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)

The preferred model of service which scored the highest was Option B.

10. The preferred service model option is to build a new modern residential care home ‘Hub’ facility:

. A purpose-built facility to be developed . Dual registration of nursing and residential care which is currently not possible and in doing so improve local access . Development of a ‘Hub’ to support greater co-location of health and social care services in the area

None of these developments would be possible under the current arrangements.

11. The new arrangement would also provide a much more sustainable model by reducing some of the challenges currently required to staff and maintain two small units. It would also allow for a wider re-design of services by investing in community services and new approaches to provide more care-at-home.

12. The proposal, if implemented, would mean NHS Highland would no longer provide residential care home services from Caladh Sona and Melvich. However, there could be possibilities for consideration around how local communities might use any properties freed up.

13. An options appraisal event was also held to consider the location for the proposed new care home ‘hub’ facility. The group agreed six broad areas for consideration: Scourie/Kinlochbervie, Durness, Kyle of Tongue, Bettyhill, /Armadale and Melvich. The area which scored highest was Kyle of Tongue.

North Sutherland Coast Redesign Full Public Consultation Document 3 14. Further work would be required to identify possible sites and any consideration would also be subject to technical and financial considerations.

15. The steering group also agreed that the ‘outlook’ of any new facility would also be of significance and this should be considered as pat of the final site selection.

16. The next part of the process is to carry out a public consultation on the recommended future model of service including the proposed location.

17. The board of NHS Highland would consider the proposals including the feed- back received from the public consultation and independent report on the consultation process via the Scottish Health Council

18. This consultation document sets out in more detail:

a) The reasons why some changes to services are required and some of the problems with current local services (Section 2, page 6);

b) How local people, service users, families, visitors and staff have been involved in the process and the role of the steering group (Section 3, page 18);

c) What options were considered and the process through which a preferred service model option was identified (Section 4, page 20);

d) What locations were considered for the proposed new facility (Section 5 page 26) and how a recommendation was arrived at;

e) How potential impacts of any of the proposed changes (such as access and transport) would be addressed (Section 6, page 29);

f) Any other considerations such as what would happen to facilities (Caladh Sona and Melvich Community Care Unit) if no longer required (Section 6.5, page 32), and finally:

g) Why a formal public consultation is being carried and how people can make their views known. This section also covers how a final decision will be made (Section 7, page 33).

The board of NHS Highland and the Scottish Health Council has endorsed the engagement process to date.

North Sutherland Coast Redesign Full Public Consultation Document 4 Overview of what would be provided from the proposed new residential care ‘Hub’ facility

Box 1 Summary of what would be included in a “Hub” facility . 24/7 function . A shared space o Residential & Nursing Care Beds o Care at Home o Telecare o GP o Community Nursing o Physiotherapy, Occupational Therapy, Speech & Language Therapy and Podiatry o Dental Services o Social Work Services o Scottish Ambulance Service (SAS) o Scottish Fire & Rescue Service

Also Provides:

. A base for third sector partners . A space for training and development . An equipment store

Box 2 Summary of services currently available in Kyle of Tongue area . Caladh Sona o Six beds in total comprising five permanent beds, one respite/bluebell bed . GP practice (based Tongue) . Kyle Centre (based Tongue, Operated by North Coast Connections)

Box 3 Summary of services currently available in Melvich area . Melvich Community Care Unit o Six beds in total comprising five permanent beds, one respite/bluebell bed o Registered Day Care for up to eight per day . GP Practice (based Armadale)

North Sutherland Coast Redesign Full Public Consultation Document 5 2. Setting the Scene: why services need to change

Main points covered in this section:

. Some of the reasons why service need to change are described . Current arrangements for local health and social care services are summarised . Existing problems with some local services are reviewed

Ambition “Everyone is able to live longer at home or in a homely setting” NHS 2020 Vision

2.1 Setting the scene for change nationally

Future health and social care services in Scotland are shaped by national strategy and policy and is set out in some key publications: Building a Health Service Fit for the Future (2011)1, Commission on the Future Delivery of Public Services (Christie Report, 2005)2, Route Map for 2020 Vision for Health and Social Care3 and most recently in the National Clinical Strategy published in February 20164 .

These all call for a fundamental shift in the way services are provided, a focus to empower individuals and communities; and to make the best use of resources (staff, skills, buildings). These publications further highlight the need to provide safe, effective and person centred care and services.

In April 2016 all boards and councils were required to have arrangements in place to integrate health and social care services. Notably in the Highland Council area such arrangements have been in place since April 2012.

2.2 Setting the scene for change in Highland

NHS Highland serves a population of approximately 320,000 residents and provides a wide range of services across the largest land area (~40%) of any health authority in Scotland. The areas covered by the board are benefiting from improved health and so people are now living longer. It is estimated that by 2031 the number of people aged 75 or over in Highland will double.

Planning for this population increase is important because older people tend to make more use of health and social care services. As people age it becomes more likely that they may acquire one or more long-term condition(s) like dementia, arthritis, diabetes and heart disease, as well as having a greater risk of getting cancer.

1 A National Framework for Service Change in the NHS in Scotland, Scottish Government, 25 May 2005 ISBN 0 7559 4669 3 2 Report on the Future Delivery of Public Services by the Commission chaired by Dr Campbell Christie, Scottish Government, 29 June 2011. ISBN 978-1-78045-214 3 Route Map to the 2020 Vision for Health and Social Care, Scottish Government, 22 May 2013 4 A national Clinical Strategy for Scotland, Scottish Government, February 2916 ISBN 9781786520012

North Sutherland Coast Redesign Full Public Consultation Document 6

More generally as people become frail and especially if living alone, remaining independent and at home can be challenging. Support may be required for everyday living be that access to shops, post-office, healthcare, local events or to avoid becoming isolated. The need to develop strong communities, good neighbours and have the support of family and friends is really important.

