Highland NHS Board7 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, ChiefOperating Officer

The Board is asked to:

Consider the detailed report on the feedback from three month public consultationinto proposed major service change

Note the feedback from the Scottish Health Council endorsing the consultationprocess

Endorse the recommendation in support of the preferred option – to developCommunity hospital and resource centre in a central location (Aviemore)

Note the next steps and the requirement for any decision on proposed major servicechange to be considered by the Cabinet Secretary for Health and Wellbeing

1. Background and Summary

This paper reflects the culmination of a huge amount of work which has taken place over thepast five years as part of a comprehensive engagement exercises with communities inBadenoch and Strathspey (part of South and Mid Operational Unit). In particular it highlightsthe main findings from the three month public consultation exercise.

Within Badenoch and Strathspey some services are not strategically located or adequatelyresourced making them not as effective or efficient as they need to be to meet futuredemands. In addition the two local community hospitals are old, not in good physicalcondition and not designed to meet modern standards.

Work has been ongoing to look at these issues with a view to providing sustainable solutionsfor the future. Through an options appraisal process a local steering group agreed a short-list of three options:

Option 1 – Do minimum

Option 2 - Community hospital and resource centre in one town (‘hub’) and scaled-downservices 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 wouldmean building a new community hospital and resource centre in Aviemore, as part of a widerredesign and modernisation of health and social care services.

It would also include the re-location of Aviemore Health Centre, some other services locatedin Aviemore and the closure of both local hospitals - Ian Charles in Grantown-on-Spey and StVincent’s in Kingussie. Any closures would be planned to take place after the new serviceswere in place.

The board of NHS Highland considered these proposed changes to be ‘major’ and wastherefore subject to a period of formal public consultation. The board approved the move toformal public consultation at a special meeting held in March 2014.

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The formal public consultation was launched on 21st April and ran for a total of 14 weeks until21st July 2014. NHS Highland was consulting on the range of options including option threeas the preferred option.

It is estimated that some 500 people took part during the consultation. Of those whocompleted NHS Highland’s consultation response survey (176) there was wide-spreadsupport for the case for change with almost 80% selecting the preferred option.

Positive feedback on the consultation process and the preferred option was also receivedfrom staff, local GP Practices and partner agencies including Highland Council, ScottishAmbulance Service, Scottish Fire and Rescue Service, Highlands and Islands Enterprise andthe Highland Hospice.

The Scottish Health Council has endorsed that the process has been in accordance withScottish Government Guidance. This includes the options appraisal process (service modeland sites), public consultation materials and the public consultation communications andengagement.

Taking everything into consideration the operational unit can demonstrate broad supportfrom the wide range of stakeholders for the preferred option (option 3) and it is now beingformally recommended to the board for endorsement.

As the preferred option represents major service change, should the board endorse therecommendation, the next step would be for the proposals to be considered by the CabinetSecretary for a final decision.

It was also clear from some of the feedback NHS Highland received (writtencorrespondence, personal contact with staff and at meetings) that there were some peoplewho had some strong concerns about aspects of the proposed redesign (most notably butnot exclusively in Grantown-on-Spey), and some topics of wider general concern (futureservices, transport, future use of buildings, bed requirements and care-at-home) requiringfurther consideration

The report, therefore also sets out some of the next steps in meeting the guidance anddescribes some of the further work that would be required should the preferred option moveto implementation.

2. NHS Highland Report on the Public Consultation

2.1 Overview

The public consultation report specifically covers the three month public consultation into theproposed redesign of services across Badenoch and Strathspey.

It describes in detail how the consultation was managed and promoted, the range of waysthat views were gathered, and an analysis of all the feedback.

It includes the findings from the feedback on the public consultation survey and the summaryfeedback from the independent review of the consultation process by the Scottish HealthCouncil.

The write-up of the options appraisal process on site selection is also included. This workcould only be completed after the consultation had closed.

Based on an assessment of all the supporting information a recommendation to the board ismade on model of service, location and site.

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The next steps in meeting the guidance are highlighted including some of the ongoing andadditional 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 toservices being proposed have been understood and the majority of the feedback suggeststhat the case for major service change is accepted.

There was consistency in views received through the different routes and from partneragencies. 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 feedbackwhich emerged during the consultation. Areas of greatest concerns were raised from someresidents in Grantown-on-Spey. This was also highlighted in the Highland Council responseand 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, werepositive about the opportunities to engage with NHS Highland and there was goodawareness about the consultation and how to make views known

NHS Highland’s Health and Social Care Committee endorsed that the consultation processcomplied with Scottish Government major service change guidance. They also supportedthat the operational unit was in a position to present the full findings to NHS Board meeting tobe held in October.

The Scottish Health Council carried out an independent review of the process and has alsoendorsed the process. They highlighted some areas of good practice as well as how theprocess 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 todevelop a community hospital and resource centre in Aviemore supported with widerdevelopment of community services. This option also received backing from all four medicalpractices and partner organisations (The Highland Council, Scottish Ambulance Service,Scottish Fire and Rescue Service, Highlands and Islands Enterprise and the HighlandHospice).

People also had the opportunity to comment on aspects of the proposed changes. Over halfthe people who responded were positive about all elements. Closing in-patient beds in IanCharles 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 sameconclusion on the favoured choice of site (Site C, Technology Park in Aviemore). Thispreference is based only on qualitative factors. Other important factors such as developmentcosts, land purchase and the suitability of the land for construction also have to beconsidered. This work would be completed if there is a decision to progress to implementthe 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 theboard for endorsement.

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2.5 Next Steps and Decision Making Process

Should the board endorse the recommendation then an updated report will go to the ScottishGovernment for a final decision by the Cabinet Secretary.

Only if the Cabinet Secretary approves the preferred option would planning for the newfacilities and services begin in earnest.

There would then be a requirement for the Business Case process to be followed, inaccordance with the Scottish Capital Investment Manual Guidance. Once the next stepswere completed an Initial Agreement document would need to be prepared and submitted forconsideration by the Capital Investment Group.

Other specific work identified that would need to take place includes:

Setting out how Primary Care and community services (delivered through the fourHealth 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.

3 Contribution to Board Objectives

The service redesign, if successfully implemented would provide significant opportunities toimplement better health, better care and better value and maximise the potential ofintegration.

The operational unit is fully aware of other strategic and operational considerations such aswider discussions relating to dental services, MSK review, transforming outpatients, olderadult mental health services, strategic overview of radiology and diagnostic services and theInverness 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, andsenior management leadership. Significant effort has been made to achieve a clinicalconsensus, and this has been supported through a series of clinical workshops and ongoingmeetings with the local GPs, facilitated through the locality clinical lead and director ofoperations.

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

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underway linked to integration of health and social care and includes opportunities for staffco-location and professional and team development.

It is important that staff are provided with a safe and improved working environment as partof the staff governance standard, to enable them to provide high quality care for serviceusers. The redesign work is consistent with meeting this standard.

Organisational Change Policy will underpin the approach to be taken supported by workforceplanning and development strategies. There would need to be a clear read across with theLocal 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 nextsteps including through the Impact Assessment and onwards through organisational changeprocess.

Updates have been provided to Staff Governance Committee, Highland Partnership Forum,Area Clinical Forum, Highland Health and Social Care Committee, NHS Highland SeniorManagement Team, and Raigmore Senior Management Team.

Meanwhile service will continue to be staffed and developed, as appropriate to ensureongoing quality of care. At this stage it is too early to implement a workforce plan.

Clinical GovernanceClinical 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 serviceimplemented would be required to be safe, effective and evidence-based. There issignificant clinical engagement and consensus in both areas. Implementation of thepreferred options would support delivery of NHS Highland’s strategic objectives.

There are significant governance implications to delivering healthcare in a hospitalenvironment which is not conducive easily meeting standards. Recent hospital inspectionsrelating to healthcare environment, disability access, hospital security, fire safety andhealthcare associate infection have all highlighted current risks. Mitigation has beenundertaken but the aged structures have made this challenging. In order to make surefacilities remain safe to deliver services last year NHS Highland invested over £100k formaintenance alone.

Furthermore, clinicians have raised concern about potential risks of patient harm caused byresources split over several sites in the present arrangements. Effective clinical governanceand application of the Highland Quality Approach including systems redesign, mistakeproofing, and reduction in unnecessary waste and ability to lower the risk of patient harm willbe far more effective in a redesigned service.

These risks will continue to be managed until any new arrangements are in place. It isanticipated that there will also be day-to-day 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, with the present arrangements.

It is anticipated that there will be issues to be managed and short-term decisions to be takenrelating to e.g. failures in equipment, ability to meet standards. Any decision will need to takeconsideration of the range of governance issues, financial impact, management of any risksand business continuity.

