Highland NHS Board 7 October 2014 Item 4.1 PROPOSED REDESIGN OF SERVICES IN BADENOCH AND STRATHSPEY Report by Nigel Small, Director of Operations (South and Mid) 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 three month public consultation into proposed major service change Note the feedback from the Scottish Health Council endorsing the consultation process Endorse the recommendation in support of the preferred option – to develop Community hospital and resource centre in a central location (Aviemore) 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 Badenoch and Strathspey (part of South and Mid Operational Unit). In particular it highlights the main findings from the three month public consultation exercise. Within Badenoch and Strathspey some services are not strategically located or adequately resourced making them not as effective or efficient as they need to be to meet future demands. In addition the two local community hospitals are old, not in good physical condition and not designed to meet modern standards. 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: Option 1 – Do minimum Option 2 - Community hospital and resource centre in one town (‘hub’) and scaled-down services in the other (‘spoke’), based on existing hospital sites Option 3 - Community hospital and resource centre in a central location (Aviemore) Option 3 was identified as the steering group’s preferred option. If implemented this would mean building a new community hospital and resource centre in Aviemore, as part of a wider redesign and modernisation of health and social care services. It would also include the re-location of Aviemore Health Centre, some other services located in Aviemore and the closure of both local hospitals - Ian Charles in Grantown-on-Spey and St Vincent’s in Kingussie. Any closures would be planned to take place after the new services were in place. The board of NHS Highland considered these proposed changes to be ‘major’ and was therefore subject to a period of formal public consultation. The board approved the move to formal public consultation at a special meeting held in March 2014. The formal public consultation was launched on 21st April and ran for a total of 14 weeks until 21st July 2014. NHS Highland was consulting on the range of options including option three as the preferred option. It is estimated that some 500 people took part during the consultation. Of those who completed NHS Highland’s consultation response survey (176) there was wide-spread support for the case for change with almost 80% selecting the preferred option. Positive feedback on the consultation process and the preferred option was also received from 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 has endorsed that the process has been in accordance with Scottish Government Guidance. This includes the options appraisal process (service model and sites), public consultation materials and the public consultation communications and engagement. Taking everything into consideration the operational unit can demonstrate broad support from the wide range of stakeholders for the preferred option (option 3) 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 (written correspondence, personal contact with staff and at meetings) that there were some people who had some strong concerns about aspects of the proposed redesign (most notably but not exclusively in Grantown-on-Spey), and some topics of wider general concern (future services, transport, future use of buildings, bed requirements and care-at-home) requiring further consideration The report, therefore also sets out some of the next steps in meeting the guidance and describes some of the further work that would be required should the preferred option move to implementation. 2. NHS Highland Report on the Public Consultation 2.1 Overview The public consultation report specifically covers the three month public consultation into the proposed redesign of services across Badenoch and Strathspey. It describes in detail how the consultation was managed and promoted, the range of ways that views were gathered, and an analysis of all the feedback. It includes the findings from the feedback on the public consultation survey and the summary feedback from the independent review of the consultation process by the Scottish Health Council. The write-up of the options appraisal process on site selection is also included. This work could only be completed after the consultation had closed. Based on an assessment of all the supporting information a recommendation to the board is made on model of service, location and site. 2 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. The feedback from the public meetings was fairly representative of the general feedback which emerged during the consultation. Areas of greatest concerns were raised from some residents in Grantown-on-Spey. This was also highlighted in the Highland Council response and further focussed work will be required should the proposed changes be implemented. 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 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 October. The Scottish Health Council carried out an independent review of the process and has also endorsed the process. They highlighted some areas of good practice as well as how the process could be improved in the future. 2.3 Feedback on the Service Model and Site 79% of people who responded to the consultation survey agreed with the proposal to develop a community hospital and resource centre in Aviemore supported with wider development of community services. This option also received backing from all four medical practices and partner organisations (The Highland Council, Scottish Ambulance Service, Scottish Fire and Rescue Service, Highlands and Islands Enterprise and the Highland Hospice). People also had the opportunity to comment on aspects of the proposed changes. Over half the people who responded were positive about all elements. Closing in-patient beds in Ian Charles and St Vincent’s and moving the Glen day centre were the least well supported. Both the public preference and the working group’s deliberations came up with the same conclusion on the favoured choice of site (Site C, Technology Park in Aviemore). This preference is based only on qualitative factors. Other important factors such as development costs, land purchase and the suitability of the land for construction also have to be considered. This work would be completed if there is a decision to progress to implement the preferred option. 2.4 Conclusion There is broad support from the wide range of stakeholders for the preferred option (option 3) and this is now being formally recommended by the south and mid operational unit to the board for endorsement. 3 2.5 Next Steps and Decision Making Process Should the board endorse the recommendation then an updated report will go to the Scottish Government for a final decision by the Cabinet Secretary. Only if the Cabinet Secretary approves the preferred option would planning for the new facilities and services begin in earnest. There would then be a requirement for the Business Case process to be followed, in accordance with the Scottish Capital Investment Manual Guidance. Once the next steps were completed an Initial Agreement document would need to be prepared and submitted for consideration by the Capital Investment Group. Other specific work identified that would need to take place includes: Setting out how Primary Care and community