Over the last 10 years NHS Highland has been making steady progress to work with local communities and staff to change the way services are being delivered:

. more people are able to stay in their own homes for longer . there is less need for people to be admitted to hospital or institutional care . for those who do need to be looked after in care homes their age of admission is increasing

One of the biggest reforms took place in April 2012 when NHS Highland and Highland Council integrated health and social care services, creating further opportunities to improve and redesign services to meet future needs. This included transfer of the management of care homes and care at home services from the Highland Council across to NHS Highland.

NHS Highland is committed to providing as much care and support as locally as possible. For some things, however, this has to be balanced with making sure that services can be adequately staffed, equipped are safe as well as affordable.

Part of these considerations are around what communities can reasonably do to support themselves and how might changes in legislation such as Community Empowerment (Scotland ) Act 2015 and Social Care (Self-Directed Support) (Scotland) Act 2013 and funding for community schemes such as through wind farm to help to sustain communities.

2.3 Setting the scene for changes in North Sutherland

2.3.1 Context

The north-west coast of Sutherland is one of the most sparsely populated in Highland, and when combined with its ageing population, the area faces some unique challenges to delivering and sustaining public services including health and social care.

The scope of this redesign covers communities from Scourie in the west across to Melvich in the east, covering a resident population of ~2,250. It is made up of a number of small villages (Scourie, Kinlochbervie, Durness, Tongue, Bettyhill and Melvich) and scattered communities (Melness/Talmine, Strathy and Armadale ). To put the population in context there are two secondary schools in the area: Farr High in Bettyhill and Kinlochbervie both of which have less than 100 pupils.

Primary care health services in north and west Sutherland include four GP Practices: Kinlochbervie/ Scourie, Durness, Tongue and Armadale with branch surgeries in

North Sutherland Coast Redesign Full Public Consultation Document 7 Bettyhill and Melvich. There are no pharmacists in the area; however, the GP practices are dispensing practices. The Public Dental Service provides domiciliary visits to care homes and patients in their own homes if required. The nearest clinics are held in and . There is a visiting service from an opticians firm based in Golspie to Durness and Tongue (Health Centres) approx quarterly. There is also a visiting service from a national chain.

There is no community hospital on the north coast, the nearest are Dunbar Hospital in for communities towards the east and Migdale in Bonar Bridge, which used by communities in the north and west. There are two six-bedded residential care homes (Caladh Sona in Melness and Melvich Community Care Unit in Melvich).

The main sources of employment in the area are in the statutory, (NHS Highland and Highland Council), tourism and agricultural sectors. There are no Highland Council Offices in the area but there are two Service Points located in Durness and Bettyhill (both operate on a part-time basis). Services are limited but most of the villages do have shops, post-office, petrol station, hotel, village hall and primary school.

Current proposals which have the potential to have impact (directly or indirectly) on the local economy are proposals for wind farms at Strathy and Altnaharra and the development of a launch site for small commercial satellites at The Moine.

There is very little public transport but there are some local community arrangements such as Transport for Tongue (T4T), Kinlochbervie Community Bus and Durness Bus. Data from the 2011 census indicates that around 15% of households in the North West & Central Sutherland Ward do not have access to a vehicle.

A number of local development trusts are in operation across the area, with a number employing development officers. There are full time officers in Durness, Melness/Tongue & . In addition there is a part-time officer based in Scourie. Staff are employed directly by the local development trust. The trusts are in turn funded by Highlands and Islands Enterprise (HIE).

It is particularly important in areas such as the north and west Sutherland to take a rounded view of all developments and proposals and see how these may come together to help or hinder development of future health and social care services.

2.3.2 The case for service change

There are a number of compelling reasons why the way services are currently organised need to change including:

. The general challenges in recruiting to health and social care staff in the north . The current location of both facilities do not lend themselves to co-location of other services . The care homes are not purpose built and not in good condition: Caladh Sona does not meet Care Inspectorate Standards and the Melvich Unit, while in better condition, is also not ideal.

North Sutherland Coast Redesign Full Public Consultation Document 8

2.4 Summary description and location of health and social care services

The location (Map1) and description of current services are summarised (in alphabetic order) below (pages 9 to 12) and some of the challenges with the current arrangements described (pages 13 to 17).

Map 1 Location of services

2.4.1 Care at Home

The NHS Highland service is managed from the Care at Home office in the Lawson Memorial Hospital/ Cambusavie Unit Campus, Golspie. The service which runs from 7:00am until 2:00pm and 5:00pm until 10:00pm is operational seven days per week and, 365 days per year. The team is managed by a Care at Home Officer who covers north, west and central Sutherland. Currently there are 12 home carers who cover the north coast. They are based in Scourie, Kinlochbervie, Durness, Melness, Bettyhill and Melvich.

The Care at Home office in Golspie is open from 9:00am until 5:00pm Monday to Friday. The Highland-wide “Out of Hours Service” covers the hours’ outwith these.

At the time of writing there is only one independent sector care provider operating in the area: Crossroads Care although work is ongoing with a second provider (Clean Bees) to develop a service, albeit to a limited part of the scoping area.

North Sutherland Coast Redesign Full Public Consultation Document 9

2.4.2 Ceilidh House, Kinlochbervie

The Ceilidh House is a community run initiative providing lunches and activities. It is open three days per week (Tuesday, Wednesday and Friday) and can accommodate between 20 and 25 people. Transport is provided via the local taxi and community bus. It is open to residents of Durness every Wednesday and to Scourie residents every second Friday. Transport is also provided for residents of Scourie (Kinlochbervie Community Bus) and Durness (Durness Bus). In addition facilities for personal care are also available.