Financial ImpactA high level financial appraisal has been carried out. At this early stage the purpose was tolook at likely overall affordability and which option would provide best value for money. Amore detailed appraisal of costs will be undertaken as the project progresses to the nextphase.

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The service redesign is part of Local Delivery Plan. One of the key sections within the LocalDelivery 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 identifiedaround the current model of service. The proposals, if implemented, would address the risksarising 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 aroundsustainability of Out-of-Hours (nurse and medical cover and inpatient management). Theserisks would be addressed as part of the new arrangements. Individual components of theservice redesign may be required to have specific risk assessment.

Financial risks have been identified around maintaining the status quo and there are nowsome wider potentially significant reputational risks if this work is not taken through tocompletion in a reasonable time-scale.

A new facility would be required to be built and this would require a suitable site to besecured.

5 Planning for Fairness

The impact assessment has been updated and is available on the website. Further detailedwork would be required as part of design of any proposed new buildings.

Further work is ongoing, including establishing a local access and transport group andcarrying out a Transport Survey.

There was one request for an audio version, one request for large-print consultationdocument 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 andcommunications exercise led and delivered by the operational unit supported by a number ofdepartments. The public consultation ran from 21st April to 21st July.

In discussion with the Scottish Health Council a wide range of approaches were identified foruse to raise awareness with the public, partners and staff about the consultation; what wasbeing 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 regularlyreviewed. The process was designed to be a responsive with capacity built in to meetanticipated requests as they emerged during the consultation.

During the course of consultation period staff attended over 50 meetings with events startingon the 24th April and concluding on 9th of July.

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A total of 8,207 summary documents were issued (homes = 7,703 and businesses =502) viaa 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, ScottishHealth 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 firstmeeting.

7 Conclusion

The changes being proposed offer the opportunity to bring about major service improvementconsistent with national strategy and the Highland Quality Approach. This would providemodern services and represent better value for money. Implementing the preferred optionwould help to accelerate transformational change and further support integration of adulthealth and social care in its widest sense.

This is a challenging but exciting modernisation programme which would impact oncommunities 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

Proposed modernisation of community andhospital 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

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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

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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 peoplewere comfortable with the consultation process and that there was strong support forthe preferred option.

79% of people who responded to the survey agreed with the proposal to develop acommunity hospital and resource centre in Aviemore supported with widerdevelopment of community services.

This option also received backing from all four medical practices and partnerorganisations (The Highland Council, Scottish Ambulance Service, Scottish Fire andRescue 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 inAviemore.

The consultation process has been endorsed both internally via the Highland Healthand Social Care Committee and independently by the Scottish Health Council.

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Executive summary

1 Services throughout NHS Highland need to change to make sure they meet thefuture needs of the population.

2 Within Badenoch and Strathspey some services are not strategically located noradequately resourced making them not as effective or efficient as they need tobe. In addition the two local community hospitals are old, not in good physicalcondition and not designed to meet modern standards.

3 Work has been ongoing over the past few years to look at these issues with aview to providing sustainable solutions in the future.

4 A local steering group including community councilors, service users, partneragencies, representatives from local groups, elected members, GPs, otherclinicians, NHS Highland staff and others went through an options appraisalprocess 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’) andscaled-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 implementedthis would mean building a new community hospital and resource centre inAviemore as part of a wider redesign and modernisation of health and social careservices.

6 It would also include the re-location of Aviemore Health Centre, some otherservices located in Aviemore and the closure of both local hospitals - Ian Charlesin Grantown-on-Spey and St Vincent’s in Kingussie. Any closures would beplanned 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 Boardapproved 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 14weeks until 21st July 2014. NHS Highland was consulting on the range of optionsincluding option three as the preferred option.

9 During the consultation period over 50 meetings and events took place and asummary document was mailed to every house (7,703 copies). Throughout theconsultation there was a regular flow of information available for the public. Allrequests for meetings during the consultation period were accommodated.

10 There was active engagement from community councils, local councillors andother key local groups such as Friends of Ian Charles, Friends of St Vincent’s,Badenoch & Strathspey Community Transport Scheme and Local Access Panel

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to name but a few. There was also wider and ongoing engagement with partneragencies, MSPs, local MP and others.

11 It is estimated that 500 people took part during the consultation. Of those whocompleted NHS Highland’s consultation response survey (176) there was wide-spread support for the case for change with almost 80% selecting the preferredoption.

12 Positive feed-back on the consultation process and the preferred model ofservice was also received from partner agencies including the Highland Council,Scottish Ambulance Service, Scottish Fire and Rescue, Highlands and IslandsEnterprise and the Highland Hospice).

13 In their independent report of the consultation process the Scottish HealthCouncil concluded:

“Based on our review and feedback from local people we are satisfied that NHSHighland has followed Scottish Government guidance on involving local people inthe consultation.”

“Overall, feedback received indicated that the majority of people had understoodthe reasons for change, how the proposals had been developed, and felt listenedto and that there has been sufficient opportunities to take part in theconsultation.”

14 Taking everything into consideration the operational unit can demonstrate broadsupport 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 theproposals to be considered by the Cabinet Secretary for a final decision.

16 It was also clear from some of the feedback NHS Highland received (writtencorrespondence, personal contact with staff and at meetings) that there weresome people who had strong opposition about aspects of the proposed re-design(most notably but not exclusively in Grantown-on-Spey), and some topics ofwider general concern (future services, transport, bed numbers, future use ofbuildings, care-at-home) requiring further consideration.

17 Should the proposal get the necessary endorsements further work would berequired, particularly around some of the detail relating to the new hospital,delivery of care-at-home, transport arrangements and what would happen tosome of the buildings.

18 This would all form part of the work required for the Business Case Process andwould require ongoing engagement with all stakeholders.

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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 proposedre-design of services across Badenoch and Strathspey.

It describes how the consultation was promoted, the range of ways that views weregathered, and an analysis of all the feedback.

It includes a summary of the feedback from NHS Highland’s consultation survey andthe 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 workcould only be completed after the consultation had closed.

Based on an assessment of all the supporting information a recommendation to theBoard is made on model of service, location and site.

The report also sets out some of the next steps in meeting the guidance anddescribes some of the further work that would be required should the preferred optionbe implemented.

There would be a requirement for the Business Case process to be followed, inaccordance with the Scottish Capital Investment Manual Guidance, which wouldmean an Initial Agreement document would be required for consideration by theCapital Investment Group.

Other specific work identified to take place includes:

Setting out how Primary Care and community services (delivered through thefour Health Centres) will be maintained and improved

Explore opportunities for co-location of children and families staff in any newfacility

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

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Collaboration with all concerned regarding the future use of any buildings nolonger required by NHS Highland

On-going engagement with local communities and stakeholders throughout thedevelopment of the business case

1.2 NHS Highland Strategic Context

NHS Highland’s strategic framework was endorsed by the Board at its meeting inOctober 2010. It was founded on the Healthcare Quality Strategy for Scotland andset 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 andre-design of services, including around community hospitals, older adult mentalhealth services, care-at-home, care homes, extended community care and integratedteams.

NHS Highland reported at their Board Meeting in June 2011 around £74m of repairs,maintenance and upgrading work to bring buildings up to minimum nationalrequirements. The most recent report shows the figure at £80m reflecting theadditional estate now owned by NHS Highland since integration in April 2012.

In terms of Badenoch and Strathspey the associated back-log maintenance costsare currently estimated at £5.2million. Notably, however, due to the changing needsof the service and physical layout and condition of the buildings they would never beable to evolve to facilitate modern integrated services.

Although the physical condition of the hospital buildings and some of the equipmenthas created some pressing urgency around the review, there are also a number ofother important considerations to be addressed including: ensuring safe andsustainable nursing and medical rotas, especially during the out-of-hours period, theneed to increase care-at-home capacity, as well as more generally modernizingservices to meet future demands.

It is within this strategic context, that the local review and re-design proposals haveemerged.

1.3 Description of Local Services

The services under review fall within the locality of Badenoch and Strathspey. Thereare 13,472 people registered with the three General Practices in the area: Grantown-on-Spey, Aviemore and Kingussie. The Kingussie Practice also runs a practice inLaggan. 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 localcommunities are also served by two community hospitals:

Ian Charles in Grantown is a 13 bedded, GP led hospital which is co-located withthe health centre and modular dental facility. The hospital is supported by 24 hournursing cover. Minor Injury services are also available at the hospital. There are avery limited number of consultant outpatient clinics and x-ray service.

