NHS Highland Highland Health and Social Care Partnership Modernisation of community and hospital services for communities in Skye, Lochalsh and South West Ross Initial Agreement Version 26 (October 2016) Skye, Lochalsh and South West Ross Initial Agreement v26 10th October2016 1 LEAD CONTACTS Enquiries to: Eric Green, Head of Estates, NHS Highland, John Dewar Building, Inverness Retail and Business Park, Highlander Way, INVERNESS IV2 7GE (01463) 706 801 [email protected] Project Director Gill McVicar Director of Operations, North and West Highland, Larachan House, Dochcarty Road, Dingwall, Ross shire, IV15 9UG (01349) 869221 07721466240 [email protected] Skye, Lochalsh and South West Ross Initial Agreement v26 10th October2016 2 Contents 1 EXECUTIVE SUMMARY AND PURPOSE ........................................................... 6 1.1 Overview and strategic direction ................................................................ 6 1.2 Location and delivery of existing arrangements ....................................... 6 1.3 Case for change ........................................................................................... 7 1.4 Investment Objectives ................................................................................. 9 1.5 Stakeholder involvement ............................................................................. 9 1.6 Options appraisal on service model and location ..................................... 9 1.7 Formal public consultation and approvals .............................................. 10 1.8 Benefits and risks ...................................................................................... 11 1.9 Constraints and dependencies ................................................................. 11 1.10 Financial considerations ........................................................................... 12 1.11 Project management and governance ..................................................... 12 2 OVERVIEW AND STRATEGIC DIRECTION ..................................................... 13 2.1 National Strategic Context ........................................................................ 13 2.2 NHS Highland ............................................................................................. 14 2.2.1 Organisational overview .............................................................................. 14 2.2.2 Strategic overview ....................................................................................... 15 2.2.3 Service Redesign ......................................................................................... 16 3 LOCATION AND DELIVERY OF EXISTING ARRANGEMENTS ...................... 19 3.1 Location of service users .......................................................................... 19 3.2 Location of services .................................................................................. 19 3.3 Existing service arrangements ................................................................. 21 3.3.1 Access .......................................................................................................... 21 3.3.2 Primary Care Services ................................................................................. 21 3.3.3 Rural Support Team ..................................................................................... 22 3.3.4 Integrated Teams ......................................................................................... 22 3.3.5 Inpatient care ............................................................................................... 22 3.3.6 Service providers ......................................................................................... 23 3.3.7 Associated Assets ....................................................................................... 23 4 CASE FOR CHANGE ......................................................................................... 25 4.1 Population Projections .............................................................................. 25 4.2 Service Projections .................................................................................... 26 4.2.1 Bed Modelling .............................................................................................. 26 4.3 Other factors ............................................................................................... 26 4.4 Business need, impacts and why action now ......................................... 27 4.5 Potential business scope .......................................................................... 28 4.5.1 Geographical ................................................................................................ 28 4.5.2 Population / user base ................................................................................. 28 4.5.3 Functionality ................................................................................................ 28 4.5.4 Organisations ............................................................................................... 28 4.5.5 Hours ............................................................................................................ 28 4.5.6 Locality-based staff ..................................................................................... 29 4.6 Service Solution ......................................................................................... 29 4.6.1 Overview of proposed new model of service ‘Hub’ and ‘Spoke’ .............. 29 4.6.2 Health and social care resource centre ‘Hub’ in Broadford ...................... 30 4.6.3 ‘Spoke’ Portree ............................................................................................ 31 4.7 Service delivery .......................................................................................... 33 4.8 Implementation ........................................................................................... 33 4.9 Critical success factors ............................................................................. 33 5 INVESTMENT OBJECTIVES ............................................................................. 35 Skye, Lochalsh and South West Ross Initial Agreement v26 10th October2016 3 6 STAKEHOLDER INVOLVEMENT ...................................................................... 36 7 OPTIONS APPRAISAL ON SERVICE MODEL AND LOCATION ..................... 40 7.1 Long list of options .................................................................................... 40 7.2 Preferred way forward and short listed options ...................................... 40 7.3 Appraisal of short listed options .............................................................. 40 7.4 Scoring of options ..................................................................................... 42 7.5 Conclusions ................................................................................................ 43 7.6 Non-financial risks appraisal .................................................................... 43 7.7 Financial Risks ........................................................................................... 43 7.8 Economic appraisal ................................................................................... 44 7.9 Preferred Service Model Option ................................................................ 44 7.10 Options appraisal to determine the location of ‘Hub’ and ‘Spoke’ ........ 44 7.11 Site options appraisal in Broadford ......................................................... 45 7.12 Portree Spoke ............................................................................................. 46 7.13 Design Quality Objectives ......................................................................... 46 8 FORMAL PUBLIC CONSULTATION ................................................................. 48 8.1 Background ................................................................................................ 48 8.2 Feedback on service model and location ................................................ 48 8.3 External assurance process ...................................................................... 49 8.4 Recommendation considered by NHS Highland board .......................... 49 8.5 Ministerial approval ................................................................................... 49 9 BENEFITS AND RISKS ..................................................................................... 50 9.1 Benefits ....................................................................................................... 50 9.2 Risks ........................................................................................................... 50 9.2.1 Current capacity in community infrastructure ........................................... 50 9.2.2 Funding ........................................................................................................ 50 9.2.3 Delay in approvals process ......................................................................... 51 10 CONSTRAINTS AND DEPENDENCIES ............................................................ 52 10.1 Financial...................................................................................................... 52 10.2 Service delivery .......................................................................................... 52 10.3 Workforce ................................................................................................... 53 10.4 Transport ...................................................................................................