2.4.3 Clean Bees

This is an independently run organisation which provides cleaning, domestic help and support with tasks such as shopping across and Sutherland. It can also provide care at home services on behalf of NHS Highland, however at present this services is restricted to the north coast of Sutherland (Melvich to Tongue). Although the majority of staff are based in the Bettyhill area there are staff based across the area.

Clean Bees work to support people to remain independent in their own homes and have close links with organisations such as the CAB. They work within the Self Directed Support (SDS) framework to provide more tailored care for clients.

2.4.4 Crossroads

Crossroads Caring Scotland: Caithness and Sutherland covers all of the scoping area. It is managed from an office base in Golspie, but has a local office in Kinlochbervie. Crossroads provides home based respite care for carers. It also provides care at home and support work on a “spot purchase” basis to NHS Highland. Five carers cover the north coast and are based in Kinlochbervie, Durness and Talmine.

In 2015 Crossroads provided 6054 hours of support across north and west Sutherland; 1000 were respite and 5054 were spot purchase care at home and support.

2.4.5 (Registered) Day Care Services

Melvich Community Care Unit provides a registered day care service operating from 9:00am – 5:00pm, Monday to Friday. It currently has seven service users.

2.4.6 GP Services

There are four GP Practices in north and west Sutherland four of which are in the area of redesign: Armadale, Durness, Scourie & Kinlochbervie and Tongue. Practice profiles are summarised (Box 4).

North Sutherland Coast Redesign Full Public Consultation Document 10 . Armadale Medical Practice has its main base at the surgery in Armadale. There are branch surgeries in Bettyhill and Melvich, both of which are open once a week. It is an independent practice with two GPs. In practice it involves one GP working during opening hours. The practice is a dispensing practice and provides the usual range of services including practice nursing. The practice provides medical input to Melvich Residential Care Unit. The premises are owned by a third party.

. Scourie/ Kinlochbervie & Durness have recently merged to become one practice. This follows Durness becoming vacant in the summer of 2015. From 1st of July 2015 the two began working more closely and links were developed between the practices in terms of providing reception staffing and practice management. GPs and Locums covered both practices during in and out of hours. The practice is a salaried GP practice with Health Centres located in Scourie and Kinlochbervie and Durness. Kinlochbervie and Durness Health Centres are owned by NHS Highland; Kinlochbervie includes the nurse base. Scourie Health Centre is owned by a third party and rented by NHS Highland. There are nursing clinics weekly in Kinlochbervie and Durness.

. The Health Centre in Tongue is a dispensing practice and an independent Practice with two GPs; one GP working during opening hours. The practice provides the medical input to Caladh Sona. The building is owned by NHS Highland.

Each practice covers its’ own on-call during the out of hours’ period from Monday to Thursday (6:00pm to 8:00am). From Friday (6:00pm) to Monday (8:00am) out of hours care is provided via the NHS Highland Hub in Inverness.

Box 4 GP Practices Age bands Practice Practice Population 0 – 14 15 – 24 25 – 44 45 – 64 65 – 74 75+ Armadale 815 96 68 143 279 136 93 Scourie / 909 110 80 162 335 133 89 Kinlochbervie & Durness Tongue 524 52 43 86 205 77 61

2.4.7 Integrated Team

The North & West Sutherland Integrated Team includes community nursing, community mental health, learning disabilities, physiotherapy, podiatry, occupational therapy and social work. The team is accessed through a single point of contact (01408 664018) Monday to Friday from 9:00am until 5:00pm.

The North & West Sutherland Integrated Team has a total budget of £962, 950 of which £874,899 is accounted for by pays. The area covered by the North & West Sutherland Integrated Team is larger than the scoping area as it also includes Assynt.

North Sutherland Coast Redesign Full Public Consultation Document 11 Speech and Language Therapy input is also available but is provided by the Highland Council.

2.4.8 Kyle Centre Tongue

The Kyle Centre is a community lunch club and drop-in centre. It is located in the centre of Tongue and can accommodate up to 12 clients each day that it operates (currently three days per week, although following refurbishment due to be completed in 2016 this number will rise to 16). It is not a registered service and as such does not provide registered day care.

Support for those attending with additional needs is provided by a support worker from Crossroads Care one day a week. When not in use as a community lunch club the Kyle Centre is available for other community groups to use as well as for other health promoting activities e.g. Otago sessions, MOT health checks (provided by appropriately trained staff from the centre)

The centre itself is within reach of the shops, bank the health centre and post office. Transport to the centre is available via Transport for Tongue to and from Durness, Melness and Skerray.

The main source of funding is via a Service Level Agreement (SLA) with NHS Highland. Additional but time-limited funding has been secured from a range of trusts for specific activities or projects e.g. Otago and MOT health checks. In addition significant levels of capital funding have been secured for the re- development works on the building itself. Funders have included the Caithness and North Sutherland Regeneration Fund.

2.4.9 Residential Care

Residential Care is provided at Caladh Sona (Talmine) and Melvich Community Care Units. Both homes have six beds and provide accommodation, meals and personal care.

2.4.10 Scottish Ambulance Service

The Scottish Ambulance Service has two bases within the scoping area (Kinlochbervie and Bettyhill). Staffing in each of the bases is full-time.

Currently in Kinlochbervie there are five Technicians although there are plans to change the model and have two paramedics and three technicians. There is also one full-time patient transport driver.

In Bettyhill there are three paramedics and one technician.

2.4.11 Scottish Fire & Rescue Service

In north Sutherland the Scottish Fire & Rescue Service (SFRS) operates a retained duty system. There are fire stations at Scourie, Kinlochbervie, Durness, Tongue and

North Sutherland Coast Redesign Full Public Consultation Document 12 Bettyhill. Applications for retained duty system Fire-fighters in the area follow the system run nationally by SFRS, whereby it runs four campaigns per annum.

