4.1 Badenoch Strathspey Redesign

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:
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1.
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
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 shortlist 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:
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3
Setting out how Primary Care and community services (delivered through the four
Health Centres) will be maintained or improved
Explore opportunities for co-location of children and families staff in any new facility
Further engagement specific elements of some of the proposals
Clarification on consistent use of terminology to describe services such as minor
injury/casualty/ A&E
Development of an Integrated Transport Plan
Strategic development and expansion of care-at-home services
Further detailed work to develop the final clinical specification for the hospital
Further modelling work on bed numbers
Carry out technical appraisal of preferred site
Collaboration with all concerned regarding the future use of any buildings no longer
required by NHS Highland
On-going engagement with local communities and stakeholders throughout the
development of the business case.
Contribution to Board Objectives
The service redesign, if successfully implemented would provide significant opportunities to
implement better health, better care and better value and maximise the potential of
integration.
The operational unit is fully aware of other strategic and operational considerations such as
wider discussions relating to dental services, MSK review, transforming outpatients, older
adult mental health services, strategic overview of radiology and diagnostic services and the
Inverness Master Plan. Over the next two to three years other work may be identified.
Governance implications
Staff Governance1
Staff are integral to the redesign and there is strong clinical, staff side representatives, and
senior management leadership. Significant effort has been made to achieve a clinical
consensus, and this has been supported through a series of clinical workshops and ongoing
meetings with the local GPs, facilitated through the locality clinical lead and director of
operations.

Going into the future there will be implications for some staff roles and responsibilities,
including where staff will work from. Some of this is a continuum of the work already
1
In this context staff is used in the broadest term and includes GP and practice staff
4
underway linked to integration of health and social care and includes opportunities for staff
co-location and professional and team development.
It is important that staff are provided with a safe and improved working environment as part
of the staff governance standard, to enable them to provide high quality care for service
users. The redesign work is consistent with meeting this standard.
Organisational Change Policy will underpin the approach to be taken supported by workforce
planning and development strategies. There would need to be a clear read across with the
Local Delivery Plan, Workforce Development Plan and Operational Unit Delivery Plans.
There may be implications for staff travel which would be considered as part of the next
steps including through the Impact Assessment and onwards through organisational change
process.
Updates have been provided to Staff Governance Committee, Highland Partnership Forum,
Area Clinical Forum, Highland Health and Social Care Committee, NHS Highland Senior
Management Team, and Raigmore Senior Management Team.
Meanwhile service will continue to be staffed and developed, as appropriate to ensure
ongoing quality of care. At this stage it is too early to implement a workforce plan.

Clinical Governance
Clinical governance issues were considered as part of the options appraisal process,
development of the clinical brief and as part of the clinical workshops. Any model of service
implemented would be required to be safe, effective and evidence-based. There is
significant clinical engagement and consensus in both areas. Implementation of the
preferred options would support delivery of NHS Highland’s strategic objectives.
There are significant governance implications to delivering healthcare in a hospital
environment which is not conducive easily meeting standards. Recent hospital inspections
relating to healthcare environment, disability access, hospital security, fire safety and
healthcare associate infection have all highlighted current risks. Mitigation has been
undertaken but the aged structures have made this challenging. In order to make sure
facilities remain safe to deliver services last year NHS Highland invested over £100k for
maintenance alone.
Furthermore, clinicians have raised concern about potential risks of patient harm caused by
resources split over several sites in the present arrangements. Effective clinical governance
and application of the Highland Quality Approach including systems redesign, mistake
proofing, and reduction in unnecessary waste and ability to lower the risk of patient harm will
be far more effective in a redesigned service.
These risks will continue to be managed until any new arrangements are in place. It is
anticipated that there will also be day-to-day operational issues to be managed and shortterm decisions to be taken relating to e.g. failures in equipment, ability to meet standards,
recruitment difficulties and affordability, with the present arrangements.
It is anticipated that there will be issues to be managed and short-term decisions to be taken
relating to e.g. failures in equipment, ability to meet standards. Any decision will need to take
consideration of the range of governance issues, financial impact, management of any risks
and business continuity.

Financial Impact
A high level financial appraisal has been carried out. At this early stage the purpose was to
look at likely overall affordability and which option would provide best value for money. A
more detailed appraisal of costs will be undertaken as the project progresses to the next
phase.
5
The service redesign is part of Local Delivery Plan. One of the key sections within the Local
Delivery Plan is the Financial Plans for NHS Highland for the next few years.
The redesign work would be closely monitored through the Improvement Committee,
Highland Health and Social Care Committee and Operational Unit Management Teams.
4
Risk Assessment
The redesign of service has grown out of a number of risks which have been identified
around the current model of service. The proposals, if implemented, would address the risks
arising from the current conditions of the hospitals linked to Infection Control and Fire Safety.
There are also current challenges around the delivery of care-at-home; and issues around
sustainability of Out-of-Hours (nurse and medical cover and inpatient management). These
risks would be addressed as part of the new arrangements. Individual components of the
service redesign may be required to have specific risk assessment.
Financial risks have been identified around maintaining the status quo and there are now
some wider potentially significant reputational risks if this work is not taken through to
completion in a reasonable time-scale.
A new facility would be required to be built and this would require a suitable site to be
secured.
5
Planning for Fairness
The impact assessment has been updated and is available on the website. Further detailed
work would be required as part of design of any proposed new buildings.
Further work is ongoing, including establishing a local access and transport group and
carrying out a Transport Survey.
There was one request for an audio version, one request for large-print consultation
document and one request for a home visit during the consultation period.
6
Engagement and Communication
As set out in the full report the public consultation has been a significant engagement and
communications exercise led and delivered by the operational unit supported by a number of
departments. The public consultation ran from 21st April to 21st July.
In discussion with the Scottish Health Council a wide range of approaches were identified for
use to raise awareness with the public, partners and staff 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 to meet
anticipated requests as they emerged during the consultation.
During the course of consultation period staff attended over 50 meetings with events starting
on the 24th April and concluding on 9th of July.
6
A total of 8,207 summary documents were issued (homes = 7,703 and businesses =502) via
a mail drop to all homes and business areas.
Close contact was maintained with all stakeholders throughout including local groups,
councillors, community councils, partner agencies, MSPs, Scottish Government, Scottish
Health Council, local GP practices and staff.
An after action review has been arranged for 5th November with the Scottish Health Council.
A local access and transport group has been established and has already held its first
meeting.
7
Conclusion
The changes being proposed offer the opportunity to bring about major service improvement
consistent with national strategy and the Highland Quality Approach. This would provide
modern services and represent better value for money. Implementing the preferred option
would help to accelerate transformational change and further support integration of adult
health and social care in its widest sense.
This is a challenging but exciting modernisation programme which would impact on
communities positively for many decades to come.
Nigel Small, Director of Operations (South and Mid)
Maimie Thompson, Head of Public Relations and Engagement
26 September 2014
7
Proposed modernisation of community and
hospital services in Badenoch and Strathspey
Report on formal public consultation
21st April to 21st July 2014
Nigel Small (Director of Operations South and Mid Operational Unit)
Maimie Thompson (Head of Public Relations and Engagement)
September 2014
#strathchat
www.nhshighland.scot.nhs.uk
Contents
Summary conclusion and recommendation
Executive Summary
1
Background
2
Management of the public consultation process
3
Raising awareness of the public consultation
4
Feedback from meetings and events
5
Feedback from the consultation survey
6
Feedback on the consultation process
7
Feedback on the service model options
8
Feedback on sites
9
Assurance of the consultation process
10 Conclusions and next steps
Appendices
Appendix 1 – Summary details on the short-list of options
Appendix 2 – Overview of the NHS service change process in Scotland
Appendix 3 – Events and stakeholder meetings including updates to committees etc
Appendix 4 – Summary of points raised at meetings and events
Appendix 5 – Further work identified to understand future bed numbers
Appendix 6 – Option appraisal process to support site selection
Appendix 7– Update on local care-at-home activities
Appendix 8 – A summary of what is included in district profiles
Appendix 9 – Feedback on aspects of the proposals
2
Summary conclusion and recommendation
There is 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.
In coming to this view, the operational unit has sought to satisfy itself that people
were comfortable with the consultation process and that there was strong support for
the preferred option.
79% of people who responded to the 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).
Both public preference and the option appraisal process identified Site C –
Technology Park - as the preferred site at this stage to develop any new hospital in
Aviemore.
The consultation process has been endorsed both internally via the Highland Health
and Social Care Committee and independently by the Scottish Health Council.
3
Executive summary
1
Services throughout NHS Highland need to change to make sure they meet the
future needs of the population.
2
Within Badenoch and Strathspey some services are not strategically located nor
adequately resourced making them not as effective or efficient as they need to
be. In addition the two local community hospitals are old, not in good physical
condition and not designed to meet modern standards.
3
Work has been ongoing over the past few years to look at these issues with a
view to providing sustainable solutions in the future.
4
A local steering group including community councilors, service users, partner
agencies, representatives from local groups, elected members, GPs, other
clinicians, NHS Highland staff and others went through an options appraisal
process during 2013/14 and 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
5
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.
6
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.
7
The Board of NHS Highland considered these proposed changes to be ‘major’
and therefore were subject to a period of formal public consultation. The Board
approved the move to consultation at their meeting in March 2014.
8
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.
9
During the consultation period over 50 meetings and events took place and a
summary document was mailed to every house (7,703 copies). Throughout the
consultation there was a regular flow of information available for the public. All
requests for meetings during the consultation period were accommodated.
10 There was active engagement from community councils, local councillors and
other key local groups such as Friends of Ian Charles, Friends of St Vincent’s,
Badenoch & Strathspey Community Transport Scheme and Local Access Panel
4
to name but a few. There was also wider and ongoing engagement with partner
agencies, MSPs, local MP and others.
11 It is estimated that 500 people took part during the consultation. Of those who
completed NHS Highland’s consultation response survey (176) there was widespread support for the case for change with almost 80% selecting the preferred
option.
12 Positive feed-back on the consultation process and the preferred model of
service was also received from partner agencies including the Highland Council,
Scottish Ambulance Service, Scottish Fire and Rescue, Highlands and Islands
Enterprise and the Highland Hospice).
13 In their independent report of the consultation process the Scottish Health
Council concluded:
“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.”
“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.”
14 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 formally recommending this option to the Board for endorsement.
15 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.
16 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 strong opposition about aspects of the proposed re-design
(most notably but not exclusively in Grantown-on-Spey), and some topics of
wider general concern (future services, transport, bed numbers, future use of
buildings, care-at-home) requiring further consideration.
17 Should the proposal get the necessary endorsements further work would be
required, particularly around some of the detail relating to the new hospital,
delivery of care-at-home, transport arrangements and what would happen to
some of the buildings.
18 This would all form part of the work required for the Business Case Process and
would require ongoing engagement with all stakeholders.
5
1 Background
Main points covered in this section:



Background to the public consultation process including what is covered in this
consultation report
Brief description of strategic context, local services and the conclusion of the
options appraisal process
Major service change process and why public consultation was required
1.1 Introduction
This report specifically covers the three month public consultation into the proposed
re-design of services across Badenoch and Strathspey.
It describes how the consultation was promoted, the range of ways that views were
gathered, and an analysis of all the feedback.
It includes a summary of the feedback from NHS Highland’s consultation survey and
the independent review of the consultation process by the Scottish Health Council.
The write-up of the options appraisal process on site selection is 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.
The report 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
be implemented.
There would be a requirement for the Business Case process to be followed, in
accordance with the Scottish Capital Investment Manual Guidance, which would
mean an Initial Agreement document would be required for consideration by the
Capital Investment Group.
Other specific work identified to take place includes:









Setting out how Primary Care and community services (delivered through the
four Health Centres) will be maintained and improved
Explore opportunities for co-location of children and families staff in any new
facility
Further engagement on aspects of some of the proposals
Development of an Integrated Transport Plan
Strategic development and expansion of care-at-home services
Further work on older adults with mental health
Further modelling work on bed numbers
Further detailed work to develop the final clinical specification for the hospital
Carry out technical appraisal of preferred site
6
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
Collaboration with all concerned regarding the future use of any buildings no
longer required by NHS Highland
On-going engagement with local communities and stakeholders throughout the
development of the business case
1.2 NHS Highland Strategic Context
NHS Highland’s strategic framework was endorsed by the Board at its meeting in
October 2010. It was founded on the Healthcare Quality Strategy for Scotland and
set out NHS Highland’s vision of Better Health, Better Care and Better Value.
It was recognized that to achieve this vision would require some modernisation and
re-design of services, including around community hospitals, older adult mental
health services, care-at-home, care homes, extended community care and integrated
teams.
NHS Highland reported at their Board Meeting in June 2011 around £74m of repairs,
maintenance and upgrading work to bring buildings up to minimum national
requirements. The most recent report shows the figure at £80m reflecting the
additional estate now owned by NHS Highland since integration in April 2012.
In terms of Badenoch and Strathspey the associated back-log maintenance costs
are currently estimated at £5.2million. Notably, however, due to the changing needs
of the service and physical layout and condition of the buildings they would never be
able to evolve to facilitate modern integrated services.
Although the physical condition of the hospital buildings and some of the equipment
has created some pressing urgency around the review, there are also a number of
other important considerations to be addressed including: ensuring safe and
sustainable nursing and medical rotas, especially during the out-of-hours period, the
need to increase care-at-home capacity, as well as more generally modernizing
services to meet future demands.
It is within this strategic context, that the local review and re-design proposals have
emerged.
1.3 Description of Local Services
The services under review fall within the locality of Badenoch and Strathspey. There
are 13,472 people registered with the three General Practices in the area: Grantownon-Spey, Aviemore and Kingussie. The Kingussie Practice also runs a practice in
Laggan. The Aviemore Health centre hosts the out-of-hours centre for the locality.
As well as a full range of services provided by the General Practice, the local
communities are also served by two community hospitals:
Ian Charles in Grantown is a 13 bedded, GP led hospital which is co-located with
the health centre and modular dental facility. The hospital is supported by 24 hour
nursing cover. Minor Injury services are also available at the hospital. There are a
very limited number of consultant outpatient clinics and x-ray service.
7
St Vincent’s in Kingussie is split into two units. The lower floor is 10 bed GP
medical unit. Upstairs is an Old Age Psychiatry unit which has seven inpatient beds
and us used for psychiatric assessment. Both units have 24 hour nursing cover.
Since integration, NHS Highland now manages two care homes (Grant House in
Grantown-on-Spey and the Wade Centre in Kingussie). In addition there are two
private homes in the district: Mains House Care Home in Newtonmore and
Grandview House Nursing Home in Grantown-on-Spey.
The area is served by multi-disciplinary teams (social workers, care at home workers,
physiotherapists, occupational therapists, speech and language therapists, dieticians,
community nurses, community mental health teams etc), who work out of a number
of different bases.
The location of the main NHS Highland run health and social care services in
Badenoch and Strathspey are shown (see map below).
No change to the location of health centres or out-of-hours arrangements are being
proposed as part of the consultation, other than the recommended re-location of the
health centre in Aviemore.
1.4 Development of Options and Conclusion of Options Appraisal
Full details on the process to develop and appraise possible options for the future
were presented to the Board in March 2014. Details are available on the NHS
Highland website and were described in the public consultation materials.
8
Three options were short-listed and the scoring identified option 3 as the clear
preferred option (see box below). Further details on each option are summarised
(Appendix 1).
Summary of scoring of options appraisal (scored out of 1000)
Option
Description
Score
Rank
Capital
cost
Running
costs
1
Do minimum
250
3
£5.2m
£3.2m
2
Community resource
centre and hospital hub
and spoke
463
2
£9m
£2.3m
3
Community resource
centre and hospital hub
913
1
£12m
£2m
1.5 Major Service Change and Public Consultation
At a special meeting held on 4th March 2014, the Board considered the changes
being proposed to be major. A requirement of proposed ‘major’ service change is the
need to carry out formal public consultation for a minimum period of three months
(Appendix 2).
CEL 4 (2010)1 provides guidance on informing, engaging and consulting people in
developing health and community care services including requirements for a public
consultation. This document also clarifies the role of the Scottish Health Council
during service change which is to quality assure the engagement process and
produce a report on their findings for the Board to submit to the minister, alongside
the final proposals.
NHS Highland worked closely with the Scottish Health Council on the
communications and engagement plan, the public consultation materials and the
consultation survey.
In April 2014 the Scottish Health Council confirmed that they were satisfied with the
arrangements NHS Highland had in place allowing the formal consultation to take
place.
1
http://www.sehd.scot.nhs.uk/mels/CEL2010_04.pdf
9
2 NHS Highland management of the public
consultation process
Main point covered in this section:

Internal and external leadership, management support and advice to set up,
manage and oversee the public consultation
2.1 Background
The formal consultation was launched on 21st April and ran for a total of 14 weeks
until 21st July 2014. Responses were accepted up until 28th July 2014.
People were given an opportunity to feedback on the three short-listed options or to
offer a view on any alternative option. Moreover, the feedback form also allowed
people to comment on specific elements of the proposal including a short-list of sites.
The decision making process was also described in the consultation materials and at
events, meetings, correspondence, media and with the Steering Group.
2.2 NHS Highland Leadership and Management Support
The public consultation was led by Nigel Small (director of operations) supported by
a small core team (Box below). A member of the core team was present at all of the
meetings or events. This was to provide consistency in approach. The core team
were also responsible for providing responses to any correspondence.
Members of NHS Highland core team and their lead responsibilities
Name
Responsibilities
Notes
Nigel Small
Senior management leadership
Point of contact for Board,
Overview of process
Scottish Government,
Signing-off responses and media
Scottish Health Council and
releases
local steering group
Boyd Peters
Senior clinical leadership
Lives in Grantown-on-Spey
Clinical advice
Responding to clinical queries
Kenny
Project management
Lives in Grantown-on-Spey
Rodgers
Financial advice including
Project manager for Nairn
endowments and business case
Town and County new build
process
Maimie
Project management
Point of contact for Board,
Thompson
Advice on service change process
Scottish Government,
overview of engagement
Scottish Health Council and
Overview of communications
local steering group
including media
John Bogle
Site selection and options appraisal Project manager for new
Advice on business case process
build of Migdale Hospital
Sue Blackhurst Co-ordination of all administration
Point of contact for local
for events and meetings
steering group
10
2.2.1 Other NHS Highland staff and GP Practice staff
Other staff including Jean-Pierre Sieczkarek (area manager), Margaret Walker
(district manager), Dan Fraser (charge nurse at Ian Charles) and Debbie Ennis
(charge nurse at St Vincent’s), Eric Green (head of estates) and Michael Waters
(capital support and project manager) made important contributions throughout the
process including attending some of the meetings.
Margaret Macrae, local staff side representative was also an active member of the
steering group.
Practice managers provided support with raising awareness of the consultation and
the Transport Survey. GPs were in attendance at each of the three public meetings.
Each of the Practices was also represented on the steering group.
2.2.2 Communications Team
All three members of the public relations and engagement team played an active part
in supporting the process including: handling media inquiries, issuing media releases,
promoting the consultation through social media, designing posters and flyers, and
management of website. They also took part in walkabouts in Newtonmore,
Kingussie, Grantown-on-Spey and Aviemore.
2.2.3 Clinical Governance Team
Staff in the clinical governance team were responsible for advising with the design of
the consultation questionnaire and transport survey (hard copy and on-line survey).
They also input the data from the hard copies of the forms, carried out the analysis
and wrote up the report on the findings.
2.2.4 Executive and Non Executive input
Executive leadership was provided by Elaine Mead (chief executive), Deborah Jones
(chief operating officer) and Nick Kenton (director of finance). This included
attendance at some of the meetings and events and liaison with Scottish
Government.
The Nairn, Badenoch and Strathspey District Partnership is chaired by a non
executive director of NHS Highland.
The Highland Health and Social Care Committee (a key committee of the Board) is
chaired by a non executive. They were responsible for providing internal assurance
to the Board on whether, in their opinion, the major service change process had been
followed.
Non executive guidance was also provided from Robin Creelman and Elaine
Wilkinson. They provided “outside-eyes” to support the process but were considered
to be impartial as they did not sit on the Highland Health and Social Care Committee.
11
2.3 Other Advice and Support
2.3.1 Local Steering Group
The make-up of the steering group and how they have been involved is described in
the consultation materials and their names and contact details are available on the
website2.
The group were kept in regular contact throughout the consultation period through
group emails and direct contact. Many members attended one or more events and
also brought queries to the attention of the core team throughout the consultation and
continue to do so.
A well-attended mid-review meeting of the steering group was held on 5th June. This
was to get feedback from members on the process and to allow time to incorporate
their suggestions. This formed part of NHS Highland’s mid-consultation review writeup.
The public consultation was also discussed at the NHS Highland Annual Review
which was held on 9th June in Fort William. Two members of the steering group
attended the event.
The Steering Group was also re-convened on 27th August 2014 to complete the
options appraisal exercise on the potential sites. This could only be completed after
the consultation closed because public preference was one of the criteria being used
on which to make a recommendation about the sites.
2.3.2 Community Councils and Local Groups
There was ongoing liaison with the community councils and local groups to support
organising of meetings, promoting events and public meetings.
All community councils were also contacted to get copies of minutes of any meetings
NHS Highland attended. This was so that the information could be included on the
NHS Highland website and also be used to validate NHS Highland’s notes from any
meetings.
2.3.3 Scottish Government
NHS Highland has kept in regular contact with the relevant departments of the
Scottish Government during the consultation process. Carmel Sheriff (performance
manager) visited Badenoch and Strathspey on 14th May. The director of operations
showed her round each of the facilities under review. This was followed up with a
wider discussion on the consultation process with the chief executive and head of
public relations and engagement.
2
To support this work NHS Highland followed advice from the Scottish Health Council. Existing
groups and community councils were approached and asked to send representatives. We were also
open to include anyone who expressed an interest to get involved and to date all requests to get
involved have been accommodated. This will continue to be an ongoing and evolving process.
As per set out in the guidance clinical staff and those who have management responsibility for its
provision were also involved. There is no definitive guidance on the optimum number of people, or the
proportion of the various stakeholders who should take part. The board is required to determine what
is “reasonable and proportionate”. There is a general comment, however that the group should
neither be too small or too large.
12
In July 2014 Steven Hanlon, capital finance and policy manager visited the current
facilities in Badenoch & Strathspey and also met local clinicians.
More generally regular capital review meetings are held with Mike Baxter, deputy
director (capital and facilities) and colleagues and these have included briefings on
the Badenoch & Strathspey re-design proposal.
Update reports were considered by Highland Health and Social care Committee on
10th July 2014 and 11th September, and were also shared with Scottish Government
colleagues.
2.3.4 Scottish Health Council
NHS Highland has worked closely with the Scottish Health Council (SHC) service
change team. This included meeting regularly during the consultation period.
SHC staff attended a number of meetings and conducted their own independent
review of the process including holding a focus group.
13
3 Raising awareness of the public
consultation
Main points covered in this section:



Actions taken to raise awareness of the public consultation
Details on planned communication and engagement activities which took place
during the consultation
Evidence that the management of the consultation was a responsive process
3.1 Introduction and Summary
In discussion with the Scottish Health Council a wide range of approaches were
identified for use to raise awareness with the public, partners and staff 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 to meet anticipated requests as they emerged during the consultation.
Describing the extent of the communications and engagement activities during the
consultation 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.
It is estimated that around 500 people actively took part in the consultation. It is
difficult, to give an exact number, however, because some people attended more
than one event, some members of the public and staff who attended events also
submitted responses, wrote letters and so on.
3.1.1 Summary Headlines

During the course of consultation period staff attended over 50 meetings with
events starting on the 24th April and concluding on 9th of July

Close contact was maintained with stakeholders ]including local groups,
councillors, community councils, partner agencies, MSPs, Scottish Government,
Scottish Health Council, local GP practices and staff

A total of 8,207 summary documents were issued (homes = 7,703 and
businesses =502) via a mail drop

NHS Highland issued regular media releases about the consultation, and paid for
three adverts to be placed in the local newspaper

Hundreds of posters promoting dates of events were distributed, numerous
articles issued for local and NHS Highland publications, and websites
14
Summary of the main initiatives
Raising awareness
 Mail drop of summary consultation document to all homes
 Articles in local publications
 Paid adverts in local newspaper
 Posters and flyers
 Walkabouts
 Media and social media
 Home page of website
 Feedback questionnaire with freepost address and envelope
 Collaboration with partner agencies
Engagement activities
 Attendance at all community councils
 Drop-in events
 Public meetings
 District Partnership meetings
 Friends of Ian Charles and St Vincent’s hospitals
 Other meetings and events
 1:1 communications (letters, e-mails, phone-calls and face-to-face)
A responsive process
In response to local feedback, or at request of the Scottish Health Council, additional
activities were organised which were not in the original plan and included:










Three public meetings (Kingussie, Aviemore and Grantonw-on-Spey)
Four requested meetings (Sunshine Club, Kingussie Lunch Club, Church of
Scotland Presbytery meeting and committee of St Vincent’s Therapy Gardens
Requested drop-in event (Newtonmore)
1:1 meetings/ discussion including home visit
Attendance at dualling A9 public exhibition (Aviemore)
Walk-about in Newtonmore, Kingussie, Grantown and Aviemore
Social media #strathchat
Further promotion on all the ways people could feedback
Two further staff drop-in events
Meeting with head teacher in Kingussie (offer to meet was also made to head
teacher of Grantown Grammar School)
3.2 Consultation Documents and Dissemination
A summary consultation document and a full consultation document were prepared in
discussion with the Scottish Health Council. They confirmed that the documents
complied with the guidance.
The documents set out the preferred option, the options appraisal process and
advantages and disadvantages of the short-listed options.
15
They also highlighted how people could make their views known. The NHS Highland
web address and named points of contact with email addresses, telephone numbers
and postal address with free-post were included.
The intention of the documents was always to be generic and reasonably high
level; hence all services and organisations were deliberately not listed. It was felt
that had this been attempted then inevitably some would have been missed.
There was one request for an audio version and one request for a large print version.
3.2.1 Distribution of Consultation Materials
A total of 8,207 summary documents were issued (homes = 7,703 and businesses
=502) via a mail drop. This took place during the week beginning 19th May. It should
be noted that this exercise is not a formal requirement, nor NHS Highland
understands, is it usually carried out. The decision to take this step was to provide
the best assurance that all homes and businesses in the area had the opportunity to
be informed.
The documents were also widely distributed initially including:
 Hospitals (St Vincent’s and Ian Charles)
 GP Surgeries/Health Centres (Laggan, Newtonmore, Aviemore and Grantown on
Spey)
 Care Homes (Wade Centre in Kingussie and Grant House in Grantown-on-Spey)
 Glen Day Care Centre in Aviemore)
 Pharmacies (Aviemore, Grantown-on-Spey and Kingussie)
 Dental units (Aviemore, Grantown-on-Spey and Kingussie),
 Service Points (Aviemore, Kingussie and Grantown-on-Spey)
 Outpatient department in Raigmore Hospital
 All events and meetings.
Further distributions were carried out by NHS Highland staff during the process
including as part of a walkabout, as well as being widely advertised, and more
generally as and when opportunities presented, visits to the area
3.3 Partner Agencies
During the consultation the director of operations has met with Scottish Ambulance
Service (21st May) and Cairngorms National Park Authority (CNPA) (30th May and
10th September). These have both been very positive with early engagement
appreciated and clear opportunities for joint working. This dialogue has been
ongoing and further meetings have taken place and are planned.
There have also been discussions with Transport Scotland including being informed
on the plans for dualling of A9.
As well as local meetings, a letter was also sent from NHS Highland chief executive
to a number of organisations including: The Highland Council, The Scottish
Ambulance Service, Cairngorms National Park Authority, Highlands and Islands
Enterprise, The Highland Hospice, Scottish Natural Heritage, Police Scotland, Fire
Service and the Highland Third Sector Partnership.
16
3.4 Voluntary, Third and Independent Sector and Others
There has also been direct contact with a number of local groups including Badenoch
and Strathspey Transport Group, Badenoch and Strathspey Access Panel, Friends of
Ian Charles and St Vincent’s, Kingussie Therapy Garden Volunteers, Advocacy
Highland, Age Concern, Badenoch Arthritis Support Group, Reshaping Care for
Older People, Highland Third Sector Interface. Highland Home Carers, HUG,
Mumsnet and Senior Citizen Network.
3.5 Direct e-Mailing and Mailing
A list of relevant local organisations and named contacts was drawn up and were
emailed on 25th April, with links to the consultation materials and an offer to meet.
A further e-mailing was carried out to people who have relevant contracts with NHS
Highland in Badenoch and Strathspey, and this was repeated towards the end of the
consultation. This included Dachaidh Community Support Ltd, Deaf Action,
Grandview House, Richmond Fellowship, Hanover (Scotland), Able Care, Carr
Gomm and Speyside Trust.
Local presbyteries and dioceses were also contacted (through Derek Brown,
Chaplain).
3.6 Advertising and Promotional Activities
Various posters and flyers were prepared and widely distributed throughout the area.
These retained the same brand as the summary consultation document. The
purposes of these were to (i) raise awareness of the consultation in general and (ii)
promote the dates of the various consultation activities.
Small adverts (free) were also prepared and issued to local groups during the first
two weeks with community newsletters, websites and social media (as detailed in the
plan). All information carried the NHS Highland web address and contact details.
These were issued early in the process and followed up with local media and social
media as well as on the NHS Highland website.
In addition three paid adverts were placed in the Strathspey and Badenoch Herald
(week beginning 5th May, week beginning 19th May and week beginning 16th June)
and were also promoted in the various media releases.
Local groups and contacts also did their own awareness raising. As an example, for
instance, in advance of the Carrbridge event (29th May) a local point of contact,
confirmed on 20th May:
“Just to let you know that I have put up Notices in the Village Hall and outside our
Village Hall about Carrbridge Consultation events.”
A further suite of posters were prepared to promote the public meetings. Members of
the steering group, Friends of Ian Charles, community council members and a local
councillor carried out the local distribution. These were also available on the website.
17
Following on from the mid-way review with the Steering Group (5th June 2014) further
promotion was done on all the ways people can feedback including an advert in the
local paper (19th June).
3.6.1 Walkabout
On 27th May a member of the NHSH Highland communications team carried out a
walkabout in Newtonmore, Kingussie, Aviemore and Grantown-on-Spey with the aim
of providing a direct spot-check of levels of awareness of the consultation in these
communities.
He spoke to around 50 people of wide age ranges and in a number of different
community settings. A total of 26 full consultation documents and 43 posters were
handed out including providing dates of consultation events.
Following feedback from the steering group a further walkabout was carried out in
Grantown in June.
3.7
NHS Highland Website
The consultation was promoted on the NHS Highland website with all the background
information, consultation materials and a calendar of events.
The links were also sent to others to display - GP Practices, local community
websites, Highlife Highland, and other relevant organisations. Some examples of the
links are provided below:
http://www.aviemoremedical.co.uk/latest_news.htm
http://www.grantownonspeymedicalpractice.co.uk/
http://carrbridgenews.co.uk/
http://highlifehighland.com/health-wellbeing
18
3.8 Media, Social Media and Other Publications
3.8.1 Media releases
The following have been issued before, during and after the consultation:
1. New group targets improved transport links – 12th September 2014
2. Health Board completes Badenoch and Strathspey consultation - 28th July 2014
3. Feedback welcome on hospital sites - 20th June 2014
4. Public consultation reaches half way stage – 4th June 2014
5. Dates for three public meetings announced - 20 May 2014
6. Public urged to take part in consultation - 6 May 2014
7. Badenoch & Strathspey District Partnership meeting 24 April - 16 April 2014
8. Public to have their say on proposed new hospital - 15 April 2014
3.8.2 Letters Published in Strathspey and Badenoch Herald
At the time of writing the report 10 letters have been published since the public
consultation got underway:
18th September 2014
Hospital future should also be put to the vote – Leonard Grassick (Grantown-onSpey)
14th August
Migdale a model hospital to imitate - Geoff Smith (Grantown-on-Spey)
(A visit to Migdale Hospital was arranged for Mr Smith to see the new facility)
31st July
Making the case for keeping the hospital open – Leonard Grassick (Grantown-onSpey)
Make sure you voice is heard – Cllr Bill Lobban (Aviemore), 2014
Cuts needs to be balanced against needs - Ian Maclean (Grantown-on-Spey)
Deflated after hazy answers – Geoff Smith (Grantown on Spey)
10th July
Consultation period should be extended Leonard Grassick (Grantown-on-Spey)
19
26th June
NHS chief’s comments worth considering - Leonard Grassick (Grantown-on-Spey)
19th June 2014
Cash bond could be way forward in building Aviemore hospital complex- Geoff Smith
(Grantown-on-Spey)
Status quo for health centres – Dr Boyd Peters (Grantown-on-Spey)
3.8.3 Social Media (Twitter and Facebook)
Events and materials were promoted through NHS Highland twitter account
(@NHSHighland) as well as through head of public relations and engagement
(@nhshmt).
Twitter and Facebook accounts were identified for relevant local communities and
these were also used to promote the consultation.
Events were scheduled into Twitter and promotion is ongoing through #strathchat
3.8.4 Other NHS Highland publications
The consultation process was also promoted through other publications including
HighLights, GP Practice Newsletters and NHS Highland Annual Review (9th June
2014) and NHS Highland News.
3.8.5 Face to Face – Meetings, Events and Groups
During the course of the consultation NHS Highland staff took part in around 50
events and meetings and included three public meetings (Appendix 3).
One request to meet a member of the public in their own home in Kingussie was also
received and this took place during the consultation.
All requests for meetings during the consultation period were accommodated.
At least one member from the core team (Nigel Small, Boyd Peters, Kenny Rodgers
and Maimie Thompson), has always been in attendance at each event.
Example of some Feedback
Kingussie Community Council Meeting,6th May 2015
“Thank you for coming down to Kingussie last night. The presentation and the
question and answer session, from the "non-professional" viewpoint was excellent.
Interestingly when I took round the posters and consultation documents people
immediately opened them and starting reading - always a good sign! I also spoke to
others there and the feedback was extremely positive. “
“Thank you for last night - thought the presentation was very good. It is not easy to
20
explain all the steps taken and decisions made and still reassure those who have not
been involved that they have a voice and their views still count, but you did it
admirably. Thought the discussion and suggestions made by the KCC were good.”
People attending the events had the opportunity to take away a consultation
response form (and freepost envelope) and were encouraged to feedback their views
and also to make contact with the Scottish Health Council.
They were also advised they could write to NHS Highland if they found that a more
helpful way to make their views known.
3.9 MSPs and Local Elected Representatives
There has been regular contact with MSPs throughout the process via email and
Face-to Face. All MSPs were sent an email on 25th April updating them on the
consultation and asking for them to support people taking part with one responding:
“It’s great to see this level of community engagement” MSP, April 2014
A meeting was held on 28th May 2014 when the chair of NHS Highland provided an
update; no concerns were raised at this stage.
They were also e-mailed a copy of the mid-way review report (6th July) and updates
after the consultation closed (28th August and 17th September).
Dave Thompson MSP for Skye, Lochaber and Badenoch is also on the mailing list for
the Steering Group. Fergus Ewing (MSP for Inverness and Nairn) and Minister for
Energy, Enterprise and Tourism has a branch surgery in Grantown-on-Spey and
has been involved in the discussions relating to transport.
A media release was also issued by Danny Alexander MP for Inverness, Nairn,
Badenoch and Strathspey on 7th July encouraging residents to take part in the
consultation.
Lib dem urge B&S residents to take part in consultation - 7th July 2014
All four local elected members are active participants on the Steering Group and
Transport Group. They have been in regular contact with the core team to help
facilitate engagement. They are on record as being positive about the process to
date.
3.10
Staff/GPs and Practice staff
The formal consultation got underway with a series of drop in events at St Vincent’s
and Ian Charles Hospital, Wade Centre (Care Home in Kingussie), Grant House
(Care Home in Grantown-on-Spey) and Glen Centre (Day Centre in Aviemore). This
was facilitated by the director of operations and around 40 staff attended the
sessions. Further drop-in events were held during the consultation.
The head of public relations and engagement also visited all the NHS Highland
facilities including GP Practices on 13th May. This was to discuss displays and
dissemination of consultation documents, issuing travel surveys, posters and other
21
consultation materials. Charge nurses, practice managers, care home managers
were all engaged and showed high level of awareness and support for the process.
In addition staff and staff side representatives are involved in the Steering Group and
a range of other activities and staff have attended a number of the events. The redesign has been an agenda item on various operational unit meetings.
Two workshops for all clinicians have been held. These were facilitated by an
independent health care planner. Further work is ongoing.
Dr Boyd Peters (Locality Clinical Lead) has also been liaising with all four Practices to
look at how any new potential model of service might impact upon their ways of
working. Several meetings have been held so far and more are planned.
22
4 Feedback from meetings and events
M




ain points covered in this section:
Method used to summarise feedback
Summary of feedback from public meetings
High-level summary of all feedback
NHS Highland response to feedback
4.1 Introduction
During the course of consultation some 50 meetings and events were attended,
including 10 community council meetings; nine public drop-in events, three public
meetings and various events for staff (Appendix 3).
The main purpose of these events was to allow further opportunities to present the
case for change; the reasons the preferred option was selected and to answer any
questions or understand any concerns.
It was not intended to “sell” the preferred option, nor to negotiate on possible
changes to the model or options. Any new proposals or modification to proposals
would come later once the analysis to all the feedback has been considered and
debated.
4.2 Method: Process for Documenting Feedback
Hand-written notes were taken during each meeting and these were then typed up as
bullet points. For the public meetings, and any other specifically arranged meetings,
steps were taken to have the notes validated by a non NHS Highland participant.
Minutes of community council meetings were put onto NHS Highland website as they
became available.
After the consultation closed the head of public relations and engagement and
operational unit head of finance reviewed all the feedback. All comments were
categorised to allow some high–level groupings.
4.3 Public Meetings
In discussion with the Scottish Health Council it was agreed to hold three public
consultation meetings. These were arranged towards the end of the consultation
period. A reporter from the Strathspey and Badenoch Herald was in attendance at
the meetings in Kingussie and Grantown-on-Spey.
4.3.1 Kingussie
The first public meeting was held in Kingussie on 25th June. Nine people attended
including hospital staff, a GP and Scottish Ambulance Service. Two members from
the Scottish Health Council were also present. There was full discussion on bed
numbers, dementia, transport and what would happen to staff should the preferred
option be implemented.
23
There was also a discussion on centralisation of services. The difference between
centralisation within Badenoch and Strathspey as opposed to Inverness was
discussed. In common with many other meetings and drop-in events, what would
happen to the existing buildings was a source of some concern. There was also
consideration of the Therapy Garden and Burrell Fund for St Vincent’s.
4.3.2 Aviemore
16 members of the public attended the Aviemore public meeting on 1st July. There
was also a GP and practice manager. Topics discussed included sites, future
services, future-proofing, transport and beds.
4.3.3 Grantown-on-Spey
The public meeting in Grantown-on Spey was the best attended meeting of the
consultation with around 80 people. Local GPs, NHS staff, Scottish Health Council
staff were also in attendance at the meeting which took place on 2nd July 2014.
There was a range of views both in support of the proposal as well as some strong
opposition to parts of the proposal. The main concern expressed was around the
proposed closure of Ian Charles Hospital, and in particular loss of in-patient beds.
The importance of developing care-at-home capacity was also discussed.
NHS Highland representatives provided responses to a range of other topics raised
covering the service model, finance, single rooms, care-at-home, care home
provision, end of life care as well as the overall need for change.
4.4 Findings: high-level summary of the feedback
Table Summary of responses by category and frequency
Theme
No
Additional services
31
Transport and access
23
Existing Services/buildings
22
Bed provision and numbers
21
Site proposal
19
Finance and endowments
16
Care Homes/Care at Home
14
Staffing
12
Population
9
Alternative proposals
8
Other (*)
8
Process
7
Palliative care
6
Grand Total
196
(*) other includes: respite, maternity, integration and housing
24
Percent
16%
12%
11%
11%
10%
8%
7%
6%
5%
4%
4%
4%
3%
100%
4.5
NHS Highland response to Feedback
All of the issues raised were summarised together with NHS Highland responses
which were provided at the meetings (Appendix 4). These are analysed in this
section of the report.
NHS Highland has been cautious about going too far to explore solutions to some of
the issues raised. This is an important point to note. Neither the operational team,
nor the steering group, wished to prejudice the outcome of the consultation.
In some cases, such as transport and access, there are already challenges being
raised and so further work will be required regardless of the outcome of the
consultation.
4.5.1 Additional Services
While it was always made clear that the re-design was much wider than hospital
services there was significant interest in what services would be in any new facility. It
was raised at some meetings that there was not enough detail around the clinical
model. This was acknowledged but it was also explained that further detailed work
would be required to support the Business Cases.
There was general support to provide more services within Badenoch and Strathspey
and the sorts of things being considered included chemotherapy, infusions, and outpatient clinics.
Some of the suggestions for additional services, for instance, Theatres, 24/7 A&E,
maternity indicated a lack of understanding of the distinction between a community
hospital and rural general hospital. The importance of explicitly considering children
and young people’s services was also highlighted. These points were also raised in
the Highland Council submission.
More generally NHS Highland needs to be clearer on using consistent terminology
and understanding about the level of service being provided relating to casualty,
minor injury and A&E services. Through the public consultation it has been
highlighted that there needs to be clarity around the use of the term A&E (including
from NHS Highland communications).
This is an issue which needs to be clarified across all parts of NHS Highland and will
need to be followed-through with a review of all communications on this matter such
as website, literature.
4.5.2 Transport & Access
NHS Highland is not a transport provider but the opportunities to use the redesign of
services to improve transport and access issues were recognised. Clearly people
have to be able to access any facilities that exist or are developed. Any changes
should take actions to reduce any inequality gaps that currently exist.
From the feedback the vast majority of people don’t currently use public transport to
access services, arguably because the service is very limited. Further work will be
required, however, to make an assessment as to whether patients, families, visitors
and staff would use public transport were it more readily available. This would have
25
some bearing on, for instance, the number of car parking spaces required at
proposed new facility.
More generally further steps need to be taken to reduce people having to travel in the
first place. In the future more outpatient consultations will be replaced with
alternative approaches such as with video-conferencing, or telephone and e-mail
support.
Making sure the right community and home based service are in place will also mean
people have to spend less time in hospital, further reducing the need for travel.
A transport and access plan will need to be developed to support the business case
process and a group has already been set-up to lead and co-ordinate the work. They
held their first meeting in September.
The group is made up of officers and elected members of The Highland Council, and
representatives of NHS Highland, Cairngorms National Park Authority, the Scottish
Ambulance Service, Badenoch & Strathspey Access Panel, Badenoch & Strathspey
Transport Company and Voluntary Action Badenoch & Strathspey and community
representatives.
The Highland Council has recently submitted a proposal for additional investment to
pilot new approaches to transport provision. A decision from Transport Scotland’s
Business Development Fund on the bid is expected in the next few months.
4.5.3 Existing Services and Buildings
4.5.3.1 Services
The consultation meetings and events provided further opportunities to clarify what
services won’t be changing. For instance it was clarified that:








GP services will remain in Grantown and Kingussie
Ambulance services will remain in Grantown and Kingussie
Physiotherapy services will be retained at Grantown and Kingussie
Dental services will remain in Grantown
Minor injury service will remain in Grantown
Out of hours services would be provided from the new hospital
Some staff providing children’s services will be located in the new building and
some services will also be provided
The existing building, services and equipment will be maintained, as far as
possible, until such time new arrangements are in place and subject to the
caveat of being able to recruit staff and be affordable
4.5.3.2 Clinical Governance and Management of Risks
Clinicians have raised concern about the potential risks of patient harm caused by
resources split over several sites in the present arrangements. This is one of the
drivers to support changes. Effective clinical governance and application of the
Highland Quality Approach including systems redesign, mistake proofing, reducing
waste and lowering the risk of patient harm will be far more effective in a re-designed
service.
26
In the covering paper to be presented to the board in October the management of
some of these risks will be briefly described.
Going forward it is also anticipated that there will be operational issues to be
managed and short-term decisions to be taken relating to e.g. failures in equipment,
ability to meet standards, recruitment difficulties and affordability, under the present
arrangements.
Any decision will need to take consideration of the range of governance issues, wider
re-design of services, pressures on Raigmore Hospital and general management of
financial pressures.
The operational unit is fully aware of other strategic and operational considerations
such as wider discussions relating to dental services, MSK review, transforming
outpatients, older adult mental health services, strategic overview of radiology and
diagnostic services and the Inverness Master Plan. Over the next two to three years
other work may be identified.
The work to redesign services has had active input and support from local clinicians
including GPs and their staff, hospital and community nursing staff and AHPs. An
external healthcare planner has been involved and met with clinicians to help define
the proposals. Local clinicians will continue to be consulted and involved as the
project moves through its various stages to completion.
4.5.3.3 History
There was significant interest in both the history and future use of the buildings,
particularly both hospitals. During the consultation NHS Highland was able to
confirm that the buildings are not listed.
There was recognition about the importance of honouring the past and making sure
the heritage of the hospitals is safeguarded. NHS Highland set out their commitment
to this in the consultation materials and this was reinforced during the consultation
events, meetings and correspondence. There is ongoing contact with relevant
stakeholders including authors of “History of Highland Hospitals”.
Moreover it was raised at the Grantown-on-Spey public meeting (and followed up by
letter) that NHS Highland had not taken into account the different histories of both
local hospitals.
4.5.3.4 Therapy Gardens
Meetings have already taken place about the Therapy Garden at St Vincent’s and the
key people who can support this work have been identified. There is commitment to
look at providing Therapy Gardens both in Kingussie as well as in any new facility.
From past experience the core team has identified the need to think about such
facilities early in the process and not as an add-on. This approach has been
welcomed by the local group.
4.5.4 Bed Provision and Numbers
There were some concerns raised about the number of beds proposed and in
general a feeling that more beds would be required to future-proof the service.
27
NHS Highland made it clear that the final number of beds had not yet been finalised
but initial work to inform the public consultation suggested the requirement would be
around 20-25 beds.
In coming to a final view important considerations would include:




Further modelling work as set out in Appendix 5
Confidence in being able to increase care-at-home capacity;
Development of care home to include step-up/step-down beds
Agreement on preferred model for supporting people requiring adult mental
health assessment and rehabilitation
Although there is a general perception that future-proofing must mean “more” in fact
the review of historical data shows that over the years NHS Highland has reduced
the length of stay and number of hospital beds (Charts below).
NHS HIGHLAND
No. of hospital beds 1986 to 2010
3 500
3 000
No. of hospital beds
2 500
2 000
1 500
1 000
500
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year
28
Observed and expected bed days by type of admission and day case numbers;
NHS Highland residents by financial year end period 2000 -2013*
Data source: SMR01 (Acute and General Hospital activity for inpatients and day cases) and NRS Midyear population estimates, 2000 -2012 (revised series) * Expected activity calculated by applying age
specific rates of bed day use and day case attendance of NHS Highland residents in 1999-2000 to
mid-year population estimates
It was clarified that there are no proposals to include maternity beds due to their
being insufficient demands to enable practitioners to maintain their skills.
4.5.5 Site Proposal
There was interest in the sites, particularly around the size of sites and how were the
sites short-listed. This was covered in the consultation materials with the final
conclusion of the process set-out in section 8 and Appendix 6.
Further detailed work will be required in terms of design, access to the site and
access in the building. This would involve engagement with all stakeholders
4.5.6 Finance including Endowments
There were a number of queries relating to finance such as how much would the
building costs and how developments would be funded.
It was explained that the final figures would not be known until the full extent of the
accommodation is described, the site purchase and development costs are known
and commercial negotiations concluded. However NHS Highland is working on a
budget figure of £12million to £15million which is based on other similar facilities
recently developed in Highland. NHS Highland is closely following the Scottish
Government process for capital investment and funding options would be explored as
part of the business case process.
29
In terms of endowments, The Theresa J Burrall legacy will continue to be used for the
benefit of St Vincent’s hospital until such a time that the hospital becomes nonoperational and the terms of the legacy cannot be met. NHS Highland Endowment
Fund Trustees would then need to apply to the courts to determine the future use of
the legacy.
The advice from NHS Scotland legal office confirms that the legacy could potentially
be used for the benefit of a different hospital and/or the community where the
services are currently provided to benefit local people in the future.
Any future decisions would be progressed by a local group from within the Kingussie
area under the responsibility of NHS Highland and with close reference to NHS
Endowment Fund regulations and the legal framework.
4.5.7 Care Homes and Care-at-Home
There are no plans for NHS Highland to open new care homes in the area but there
are ambitions to look at developing both existing care homes and more generally to
work more collaboratively with the independent sector.
NHS Highland has been taking a number of steps to try and improve the immediate
situation with care-at-home including advertising more posts, working with the
independent sector and our own staff doing over-time, but the current situation
remain challenging clearly highlighting that doing more of the same is not the answer
(Appendix 7).
NHS Highland and others recognise the need to think differently by looking at new
roles, developing apprenticeship schemes, offering better pay and conditions and
improved career structures.
This is going to be a growing challenge and one which NHS Highland cannot fix on
its own. We will continue to work with individuals, families, staff, local communities,
independent and third sector organisations to see how together we can develop more
effective and acceptable solutions.
Notably only option 3 would release funding to make significant investments into the
care-at-home and wider community services.
4.5.8 Staffing
Members of the public, community councils and others also expressed interest and
some concern around future staffing arrangements. Throughout the consultation
process there was consistent praise for the existing culture of care and a plea for that
not to be lost.
Questions relating to redundancies, staff travel, who would provide medical cover in
the new hospital and whether local builders were used were all answered by the
consultation team (Appendix 4).
4.5.9 Alternative Proposals
Some people felt strongly that both existing hospitals should be upgraded and were
off the view that it would cost less.
30
As explained in the consultation materials the work carried out by NHS Highland
estates and clinical colleagues highlighted that up-grading the existing buildings
would never provide the standards required for modern healthcare. Modernising
what currently exists would not bring the benefits of co-locating services nor enable
the improvements in community care which are required.
Two people thought that there should have been an option to have a range of
services available in all three main centres (Aviemore, Grantown-on-Spey and
Kingussie.
4.5.10 Population
People wanted to know whether projected population increases (An Camas Mor,
seasonal visitors etc) had been considered and also had use of services by agerange been considered (*).
Public Health colleagues, service planners and experienced health care planners
have all been considering this matter as part of planning for the future. This includes
preparing district profiles (Appendix 8). These have been designed to assist
services in the assessment of the health and social care needs of the populations. It
will also be considered as part of the bed modelling work (Appendix 5).
There are variations between communities that need to be factored in. Aviemore has
done the most expanding (20% rise in practice population in 10 years); yet the over
65-population has not significantly increased. The majority of the new housing tends
to attract younger people, often families, therefore this has considerations for
services for children’s and families (and of course schools). In terms of health, these
services are usually delivered through health centres and were one of the arguments
for building a new health centre in Aviemore as part of the proposals.
Equally people in Grantown-on-Spey wished to highlight that they have a higher
percentage of older people and feel that losing in-patient facilities will compromise
the needs of older people needing hospital care.
(*) – A statement on this matter was also raised at the Grantown-on-Spey public
meeting and followed up by letter (dated 18th July). Letter was passed to public
health colleagues (see also appendices 5 and 7). Detailed analysis has been
completed by Public Health and confirmed that the profile of older populations is not
unique to Grantown-on-Spey.
4.5.11 Other topics
Palliative care, dementia, respite, supported housing were some of the other issues
raised during events and meetings.
31
5 Public Consultation: Feedback from Survey
Main points covered in this section:


Summary of who responded to the consultation survey
Feedback on the consultation process, service model and possible sites
5.1 Introduction
As part of the public consultation a survey was designed to capture feedback on the
consultation process, service model options, and possible sites. These are explored
in more detail in sections six, seven and eight respectively.
A copy of the full report is available on the NHS Highland website and the key results
are summarised below:
176 responses were received; 62 were online and 114 were paper based.
5.2
About the Respondents






60% were aged between 60 and 80
60% were female
27% had a long term health condition or disability
13% indicated that they were carers
3% had stayed in St Vincent’s Hospital in the last 12 months
2% had stayed in Ian Charles Hospital in the last 12 months
5.3 Summary Findings


Responses were received from residents from across the area, with Aviemore
residents providing 35% of the overall (63 responses)
Responses were positive about the amount of consultation and associated
materials

In rating aspects of the proposed changes
o ‘Improving community transport’ received the most support (94.2%)
o ‘Closing in-patient beds in Ian Charles hospital’ received the least
support (53.8%)

Option 3 –the preferred service change option was supported by (78.5%)
32

If option 3 is implemented, the preferred site was the Technology Park (63%)

88% of respondents have access to or own a car
6 Feedback on the Consultation Process
Main points covered in this section:

Summary of feedback on the consultation process collected from a number of
different approaches:
6.1 Introduction
Feedback on the consultation process was captured by NHS Highland via a number
of routes:




consultation survey
events and meetings
correspondence from members of the public
Partner agencies, community councils and groups
The Scottish Health Council, however, also carried out their own independent survey
(section 9).
6.2 Responses to NHS Highland survey on consultation process
NHS Highland’s consultation survey included a section on the consultation
materials, events and how they were informed about the consultation. The main
findings were:

People said they had found out about the consultation through a number of
ways including the mail-drop, local newspaper, direct from staff, website/social
media and local councillors.

Just under three quarters (73%) said they had received a copy of the summary
consultation document; 17% and 10% said they had not or were unsure,
respectively.

Almost nine out of ten people who responded (89%) said they had read the
summary document and over half (56%) said they had read the full document.

Nine out of ten people responded that they felt that the consultation materials
had given them enough information about the proposals and case for change.

There were mixed views about which events were most helpful and more than
half said they did not attend any events.
33

People had the opportunity to comment on whether NHS Highland had taken
reasonable efforts to involve and inform local people about the proposed
redesign of services (Box). Over eighty percent (82%) responded positively.
Do you feel NHS Highland had taken reasonable efforts to involve and inform local
people about the proposed redesign of services:
Response
To a great extent
To some extent
Neutral
Not really
Not at all
Percent
57
25
9
7
2
100
Number
88
42
15
12
3
160
6.2.1 Comments
The following responses were taken from groups who responded to the consultation
response survey in relation the question
“Do you feel NHS Highland has taken reasonable efforts to involve and inform local
people about the proposed re-design of services?”

Scottish Fire and Rescue Service, Highland area
Yes to a great extent

Cairngorm Ski Patrol
Yes to some extent

St Vincent’s Therapy Garden
Yes to a great extent.
“There have been meetings across B&S where people could attend and hear more.
There have been articles in the local paper and telephone number and contact
details for further information.”

Community Councils
Responses to the survey were received from four community councils. All responded
positively:
Yes to a great extent.
6.3
Feedback via letters from members of the public
34
Feedback from correspondence was themed and some points on the consultation
process were highlighted:







Should have been details on the options that were discounted
Don’t favour questionnaire for providing a response
Don’t like the use of age-bands
Critical of consultation form – too much on process
Disappointed that the consultation document didn’t say more about Independent
Sector
Should have been public meetings three years ago, public meetings should have
been at the start of the process, people are confused
Consultation was a waste of time and biased towards medical staff
6.3.1 Letters published in Strathspey & Badenoch Herald
Several letters have been published which included issues relating to the
consultation process:
18th September 2014
Hospital future should also be put to the vote – Leonard Grassick (Grantown-onSpey)
26th June
NHS chief’s comments worth considering - Leonard Grassick (Grantown-on-Spey)
In terms of the consultation process Mr Grassick includes the following comments in
his letter:
“There has been a poor response to the drop-in sessions and correspondence to
NHS Highland on the plans to redesign local healthcare services but this is
understandable in the circumstances.
“Locals have been bulldozed into submission by all the literature provided, including
asking which of the four preferred sites for a new hospital in Aviemore they prefer.”
“Residents across Badenoch and Strathspey should have been given the chance to
discuss this option at a very early stage and there could have even been a vote on
this inclusion.”
10th July
Consultation period should be extended Leonard Grassick (Grantown-on-Spey)
“The consultation period on this crucial matter should be extended. NHS Highland
needs to take a step back and figure out how they will cope with care in the
community without the excellent facilities at Ian Charles.”
31st July
Making the case for keeping the hospital open – Leonard Grassick (Grantown-onSpey) 31st July 2014
This letter includes a comment about the make-up of the steering group:
35
“I have been looking through the contact list for the hospital development group and it
looks top heavy with medical personnel and no sign of the ordinary working person
being given a place on it.”
Make sure you voice is heard – Cllr Bill Lobban (Aviemore)
Cllr Lobban’s letter includes the following comment:
“The NHS consultation process, has when compared to other consultations for
example the Highland Council, been exemplary and is on-going but I would implore
residents to please make your individual voice heard otherwise we may end up with
something that none of us wants.”
6.4 Feedback received from participants at events
Some points specifically relating to the consultation process were raised at some of
the meetings and events, as follows:



The consultation outcome has already been decided “done deal”
What are the time-scales?
There should have been a fourth option (*)
(*) –Two people felt strongly that there should have been more detail covering why
options had been excluded: what the options were and on what basis were they
excluded (see also below). In their report the Scottish Health Council also suggested
that it would have been helpful to have provided some information on all the issues
considered.
More generally there were a number of queries around why sites were being
considered at this stage. Some felt that this must mean that a decision had already
been taken “done deal”.
It was explained that having identified a preferred option this was a requirement of
the process. As NHS Highland had anticipated that this would be a query/concern it
was included as part of the standard presentation.
6.5 Feedback comments from the survey
“The Group has a significant presence of Health Care professionals. It is therefore
not surprising that Option 3 is preferred. It is the option proposed and developed by
the Health Care Services for the Health Care Services
From outset I thought that the option of improving the services and facilities to the
required level for now and the future at all three centres should have been included.
Whether the Steering Group considered, discussed, explored, fully costed and then
dismissed this option is not known. To state now that this option is not affordable or
sustainable is not acceptable”.
(Further feedback on this matter was also received by the same respondent via
email).
6.6 Feedback from partner agencies
36

Highland Council
“The Ward 21 Elected Members have been fully engaged in the consultation process
which they feel has been carried out in a thorough, inclusive and comprehensive
manner with a good level of community engagement. Members have a good track
record of attendance at stakeholder meetings and consultation events.
“They have observed the consistent approach taken by NHS Highland Senior
management and have said that the director of operations and his team should be
congratulated for the exemplary manner in which they have conducted the work.
There has also been recognition at a local level for the work done by Dr Boyd
Peters.”