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St Vincent’s in Kingussie is split into two units. The lower floor is 10 bed GPmedical unit. Upstairs is an Old Age Psychiatry unit which has seven inpatient bedsand us used for psychiatric assessment. Both units have 24 hour nursing cover.

Since integration, NHS Highland now manages two care homes (Grant House inGrantown-on-Spey and the Wade Centre in Kingussie). In addition there are twoprivate homes in the district: Mains House Care Home in Newtonmore andGrandview 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 numberof different bases.

The location of the main NHS Highland run health and social care services inBadenoch and Strathspey are shown (see map below).

No change to the location of health centres or out-of-hours arrangements are beingproposed as part of the consultation, other than the recommended re-location of thehealth 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 futurewere presented to the Board in March 2014. Details are available on the NHSHighland website and were described in the public consultation materials.

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Three options were short-listed and the scoring identified option 3 as the clearpreferred 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 RankCapital

costRunning

costs

1 Do minimum 250 3 £5.2m £3.2m

2Community resourcecentre and hospital huband spoke

463 2 £9m £2.3m

3Community resourcecentre 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 changesbeing proposed to be major. A requirement of proposed ‘major’ service change is theneed 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 indeveloping health and community care services including requirements for a publicconsultation. This document also clarifies the role of the Scottish Health Councilduring service change which is to quality assure the engagement process andproduce a report on their findings for the Board to submit to the minister, alongsidethe final proposals.

NHS Highland worked closely with the Scottish Health Council on thecommunications and engagement plan, the public consultation materials and theconsultation survey.

In April 2014 the Scottish Health Council confirmed that they were satisfied with thearrangements NHS Highland had in place allowing the formal consultation to takeplace.

1 http://www.sehd.scot.nhs.uk/mels/CEL2010_04.pdf

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2 NHS Highland management of the publicconsultation 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 weeksuntil 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 tooffer a view on any alternative option. Moreover, the feedback form also allowedpeople 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 atevents, 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 bya small core team (Box below). A member of the core team was present at all of themeetings or events. This was to provide consistency in approach. The core teamwere also responsible for providing responses to any correspondence.

Members of NHS Highland core team and their lead responsibilitiesName Responsibilities NotesNigel Small Senior management leadership

Overview of processSigning-off responses and mediareleases

Point of contact for Board,Scottish Government,Scottish Health Council andlocal steering group

Boyd Peters Senior clinical leadershipClinical adviceResponding to clinical queries

Lives in Grantown-on-Spey

KennyRodgers

Project managementFinancial advice includingendowments and business caseprocess

Lives in Grantown-on-SpeyProject manager for NairnTown and County new build

MaimieThompson

Project managementAdvice on service change processoverview of engagementOverview of communicationsincluding media

Point of contact for Board,Scottish Government,Scottish Health Council andlocal steering group

John Bogle Site selection and options appraisalAdvice on business case process

Project manager for newbuild of Migdale Hospital

Sue Blackhurst Co-ordination of all administrationfor events and meetings

Point of contact for localsteering group

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2.2.1 Other NHS Highland staff and GP Practice staffOther 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 theprocess including attending some of the meetings.

Margaret Macrae, local staff side representative was also an active member of thesteering group.

Practice managers provided support with raising awareness of the consultation andthe 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 TeamAll three members of the public relations and engagement team played an active partin supporting the process including: handling media inquiries, issuing media releases,promoting the consultation through social media, designing posters and flyers, andmanagement of website. They also took part in walkabouts in Newtonmore,Kingussie, Grantown-on-Spey and Aviemore.

2.2.3 Clinical Governance TeamStaff in the clinical governance team were responsible for advising with the design ofthe 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 analysisand wrote up the report on the findings.

2.2.4 Executive and Non Executive inputExecutive leadership was provided by Elaine Mead (chief executive), Deborah Jones(chief operating officer) and Nick Kenton (director of finance). This includedattendance at some of the meetings and events and liaison with ScottishGovernment.

The Nairn, Badenoch and Strathspey District Partnership is chaired by a nonexecutive director of NHS Highland.

The Highland Health and Social Care Committee (a key committee of the Board) ischaired by a non executive. They were responsible for providing internal assuranceto the Board on whether, in their opinion, the major service change process had beenfollowed.

Non executive guidance was also provided from Robin Creelman and ElaineWilkinson. They provided “outside-eyes” to support the process but were consideredto be impartial as they did not sit on the Highland Health and Social Care Committee.

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2.3 Other Advice and Support

2.3.1 Local Steering GroupThe make-up of the steering group and how they have been involved is described inthe consultation materials and their names and contact details are available on thewebsite2.

The group were kept in regular contact throughout the consultation period throughgroup emails and direct contact. Many members attended one or more events andalso brought queries to the attention of the core team throughout the consultation andcontinue to do so.

A well-attended mid-review meeting of the steering group was held on 5th June. Thiswas to get feedback from members on the process and to allow time to incorporatetheir suggestions. This formed part of NHS Highland’s mid-consultation review write-up.

The public consultation was also discussed at the NHS Highland Annual Reviewwhich was held on 9th June in Fort William. Two members of the steering groupattended the event.

The Steering Group was also re-convened on 27th August 2014 to complete theoptions appraisal exercise on the potential sites. This could only be completed afterthe consultation closed because public preference was one of the criteria being usedon which to make a recommendation about the sites.

2.3.2 Community Councils and Local GroupsThere was ongoing liaison with the community councils and local groups to supportorganising of meetings, promoting events and public meetings.

All community councils were also contacted to get copies of minutes of any meetingsNHS Highland attended. This was so that the information could be included on theNHS Highland website and also be used to validate NHS Highland’s notes from anymeetings.

2.3.3 Scottish GovernmentNHS Highland has kept in regular contact with the relevant departments of theScottish Government during the consultation process. Carmel Sheriff (performancemanager) visited Badenoch and Strathspey on 14th May. The director of operationsshowed her round each of the facilities under review. This was followed up with awider discussion on the consultation process with the chief executive and head ofpublic relations and engagement.

2To 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 alsoopen to include anyone who expressed an interest to get involved and to date all requests to getinvolved 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 itsprovision were also involved. There is no definitive guidance on the optimum number of people, or theproportion 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 shouldneither be too small or too large.

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In July 2014 Steven Hanlon, capital finance and policy manager visited the currentfacilities in Badenoch & Strathspey and also met local clinicians.

More generally regular capital review meetings are held with Mike Baxter, deputydirector (capital and facilities) and colleagues and these have included briefings onthe Badenoch & Strathspey re-design proposal.

Update reports were considered by Highland Health and Social care Committee on10th July 2014 and 11th September, and were also shared with Scottish Governmentcolleagues.

2.3.4 Scottish Health CouncilNHS Highland has worked closely with the Scottish Health Council (SHC) servicechange team. This included meeting regularly during the consultation period.

SHC staff attended a number of meetings and conducted their own independentreview of the process including holding a focus group.

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3 Raising awareness of the publicconsultation

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 wereidentified for use to raise awareness with the public, partners and staff about theconsultation; what was being proposed, promotion of meetings and how people couldmake their views known.

These activities were set out in a communications and engagement plan which wasregularly reviewed. The process was designed to be a responsive with capacity builtin to meet anticipated requests as they emerged during the consultation.

Describing the extent of the communications and engagement activities during theconsultation is particularly important. It provides the context from which to interpretthe number of attendances at the meetings and numbers responding to theconsultation survey.

It is estimated that around 500 people actively took part in the consultation. It isdifficult, to give an exact number, however, because some people attended morethan one event, some members of the public and staff who attended events alsosubmitted responses, wrote letters and so on.

3.1.1 Summary Headlines

During the course of consultation period staff attended over 50 meetings withevents 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 andbusinesses =502) via a mail drop

NHS Highland issued regular media releases about the consultation, and paid forthree adverts to be placed in the local newspaper

Hundreds of posters promoting dates of events were distributed, numerousarticles issued for local and NHS Highland publications, and websites

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Summary of the main initiativesRaising 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 processIn response to local feedback, or at request of the Scottish Health Council, additionalactivities 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 indiscussion with the Scottish Health Council. They confirmed that the documentscomplied with the guidance.

The documents set out the preferred option, the options appraisal process andadvantages and disadvantages of the short-listed options.

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They also highlighted how people could make their views known. The NHS Highlandweb address and named points of contact with email addresses, telephone numbersand postal address with free-post were included.