2.5 Challenges with current service provision

Some of the challenges with the sustainability of the current services are summarised (Box 5) and described in sections 2.5.1 and 2.5.2.

Box 5 Summary of some of the challenges . Serious staffing challenges . Need to move to more multi-disciplinary approach . Community staff based across several sites . Limited co-location with partner agencies . Providing care-at-home using traditional approaches is proving challenging . Implementing new models of care home provision to support sustainability

2.5.1 Care at Home

. Given the large distances and dispersed communities there have been challenges in providing care at home in the traditional way. There are not enough clients in any one locality to warrant dedicated staff yet the distances between communities is large meaning more time is spent travelling than providing care.

. There is ongoing work to support the development of local independent providers. This is being done with the help of Scottish Care. The NHS service is also exploring new models of working including plans to pilot a health and social care worker role that would work both with the local nursing team as well as with the care at home team.

. At the time of writing there is only one independent sector care provider operating in the area: Crossroads Care although work is ongoing with a second provider (Clean Bees) to develop a service, albeit to a limited part of the scoping area.

2.5.2 Care Home: residential and nursing care

. Residential

Caladh Sona in Talmine and Melvich Community Care Residential Care Units are converted Sheltered Housing properties. Neither facility is entirely suitable for purpose (Box 6).

Box 6 Challenges of current model for care homes . Challenges with staffing two facilities 30miles apart . Facilities not purpose built (converted sheltered housing) . Caladh Sona does not meet Care Inspectorate standards on room size . Melvich Unit is short on space . Care homes share a manager but otherwise units are stand alone

North Sutherland Coast Redesign Full Public Consultation Document 13 . Size of each unit make cost per resident very high e.g. overnight same number of staff required for 12 as for 6 so current model doubles staffing requirement . Limited opportunity for co-locating services

Caladh Sona is the older of the two and does not meet Care Inspectorate standards on room sizes. The infrastructure (kitchen, sluice area, toilets, utility areas, staff offices etc) is of poor quality and is generally cramped.

While the Melvich Unit has better resident accommodation it lacks common living area space, office accommodation and other supportive facilities. Access to the building is increasingly difficult as there is insufficient parking close to the building.

Both units contain six beds in total (five permanent beds plus an additional bed which can be used for planned respite or as a step-up/step-down bed which is known locally as the “bluebell bed”).

The bluebell bed is a flexible-use bed for short-stay and is supported by community nursing staff and local GPs. It is used to avoid admission to hospital, support early discharges from hospital and to provide palliative/end of life care.

Both Caladh Sona and Melvich Community Care Unit share a manager but all other staff and costs are as per stand alone units. This has an added impact in relation to the recruitment of permanent and relief staff, with the two units competing from the same pool of employees. In practice it has proved very difficult to maintain cover for sickness over the two units and there is little or no ability to cross cover the units.

The minimum staffing (care staff) for the units at six beds is about right during the day but taking into account requirements from Scottish Fire & Rescue Services regarding night staffing is the same as for a 17 bedded unit. In terms of catering the staffing requirement is equivalent to that of a 14 bedded unit. Therefore to keep both facilities running requires double the number of staff and the cost per week to run each home is significantly higher than the average for other NHS Highland run care homes (Box 7).

Box 7 Residential Unit Number of beds Expenditure Cost per week 2014/15 Average NHS Highland 16 £9,170,646 £1,023.00 Caladh Sona 6 £484,135 £1,579.23 Melvich Centre 6 £575,099 £1,607.95 [Box 7] Gross Residential costs per week 2014/2015

North Sutherland Coast Redesign Full Public Consultation Document 14

Occupancy

The information provided below covers the period from 2009 onwards.

In total over the period there were 11 permanent residents at Caladh Sona and 18 at Melvich.

Occupancy

Caladh Sona Melvich

100% 100% 98% 92% 93% 90% 88% 90% 82%

65% 68% 55%

2009/10 2010/11 2011/12 2012/13 2013/14 2014/15

Figure 1.1 highlights the occupancy breakdown per financial year for Caladh Sona and Melvich.

North Sutherland Coast Redesign Full Public Consultation Document 15 Admissions Per Year

1 3 1 4 1 2 3 3

4 1 1 2 1 1

2009 2010 2011 2012 2013 2014 2015 2016

Caladh Sona Melvich

Figure 1.2 highlights the number of new admissions to residential care p/y (note 2015/16 figures to end April ‘16) As at the time of writing (July‘16) residents at Caladh Sona came from Scourie (1), Tongue (1), Skerray (1) and Bettyhill (1). For Melvich they came from Kylesku (1), Reay (1), Laid (1) and Lairg (2).

Caladh Sona Melvich (July 2016) (July 2016)

Laid Tongue Respite 1 Respite 1 1 2 Bettyhill Kylesku 1 1 Lairg 2 Skerry Scourie Reay 1 1 1

Figure 1.3 highlights where geographically residents in both Caladh Sona and Melvich have “come from”

Age Profile: The youngest residents at Caladh Sona and Melvich are aged 71 and 75 respectively. The oldest are aged 91 and 98.

Length of Stay: The Scottish Care Home Census calculates length of stay in two different ways – “complete” or “incomplete”. A “complete” length of stay is calculated for any resident who left the care home during the year prior to the census point. An

North Sutherland Coast Redesign Full Public Consultation Document 16 “incomplete” length of stay is calculated for every who is resident in the care home on the census date and calculates the length of time the individual has been resident in the care home up to the census point. The figures are based on the length of stay within a particular care home and will not take account of length of stay in previous care homes.