Highlands and Islands Enterprise
“We acknowledge and welcome the extensive consultation and engagement
processes undertaken by the NHS to secure community views such that communities
affected by the future changes can inform and shape their service provision.”

Highland Hospice
The Highland Hospice commented that it was “good to see such a wide and open
consultation with local people”.
6.6 Feedback from NHS Highland local staff side representative
A Staff side representative was on the steering group and attended many of the
meetings.
“I am certainly happy to endorse the process and feel that staff have been kept very
well informed.”
37
7 Feedback on Service Model Options
Main points covered in this section:

Feedback on the short-list of options and aspects of the proposed changes from
a range of sources:
 Consultation survey
 Open responses
 Partner agencies
 Local GP practices
7.1 Introduction
Throughout the process people were encouraged to make their views known after
they had considered the relevant information and had responses to any queries.
7.2 Method
The consultation response form was agreed with the Scottish Health Council and
included a section on the proposed changes and options.
Issues relating to the service model options were also raised at meetings, events and
correspondence.
7.3 Results
7.3.1 Feedback on preferred option
Over three quarters (78.5%) of people who responded supported the preferred option
Select your preferred option
Option 1 - Do minimum
Option 2 - Community resource centre
and hospital in one town (Grantown or
Kingussie) and scaled-down services
in other (e.g. no in-patient beds)
Option 3 - Community resource centre
and hospital (with ~20-25 in-patient
beds) in Aviemore supported by other
services and developments
Other – please provide suggestion
I have no preference
38
Number
10
As a %
5.8%
8
4.7%
135
78.5%
15
4
176
8.7%
2.3%
100%
7.3.2 Feedback on other options
Suggestions came forward on alternative proposals, summarised as follows:
 Upgrade hospital services in Grantown and Kingussie x4
 Increase patient bed numbers x3
 Option 3 but retaining some hospital services at Kingussie and Grantown x2
 Agree with option 3 but why Aviemore? I don't think that is fair on those from
Laggan or Dalwhinnie
 Leave as it is. If Aviemore require more (new beds) look at the requirement.
 Three new modern efficient medical centres that are adequate to deal with the
contemporary need of all 3 communities and smaller villages surrounding them.
x2
 Agree with new hospital being at Aviemore -- BUT-- do not agree with the "Glen
Centre" being relocated
 New facility should be in Grantown
7.3.3 Feedback on aspects of the proposals
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 inpatient beds in Ian Charles and St Vincent’s and moving the Glen day centre were
the least well supported (Appendix 9).
7.4 Open responses (e-mails and letters) **
7.4.1 Method
The correspondence was categorised into themes and responses coded as to
whether people were in support of the preferred option or otherwise and summarised.
7.3.2 Results
Thirty-one people corresponded with NHS Highland about the consultation via letter
or email.
Support for preferred option
Yes
Yes-Qualified
No
Not clear
Number
12
2
9
6
29
39
Percent
41.4
6.9
31
20.7
** - Some people were in regular contact and in such cases meetings were offered.
Communications were often wide ranging with many issues beyond the scope of the
consultation, but nevertheless relevant.
One lady wrote a 25 page hand-written letter covering a range of topics including:
general issues affecting the elderly, transport, training for family carers, housing,
dementia care and what we need. A meeting has been arranged to discuss the feedback.
Another gentleman has submitted detailed responses, also wide ranging covering
topics as diverse as A9 dual carriageway, emergency response times, dental
services, whether proposals meet with the National Park aims, happiness and local
services and the Crichel Down rules
In terms of responses by community there was a range of views with eight people
from Grantown-on-Spey not in support of the preferred option and four people in
support.
Resident
Advie
Aviemore
Boat of Garten
Grantown-on-Spey
Kincraig
Kingussie
Laggan
Newtonmore
Total
7.5
Support
2
2
1
4
1
1
2
13
Don’t support
8
1
9
Responses from Community Councils
Four community councils submitted responses via the survey and all selected Option
3 as their preferred choice.
One of the community council included an additional comment:
“Option 3 but with room for expansion and more beds to cope with expected 2000
new homes in the area.”
7.6
Response from local Medical Practices
The doctors who are partners in the medical practices of Kingussie, Aviemore and
Grantown-on-Spey have considered the proposals in detail and are fully supportive.
7.7
Responses from Partners
7.7.1 The Highland Council
In their formal letter of response the Council concluded as follows:
40
“The case for change has been well and clearly made through a wide range of
consultation methods and documents. The Highland Council endorses the
consultation process, is supportive of the move to modernise and reconfigure
services and confirms that it is broadly supportive of Option 3 for a single hub
community hospital and resource centre in Aviemore.
“The Highland Council looks forward to the detailed outcomes of the consultation and
to working in partnership with NHS Highland on next and future stages.”
Highland Council comments/observations
Whilst the consultation process has been generally positive across Badenoch and
Strathspey, it is recognised that some people do not want change. It is noted that the
final public consultation meeting held in Grantown on Spey saw community concerns
and objections raised specifically with regard to the Ian Charles Hospital. Further
targeted consultation and community work may be required here by NHS Highland.
It is also noted that a greater distinction could have been drawn between what a
community hospital offers and what a district general hospital provides. Perception is
also that community hospitals are orientated toward elderly care, and whilst
statistically there is no doubt that this will be the higher patient ratio, provision has to
be made for children and young people and awareness raised on what can be
provided in terms of local services.
Highland Council main areas of response:
1. Care and Learning. The Care and Learning Service would be broadly in support
of Option 3 and the proposed location in Aviemore. Opportunities should be
explored for co-location of Children and Families staff in any new facility and
managers would be interested in being part of discussions about the proposed
building and its facilities at an appropriate stage. Consideration should be given
to early discussion on the provision of services for children and young people, on
shared clinical space as well as space for permanent and visiting staff.
Essentially how much space and how much would it cost are key factors for
consideration.
As a result of the consultation process there is now discussion taking place with
local schools around closer working with NHS Highland, and further opportunities
will be sought to involve young people in the process. There are also
opportunities to work with colleagues in High Life Highland on a range of health
led initiatives.
2. Access and Transport. This has emerged as a key theme throughout the
consultation. It is recognised that NHS Highland is not a transport provider and
that a positive and proactive planning approach to the design of an effective
transport system is required. The Highland Council is keen to work with in
partnership with NHSH and others in developing access and transport solutions.
It is noted that a Transport Survey is currently being undertaken by NHS
Highland. It is also noted that a date is being set to bring key stakeholders
together with regard to forming an Access and Transport Group.
41
3. Care at Home. An obvious challenge is around providing care at home and it is
clear that this requires new thinking and new ways of working. The Council would
be keen to work with and support NHS Highland in this key area. Further
consideration to be given to fully integrated approaches and how the Highland
Council can support this.
4. Future Site Management. Whilst aware the NHS Highland would not want to
prejudice the outcome of the consultation, it is recognised that should local
hospitals close there could be a key role for both the Highland Council and the
Cairngorm National Park Authority in providing assistance in considering the
reuse or redevelopment of buildings and sites which may become redundant.
The emotional attachment to sites and buildings in local communities has clearly
emerged through the consultation process and is recognised. It is particularly
relevant therefore, with regard to archive and heritage, to ensure that history is
captured and artefacts safeguarded.
5. District Partnership. Future role for the District Partnership to be explored as a
mechanism to update stakeholders and as a platform for public engagement.
(Reports have been tabled at the District Partnership including most recently an
update on the consultation process at the meeting held on 25th September in
Kingussie).
7.7.2 Scottish Ambulance Service
Scottish Ambulance Service welcome and support the development of the proposed
new model of care and would welcome the opportunity to work in partnership with
NHS Highland as the development progresses. A meeting has been arranged with
senior officials for the 3rd of October.
7.7.3 The Cairngorms National Park Authority
The Park Authority has appreciated early involvement. As they have statutory and
enabling roles they did not feel it was appropriate to comment on the options but
have provided initial comments on potential sites and potential future use of existing
sites.
7.7.4 Scottish Fire and Rescue (Highland area)
“Recognise the challenges in health care provision and balancing competing financial
demands. Therefore support the views of NHS Highland management to progress
towards an improved service provision in the wider Badenoch & Strathspey area.
Improved home care and partnership working with other CPP members will support
the vision of safer communities and safer homes.”
7.7.5 The Highland Hospice
Highland Hospice supports the broad aims of the proposal which they feel provides
an opportunity to meet existing and future health and care needs for Badenoch and
Strathspey.
42
They are also keen to work jointly to consider the palliative and end of life care
improvements that could result from these proposals including how they can
contribute.
7.6.6 Highlands and Islands Enterprise
“From the investment values indicated in the consultation, development of modern
facilities and associated infrastructure as proposed would be considered by HIE to be
a welcome enhancement in service offer and the scale of the construction projects
proposed will in themselves create valuable, through short term economic stimuli
locally.
We would encourage the integration of community benefit clauses within the service
tenders, including the requirement to source locally and via the third sector to
maximise local social and economic benefits. The Government’s Procurement
reform agenda is enabling in these respects.
We would be pleased to continue our dialogue with you, working together with third
sector partners and social enterprises to further shape the routes through which
effective avenues can be established (as an integral part of your service re design) to
enable third sector led service delivery; where this brings opportunities to add value,
bring tailoring to services, build community capacity and embed greater social
outcomes through locally-led heath and social care service delivery.
The proposed service changes will affect some communities in terms of accessibility
of services (where these change from current locations). We note your intention to
work across strategic partnerships with stakeholders including public sector partners
with direct responsibility for transportation. We would be pleased to contribute to
such discussions, together with our local authority and other partners.”
43
8 Feedback on Possible Sites
Main points covered in this section:


Site preferred by the public
Further considerations and next steps
8.1 Introduction
An options appraisal was carried out to assess the possible site options in Aviemore.
The details of the full process including a map showing the short-listed are described
(Appendix 6).
This section of the report provides feedback on public views on the four sites. Public
preference was identified as one of the five criteria on which to assess the different
site options.
As public preference was one of the criteria the final decision on selecting a preferred
site was completed after the consultation had closed.
Issues relating to the site proposal were also raised at the consultation events and
meetings.
Box Summary description of shortlisted sites
Site A Grainish Farm
On the eastern side of the B9152 travelling north leaving the village.
Site B Milton
Beside the A9 underpass (north side) leading to Upper Burnside.
Site C Technology Park
Land between the 2 rail lines beyond the closed call centre.
Site D Pony Field
This is beside the Macdonald Aviemore Resort and lies between the A9 and new
housing to the north of the Scandinavian Village
44
8.2 Public Preference
Results for this were determined from the feedback during the consultation process.
160 expressions of preference were noted through the consultation process including
51 “no preference” There were also seven responses which suggested ‘other’. For
the purposes of determining the scoring “no preference” and “other” were excluded.
From the feedback provided as part of the public consultation the Technology Park
(Site C) was the most favoured (Table below).
Site
A
B
C
D
Name
Grainish Farm
Milton
Technology Park
Pony Field
Votes
18
1
64
19
%
18
1
63
19
Rank
3
4
1
2
8.3 Conclusion
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).
8.4 Next Steps
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 which will be carried out by technical advisors if
there is a decision to progress to implement the preferred option.
45
9 Assurance of the Formal Consultation
Process
Main points covered in this section:


Feedback from NHS Highland internal assurance
Feedback from Scottish Health Council independent review
9.1 Introduction
The process was assured both internally through the Highland Health and Social
Care Committee and externally via the Scottish Health Council:
9.2 Highland Health and Social Care Committee
Committee members were kept regularly up-to-date with the consultation including
two formal papers:


11th September 2014 – Final report on process
12th July 2014 - Update report
A mid-way review paper was also circulated by email on 10th June 2014. All the
papers are available on the NHS Highland website.
Issue raised on 11th September 2014
What is the latest position on the Public Consultation relating to Badenoch &
Strathspey?
Assurance
Circulated report indicated consultation exercise completed on 21 July 2014. Internal
review concluded major service change guidance followed fully. The report gave an
update on public consultation activities, in relation to an access and transport
evaluation, the background to selection of a potential site for a new hospital at the
Aviemore Technology Park and feedback on the public consultation process. It was
intended that a full report would be provided to the NHS Board at their meeting on 7
October 2014.
9.2.1 Conclusion of Committee
At their meeting held on 11th September the committee members were satisfied that
the major service change guidance had been fully followed. They commented on the
number of responses received and in particular highlighted the number of younger
people who had taken part.
Agreed to endorse that the process complied with Scottish Government major
service change guidance
Agreed to endorse recommendation to present full findings to NHS Board on
7th October 2014.
46
9.3 Scottish Health Council (SHC)
The Scottish Health Council produced a detailed report on the process for involving
and informing people and highlighting any issues raised by local people during the
process. It was published on 26th September and on their website:
http://www.scottishhealthcouncil.org/publications/major_service_change_reports.aspx
It is also available on NHS Highland website. In summary/conclusion the report
states that:
“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.
“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.”
47
10 Conclusions and Next Steps
Main points covered in this section:

Conclusion and recommendations based on feed-back on the consultation
process, service proposals, options and sites

Next steps and decision making process going forward from here
10.1
Summary conclusion and recommendation
This report brings together all the key elements of the public consultation: the
background, consultation process, feedback on options and next steps.
Taking everything into consideration there is broad support from the wide range of
stakeholders for option 3 - the preferred option (Box) and it is now being formally
recommended to the Board for endorsement.
Option 3 - Community hospital and resource centre
in a central location (Aviemore)
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.
In coming to this view, the operational unit has sought to satisfy itself that people
were comfortable with the consultation process and that there was strong support for
the preferred option. The consultation process has been endorsed both internally via
the NHS Highland Health and Social Care Committee and independently by the
Scottish Health Council.
79% supported the preferred option and both public preference and the option
appraisal process identified Site C – Technology Park as the preferred site to
develop any new hospital.
As the preferred option represents major service change, should the Board endorse
the proposal, the next step would be for the proposals to be considered by the
Cabinet Secretary for a final decision.
Further detailed work would still be required as part of the business case process.
48
10.2
Feedback on Consultation Process
NHS Highland has embarked on an extensive and wide-ranging public consultation
exercise. The communications and engagement activities were both pre-planned
and responsive to requests made during the three month period.
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 acceptance.
Although the queries raised were predominately addressed in the consultation
materials, the events and discussions provided further opportunities to expand on
some of the detail and really understand any ideas or concerns.
There was consistency in the feedback 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 representative of the wider feedback
which emerged during the consultation. Areas of greatest concerns were raised from
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 fedback, 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 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 the
NHS Board meeting to be held on 7th October 2014. This meeting is held in public.
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.
10.3
Feedback on proposals, options and sites
78.5% of people who responded to the 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 and the Highland Hospice).
There was also a consensus on a preferred site at this stage (Site C – Technology
Park). Some felt it added bias to the consultation to have identified possible sites at
this stage.
Some aspects of the proposals require further detailed work. Some of this relates to
specific concerns raised during the consultation but for other issues, it was not
appropriate to look in any detail prior to any decision being taken.
49
10.4
Next steps and Decision Making Process
The Board of NHS Highland will consider the report and the recommendation at their
meeting to be held on 7th October 2014.
Should they endorse the recommendation then it will go to 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.
Significant work would still be required including to agree the specification, the design
and purchase a site. Current estimates are that construction might start around
summer 2017 with possible occupation of the new facilities in December 2018. But it
is stressed this is a very tentative time-table at this stage.
50
APPENDIX 1 – Summary details on the short-list of options
Option 1 – Do minimum
Everything would stay the same but with some investment to address health and
safety requirements around the hospitals.