The intention of the documents was always to be generic and reasonably highlevel; hence all services and organisations were deliberately not listed. It was feltthat 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 MaterialsA 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 shouldbe noted that this exercise is not a formal requirement, nor NHS Highlandunderstands, is it usually carried out. The decision to take this step was to providethe best assurance that all homes and businesses in the area had the opportunity tobe 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 processincluding as part of a walkabout, as well as being widely advertised, and moregenerally as and when opportunities presented, visits to the area

3.3 Partner Agencies

During the consultation the director of operations has met with Scottish AmbulanceService (21st May) and Cairngorms National Park Authority (CNPA) (30th May and10th September). These have both been very positive with early engagementappreciated and clear opportunities for joint working. This dialogue has beenongoing and further meetings have taken place and are planned.

There have also been discussions with Transport Scotland including being informedon the plans for dualling of A9.

As well as local meetings, a letter was also sent from NHS Highland chief executiveto a number of organisations including: The Highland Council, The ScottishAmbulance Service, Cairngorms National Park Authority, Highlands and IslandsEnterprise, The Highland Hospice, Scottish Natural Heritage, Police Scotland, FireService and the Highland Third Sector Partnership.

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3.4 Voluntary, Third and Independent Sector and Others

There has also been direct contact with a number of local groups including Badenochand Strathspey Transport Group, Badenoch and Strathspey Access Panel, Friends ofIan Charles and St Vincent’s, Kingussie Therapy Garden Volunteers, AdvocacyHighland, Age Concern, Badenoch Arthritis Support Group, Reshaping Care forOlder 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 wereemailed 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 NHSHighland in Badenoch and Strathspey, and this was repeated towards the end of theconsultation. This included Dachaidh Community Support Ltd, Deaf Action,Grandview House, Richmond Fellowship, Hanover (Scotland), Able Care, CarrGomm 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. Thepurposes 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 firsttwo weeks with community newsletters, websites and social media (as detailed in theplan). 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 socialmedia 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, forinstance, 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 ourVillage Hall about Carrbridge Consultation events.”

A further suite of posters were prepared to promote the public meetings. Members ofthe steering group, Friends of Ian Charles, community council members and a localcouncillor carried out the local distribution. These were also available on the website.

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Following on from the mid-way review with the Steering Group (5th June 2014) furtherpromotion was done on all the ways people can feedback including an advert in thelocal paper (19th June).

3.6.1 WalkaboutOn 27th May a member of the NHSH Highland communications team carried out awalkabout in Newtonmore, Kingussie, Aviemore and Grantown-on-Spey with the aimof providing a direct spot-check of levels of awareness of the consultation in thesecommunities.

He spoke to around 50 people of wide age ranges and in a number of differentcommunity settings. A total of 26 full consultation documents and 43 posters werehanded out including providing dates of consultation events.

Following feedback from the steering group a further walkabout was carried out inGrantown in June.

3.7 NHS Highland Website

The consultation was promoted on the NHS Highland website with all the backgroundinformation, consultation materials and a calendar of events.

The links were also sent to others to display - GP Practices, local communitywebsites, Highlife Highland, and other relevant organisations. Some examples of thelinks 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

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3.8 Media, Social Media and Other Publications

3.8.1 Media releasesThe 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 publicconsultation got underway:

18th September 2014Hospital future should also be put to the vote – Leonard Grassick (Grantown-on-Spey)

14th AugustMigdale 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 JulyMaking the case for keeping the hospital open – Leonard Grassick (Grantown-on-Spey)

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 JulyConsultation period should be extended Leonard Grassick (Grantown-on-Spey)

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26th JuneNHS chief’s comments worth considering - Leonard Grassick (Grantown-on-Spey)

19th June 2014Cash 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 andthese 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 includingHighLights, GP Practice Newsletters and NHS Highland Annual Review (9th June2014) and NHS Highland News.

3.8.5 Face to Face – Meetings, Events and GroupsDuring the course of the consultation NHS Highland staff took part in around 50events 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 alsoreceived 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 Rodgersand 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 thequestion and answer session, from the "non-professional" viewpoint was excellent.Interestingly when I took round the posters and consultation documents peopleimmediately opened them and starting reading - always a good sign! I also spoke toothers there and the feedback was extremely positive. ““Thank you for last night - thought the presentation was very good. It is not easy to

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explain all the steps taken and decisions made and still reassure those who have notbeen involved that they have a voice and their views still count, but you did itadmirably. Thought the discussion and suggestions made by the KCC were good.”

People attending the events had the opportunity to take away a consultationresponse form (and freepost envelope) and were encouraged to feedback their viewsand also to make contact with the Scottish Health Council.

They were also advised they could write to NHS Highland if they found that a morehelpful 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 andFace-to Face. All MSPs were sent an email on 25th April updating them on theconsultation 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 anupdate; no concerns were raised at this stage.

They were also e-mailed a copy of the mid-way review report (6th July) and updatesafter the consultation closed (28th August and 17th September).

Dave Thompson MSP for Skye, Lochaber and Badenoch is also on the mailing list forthe Steering Group. Fergus Ewing (MSP for Inverness and Nairn) and Minister forEnergy, Enterprise and Tourism has a branch surgery in Grantown-on-Spey andhas 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 theconsultation.

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 andTransport Group. They have been in regular contact with the core team to helpfacilitate engagement. They are on record as being positive about the process todate.

3.10 Staff/GPs and Practice staff

The formal consultation got underway with a series of drop in events at St Vincent’sand Ian Charles Hospital, Wade Centre (Care Home in Kingussie), Grant House(Care Home in Grantown-on-Spey) and Glen Centre (Day Centre in Aviemore). Thiswas facilitated by the director of operations and around 40 staff attended thesessions. Further drop-in events were held during the consultation.

The head of public relations and engagement also visited all the NHS Highlandfacilities including GP Practices on 13th May. This was to discuss displays anddissemination of consultation documents, issuing travel surveys, posters and other

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consultation materials. Charge nurses, practice managers, care home managerswere 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 anda range of other activities and staff have attended a number of the events. The re-design has been an agenda item on various operational unit meetings.

Two workshops for all clinicians have been held. These were facilitated by anindependent health care planner. Further work is ongoing.

Dr Boyd Peters (Locality Clinical Lead) has also been liaising with all four Practices tolook at how any new potential model of service might impact upon their ways ofworking. Several meetings have been held so far and more are planned.

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4 Feedback from meetings and events

Main 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 publicmeetings and various events for staff (Appendix 3).

The main purpose of these events was to allow further opportunities to present thecase for change; the reasons the preferred option was selected and to answer anyquestions or understand any concerns.

It was not intended to “sell” the preferred option, nor to negotiate on possiblechanges to the model or options. Any new proposals or modification to proposalswould come later once the analysis to all the feedback has been considered anddebated.

4.2 Method: Process for Documenting Feedback

Hand-written notes were taken during each meeting and these were then typed up asbullet 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 theybecame available.

After the consultation closed the head of public relations and engagement andoperational unit head of finance reviewed all the feedback. All comments werecategorised to allow some high–level groupings.

4.3 Public Meetings

In discussion with the Scottish Health Council it was agreed to hold three publicconsultation meetings. These were arranged towards the end of the consultationperiod. A reporter from the Strathspey and Badenoch Herald was in attendance atthe meetings in Kingussie and Grantown-on-Spey.

4.3.1 KingussieThe first public meeting was held in Kingussie on 25th June. Nine people attendedincluding hospital staff, a GP and Scottish Ambulance Service. Two members fromthe Scottish Health Council were also present. There was full discussion on bednumbers, dementia, transport and what would happen to staff should the preferredoption be implemented.

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There was also a discussion on centralisation of services. The difference betweencentralisation within Badenoch and Strathspey as opposed to Inverness wasdiscussed. In common with many other meetings and drop-in events, what wouldhappen to the existing buildings was a source of some concern. There was alsoconsideration of the Therapy Garden and Burrell Fund for St Vincent’s.

4.3.2 Aviemore16 members of the public attended the Aviemore public meeting on 1st July. Therewas also a GP and practice manager. Topics discussed included sites, futureservices, future-proofing, transport and beds.

4.3.3 Grantown-on-SpeyThe public meeting in Grantown-on Spey was the best attended meeting of theconsultation with around 80 people. Local GPs, NHS staff, Scottish Health Councilstaff 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 strongopposition to parts of the proposal. The main concern expressed was around theproposed 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 raisedcovering the service model, finance, single rooms, care-at-home, care homeprovision, 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 frequencyTheme No Percent

Additional services 31 16%

Transport and access 23 12%

Existing Services/buildings 22 11%

Bed provision and numbers 21 11%

Site proposal 19 10%

Finance and endowments 16 8%

Care Homes/Care at Home 14 7%

Staffing 12 6%

Population 9 5%

Alternative proposals 8 4%

Other (*) 8 4%

Process 7 4%

Palliative care 6 3%

Grand Total 196 100%(*) other includes: respite, maternity, integration and housing

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4.5 NHS Highland response to Feedback

All of the issues raised were summarised together with NHS Highland responseswhich were provided at the meetings (Appendix 4). These are analysed in thissection of the report.