The Scottish average length of stay (months) for 2015 in a residential care home is:

“Complete” 28 months (mean) 17 months (median) “Incomplete” 36 months (mean) 26 months (median)5

Average length of stay (months) in a care home (Independent Sector) in Highland (area covered by the Local Authority) for 2014/15 is based on discharges and is shown below:

“Complete” 35 months (mean)

The length of stay varies for both units with Caladh Sona having had a more static group of service users. The longest residing client in Caladh Sona will have stayed there for a period of over 10 years. With regards to Melvich currently their longest residing client has been in placement for over two years. However, during the period for which the average length of stay was calculated (2014/15) the longest residing client at Melvich had been a resident for approximately seven years.

The average length of stay for Caladh Sona and Melvich (incomplete data) (for the period 2014/15) is shown below

Caladh Sona 32 months (mean) Melvich 34½ months (mean)

. Respite / Bluebell Bed

As noted previously both Caladh Sona and Melvich have one bed allocated for respite or bluebell bed use. Respite is predominantly planned however if the bed is available it can be used for unplanned respite.

In 2014/15 Caladh Sona had 11 respite placements, totalling 285 nights. In 2015/16 there were 12 admissions totalling 137 nights. Melvich had 16 admissions for respite in 2014/15, totalling 284 bed nights. In 2015/16 there were 29 admissions totalling 281 bed nights.

In 2014/15 there were six bluebell bed admissions to Caladh Sona totalling 74 bed nights, in 2015 /16 there have been four admissions totalling 43 nights while at Melvich there were four admissions totalling 16 bed nights in 2014/15 and three admissions totalling 21 bed nights in 2015/16.

Those who use Caladh Sona and Melvich for respite come from a wide geographical area, the Highland Council area.

5 ISD Scotland Care Home Census 2015 (Statistics on Adult Residents in Care Homes in Scotland)

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. Nursing

Where nursing care differs from residential care is that in a nursing home the team on duty will always include at least one qualified nurse (the number will depend on the number of residents) and can therefore look after residents with a medical condition that requires nursing attention.

There are no other providers of residential or nursing care in the area of scope. The nearest are located in Thurso to the east (nursing and residential), Golspie (residential) and Dornoch to the south east (nursing) and Ullapool to the west (nursing and residential).

It is within this context that the current review and proposed redesign of services across the North Coast of Sutherland is taking place.

North Sutherland Coast Redesign Full Public Consultation Document 18 3. Working with local people to develop proposals

Main points covered in this section:

. Steps already taken to raise the profile of the need to change the way some services are provided . How local people have been involved and informed so far

3.1 Local engagement

NHS Boards are required to follow guidance CEL (2010) 4 “Informing, Engaging and Consulting People in Developing Health and Community Care Services”. This clarifies the role of the Scottish Health Council during major service change, which includes ensuring that the board’s public involvement activities are in line with the guidance. In particular, boards are required to demonstrate how they:

. Work with local people to develop options which are person-centred, sustainable and consistent with standards and national policy; . Ensure that public stakeholders are involved in developing options and in the process to appraise options; . Make sure that the development and appraisal of options is consistent with the approach outlined in HM Treasury guidance, ‘The Green Book’ and the Scottish Capital Investment Manual.

In 2014 the Highland Council announced a funding commitment to provide capital to replace Caladh Sona. While the Council own the facility the service transferred to NHS Highland in 2012. Across Highland integration of adult health and social care has provided the opportunity to give wider consideration, as to how best to meet the health and social care needs of an area. North West Sutherland is no exception.

Therefore in April and May 2015 a series of informal meetings took place with local community councils, community groups, councillors, GPs and staff in North, West and Central Sutherland (Box 8).

All of the pre-engagement work formed part of the preparatory work before moving into the more formal process of developing service model options and then carrying out the option appraisal exercises (Sections 4 and 5).

The work has been co-ordinated and overseen by a Steering Group which was established in August 2015. Participants were invited from all the communities in scope6 . Six local events took place between August 2015 and February 2016. These were reasonably well attended and looked at options for possible future models of service. The associated advantages and disadvantages of the different models as well as where services would best be located to support future sustainability were considered.

6 Scourie to Melvich

North Sutherland Coast Redesign Full Public Consultation Document 19 Box 8 Involving and informing stakeholders

Steering group

Participants were invited from all the communities in scope, however, attendance was patchy for some of the meetings and there was no representation from Scourie/Kinlochbervie at any of the meetings. Steps were taken to address lack of attendance but could not be resolved

Members of the steering group were sent updates after each event and were asked to share with local contacts including by displaying in local shops and post offices as well as via local websites and Facebook

Media

Media releases have been provided for the local newspapers, BBC Scotland, social media, and websites. The ongoing process has been regularly reported including in the Northern Times and BBC.

A summary of the process and progress has been reported to NHS Highland Board including in media Briefing Notes and in staff publication HighLights. All of these documents are available on NHS Highland website http//www.nhshighland.co.uk

A short film

A short film describing the background to the current redesign work, explaining the need to ensure that modern, effective health and social care can be provided for future generations in the area was prepared. It can be viewed http://www.newsroom.scot/communitynews/2015/10/15/nhs-north-coast-redesign/

Briefings

There have also been regular briefings to local councillors, MPs, MSPs, Scottish Government officials and the Scottish Health Council. Updates have been provided to the District Partnership and other relevant groups in NHS Highland including the board.

Social Media

Ongoing use of Facebook and Twitter

NHS Highland Website

A section set up on NHS Highland website accessed via the home page is available and includes all the papers and notes of meetings. http://www.nhshighland.scot.nhs.uk/News/PublicConsultation/NorthCoastRedesign/Pages/W elcome.aspx

North Sutherland Coast Redesign Full Public Consultation Document 20 4. Developing possible service models and appraisal of options

Main points covered in this section:

. Summary of the service change guidance required to be followed . Process for considering new models of service . Brief description of three options short- listed . Advantages and disadvantages of short-listed options . Options appraisal exercise to determine a preferred option . Additional information on the preferred option

4.1 Overview

Six half-day workshops were held, one in August, two in September, one in each November and December 2015 and one in February 2016. NHS Highland offered choice on the times of the meetings including evening and Saturdays. Venues moved around the area.