Main Disadvantages
Missed opportunities to improve careat-home and safety issues
Buildings will never be fit for modern
services, even with investment
Not sustainable - may result in major
loss of services in the longer term



Main Advantages
It is what people know and like
Keeps services in existing hospital
locations
Easy to implement
Costs
The running costs for both hospitals alone are £3.2million per year. Capital costs
would be £5.2million to bring the buildings up to minimum standard.
Summary
This option scored 250 points. The low score reflects that this option would not
address current or future problems. It would not improve access to medical cover
during out of hours, allow investment in care-at-home, support integration or
modernise the buildings.
Option 2 - Community hospital and resource centre in one town (‘hub’) and
scaled-down services in the other (‘spoke’), based on existing hospital sites
Hub
In either Grantown-on-Spey or Kingussie there would be a new facility which would
provide in-patient beds, outpatient services, A&E, 24/7 nursing cover with a limited xray service. It would be very similar to the existing hospital services provided from
Ian Charles with the main change being all the in-patient beds provided in one
purpose-built facility.
Spoke
Limited out-patient clinics and base for some community nurses and social care staff.
Other
Continue to integrate services with some investment into care-at-home, service,
community services and co-location of some staff.
Main Advantages
Main Disadvantages

Resources still split across three main
sites

Does not address service issues such
as out-of-hours medical and nursing
cover, limited access to x-ray
Won’t be sustainable in the future - may
result in major loss of services in the
longer term




51
All in-patients beds on one site
allowing better use of staff and
other resources
Improves quality of accommodation
of in-patient and out-patient
Familiar - keeps some services in
existing locations
Costs
Running costs with this model would be around £2.3million. The capital costs to
redevelop hospital sites would be around £9million
Summary
Option 2 scored 463 points. This was seen as an improvement on current services
but the low score reflects that this is not a good option. Having all the in-patient beds
being located on one site would bring some benefits but overall it would not improve
access. It would still mean money being heavily invested in buildings rather than in
community services or care-at-home service. It does not tackle any of the staffing
issues associated with out-of-hours or access to x-ray.
Option 3 – Community hospital and resource centre and spokes
Hub
A new community hospital and resource centre in Aviemore with good access to
public transport and the A9. This purpose-built facility would allow services to be fully
integrated.
The centre would provide the full range of community hospital services, including inpatient beds, out-of-hours, accident and emergency, outpatient clinics. The local
health centre, day care centre and NHS staff based in Aviemore would all move into
the new building.
Other
Development of care-at-home service, extended community care and community
beds in care homes would all come as part of wider redesign to improve all services.
Once these services were in place Ian Charles and St Vincent’s hospitals would
close.