NHS Highland has been cautious about going too far to explore solutions to some ofthe 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 beingraised and so further work will be required regardless of the outcome of theconsultation.

4.5.1 Additional ServicesWhile it was always made clear that the re-design was much wider than hospitalservices there was significant interest in what services would be in any new facility. Itwas raised at some meetings that there was not enough detail around the clinicalmodel. This was acknowledged but it was also explained that further detailed workwould be required to support the Business Cases.

There was general support to provide more services within Badenoch and Strathspeyand the sorts of things being considered included chemotherapy, infusions, and out-patient 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 communityhospital and rural general hospital. The importance of explicitly considering childrenand young people’s services was also highlighted. These points were also raised inthe Highland Council submission.

More generally NHS Highland needs to be clearer on using consistent terminologyand understanding about the level of service being provided relating to casualty,minor injury and A&E services. Through the public consultation it has beenhighlighted that there needs to be clarity around the use of the term A&E (includingfrom NHS Highland communications).

This is an issue which needs to be clarified across all parts of NHS Highland and willneed to be followed-through with a review of all communications on this matter suchas website, literature.

4.5.2 Transport & AccessNHS Highland is not a transport provider but the opportunities to use the redesign ofservices to improve transport and access issues were recognised. Clearly peoplehave to be able to access any facilities that exist or are developed. Any changesshould take actions to reduce any inequality gaps that currently exist.

From the feedback the vast majority of people don’t currently use public transport toaccess services, arguably because the service is very limited. Further work will berequired, however, to make an assessment as to whether patients, families, visitorsand staff would use public transport were it more readily available. This would have

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some bearing on, for instance, the number of car parking spaces required atproposed new facility.

More generally further steps need to be taken to reduce people having to travel in thefirst place. In the future more outpatient consultations will be replaced withalternative approaches such as with video-conferencing, or telephone and e-mailsupport.

Making sure the right community and home based service are in place will also meanpeople 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 caseprocess and a group has already been set-up to lead and co-ordinate the work. Theyheld their first meeting in September.

The group is made up of officers and elected members of The Highland Council, andrepresentatives of NHS Highland, Cairngorms National Park Authority, the ScottishAmbulance Service, Badenoch & Strathspey Access Panel, Badenoch & StrathspeyTransport Company and Voluntary Action Badenoch & Strathspey and communityrepresentatives.

The Highland Council has recently submitted a proposal for additional investment topilot new approaches to transport provision. A decision from Transport Scotland’sBusiness Development Fund on the bid is expected in the next few months.

4.5.3 Existing Services and Buildings

4.5.3.1 ServicesThe consultation meetings and events provided further opportunities to clarify whatservices 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 thecaveat of being able to recruit staff and be affordable

4.5.3.2 Clinical Governance and Management of RisksClinicians have raised concern about the potential risks of patient harm caused byresources split over several sites in the present arrangements. This is one of thedrivers to support changes. Effective clinical governance and application of theHighland Quality Approach including systems redesign, mistake proofing, reducingwaste and lowering the risk of patient harm will be far more effective in a re-designedservice.

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In the covering paper to be presented to the board in October the management ofsome of these risks will be briefly described.

Going forward it is also anticipated that there will be operational issues to bemanaged and short-term decisions to be taken relating to e.g. failures in equipment,ability to meet standards, recruitment difficulties and affordability, under the presentarrangements.

Any decision will need to take consideration of the range of governance issues, widerre-design of services, pressures on Raigmore Hospital and general management offinancial pressures.

The operational unit is fully aware of other strategic and operational considerationssuch as wider discussions relating to dental services, MSK review, transformingoutpatients, older adult mental health services, strategic overview of radiology anddiagnostic services and the Inverness Master Plan. Over the next two to three yearsother work may be identified.

The work to redesign services has had active input and support from local cliniciansincluding GPs and their staff, hospital and community nursing staff and AHPs. Anexternal healthcare planner has been involved and met with clinicians to help definethe proposals. Local clinicians will continue to be consulted and involved as theproject moves through its various stages to completion.

4.5.3.3 HistoryThere was significant interest in both the history and future use of the buildings,particularly both hospitals. During the consultation NHS Highland was able toconfirm that the buildings are not listed.

There was recognition about the importance of honouring the past and making surethe heritage of the hospitals is safeguarded. NHS Highland set out their commitmentto this in the consultation materials and this was reinforced during the consultationevents, meetings and correspondence. There is ongoing contact with relevantstakeholders including authors of “History of Highland Hospitals”.

Moreover it was raised at the Grantown-on-Spey public meeting (and followed up byletter) that NHS Highland had not taken into account the different histories of bothlocal hospitals.

4.5.3.4 Therapy GardensMeetings have already taken place about the Therapy Garden at St Vincent’s and thekey people who can support this work have been identified. There is commitment tolook 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 suchfacilities early in the process and not as an add-on. This approach has beenwelcomed by the local group.

4.5.4 Bed Provision and NumbersThere were some concerns raised about the number of beds proposed and ingeneral a feeling that more beds would be required to future-proof the service.

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NHS Highland made it clear that the final number of beds had not yet been finalisedbut initial work to inform the public consultation suggested the requirement would bearound 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 factthe review of historical data shows that over the years NHS Highland has reducedthe length of stay and number of hospital beds (Charts below).

NHS HIGHLAND

No. of hospital beds 1986 to 2010

-

500

1 000

1 500

2 000

2 500

3 000

3 500

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

No

.of

ho

spita

lbe

ds

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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 Mid-year population estimates, 2000 -2012 (revised series) * Expected activity calculated by applying agespecific rates of bed day use and day case attendance of NHS Highland residents in 1999-2000 tomid-year population estimates

It was clarified that there are no proposals to include maternity beds due to theirbeing insufficient demands to enable practitioners to maintain their skills.

4.5.5 Site ProposalThere was interest in the sites, particularly around the size of sites and how were thesites short-listed. This was covered in the consultation materials with the finalconclusion 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 andaccess in the building. This would involve engagement with all stakeholders

4.5.6 Finance including EndowmentsThere were a number of queries relating to finance such as how much would thebuilding costs and how developments would be funded.

It was explained that the final figures would not be known until the full extent of theaccommodation is described, the site purchase and development costs are knownand commercial negotiations concluded. However NHS Highland is working on abudget figure of £12million to £15million which is based on other similar facilitiesrecently developed in Highland. NHS Highland is closely following the ScottishGovernment process for capital investment and funding options would be explored aspart of the business case process.

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In terms of endowments, The Theresa J Burrall legacy will continue to be used for thebenefit 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 EndowmentFund Trustees would then need to apply to the courts to determine the future use ofthe legacy.

The advice from NHS Scotland legal office confirms that the legacy could potentiallybe used for the benefit of a different hospital and/or the community where theservices are currently provided to benefit local people in the future.

Any future decisions would be progressed by a local group from within the Kingussiearea under the responsibility of NHS Highland and with close reference to NHSEndowment Fund regulations and the legal framework.

4.5.7 Care Homes and Care-at-HomeThere are no plans for NHS Highland to open new care homes in the area but thereare ambitions to look at developing both existing care homes and more generally towork more collaboratively with the independent sector.

NHS Highland has been taking a number of steps to try and improve the immediatesituation with care-at-home including advertising more posts, working with theindependent sector and our own staff doing over-time, but the current situationremain 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 newroles, developing apprenticeship schemes, offering better pay and conditions andimproved career structures.

This is going to be a growing challenge and one which NHS Highland cannot fix onits own. We will continue to work with individuals, families, staff, local communities,independent and third sector organisations to see how together we can develop moreeffective and acceptable solutions.

Notably only option 3 would release funding to make significant investments into thecare-at-home and wider community services.

4.5.8 StaffingMembers of the public, community councils and others also expressed interest andsome concern around future staffing arrangements. Throughout the consultationprocess there was consistent praise for the existing culture of care and a plea for thatnot to be lost.

Questions relating to redundancies, staff travel, who would provide medical cover inthe new hospital and whether local builders were used were all answered by theconsultation team (Appendix 4).

4.5.9 Alternative ProposalsSome people felt strongly that both existing hospitals should be upgraded and wereoff the view that it would cost less.

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As explained in the consultation materials the work carried out by NHS Highlandestates and clinical colleagues highlighted that up-grading the existing buildingswould never provide the standards required for modern healthcare. Modernisingwhat currently exists would not bring the benefits of co-locating services nor enablethe improvements in community care which are required.