Of the six events, the four information gathering and scoping events were facilitated by NHS Highland’s Gill McVicar, director of operations north and west operational unit. The fifth and sixth (decision making) were facilitated by an independent consultant Euan Mackay, of Grangeston.

All of the events were attended by members of the steering group and included a range of representatives. These included community council members, elected members, voluntary sector, other public agencies, development officers, GPs and NHS Highland Staff. There were between 25 to 44 participants at each event with approximately a third to a half coming from the community.

At the first workshop (17 August 2015), held in Strathy, the reasons for change were considered. There was clear agreement on the need for change, the scope of the change and a vision for the future.

4.2 Benefits Criteria

During the second workshop (8th September ’15) in Tongue the group agreed the criteria on which the base a future model of service (see also Box 9):

. supports flexibility and sustainability of resources . improves access to services . realises national & local strategic fit . makes best use of all available space/resources (buildings, staff, running costs) . effective service links

In the first instance it was explained that this exercise was looking at the non- financial benefits. In other words what ideally was important to the group prior to bringing in any financial or technical considerations? There was however, a general common sense approach was asked for and taken around resources

North Sutherland Coast Redesign Full Public Consultation Document 21

Box 9 Criteria Description Example Flexibility and . supports flexibility and Having resources tied up in sustainability sustainability of resources buildings is not flexible; the challenges of running two care homes in the area is not sustainable particularly in terms of challenges with staffing Access . improves access to services Having dual registration (nursing and residential) would overall support more people to be cared for in the area National & local . realises national & local Support more people to be strategic fit strategic fit independent living in their own home; To have fewer but better care homes Best use of . makes best use of all Small units do not make best resources available space/resources use of resources; duplication (buildings, staff, running and double running costs. costs)

Effective . effective service links Development of a ‘Hub’ facility could support better co-location and joint working

4.3 Long list of options

A long list of options was also identified during the second workshop (8th September ’15). These ranged from having no care homes in the area to maintaining the existing care homes and building an additional unit. The list included a number of different scenarios or options around who or which organisations could provide the service. The advantages and disadvantages were considered.

These were further explored at workshop 3 (15 September 2015) where presentations were also heard on the Community Empowerment (Scotland) Act, developing community resilience, likelihood of improving connectivity and new models to enhance care at home.

North Sutherland Coast Redesign Full Public Consultation Document 22 4.3.1 Options not short-listed

The following summarises why four options were not short-listed:

Service model option Reason not short-listed Close both units and make no other Would not address some of the current and changes future challenges. Does not fit with strategy of providing more care closer to home. Close both units but strengthen Unanimously rejected by the steering group primary care, community services as they did not believe it would be possible and enhance community resilience to sufficiently enhance care at home or community services to cope without any facility. Even though there was a consensus that most people would prefer to be looked after at home. Replace on a like for like basis – Does not fit with NHSH strategy which is to Caladh Sona and Melvich have fewer but better care homes; also not in any financial or capital plan Caladh Sona and Melvich to remain Does not fit with NHSH strategy to have open and an additional unit to be fewer but better care homes; also not in any built financial or capital plan

4.4 Short list of options

At the fourth workshop (November ’15) the short-list of three options was confirmed by the Steering Group:

Option A (*) Status quo / minimal change (i.e. current arrangements)

Option B (**) New build care home as part of a ‘Hub’ facility in one location to replace existing care homes (Caladh Sona and Melvich)

Option C (**) New build care home plus maintain one of the existing facilities (Caladh Sona and Melvich)

(*) Status quo is required to be included in any Option appraisal as it is the model against which all other options are assessed against

(**) Options B and C would include “strengthened community, primary and emergency care services in linked teams, enhanced community resilience utilising potential for inward investment”.

North Sutherland Coast Redesign Full Public Consultation Document 23 4.5 Appraisal of short list of options

In order to consider each option a short-description was prepared and the associated advantaged and disadvantages considered and summarised.

Option A – Status quo / minimal change

Everything would stay the same but with some investment to look to reduce concerns around regulatory and statutory requirements around Caladh Sona.

Main disadvantages Main advantages . Care Home Buildings will never be fit . It is what people know and are for purpose familiar with

. Missed opportunity to look at service . Keeps services in existing locations across area and further develop (if they can be staffed) integration . Not sustainable and does not . No service change required address staffing two facilities

Option B – New build care home as part of a ‘Hub’ facility in one location to replace existing care homes (Caladh Sona and Melvich)

Main disadvantages Main advantages . Disrupts strong attachment to existing . Helps to addresses the issues care home facilities and location associated with staffing two small units . Change of location for some care . Provides expanded services from home residents and staff new modern facilities . Culture change for communities and . Greater opportunities for further staff to get used to integrated working and co-location

Option C- New build care home plus maintain one of the existing facilities (Caladh Sona and Melvich)

Main disadvantages Main advantages . Does not address issues relating to . Addresses issues associated with staffing two units physical standards of one building . Would not be possible to expand . Services maintained on two sites service to include nursing care or ‘Hub’ facility . Limited resources freed up to . It is what people know and are develop community services familiar with

4.6 Options appraisal and weighted criteria

Options appraisal is an approach to help facilitate a decision making process in an open and transparent manner. It allows for discussion and development of initially non financial benefits criteria on which to build service around and a formal

North Sutherland Coast Redesign Full Public Consultation Document 24 assessment of the options to be considered. It offers a means to facilitate the views of all of the members of the steering group to be taken into account in the decision making process.