Main Disadvantages
Strong attachment to existing hospital
buildings


Culture change for communities and staff
to get used to


Change of location of hospital for some
staff and communities

Main Advantages
Improves quality of many services
and overall much safer, more
effective and efficient
Addresses service issues allowing
better out-of-hours medical and
nursing cover, access to x-ray plus
investment in care-at-home and the
community
Integrated service designed to meet
the current and future needs of the
population
Costs
The running costs would be significantly lower at £2million and capital costs
estimated at £12 to £15million.
Summary
This option scored an extremely high 913. It would allow a fully integrated service to
be set-up which would make better use of the resources to meet the needs of the
local population.
52
APPENDIX 2 – Overview of the NHS service change process in Scotland
Identify strategic options and need for service change
Initial discussion with SGHD sponsor in cases of potential major change
Develop initial comms/stakeholder involvement plans in liaison with SHC
Undertake pre-engagement activity with key stakeholders
Options Appraisal in line with Green Book, SCIM and SHC guidance
Proposed change considered major? Confirm with SGHD sponsor
No
Yes
Proceed with proportionate public
engagement as agreed with SHC
NHS Highland board to
consider proposal and
consultation materials
Approve formal consultation
and materials
Yes
No
Revisit
proposals
Undertake formal public
Consultation
SHC assurance report to NHS Board
NHS Board Decision on Service Change
NonMajor
Ministerial Approval
Yes
No
Commence Business Case process (SCIM)
If infrastructure investment case
Proceed to implementation
Feedback and Evaluation
53
Major
Revisit proposals
APPENDIX 3 – Events and stakeholder meetings including updates to committees etc
(21st April to current)
Category
District
Partnership
Event
Kingussie
Nairn
Kingussie
Date
24th April
11th June
25th September
Attendance
+ 4 members of public
Community
Councils
meetings
Nethy Bridge
1st May & 5th June
Kingussie
Aviemore
Dulnain
Grantown-on-Spey
Carrbridge
Boat of Garten
Kincraig
Newtonmore & Vicinity
6th May
8th May
14 May
20 May
29 May
2nd June
10th June
7th July
+9 members of the
public
+ 6 members of public
+6
Drop-in events
Dulnain
Grantown-on-Spey
Carrbridge
Boat-of-Garten
Nethy Bridge
Kincraig
Aviemore
Newtonmore
Laggan
14th May
20th May
29 May
2nd June
5th June
10th June
11th and 12th June
19th June
19th June
Steering Group
Mid-way review
5th June
Post-consultation
27th August
review and complete
options appraisal on
sites
Other
Lunch Club, Kingussie
Walk-about
Friends of St. Vincent’s
Dalwhinnie Community
Group
CoS Presbytry
Laggan Community
Association
Friends of Ian Charles
Sunshine Club
Public meeting,
Kingussie
Public meeting,
Aviemore
Public meeting,
Grantown-on-Spey
St Vincent’s Therapy
Garden
Spey Valley Rotary
54
+1
+ councillor
4 + SHC
9
2
12
9
4
30
12
8
19 May
27 May
28 May
28 May
22
50
8
6
17th June
19th June
35
8
23rd June
23rd June
25th June
15
42
6 +x2 SHC
1st July
7th July
16 Members of public +
x2 SHC
82 Members of public +
x2 SHC + Reporter
Committee members
9th July
12
2nd July
APPENDIX 3 (cont’d)
Attendance at public meeting, events and stakeholder meetings
Category
Partner Agencies
Event
Scottish Government
Scottish Ambulance
Cairngorm National
Park Authority
Transport Scotland
Kingussie High
Notes
Date
th
14 May + July
21st May
+ 3rd October
th
th
30
May, 10
September
11th June
24th June
NHS Highland
Staff drop-in events
w/b 21st April
(various)
17th & 18th July
3rd June
various
9th June
Consultant psychiatrist
Local GPs
Annual Review
South
and
mid
operational
unit
management
team
meetings/
Local
Partnership
Raigmore
senior
management team
NHS Highland senior
management team
Highland health and
social care committee
NHS Highland Board
55
Staff also represented
at
all
meetings,
steering group
1st May, 23rd June
ongoing
Local stakeholders met
with the Minister
Ongoing
16th July
Ongoing
25th September
Ongoing
1st May, 10th July,
11th September
3rd June, 12th
August,
Ongoing
7th October
APPENDIX 4 Summary of points raised at meetings, events and drop-in. Themed and ranked based on the frequency of times raised at
different events
Notes
After the consultation closed comments were categorised to allow some high–level groupings (Table). For instance additional services in
the preferred option were mentioned at 31 of the 34 meetings and accounted for 16% of all the points raised at meetings and events.
There was also a read across with the correspondence and survey responses.
Table Summary of responses by category
Categories
No.
%
1. Additional Services
31
16%
2. Transport
23
12%
3. Existing Services/Buildings
22
11%
4. Bed Provision
21
11%
5. Site Proposal
19
10%
6. Finance including endowments
16
8%
7. Care Homes/Care at Home
14
7%
8. Staffing
12
6%
9. Population
9
5%
10. Alternative proposals
8
4%
11. Other
8
4%
12. Process
7
4%
13. Palliative Care
6
3%
Grand Total
196
Category
Points raised
NHS Highland Response
Additional
services
 Will there be additional
services in the new hospital?
Yes. But the detail will come later when the full clinical specification will be required to
be developed as part of the Full Business Case. Specialist outpatient clinics or input,
chemotherapy and infusions are all things that were raised and will be considered (see
also below)
1.2
 Will there be greater use of
new technology and telemedicine consultations?
The new facility will be fully equipped to take advantage of new and emerging
technologies including allowing for increased use of tele-medicine consultations with
consultants/specialist nurses.
1.3
 Will the x-ray service be
enhanced?
New more modern x-ray equipment will provide an overall improvement. While there
will no longer be an x-ray service in Grantown it will release radiographer travelling
time to enable more examinations to be carried out in Aviemore. The current
arrangements are not satisfactory and in particular for in-patients (see notes below).
Moreover the equipment is at the end of life.
1.1
Notes
Currently St Vincent's patients can't have an x-ray unless they are put in an ambulance
and transported to Aviemore (and back). Ian Charles patients can have an x-ray (but
machine is out of date, no spare parts available), if a radiographer is available.
(Currently on-site one day per week). Otherwise to get an x-ay, the radiographer must
close down the Aviemore service, travel through to Grantown, warm up the machine,
take the x-ray, close down shop and travel back to Aviemore. Implementation of the
preferred option would vastly improve this situation.
The equipment was installed in 2002 beginning to fail and no longer possible to cover
it with a service contract as spare parts are no longer available. The equipment also
does not have automatic exposure control devices, available on all other NHSH
general X–ray equipment and considered as a standard feature for the optimisation of
medical exposures.’
1.4
 We need a 24 A&E service.
Current out of hours cover is
not enough?
Local doctors say that the current service is more than adequate for current case mix
that they look after. It would not be appropriate to do more complex cases as staffing
is by GPs not specialists. The level of activity does not warrant the necessary back-up
required for more complex care such as theatre/anaesthetics, CT, MRI and 24/7 x-ray.
Out of hour - In-patients
The proposed arrangements will improve out-of-hours nursing and medical cover
because all the inpatient care would be co-located.
57
Category
Points raised
NHS Highland Response
Notes
There are 50 hours (Mon - Fri 8am to 6pm) when a GP provides cover during the week
in each hospital. In the evenings, weekends and overnight periods medical cover is
provided from the Out of Hours service based in Aviemore. Local GPs provide this
service.
This means that our hospital in-patients are at a distance of either 10 or 15 miles from
the doctor during these periods of time. Under the new arrangements all inpatients will
be located in the same place (gets round the difficulty that arises when both hospitals
need the doctor at the same time) and delays due to loading up plus journey time will
be eliminated.
Terminology
The re-design will also help to address a long-standing issue around terminology A&E,
Casualty, Minor Injury Unit. A&E/ Emergency Department should only be used for
consultant-led departments with all the necessary back-up; trauma teams; theatres and
so on. Traditionally the term A&E/ casualty has been used for many of our community
hospitals which really provide GP or Nurse led minor injury/ailment services. Adding to
public confusion is that the sign outside the hospital says A&E.
 Need an enhanced A&E
service to better treat fractures
 Will there be a pharmacy onsite?
As above plus the numbers don't justify this.
1.7
 There is not enough detail in
the clinical model
Agree. Further detail will be worked up, if and when the preferred option is approved.
The requirement to provide further detail comes later on as part of the Full Business
Case.
1.8
 Will there be a handyman
service?
The Handyman Schemes elsewhere in Highland involves Third Sector, Council
services etc with very clear community roles for the Handyman in terms of care and
repair, adaptations etc There is currently not a service like this in Badenoch and
Strathspey but we will be looking to develop something along the above lines.
1.9
 Will there be a hydrotherapy
pool?
 Will there be an operating
Theatre?
No. There are no plans for a hydrotherapy pool.
1.5
1.6
1.10
There will be a hospital pharmacy on site but there are no plans to relocate the current
community pharmacy.
No. There will not be an operating theatre because there is not the demand.
However, there will be modern treatment rooms which will allow opportunities for more
minor surgery to be carried out
58
Category
1.11
Points raised
NHS Highland Response
 There should be an on-site
facilities for laundry?
A laundry could be provided but at a cost. This will need be considered alongside
other priorities but local people will have an opportunity to influence these
discussions/priorities. Other services like café/ dining facilities will be discussed. In
these deliberations we will seek to balance patient/visitor requests with costs and
impact on local providers.
Notes:
The context for this query was that it was raised at a meeting that there was no laundry
in Migdale (Bonar Bridge) and the inconvenience this caused
The policy is for patient’s relatives to take laundry home for washing. It is recognised,
however, that this poses challenges where visitors may be infrequent or some patients
may have no visitors/ relatives.
2.1
Transport and
Access
 Transport infrastructure must
be in place to support
relocation of hospital services
Transport is of paramount importance and needs to be developed.
While NHS Highland is not a transport provider, we believe the redesign is a catalyst to
facilitate joint working across various partners. In terms of NHS Highland’s
contribution, the proposals make provision for further investment into community
transport. A working group on transport has been established and an initial Transport
survey has been completed.
Notes:
From the survey we note that the majority of people don’t use public transport to come
to hospital or for GP appointments. Arguably this is because the service is very
limited. People who are visiting the hospitals generally come by car. Extremely few
walk up the hill from Kingussie to St Vincent's and a very small number of people walk
to the Ian Charles. Inpatients mostly arrive by ambulance and occasionally by private
transport.
2.2
 Traffic flow/jams will affect
ability for ambulances to gain
access to and from the
hospital?
More generally further steps need to be taken to reduce people having to travel in the
first place. In the future more outpatient consultations will be replaced with Videoconferencing, Skype, or telephone and e-mail. Making sure we have the right
community and home based service in place will also mean people have to spend less
time in hospital further reducing the need for travel.
This was raised as a concern and is something we will look into in collaboration with
others including Police and Ambulance. However, busy towns and cities manage flow
of ambulance traffic. The steering group will consider when assessing sites.
59
Category
Points raised
NHS Highland Response
2.3
 There is no taxi service in
Kingussie?
This was confirmed during the consultation process. It must have a number of
implications for local people. In terms of NHS services it poses a problem with the
current remote location of St Vincent's Hospital. It is intended that any retained
services in Kingussie will be more centrally located and any wider access and transport
issues will be improved.
2.4
 Will dualling of the A9 impact
on site selection?
We have met with Transport Scotland representatives, and believe one of the four
shortlisted sites could potentially be affected by A9 dualling. This will be noted during
the site selection process. Moreover the dualling has not actually started and timescales are somewhat uncertain. It is recognised that there will always be some
uncertainties to contend with.
2.5
 Will there be access to the A9
to the new hospital?
This is unlikely, two of the shortlisted sites lie adjacent to the A9 but Transport
Scotland has indicated that they are unlikely to approve any further junctions. The
ambulance service have also indicated that this is not a requirement
3.1
3.2
Clarification on
existing
services and
buildings
Will physiotherapy services be
Yes that is our intention
retained at Kingussie/Grantown?
Will ambulance services remain in There are no plans to alter the current ambulance services apart from relocating the
Grantown and Kingussie?
Aviemore Ambulance station
3.3
Will GP services remain in
Kingussie/Grantown?
There are no plans to alter the current distribution of GP practices
3.4
Will children’s services be colocated in the new building?
Children's services staff might be, but the children's services themselves would
continue to be delivered closer to home (schools, health centres, homes)
3.5
Can the existing buildings last the
five years until the new hospital is
built?
Will dental service remain in
Grantown?
We are required to maintain our current buildings in a safe condition and will do this for
the remaining life of these properties
3.7
Will minor injury service remain in
Grantown
Yes the minor injury service will remain in Grantown
3.8
Will the out-of-hours (OOH)
services be located in the new
building?
Yes OOH will be located in the new development in Aviemore
3.6
Yes there are no plans to remove dental services
60
Category
Points raised
NHS Highland Response
3.9
What will happen to the existing
buildings
There is no NHS use identified for buildings that might be vacated, Should this be a
requirement, NHS Highland will be asked to declare them surplus to requirements
once vacated. NHSH will then follow the prescribed procedures for disposal this
includes checking if there are any public sector uses for the buildings. Scottish Futures
Trust and the Cairngorm National Park Authority have been consulted regarding
possible community benefits which might be derived from the disposal of any
properties and land.
3.10
Are the hospital buildings listed?
No as far as we have been able to ascertain none of the buildings are listed
3.11
What will happen to the Therapy
Garden in St Vincent’s? Can it be
re-provided at the new hospital?
Some early discussions have been held with some of those involved with the Therapy
Garden and it would be our intention to support the group to provide a therapy garden
at the new Aviemore facility and also at an alternative location within Kingussie.
Discussions ongoing.
Are enough beds included in the
proposal?
The final number of beds has not yet been decided on though we have done some
initial work to inform the public consultation. Our Health Intelligence Unit will be
carrying out further modelling work to assist in any final decision. Local medical
experience; bed experts; service planners will work out the right number which will
take into account flexibility and future requirements. The current stated estimated
provision is between 20-25 beds. The number will be based on the optimum
requirement; not the exceptions.
4.1
Bed numbers
and provision
Notes:
Identifying the right number of beds requires specialist expertise, modelling and is
dependent on many factors. The number we have now is on the high side with beds
occupied with patients who would be better served in other settings. This is due to a
lack of home care. For instance recently 8 out of 23 beds in the valley had people in
them who didn’t need to be in hospital at all.
Currently it is not always possible to use all the beds because they are in bays of four
or six. This may not always suit the mix of males and females. It can also mean
whole bays have to be shut when there are infection outbreaks. The new hospital will
have all single room; bringing a wider range of benefits including higher occupancy.
4.2
Will mental health/dementia beds
be included in the new hospital?
We would want the building to be suitable for dementia patients in ways that the
current buildings are not. (As many as half of our GP inpatients have a degree of
dementia, it co-exists with the physical conditions that affect older people.)
61
Category
Points raised
NHS Highland Response
Discussions are ongoing with consultant colleagues from New Craigs who manage the
bed to identify the clinical need and what is required going into the future.
4.3
Will the rooms in the ward be
single rooms
All beds in the new hospital will be in single rooms- this is Scottish Government policy.
There are good clinical reasons, particularly regarding control of infection, for having
all single rooms. In addition single rooms also help with bed management e.g. the
gender of a patient does not matter when an admission is required, currently if there is
only one bed available in a multi-bedded female ward then only a female patient can
be admitted and vice versa. Space for patient socialising and dining (should they so
wish) will also be provided.
Notes:
With regard to single rooms, CEL48(2008) “Provision of Single Room Accommodation
and Bed Spacing” refers. It states “For all new-build hospitals ….. there should be a
presumption that all patients will be accommodated in single rooms, unless there are
clinical reasons for multi-bedded rooms to be available.”
5.1
5.2
Site proposal
Are the proposed sites big
enough?
One of the short-listing criteria for the sites was that they had to be a minimum of three
acres in size or be capable of being made so. It takes into account the likely building
size, parking, gardens and a 20% expansion capability. Further work will be required
once it has been determined exactly what will be provided from the new facility
including the number of staff likely to be working in the new facility
Will the site/building be
expandable in the future?
The development will allows for 20% future expansion which is what is recommended
for NHS planning purposes. Over and above this there has been some discussion
about what other support services might be beneficial to have co-located.
Notes:
It is important to appreciate that future-proofing does not necessarily mean bigger. For
instance the available evidence (including for Highland) show that we have needed far
fewer in-patient beds over the last 20 years. Changes in technology, greater use of
tele-medicine, advances in medicines and treatments will all mean people spend less
time in hospital settings. What is of upper most importance is that any development is
flexible and able to respond to changing circumstances – flexing up or down to suit
local need.
62
Category
Points raised
NHS Highland Response
5.3
How were the sites short-listed?
The long list of potential sites was drawn up after personal visits to the area by Board
officers, by contact with architects and other public bodies in the area, by discussions
with steering group members and by an advertisement in the local newspaper. This
produced a long list of 10 sites which was reduced to a short list of four by applying
two exclusion factors - 1) sites had to be a minimum of 3 acres in size or have the
potential to be made so and 2) be within or immediately adjacent to the Aviemore
settlement boundary. These exclusion factors were drawn up by the steering group
and with advice from the Cairngorms National Park Authority.
5.4
Why is Aviemore selected as the
preferred location?
Will there be a heli-pad close to
the new hospital?
Because of its central location and proximity to Inverness (Raigmore Hospital).
5.5
No. Medical advice is that a heli-pad is not required, current arrangements for the use
of helicopters will continue
Note:
Those who need to be taken off the mountain to data have always need to go direct to
Raigmore or further afield for diagnostic purposes and necessary medical and surgical
expertise. Landing a casualty in Aviemore would only serve to cause delay and adding
further risks. The same applies to those injured in for instance A9 causalities.
5.6
Co-location is not a significant
advantage to justify a new build in
Aviemore
Co-location means inpatients will have a doctor in the building with them almost all the
time (as opposed to less than 1/3 the week which is the current situation. This brings
wider benefits for multi-disciplinary team working. Professional opinion is that colocation of all health and social care professionals greatly improves communication
resulting in better and quicker outcomes for patients. Other benefits include more
efficient use of buildings and staff time.
5.7
Will sites be compulsory
purchased?
It is not anticipated that this will be necessary, the owners of all four shortlisted sites
have indicated a willingness to sell, subject of course to negotiations on price
How much will the building cost?
The final figures will not be known until the full extent of the accommodation is
described, the site purchase and development costs are known and commercial
negotiations are concluded. However we are working on a budget figure of £12million
to £15million which is based on other similar facilities e.g. Migdale Hospital in Bonar
Bridge and Nairn Town and County. This would include incorporating facilities for new
Health Centre.
6.1
Finance
including
endowments
63
Category
Points raised
NHS Highland Response
6.2
How will the building be financed?
NHS Highland is closely following the Scottish Government process for capital
investment. The Business Case process will explore funding options but at this stage it
seems likely that the building will be principally financed through the revenue route
which will involve Hubco
6.3
The building should not be
financed by PFI or similar
NHS Highland is closely following the Scottish Government process for capital
investment. The Business Case process will explore funding options but at this stage it
seems likely that the building will be principally financed through the revenue route
which will involve Hubco
6.4
Will there be savings as a result
of the service re-design?
The principle aim of the project is to improve services to ensure they are safe,
sustainable and meet future needs. Any service must also be affordable. The current
arrangements with are not efficient or cost effective and by re-designing services there
are opportunities to free up resources. The proposal is to uses these resources to
invest in community services, care-at-home and a contribution to community transport
provision.
6.5
Are you being ambitious enough?
Yes. We believe that the proposals will provide the best healthcare for the people of
the valley which can be staffed and sustained.
6.6
Hubco finance offer is very
expensive – will cost £30k over
25 years for a £12m hospital.
Cheaper to upgrade Ian Charles
for £3m
What will happen to the Burrell
endowments at St Vincent’s
There is a national shortage of capital funding and it is likely that the revenue model
available through hub will be the only viable option in the short to medium term. Any
attempt to upgrade the existing hospitals would result in a less than optimal solution
and poorer services for patients than the preferred option.
6.7
The Theresa J Burall legacy will continue to be used for the benefit of St Vincent’s
hospital until such a time that the hospital becomes non-operational and the terms of
the legacy cannot be met. NHS Highland Endowment Fund Trustees would then need
to apply to the courts to determine the future use of the legacy.
The advice from NHS Scotland legal office confirms that the legacy could potentially be
used for the benefit of a different hospital and/or the community where the services are
currently provided to benefit local people in the future. Any future decisions progressed
by a local group from within the Kingussie area under the responsibility of NHS
Highland and with close reference to NHS Endowment Fund regulations and the legal
framework.
64
Category
Points raised
NHS Highland Response
Care-at-home
and care
homes
Can you recruit more care-athome staff?
This has been an on-going problem for many years now and we feel this is something
that needs to change regardless of anything else. Whether we do or don't build a new
hospital in B&S, we want to see greater recruitment and retention of people doing this
kind of work locally. We understand this is a Highland wide problem, although this
Locality may be worse than the average.
7.2
We need more care-at-home staff
This is recognised and the preferred option was the only option to identify ways of
investing further in community staff including care-at-home
7.3
Will there be a care home
attached to the new hospital ?
There are no plans for a care home to be built in Aviemore as part of this project
Existing excellent culture of care
must be maintained
Will local doctors be providing the
medical services at the new
hospital?
Will local people be employed in
the new hospital?
Agree. Staff will be fully consulted and involved in the proposals.
8.4
Will there be any redundancies?
he NHS in Scotland has a policy of no compulsorily redundancies, staff will be given
the opportunity to either work in the new facilities or be redeployed to other areas
8.5
Will there be enough staff?
There is sufficient staff currently employed within B&S to operate the new facilities. It is
generally accepted that modern facilities are an aid to recruitment
8.6
How will staff get to work?
If and when the proposals are approved detailed discussions will be held with staff and
their representatives to discuss employment issues such as travel to work and how the
Board can assist them e.g. shift times that fit in with public transport. Staff travel to
work will also be considered as part of the transport group.
8.7
Will local builders be contracted
to build the hospital?
It is likely that the new facilities will be built by hubco under a design, build, finance and
maintain contract. hubco will tender at least 80% of the total work package value to
local contractors. Hubco will hold local supply chain meetings or 'roadshows' where
they can come along to hear about hub and what its role is and also meet the buyer
events where they can meet the main contractor.
7.1
8.1
8.2
8.3
Staffing
Yes
Existing staff whose jobs will be affected by the proposals will be given the opportunity
of moving to the new facilities, any posts remaining unfilled will be filled in the usual
way, local people will be given the opportunity to apply
65
9.1
Category
Points raised
NHS Highland Response
Population
Have you considered the
projected population increases?
An Camus Mor, seasonal visitors
Yes this is an important point and one which we have and will continue to consider
pulling expertise in from our Public health colleagues, service planners and
experienced health care planners.
We know that Aviemore has done the most expanding (20% rise in practice population
in 10 years; yet the over 65-population has not significantly increased (and this is the
population that starts to use the hospital in patient facilities more). The majority of the
new housing tends to attract younger people, often families, therefore this has
considerations for services for children’s and families (and of course schools). In terms
of health these services are usually delivered through health centres and are one of
the strong arguments for building a new health centre in Aviemore as part of the
proposals. Although there has been a lot of focus on the hospitals (and understandably
so) we have been at pains to point out that this is a wide re-design and the primary
care/ health centre element is very important.
10.1
The hospital should remain in
Grantown and Ian Charles be
upgraded
Upgrading an existing old building will never provide the standards required for modern
healthcare, we are planning services for the next 50 years and we need a new modern
facility for patients and staff which meet the highest health & safety, control of infection,
patient dignity and energy efficiency standards as possible.
10.2
Both hospitals should be
modernised and would cost less
Modernising within the limited scope available would not bring the benefits of colocating services or enable the improvements in community care which are required
10.3
Outpatient services should be
retained in Grantown
Psychiatry and Medicine for the Elderly visit the three health centres. No changes are
being proposed although in line with other outpatient services if there are alternatives
such as Video-conferencing.
10.4
There should be a 4th option –
upgrade all sites to modern
standards
Clarify if this includes new build in Aviemore
The consultation outcome has
already been decided “done deal”
The consultation process has been open and inclusive, it has been monitored
throughout by the Scottish Health Council. They will be producing an independent
report.
What are the time-scales?
The results of the public consultation are being analysed, a report will be considered at
an NHS Highland Board meeting hopefully in October this year, if not in December.
11.1
11.2
Alternative
proposals
Service
change
process
66
Category
Points raised
NHS Highland Response
Thereafter if the Board approves the preferred option it will go to Scottish Government
for a final decision. Only if the SG approve the preferred option will planning for the
new facilities and services begin in earnest Significant work would still be required and
current estimates are that construction might start around Summer 2015 with possible
occupation of the new facilities in December 2018. But it is stressed this is a very
tentative time-table at this stage.
12.1
Palliative care
12.2
Need increased Marie Curie to
support people at end-of-life to
die at home
End of life care will be included in our review of services
Need to retain palliative care beds
at Kingussie and Grantown to
allow people at end-of-life to die
in their own town
Notes
End of life care will be included in our review of services
Hospice outreach = a consultant visiting (e.g. weekly or fortnightly.) Advice available
for doctors too but not often required and is done by telephone in any case.
End of life care = someone doing the nursing/personal hygiene work so the patient
gets drugs as needed plus dignity is maintained and relatives don't have it all to do.
Community nurses do a bit of it in the day, OOH nurses now started doing a bit in the
evening: both mainly doing the medication side of things. Marie Curie sit with folk
overnight so family members can get some sleep. If family not available, not willing or
not capable, admission is required.
13.1
13.2
Other (respite,
maternity,
housing,
dementia and
integration
Will respite provision be retained
in Grantown and Kingussie?
End of life care will be included in our review of services, we recognise that the
voluntary sector have an important role to play in the delivery of health services
Will there be maternity beds?
No. There is no proposal to include maternity beds, there is insufficient demand to
enable practitioners to maintain their skills.
Notes
There are national rules about how many deliveries a unit must be doing so that
midwives and doctors maintain their skills and experiences. Back up facilities required
would include emergency facilities, theatres, team of obstetric doctors, anaesthetists,
theatre staff etc For these reasons a maternity unit would not be viable.
67
Category
13.3
13.4
Points raised
NHS Highland Response
We need cluster housing for
learning and physical disability
patients. There is nothing in the
Strath
Will there be supported housing
Housing lies within the responsibility of the Local Authority and is outwith the remit of
this project but all four shortlisted sites provide the opportunity for supported housing
by others
Housing lies within the responsibility of the Local Authority and is outwith the remit of
this project but all four shortlisted sites provide the opportunity for supported housing
by others
13.5
Integration of health and social
care services are important
NHS Highland manages the entire adult health and social care budget for the locality
providing far greater opportunities to make best of all resources, skills and talents.
13.6
How will people with dementia be
cared for in the future?
Need a clinician to answer this one but presumably there will be mention of an
enhanced community service? Would it be worth quoting some stats about the home
addresses of patients in that specialty at St Vincent’s?
68
APPENDIX 5 – Further work identified to understand future bed numbers
Ian Douglas, Health Intelligence Specialist (Directorate of Public Health) and Frances
Matthewson, Senior Planning Analyst (Service Planning Team) were asked to
develop ‘bed modelling’ to help the project team understand future bed requirements
based upon drivers of service demand. This work will have five components:
I)
Understanding baseline activity and capacity (bed numbers, trends in
occupied bed days for patient groups/specialties, throughput and occupancy
and blocked beds etc)
II)
Estimating demand of catchment populations in 0, 5 and 10 year time horizons
III)
Modelling care – estimating impact of possible changes in supporting
community care arrangements, adjusting for other commissioning intentions
(including repatriation of care from other sites / end of life care arrangements)
IV)
Future utilisation of beds (occupancy and throughput)
V)
Output – recommended bed numbers
Timescale:
To be completed by end of November 2014
APPENDIX 7 – Option appraisal process to support site selection
The preferred service model option included building a new community hospital in a
central location (Aviemore). As part of the overall process NHS Highland was
advised to identify possible sites in Aviemore to include as part of the consultation
materials.
The process from identifying sites through to selection of a preferred site is
described. This is based on quality factors which included access. Further work
would still be required to consider any technical consideration should the decision be
taken to progress with the preferred option.
Method
The Options Appraisal work followed a well established process recommended by
Scottish Government in the Scottish Capital Investment Manual – Business Case
Guide. Through this process four short-listed sites (see map) were assessed against
a number of quality criteria. These had been agreed by the group in advance of the
consultation, and without prior knowledge of the potential sites.
The five quality criteria which were selected by the steering group were:
 Access/transport
 Public preference
 Environmental considerations
 Proximity to other services and potential for expansion
 Planning acceptability