Two people thought that there should have been an option to have a range ofservices available in all three main centres (Aviemore, Grantown-on-Spey andKingussie.

4.5.10 PopulationPeople wanted to know whether projected population increases (An Camas Mor,seasonal visitors etc) had been considered and also had use of services by age-range been considered (*).

Public Health colleagues, service planners and experienced health care plannershave all been considering this matter as part of planning for the future. This includespreparing district profiles (Appendix 8). These have been designed to assistservices in the assessment of the health and social care needs of the populations. Itwill also be considered as part of the bed modelling work (Appendix 5).

There are variations between communities that need to be factored in. Aviemore hasdone the most expanding (20% rise in practice population in 10 years); yet the over65-population has not significantly increased. The majority of the new housing tendsto attract younger people, often families, therefore this has considerations forservices for children’s and families (and of course schools). In terms of health, theseservices are usually delivered through health centres and were one of the argumentsfor 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 higherpercentage of older people and feel that losing in-patient facilities will compromisethe needs of older people needing hospital care.

(*) – A statement on this matter was also raised at the Grantown-on-Spey publicmeeting and followed up by letter (dated 18th July). Letter was passed to publichealth colleagues (see also appendices 5 and 7). Detailed analysis has beencompleted by Public Health and confirmed that the profile of older populations is notunique to Grantown-on-Spey.

4.5.11 Other topicsPalliative care, dementia, respite, supported housing were some of the other issuesraised during events and meetings.

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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 theconsultation process, service model options, and possible sites. These are exploredin 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%)

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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 numberof 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 consultationmaterials, events and how they were informed about the consultation. The mainfindings were:

People said they had found out about the consultation through a number ofways including the mail-drop, local newspaper, direct from staff, website/socialmedia and local councillors.

Just under three quarters (73%) said they had received a copy of the summaryconsultation 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 thesummary document and over half (56%) said they had read the full document.

Nine out of ten people responded that they felt that the consultation materialshad given them enough information about the proposals and case for change.

There were mixed views about which events were most helpful and more thanhalf said they did not attend any events.

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People had the opportunity to comment on whether NHS Highland had takenreasonable efforts to involve and inform local people about the proposedredesign of services (Box). Over eighty percent (82%) responded positively.

Do you feel NHS Highland had taken reasonable efforts to involve and inform localpeople about the proposed redesign of services:

Response Percent NumberTo a great extent 57 88To some extent 25 42Neutral 9 15Not really 7 12Not at all 2 3

100 160

6.2.1 CommentsThe following responses were taken from groups who responded to the consultationresponse survey in relation the question

“Do you feel NHS Highland has taken reasonable efforts to involve and inform localpeople 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 contactdetails for further information.”

Community Councils

Responses to the survey were received from four community councils. All respondedpositively:

Yes to a great extent.

6.3 Feedback via letters from members of the public

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Feedback from correspondence was themed and some points on the consultationprocess 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 HeraldSeveral letters have been published which included issues relating to theconsultation process:

18th September 2014Hospital future should also be put to the vote – Leonard Grassick (Grantown-on-Spey)

26th JuneNHS chief’s comments worth considering - Leonard Grassick (Grantown-on-Spey)

In terms of the consultation process Mr Grassick includes the following comments inhis letter:

“There has been a poor response to the drop-in sessions and correspondence toNHS Highland on the plans to redesign local healthcare services but this isunderstandable in the circumstances.

“Locals have been bulldozed into submission by all the literature provided, includingasking 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 todiscuss this option at a very early stage and there could have even been a vote onthis inclusion.”

10th JulyConsultation period should be extended Leonard Grassick (Grantown-on-Spey)

“The consultation period on this crucial matter should be extended. NHS Highlandneeds to take a step back and figure out how they will cope with care in thecommunity without the excellent facilities at Ian Charles.”

31st JulyMaking the case for keeping the hospital open – Leonard Grassick (Grantown-on-Spey) 31st July 2014

This letter includes a comment about the make-up of the steering group:

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“I have been looking through the contact list for the hospital development group and itlooks top heavy with medical personnel and no sign of the ordinary working personbeing 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 forexample the Highland Council, been exemplary and is on-going but I would imploreresidents to please make your individual voice heard otherwise we may end up withsomething 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 ofthe 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 whyoptions had been excluded: what the options were and on what basis were theyexcluded (see also below). In their report the Scottish Health Council also suggestedthat it would have been helpful to have provided some information on all the issuesconsidered.

More generally there were a number of queries around why sites were beingconsidered at this stage. Some felt that this must mean that a decision had alreadybeen taken “done deal”.

It was explained that having identified a preferred option this was a requirement ofthe process. As NHS Highland had anticipated that this would be a query/concern itwas 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 thereforenot surprising that Option 3 is preferred. It is the option proposed and developed bythe Health Care Services for the Health Care Services

From outset I thought that the option of improving the services and facilities to therequired level for now and the future at all three centres should have been included.Whether the Steering Group considered, discussed, explored, fully costed and thendismissed this option is not known. To state now that this option is not affordable orsustainable is not acceptable”.

(Further feedback on this matter was also received by the same respondent viaemail).

6.6 Feedback from partner agencies

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Highland Council

“The Ward 21 Elected Members have been fully engaged in the consultation processwhich they feel has been carried out in a thorough, inclusive and comprehensivemanner with a good level of community engagement. Members have a good trackrecord of attendance at stakeholder meetings and consultation events.

“They have observed the consistent approach taken by NHS Highland Seniormanagement and have said that the director of operations and his team should becongratulated 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 BoydPeters.”

Highlands and Islands Enterprise

“We acknowledge and welcome the extensive consultation and engagementprocesses undertaken by the NHS to secure community views such that communitiesaffected 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 openconsultation 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 themeetings.

“I am certainly happy to endorse the process and feel that staff have been kept verywell informed.”

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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 afterthey 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 andincluded a section on the proposed changes and options.

Issues relating to the service model options were also raised at meetings, events andcorrespondence.

7.3 Results

7.3.1 Feedback on preferred optionOver three quarters (78.5%) of people who responded supported the preferred option

Select your preferred option Number As a %Option 1 - Do minimum 10 5.8%

Option 2 - Community resource centreand hospital in one town (Grantown orKingussie) and scaled-down services

in other (e.g. no in-patient beds)

8 4.7%

Option 3 - Community resource centreand hospital (with ~20-25 in-patient

beds) in Aviemore supported by otherservices and developments

135 78.5%

Other – please provide suggestion 15 8.7%I have no preference 4 2.3%

176 100%

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7.3.2 Feedback on other optionsSuggestions 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 fromLaggan 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 thecontemporary need of all 3 communities and smaller villages surrounding them.x2

Agree with new hospital being at Aviemore -- BUT-- do not agree with the "GlenCentre" being relocated

New facility should be in Grantown

7.3.3 Feedback on aspects of the proposalsPeople 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 werethe least well supported (Appendix 9).

7.4 Open responses (e-mails and letters) **

7.4.1 MethodThe correspondence was categorised into themes and responses coded as towhether people were in support of the preferred option or otherwise and summarised.

7.3.2 ResultsThirty-one people corresponded with NHS Highland about the consultation via letteror email.

Support for preferred option Number PercentYes 12 41.4Yes-Qualified 2 6.9No 9 31Not clear 6 20.7

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** - 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 theconsultation, 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 feed-back.

Another gentleman has submitted detailed responses, also wide ranging coveringtopics as diverse as A9 dual carriageway, emergency response times, dentalservices, whether proposals meet with the National Park aims, happiness and localservices and the Crichel Down rules

In terms of responses by community there was a range of views with eight peoplefrom Grantown-on-Spey not in support of the preferred option and four people insupport.

Resident Support Don’t supportAdvie 2Aviemore 2Boat of Garten 1Grantown-on-Spey 4 8Kincraig 1Kingussie 1Laggan 1Newtonmore 2Total 13 9

7.5 Responses from Community Councils

Four community councils submitted responses via the survey and all selected Option3 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 2000new homes in the area.”

7.6 Response from local Medical Practices

The doctors who are partners in the medical practices of Kingussie, Aviemore andGrantown-on-Spey have considered the proposals in detail and are fully supportive.

7.7 Responses from Partners

7.7.1 The Highland CouncilIn their formal letter of response the Council concluded as follows:

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“The case for change has been well and clearly made through a wide range ofconsultation methods and documents. The Highland Council endorses theconsultation process, is supportive of the move to modernise and reconfigureservices and confirms that it is broadly supportive of Option 3 for a single hubcommunity hospital and resource centre in Aviemore.