A fifth workshop, led by an independent facilitator was held in December 2015. The event was attended by around 25 people. It included members of the steering group. The majority had taken part in earlier workshops. Slightly under half of those attending were representatives of local community councils and groups. The purpose of the event was to evaluate the options in terms of the previously agreed benefit (non financial) criteria. This was achieved by splitting into groups with each group carrying out the following:

. review the short list of options and benefit criteria . rank the benefit criteria from most to least important . weight the criteria to reflect their relative importance . score the options

The weights and scores were combined to arrive at an overall final score out of 1000

4.7 Results from non-financial benefits scoring workshop

4.7.1 Benefits criteria, ranking and weighting

Before coming to their determination, representatives of community councils and other local groups, NHS Highland staff and GPs ranked the criteria from the most to the least important and, weighted them for relative importance (Box 10.). From the various submissions an average was calculated

Box 10 Criteria Rank Weight Improves access 1 36 Flexibility & sustainability 2 25 Effective service links 3 23 Best use of space 4 15 Strategic fit 5 11

Each option was then scored by each group and a combined figure was calculated by multiplying the scores by the weighting to give a figure out of 1000, as follows

Option A Option B Option C 172 721 508

4.8 Conclusion of Stage 1: Options appraisal on model of service

The stakeholders selected Option B as their preferred option. The very low score of Option A ‘status quo’ confirms that the participants did not feel that the current model of service performs well against the benefits criteria. This backs up the assumption of the clear need to change the service model.

North Sutherland Coast Redesign Full Public Consultation Document 25 Box 11 Summary of what would be included in “Hub” facility . 24/7 function . A shared space o Residential & Nursing Care Beds o Care at Home o Telecare o GP o Community Nursing o Physiotherapy, Occupational Therapy, Speech & Language Therapy and Podiatry o Dental Services o Social Work Services o Scottish Ambulance Service (SAS) o Scottish Fire & Rescue Service

Also Provides . A base for third sector partners . A space for training and development . An equipment store

North Sutherland Coast Redesign Full Public Consultation Document 26 5. Options appraisal to determine the location of “hub” facility

5.1 Background

The preferred model of service would require a location to be determined for the new Residential and Nursing Care Home and ‘Hub’ facility.

A sixth workshop was held to specifically carry out an Option Appraisal on possible location. The Group agreed that the area in scope for consideration to build a new facility was Scourie to Melvich with six broad locations agreed:

. Scourie / Kinlochbervie area . Durness area . Kyle of Tongue area . Bettyhill area . Strathy / Armadale area . Melvich area

5.2 Benefits Criteria

At the workshop the participants identified eight criteria as being important to determine location. While recognising all the criteria were important, each of the criteria were ranked and weighted to reflect their relative importance (Box 12).

Box 12 Benefit Criteria Description of key supporting Rank Weight characteristics (Out of 100) Recruitment and The location which is most likely retention of staff to make staffing the facility 1 36 sustainable Geographical Narrowest range of distance 2 17 centre Infrastructure Communication links, road links, 3 11 utilities and accommodation Suitability for Close proximity to other development of services based locally e.g. GP, 4 10 “hub” Scottish Ambulance Service, and Fire etc. Social impact / Social networks community 5 8 resilience Economic impact Potential impact on local rural 6 7 communities Access to care Availability of alternatives homes / residential beyond the scoping area; 7 7 care distance to/from these) Ease of acquisition Current ownership and 8 5 of land (*) acquisition timescales (*) Cost will also be a key consideration but this will be further assessed after locations have been prioritised.

North Sutherland Coast Redesign Full Public Consultation Document 27 5.3 Scoring

The group were asked to score the agreed locations against the agreed criteria. Scores were between 1 and 10 with 1 being the lowest score and 10 being the highest. Combining the scores and the weighting the following results were arrived at (Box 13):

Box 13 Location Scores (out of 1000)

Scourie / Kinlochbervie 334

Durness 347

Kyle of Tongue 754

Bettyhill 630

Strathy / Armadale 430

Melvich 501

5.4 Conclusion of Stage II: Options appraisal on location of new build residential care home ‘Hub’

The stakeholders scored Kyle of Tongue areas as their preferred option.

While it was agreed that outlook of the Care Home was very important it was felt this was best considered when looking at sites and that it should involve the residents, visitors and staff who would be in the building.

A full copy of the independent consultants report on the Options Appraisal process is available on NHS Highland website or on request (see back page).

North Sutherland Coast Redesign Full Public Consultation Document 28 6. Addressing potential impacts and other considerations

6.1 Introduction

If the preferred option was implemented, as well as improvements, there could be potential for adverse impacts for some services users and staff especially the closure of the Melvich Unit.

6.2 Service users

6.2.1 Residential Care Service Users

A small number of residents would be directly impacted during any transitions phase. Since 2009, there were eight permanent residents in Caladh Sona and 14 in the Melvich Unit. The number of new admissions per year to each home is usually one or two.

Residents come from a range of communities across the north coast as well out of area (Chart). Most people (families, visitors) already have to travel to visit residents.

Caladh Sona Melvich (July 2016) (July 2016)

Laid Tongue Respite 1 Respite 1 1 2 Bettyhill Kylesku 1 1 Lairg 2 Skerry Scourie Reay 1 1 1

“Home” location of residents as at July 2016

North Sutherland Coast Redesign Full Public Consultation Document 29 6.2.2 Day Care Service Users

Melvich Community Care Unit is registered with the Care Inspectorate to provide day care (eight places per day). The catchment area is Reay to the east, Bettyhill to the west and to south. At present there are seven day care service users.

Melvich Community Care Unit Day Care Users

Strath Haladale Strathy 1 2 Port Skerra 2 Bettyhill 1 Melvich 1

Staffing associated with the day centre includes one (whole time equivalent) day care officer. Staff associated with both the residential home and day care includes a driver/handyperson and a cook.

6.3 Staff

Any change of location of services would have an impact on some staff. Going into the future there would be implications for some staff roles and responsibilities, including where staff would work from.