The group also agreed that the final decision should weight the quality/cost factors as
60:40.
Phase I – Identification of potential sites
This involved undertaking a search of possible sites within or close to the Aviemore
settlement boundary (as per Cairngorm National Park Authority plan).
Sites were suggested by members of the project group, visits around Aviemore by
NHS Highland staff, contact with architects and liaison with partner agencies. From
this process seven sites were identified. An advertisement was also placed in the
Strathspey and Badenoch Herald which produced a further three sites. This meant
there were 10 sites identified for initial consideration.
Phase II – Factors for assessing long list to produce shortlist
A workshop with steering group members and others was held in Aviemore on 3rd
April. This involved 29 people, half of whom were community members and service
users. The majority had participated in the earlier option appraisal events.
70
The purpose of this specific event was to agree high-level factors to allow a shortlist
of sites to be agreed, and then to agree criteria and weighting (relative importance of
each criterion) which would be applied to the shortlist of sites to allow NHS Highland
to identify a preferred site(s). This was the same methodology used for previous
option appraisal and so participants were familiar with the approach.
71
Process for agreeing criteria and weighting to be applied to the shortlist
The discussion to consider and agree criteria and weighting took place before any of
the site locations were shared. This was to avoid any bias.
Participants at the workshop were asked to consider important factors for service
users accessing the services. These were criteria that service users and public could
reasonably have a view on and therefore could reasonably influence. After
considerable discussion the following factors were agreed:





Access / transport (such as proximity to A9, public transport, disabled access,
traffic flow)
Public preference on the shortlist of sites (to be identified as part of the
consultation)
Environmental considerations (outlook, location, green space, impact of
development)
Proximity to other services/potential for expansion (current and future)
Planning acceptability (some sites will be more acceptable than others and
more easily fit or be adapted to fit with the Park Plan)
Weighting
Although all these criteria were important, it was also agreed that they were not all of
equal importance i.e. some were more important than others and therefore the
criteria were weighted to reflect this. The process to do this was to first agree the
most important criterion. The group decided that this was Access and it was ranked
as 100. The group then agreed that the second most important criterion - Public
Preference and gave it a ranking of 85 and so on. These rankings were then
converted to percentages (Table below)
Assessment Criteria
Ranking
Weighting (%)
Access
Public preference
Environmental factors
Proximity to other services/
Potential for expansion
Planning acceptability
100
85
75
27.03
22.97
20.27
65
45
17.57
12.16
The weightings would be applied later to the scores for each site.
10.3.1 Process to determine short list
Participants first agreed on two high-level exclusion factors:
(i)
sites have to be a minimum of three acres in size or the potential to be, and
(ii)
within or immediately adjacent to Aviemore settlement boundary.
These were considered to be yes/no criteria and a no answer to either would exclude
the site from further consideration.
72
Application of process to identify shortlist
From the 10 sites initially identified, six were excluded on the basis of not being big
enough or were out with the Aviemore settlement boundary. The remaining four sites
went forward as part of the public consultation to seek the views of the public (Box)
Summary description of shortlisted sites
Site A Grainish Farm
On the eastern side of the B9152 travelling north leaving the village.
Site B Milton
Beside the A9 underpass (north side) leading to Upper Burnside.
Site C Technology Park
Land between the 2 rail lines beyond the closed call centre.
Site D Pony Field
This is beside the Macdonald Aviemore Resort and lies between the A9 and new
housing to the north of the Scandinavian Village
Please note A to D does NOT represent a ranking of the sites.
The following additional information on the sites together with a map was made
available in the public consultation document.
Site
Estimates of population within a 15 minute walk of each site
A
B
C
D
1,800
1,820
2,340
1,180
Phase III – Assessment of sites based on qualitative factors
As public preference was one of the criteria to assess the sites this work could only
be completed after the consultation had closed.
The steering group held a further meeting on 27th August 2014 to complete the
options qualitative appraisal process on potential sites. 29 attended the meeting and
included local service users, councillors, community councillors, local access panel,
Cairngorms National Park Authority, Ambulance Service, Friends of Ian Charles and
St Vincent’s Hospital, Aviemore GP Practice, NHS Highland staff including
partnership representative.
73
Quality versus Cost
It was recognised at the 3rd April meeting of the group that in addition to the
qualitative criteria regarding site selection, cost would also need to be taken into
account. These were described as technical or quantitative criteria and could include
such things as, site purchase cost, cost of developing the site i.e. ground conditions,
availability of utilities, access arrangements, etc This quantitative assessment and
scoring would require to be completed by the Board’s technical advisors.
At the meeting on 27th August the group were also asked to make a determination on
the balance between quality and cost. The group agreed that the final decision
should weight the quality/cost factors as 60: 40
Assessment of sites against criteria
Each criterion was taken in turn to look at how the group thought each site performed
relative to each other. In considering the options they were asked to consider the
potential advantages for people travelling to Aviemore (i.e. hospital services) and
those travelling to GP Practice.
This allowed each of the sites to be scored out of 10 for each of the criteria. The
previously agreed weightings were then applied to these scores to arrive at a final
qualitative score for each site:
Public preference
Results for this were determined from the feedback during the consultation process.
These results did not require input from the group and were revealed at the end after
the other criteria had been scored:
Site
A
B
C
D
Name
Grainish Farm
Milton
Technology Park
Pony Field
Votes
18
1
64
19
%
18
1
63
19
Notes
160 expressions of preference were noted through the consultation process including
51 “no preference” There were also 7 responses which suggested other unidentified
sites but for the purposes of determining the scoring “no preference” and “other” were
excluded.
74
Results from benefit weighting scenarios
Weighted benefit scores (see notes below)
Option
Description
Consensus
Rank
A
Grainish Farm
530.54
2
B
Milton
340.14
4
C
Technology Park
750.14
1
D
Pony Field
467.97
3
Notes
Scores are out of 1000
Sensitivity Analysis
In order to test the robustness of the decision, sensitivity analysis was carried out.
This involved removing each of the selection criteria in turn to see if one particular
criterion skewed the decision. Further analysis was carried out by scoring the
preferred choice – Site C Technology Park at 0 for each of the criteria in turn. The
Technology Park remained the highest scoring site in each of these scenarios.
The mechanics of the process are being independently audited by the Head of
eHealth.
Conclusion
Both the public preference and the working group’s deliberations came up with the
same conclusion (site C, Technology Park). The sensitivity analysis also showed
that this was a robust choice.
Next Steps
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 which will be carried out by technical advisors now
needs to take place.
The reason that it is not carried out for all the short-listed sites is because it is costly
and time consuming. It is only appropriate to carry out this level of work on one or
two sites. This work will only be taken forward should there be a decision to progress
with implementation of the preferred option.
.
75
APPENDIX 7 Update on local care-at-home activities
NHS Highland is working with all sectors to coordinate and collaborate on recruitment
and to make home visits work as well as possible. We have made progress and are
starting to develop some innovative ways to address the issue of home carer
recruitment.
This includes becoming the first Health Board in Scotland to achieve the living wage
for carers in the independent sector. This means that through our contract we have
increased the hourly rate and directed that this should be passed onto the carers.
In addition, NHS Highland is developing a modern apprenticeship scheme – in
partnership with the Job Centre, Inverness College, Highland Council’s Education
Department and Independent Care Providers - to promote caring as a career.
It is proposed to train to SVQ Level 2 over the first two years and to use year three as
an opportunity for each trainee to develop specific skills based on their experience of
years’ one and two. The scheme would be modular and it is proposed that over
years’ one and two, each trainee would undertake six, three month placements in a
variety of care settings.
At the end of year three, trainees will be encouraged into mainstream posts, or make
a choice about specialist training; e.g. Health or Social Work.
Our position is beginning to improve with the implementation of these ideas and we
are also trialling different ways to managing runs with the independent sector –
including a move away from 15 minute time slots.
76
APPENDIX 8 – A summary of what is included in public health district profiles
Adult and Children & Young People’s (CAYPs) health profiles of the Highland HSCP
areas and the Argyll and Bute CHP
These were compiled by NHS Highlands Public Health Department and launched in
December 2012 for adults and in June 2013 for CAYP.
They were designed to assist services in the assessment of the health and social
care needs of the populations within the geographies of the Operational Units and
within Argyll & Bute CHP. The measures used were selected to inform each of four
aspects of health and social care:




The wider determinants of health
The potential for health improvement
The protection of health
The need for health & social care
So for example, if rurality is particularly challenging or socio-economic deprivation,
these measures will be found in the wider determinants of health category. Lifestyle
related measures such as hospitalisation rates for alcohol-related conditions or the
average life-expectancy will be amongst others in the potential for health
improvement category. Relative uptake of screening programmes is an example of
the protection of health category whilst the prevalence numbers with long-term
conditions is in the need for health & social care.
These measures are available at different geographical levels from intermediate
geographies, districts (localities in Argyll and Bute CHP), areas and Operational
Units/CHP. They are also accompanied by comparator measures at National, Health
Board; and Operational Unit/CHP level.
To help users identify where strengths and weaknesses lie in their area, one page
summaries were compiled which identified particular challenges, examples of good
practice and areas for improvement across each operational unit. These together
with the profiles themselves can be accessed both on the internet:
Adults: Adult_Profiles (internet)
CAYP: CAYP_Profiles (internet)
Notes
77
APPENDIX 9 – Feedback on aspects of the proposals
Table Feedback on aspects of changes being proposed as part of the service re-design
Response group
Number of
Aspect
responses
Positive
neutral
Negative
Improving community
94.2%
3.5%
2.3%
171
transport
Improving out-of-hours
94.1%
4.7%
1.2%
170
inpatient medical cover
More efficient use of
94%
2.4%
3.6%
168
resources
Better joint working
93.4%
4.2%
2.4%
167
Improving public
93.4%
4.2%
2.4%
167
transport
Developing care homes
89.4%
7.1%
3.5%
170
Providing more care-at88.4%
7.5%
4%
173
home (homecare)
Retaining General
Practice Health Centres
86.8%
13.2%
174
at Grantown and
Kingussie
Providing services from
86%
7.6%
6.4%
171
modern buildings
Developing new hospital
and resource centre in
81.8%
5.9%
12.4%
170
Aviemore
Retaining some
outpatient services at
77.8%
18.1%
4.1%
171
Grantown and Kingussie
Retaining NHS Dental
73.4%
24.9%
1.7%
173
Services at Grantown
Moving Aviemore Health
68%
20.3%
11.6%
172
Centre into new facility
Closing in-patient beds in
54.5%
24.6%
21%
167
St Vincent’s hospital
Moving Glen day centre
in Aviemore into new
54.4%
28.7%
17%
171
facility
Closing in-patient beds in
53.8%
21.9%
24.3%
169
Ian Charles hospital
78
Making decisions
The Board of NHS Highland will consider the recommendation at their
meeting to be held in Inverness on 7th October 2014.
This is a meeting held in public and papers for the meeting are available
on the NHS Highland website, one week in advance of the meeting.
http://www.nhshighland.scot.nhs.uk/Meetings/BoardsMeetings/Pages/W
elcome.aspx
If you have any queries about the Board meeting, please contact
kenny.oliver@nhs.net or maimie.thompson@nhs.net
NHS Highland
Assynt House,
Beechwood Park,
Inverness, IV2 3BW
01463 717123
How to find out more
For any further information, please get in touch with:
Dr Boyd Peters
clinical lead
Nigel Small
director of operations
Maimie Thompson
head of public relations
Tel 01479 811792
Tel 01463 704622
Tel 01463 704722
boydpeters@nhs.net nigel.small@nhs.net
maimie.thompson@nhs.net
Local contacts
Contact details of the members of the steering group are also available
on the NHS Highland website.
www.nhshighland.scot.nhs.uk
79