“The Highland Council looks forward to the detailed outcomes of the consultation andto 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 andStrathspey, it is recognised that some people do not want change. It is noted that thefinal public consultation meeting held in Grantown on Spey saw community concernsand objections raised specifically with regard to the Ian Charles Hospital. Furthertargeted 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 acommunity hospital offers and what a district general hospital provides. Perception isalso that community hospitals are orientated toward elderly care, and whilststatistically there is no doubt that this will be the higher patient ratio, provision has tobe made for children and young people and awareness raised on what can beprovided in terms of local services.

Highland Council main areas of response:

1. Care and Learning. The Care and Learning Service would be broadly in supportof Option 3 and the proposed location in Aviemore. Opportunities should beexplored for co-location of Children and Families staff in any new facility andmanagers would be interested in being part of discussions about the proposedbuilding and its facilities at an appropriate stage. Consideration should be givento early discussion on the provision of services for children and young people, onshared clinical space as well as space for permanent and visiting staff.Essentially how much space and how much would it cost are key factors forconsideration.

As a result of the consultation process there is now discussion taking place withlocal schools around closer working with NHS Highland, and further opportunitieswill be sought to involve young people in the process. There are alsoopportunities to work with colleagues in High Life Highland on a range of healthled initiatives.

2. Access and Transport. This has emerged as a key theme throughout theconsultation. It is recognised that NHS Highland is not a transport provider andthat a positive and proactive planning approach to the design of an effectivetransport system is required. The Highland Council is keen to work with inpartnership with NHSH and others in developing access and transport solutions.

It is noted that a Transport Survey is currently being undertaken by NHSHighland. It is also noted that a date is being set to bring key stakeholderstogether with regard to forming an Access and Transport Group.

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3. Care at Home. An obvious challenge is around providing care at home and it isclear that this requires new thinking and new ways of working. The Council wouldbe keen to work with and support NHS Highland in this key area. Furtherconsideration to be given to fully integrated approaches and how the HighlandCouncil can support this.

4. Future Site Management. Whilst aware the NHS Highland would not want toprejudice the outcome of the consultation, it is recognised that should localhospitals close there could be a key role for both the Highland Council and theCairngorm National Park Authority in providing assistance in considering thereuse or redevelopment of buildings and sites which may become redundant.The emotional attachment to sites and buildings in local communities has clearlyemerged through the consultation process and is recognised. It is particularlyrelevant therefore, with regard to archive and heritage, to ensure that history iscaptured and artefacts safeguarded.

5. District Partnership. Future role for the District Partnership to be explored as amechanism to update stakeholders and as a platform for public engagement.

(Reports have been tabled at the District Partnership including most recently anupdate on the consultation process at the meeting held on 25th September inKingussie).

7.7.2 Scottish Ambulance ServiceScottish Ambulance Service welcome and support the development of the proposednew model of care and would welcome the opportunity to work in partnership withNHS Highland as the development progresses. A meeting has been arranged withsenior officials for the 3rd of October.

7.7.3 The Cairngorms National Park AuthorityThe Park Authority has appreciated early involvement. As they have statutory andenabling roles they did not feel it was appropriate to comment on the options buthave provided initial comments on potential sites and potential future use of existingsites.

7.7.4 Scottish Fire and Rescue (Highland area)“Recognise the challenges in health care provision and balancing competing financialdemands. Therefore support the views of NHS Highland management to progresstowards an improved service provision in the wider Badenoch & Strathspey area.Improved home care and partnership working with other CPP members will supportthe vision of safer communities and safer homes.”

7.7.5 The Highland HospiceHighland Hospice supports the broad aims of the proposal which they feel providesan opportunity to meet existing and future health and care needs for Badenoch andStrathspey.

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They are also keen to work jointly to consider the palliative and end of life careimprovements that could result from these proposals including how they cancontribute.

7.6.6 Highlands and Islands Enterprise“From the investment values indicated in the consultation, development of modernfacilities and associated infrastructure as proposed would be considered by HIE to bea welcome enhancement in service offer and the scale of the construction projectsproposed will in themselves create valuable, through short term economic stimulilocally.

We would encourage the integration of community benefit clauses within the servicetenders, including the requirement to source locally and via the third sector tomaximise local social and economic benefits. The Government’s Procurementreform agenda is enabling in these respects.

We would be pleased to continue our dialogue with you, working together with thirdsector partners and social enterprises to further shape the routes through whicheffective avenues can be established (as an integral part of your service re design) toenable third sector led service delivery; where this brings opportunities to add value,bring tailoring to services, build community capacity and embed greater socialoutcomes through locally-led heath and social care service delivery.

The proposed service changes will affect some communities in terms of accessibilityof services (where these change from current locations). We note your intention towork across strategic partnerships with stakeholders including public sector partnerswith direct responsibility for transportation. We would be pleased to contribute tosuch discussions, together with our local authority and other partners.”

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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. Publicpreference was identified as one of the five criteria on which to assess the differentsite options.

As public preference was one of the criteria the final decision on selecting a preferredsite was completed after the consultation had closed.

Issues relating to the site proposal were also raised at the consultation events andmeetings.

Box Summary description of shortlisted sites

Site A Grainish FarmOn the eastern side of the B9152 travelling north leaving the village.

Site B MiltonBeside the A9 underpass (north side) leading to Upper Burnside.

Site C Technology ParkLand between the 2 rail lines beyond the closed call centre.

Site D Pony FieldThis is beside the Macdonald Aviemore Resort and lies between the A9 and newhousing to the north of the Scandinavian Village

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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 including51 “no preference” There were also seven responses which suggested ‘other’. Forthe 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 Name Votes % RankA Grainish Farm 18 18 3B Milton 1 1 4C Technology Park 64 63 1D Pony Field 19 19 2

8.3 Conclusion

Both the public preference and the working group’s deliberations came up with thesame 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 asdevelopment costs, land purchase and the suitability of the land for construction alsohave to be considered. This work which will be carried out by technical advisors ifthere is a decision to progress to implement the preferred option.

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9 Assurance of the Formal ConsultationProcess

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 SocialCare 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 includingtwo 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 thepapers are available on the NHS Highland website.

Issue raised on 11th September 2014What is the latest position on the Public Consultation relating to Badenoch &Strathspey?

AssuranceCirculated report indicated consultation exercise completed on 21 July 2014. Internalreview concluded major service change guidance followed fully. The report gave anupdate on public consultation activities, in relation to an access and transportevaluation, the background to selection of a potential site for a new hospital at theAviemore Technology Park and feedback on the public consultation process. It wasintended that a full report would be provided to the NHS Board at their meeting on 7October 2014.

9.2.1 Conclusion of Committee

At their meeting held on 11th September the committee members were satisfied thatthe major service change guidance had been fully followed. They commented on thenumber of responses received and in particular highlighted the number of youngerpeople who had taken part.

Agreed to endorse that the process complied with Scottish Government majorservice change guidance

Agreed to endorse recommendation to present full findings to NHS Board on7th October 2014.

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9.3 Scottish Health Council (SHC)

The Scottish Health Council produced a detailed report on the process for involvingand informing people and highlighting any issues raised by local people during theprocess. 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 reportstates that:

“Based on our review and feedback from local people we are satisfied that NHSHighland has followed Scottish Government guidance on involving local people in theconsultation.

“Overall, feedback received indicated that the majority of people had understood thereasons for change, how the proposals had been developed, and felt listened to andthat there has been sufficient opportunities to take part in the consultation.”

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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: thebackground, consultation process, feedback on options and next steps.

Taking everything into consideration there is broad support from the wide range ofstakeholders for option 3 - the preferred option (Box) and it is now being formallyrecommended to the Board for endorsement.

Option 3 - Community hospital and resource centrein a central location (Aviemore)

If implemented this would mean building a new community hospital and resourcecentre in Aviemore as part of a wider redesign and modernisation of health andsocial care services.

It would also include the re-location of Aviemore Health Centre, some otherservices located in Aviemore and the closure of both local hospitals - Ian Charlesin Grantown-on-Spey and St Vincent’s in Kingussie. Any closures would beplanned to take place after the new services were in place.

In coming to this view, the operational unit has sought to satisfy itself that peoplewere comfortable with the consultation process and that there was strong support forthe preferred option. The consultation process has been endorsed both internally viathe NHS Highland Health and Social Care Committee and independently by theScottish Health Council.

79% supported the preferred option and both public preference and the optionappraisal process identified Site C – Technology Park as the preferred site todevelop any new hospital.

As the preferred option represents major service change, should the Board endorsethe proposal, the next step would be for the proposals to be considered by theCabinet Secretary for a final decision.