There could also be implications for staff travel which would be considered as part of the Impact Assessment and onwards through organisational change process and the policy surrounding “Change of Base”

6.3.1 Staff Profiles

Caladh Sona (Permanent & Fixed Term Contract) Relief

Melness (incl. Talmine) 9 2 Tongue 2 1 Skerray/Borgie 1 2 Hope 1 Bettyhill 1 Armadale 1

Aged 65+ 1

North Sutherland Coast Redesign Full Public Consultation Document 30 Melvich (Permanent & Fixed Term Contract) Relief

Melvich (incl. Port Skerra) 5 1 Bettyhill/Strathy 4 1 Thurso 4 Reay 2 1 Forsinard 1 Berridale 1 Skerray 1 1

Aged 65+ 0

6.4 Travel Information

Mileages and timings are approx and are taken from RAC

Travel to Melness

Miles (approx) Time (approx) Tongue to Melness 06 0:12 Bettyhill to Melness 17 0:35 Armadale to Melness 23 0:46 Strathy to Melness 27 0:52 Durness to Melness 30 0:54 Melvich to Melness 30 0:57 Reay to Melness 36 1:05 Lairg to Melness 43 1:19 Thurso to Melness 47 1:21 Kinlochbervie to Melness 48 1:25 Scourie to Melness 55 1:36

Travel to Melvich

Miles (approx) Time (approx) Strathy to Melvich 3 0:4 Armadale to Melvich 6 0:10 Reay to Melvich 6 0:10 Bettyhill to Melvich 13 0:21 Thurso to Melvich 17 0:26 Tongue to Melvich 25 0:45 Melness to Melvich 30 0:57 Durness to Melvich 54 1:33 Lairg to Melvich (via Tongue 58 1:39 & Bettyhill) Kinlochbervie to Melvich 72 2:04 Scourie to Melvich 79 2:15

North Sutherland Coast Redesign Full Public Consultation Document 31 6.5 Other considerations

6.5.1 Design of building

Further detailed work would still be required to determine the exact specification of the facility and the design as well as to identify a site.

Service users, members of the public and relevant experts would be invited to be involved in this work. The outlook of the proposed new facility would require careful consideration, balancing having a desired outlook with proximity to other services and the community in general.

6.5.2 Caladh Sona

If the preferred option was implemented Caladh Sona Unit would no longer be required for residential care.

6.5.3 Melvich Unit

If the preferred option was implemented Melvich Community Care Unit would no longer be required for residential care.

6.5.4 Freeing up buildings

Any NHS Highland or Highland Council buildings no longer required (e.g. Caladh Sona and/or Melvich Community Care Unit) could be available for alternative use or disposal. This would be done in accordance with Scottish Government policy (NHS Scottish Property Transactions Handbook) including Community Empowerment (Scotland) Act 2015. Although different parts of the Act are likely to come into force at different times the Scottish Government Website indicates that it “expects most parts of the Act to come into force by late summer 2016”.

North Sutherland Coast Redesign Full Public Consultation Document 32 7. Public consultation, how to tell us your views and the decision making process

7.1 Major Service Change

The changes being proposed are considered to be ‘major’. This means the proposals are subject to a minimum three-month period of formal public consultation.

7.2 How to find our more

NHS Highland will hold drop-in events; offer to attend meetings of community councils, district partnership and other local groups. These will also be advertised locally and in the media or you can find out from the various secretaries of community councils or NHS Highland (see back page).

We will also be pleased meet or speak to any individuals, groups or staff on request, if at all possible. To find out more, including requesting a meeting, see details on the back page.

7.3 Tell us what you think

Although NHS Highland is consulting on the preferred option – Option B in the Kyle of Tongue area, no final decision has been made. The feedback from the public consultation would allow further opportunities for local communities and staff to influence the NHS Highland board prior to them making a decision on the preferred model and location.

A consultation summary document and feed-back form will be distributed to the communities in scope as well to visitors and families of residents.

If you don’t receive a form or would like additional forms please get in touch You can also submit your view on-line If you would prefer to not fill out a form but express your views in writing please do so.

Please see contact details are on the back page.

7.4 Evaluation of the Options Appraisal Process

Scottish Health Council (SHC) has evaluated the Options Appraisal Process. They have done this by attending the workshop meetings and asking participants to complete feed-back questionnaire.

They have also conducted some work with communities who only partially engaged or did not engage at all to find out why. Their assessment of the Option Appraisal process in to service model and location can be found on the NHS Highland website. Or contact NHS Highland or SHC to request a copy.

North Sutherland Coast Redesign Full Public Consultation Document 33 7.5 Evaluation of the consultation process

The Scottish Health Council will also carry out an evaluation of the consultation process, materials and any events and meetings.

This is to find out how well people feel informed about why changes are being proposed and if they were able to get answers to any questions they raised. They will produce an Assurance Report which will be part of the evidence the board NHS highland will consider when making a decision on the proposals.

7.6 Information about you and equality and diversity monitoring

We also want to know who has provided responses on the consultation. This is to make sure that we are able to consider different perspectives. This is optional but any information provided would be treated in confidence. For instance the feed-back from will include gathering information on:

 Age band  Where you live?  Do you live on your own?  Do you have a disability?  Are you a car owner/have access to a car?

7.7 Making decisions

The director of operations for north and west and head of PR and engagement will prepare a paper for NHS Highland board to consider. This would be based on a number of things including the outcome of the options appraisal exercise, feedback from public consultation and overview of any other considerations or any new information or circumstances.

The board will also consider the Assurance Report which will be prepared by the Scottish Health Council on the process.

It is difficult to be exact but the findings would probably be presented at the earliest at the board meeting due to be held on 29th November 2016.

North Sutherland Coast Redesign Full Public Consultation Document 34