Further detailed work would still be required as part of the business case process.

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10.2 Feedback on Consultation Process

NHS Highland has embarked on an extensive and wide-ranging public consultationexercise. The communications and engagement activities were both pre-plannedand responsive to requests made during the three month period.

The approach appears to have been generally well received. The reasons for thechanges to services being proposed have been understood and the majority of thefeedback suggests acceptance.

Although the queries raised were predominately addressed in the consultationmaterials, the events and discussions provided further opportunities to expand onsome of the detail and really understand any ideas or concerns.

There was consistency in the feedback received through the different routes andfrom partner agencies. By the end of the consultation no new themes or issues werebeing raised.

The feedback from the public meetings was representative of the wider feedbackwhich emerged during the consultation. Areas of greatest concerns were raised fromresidents in Grantown-on-Spey. This was also highlighted in the Highland Councilresponse and further focussed work will be required should the proposed changes beimplemented.

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 therewas good awareness about the consultation and how to make views known

NHS Highland’s Health and Social Care Committee endorsed that the processcomplied with Scottish Government major service change guidance. They alsosupported that the operational unit was in a position to present the full findings to theNHS 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 andhas also endorsed the process. They highlighted some areas of good practice aswell 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 acommunity hospital and resource centre in Aviemore supported with widerdevelopment of community services. This option also received backing from all fourmedical practices and partner organisations (The Highland Council, ScottishAmbulance Service, Scottish Fire and Rescue Service and the Highland Hospice).

There was also a consensus on a preferred site at this stage (Site C – TechnologyPark). Some felt it added bias to the consultation to have identified possible sites atthis stage.

Some aspects of the proposals require further detailed work. Some of this relates tospecific concerns raised during the consultation but for other issues, it was notappropriate to look in any detail prior to any decision being taken.

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10.4 Next steps and Decision Making Process

The Board of NHS Highland will consider the report and the recommendation at theirmeeting to be held on 7th October 2014.

Should they endorse the recommendation then it will go to Scottish Government for afinal decision by the Cabinet Secretary

Only if the Cabinet Secretary approves the preferred option would planning for thenew facilities and services begin in earnest.

Significant work would still be required including to agree the specification, the designand purchase a site. Current estimates are that construction might start aroundsummer 2017 with possible occupation of the new facilities in December 2018. But itis stressed this is a very tentative time-table at this stage.

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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 andsafety requirements around the hospitals.

Main Disadvantages Main Advantages

Missed opportunities to improve care-at-home and safety issues

It is what people know and like

Buildings will never be fit for modernservices, even with investment

Keeps services in existing hospitallocations

Not sustainable - may result in majorloss of services in the longer term

Easy to implement

CostsThe running costs for both hospitals alone are £3.2million per year. Capital costswould be £5.2million to bring the buildings up to minimum standard.

SummaryThis option scored 250 points. The low score reflects that this option would notaddress current or future problems. It would not improve access to medical coverduring out of hours, allow investment in care-at-home, support integration ormodernise the buildings.

Option 2 - Community hospital and resource centre in one town (‘hub’) andscaled-down services in the other (‘spoke’), based on existing hospital sites

HubIn either Grantown-on-Spey or Kingussie there would be a new facility which wouldprovide in-patient beds, outpatient services, A&E, 24/7 nursing cover with a limited x-ray service. It would be very similar to the existing hospital services provided fromIan Charles with the main change being all the in-patient beds provided in onepurpose-built facility.

SpokeLimited out-patient clinics and base for some community nurses and social care staff.

OtherContinue to integrate services with some investment into care-at-home, service,community services and co-location of some staff.

Main Disadvantages Main Advantages

Resources still split across three mainsites

All in-patients beds on one siteallowing better use of staff andother resources

Does not address service issues suchas out-of-hours medical and nursingcover, limited access to x-ray

Improves quality of accommodationof in-patient and out-patient

Won’t be sustainable in the future - mayresult in major loss of services in thelonger term

Familiar - keeps some services inexisting locations

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CostsRunning costs with this model would be around £2.3million. The capital costs toredevelop hospital sites would be around £9million

SummaryOption 2 scored 463 points. This was seen as an improvement on current servicesbut the low score reflects that this is not a good option. Having all the in-patient bedsbeing located on one site would bring some benefits but overall it would not improveaccess. It would still mean money being heavily invested in buildings rather than incommunity services or care-at-home service. It does not tackle any of the staffingissues associated with out-of-hours or access to x-ray.

Option 3 – Community hospital and resource centre and spokes

HubA new community hospital and resource centre in Aviemore with good access topublic transport and the A9. This purpose-built facility would allow services to be fullyintegrated.

The centre would provide the full range of community hospital services, including in-patient beds, out-of-hours, accident and emergency, outpatient clinics. The localhealth centre, day care centre and NHS staff based in Aviemore would all move intothe new building.

OtherDevelopment of care-at-home service, extended community care and communitybeds 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 wouldclose.

Main Disadvantages Main Advantages

Strong attachment to existing hospitalbuildings

Improves quality of many servicesand overall much safer, moreeffective and efficient

Culture change for communities and staffto get used to

Addresses service issues allowingbetter out-of-hours medical andnursing cover, access to x-ray plusinvestment in care-at-home and thecommunity

Change of location of hospital for somestaff and communities

Integrated service designed to meetthe current and future needs of thepopulation

CostsThe running costs would be significantly lower at £2million and capital costsestimated at £12 to £15million.

SummaryThis option scored an extremely high 913. It would allow a fully integrated service tobe set-up which would make better use of the resources to meet the needs of thelocal population.

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APPENDIX 2 – Overview of the NHS service change process in Scotland

Approve formal consultationand materials

Ministerial Approval

Commence Business Case process (SCIM)If infrastructure investment case

Initial discussion with SGHD sponsor in cases of potential major change

Identify strategic options and need for service change

Proposed change considered major? Confirm with SGHD sponsor

No Yes

Proceed with proportionate publicengagement as agreed with SHC

NHS Board Decision on Service Change

Undertake formal publicConsultation

NoYes

Non-Major

Major

Develop initial comms/stakeholder involvement plans in liaison with SHC

Options Appraisal in line with Green Book, SCIM and SHC guidance

SHC assurance report to NHS Board

Proceed to implementation

Feedback and Evaluation

Yes No Revisit proposals

Undertake pre-engagement activity with key stakeholders

Revisitproposals

NHS Highland board toconsider proposal andconsultation materials

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APPENDIX 3 – Events and stakeholder meetings including updates to committees etc(21st April to current)

Category Event Date AttendanceDistrictPartnership

Kingussie 24th April + 4 members of publicNairn 11th JuneKingussie 25th September

CommunityCouncilsmeetings

Nethy Bridge 1st May & 5th June +9 members of thepublic

Kingussie 6th May + 6 members of publicAviemore 8th May + 6Dulnain 14 MayGrantown-on-Spey 20 MayCarrbridge 29 MayBoat of Garten 2nd June +1Kincraig 10th JuneNewtonmore & Vicinity 7th July + councillor

Drop-in events Dulnain 14th May 4 + SHCGrantown-on-Spey 20th May 9Carrbridge 29 May 2Boat-of-Garten 2nd June 12Nethy Bridge 5th June 9Kincraig 10th June 4Aviemore 11th and 12th June 30Newtonmore 19th June 12Laggan 19th June 8

Steering Group Mid-way review 5th JunePost-consultationreview and completeoptions appraisal onsites

27th August

Other Lunch Club, Kingussie 19 May 22Walk-about 27 May 50Friends of St. Vincent’s 28 May 8Dalwhinnie CommunityGroup

28 May 6

CoS Presbytry 17th June 35Laggan CommunityAssociation

19th June 8

Friends of Ian Charles 23rd June 15Sunshine Club 23rd June 42Public meeting,Kingussie

25th June 6 +x2 SHC

Public meeting,Aviemore

1st July 16 Members of public +x2 SHC

Public meeting,Grantown-on-Spey

2nd July 82 Members of public +x2 SHC + Reporter

St Vincent’s TherapyGarden

7th July Committee members

Spey Valley Rotary 9th July 12

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APPENDIX 3 (cont’d)

Attendance at public meeting, events and stakeholder meetings

Category Event Date NotesPartner Agencies Scottish Government 14th May + July

Scottish Ambulance 21st May + 3rd OctoberCairngorm NationalPark Authority

30th May, 10th

SeptemberTransport Scotland 11th JuneKingussie High 24th June

NHS Highland Staff drop-in events w/b 21st April(various)17th & 18th July

Staff also representedat all meetings,steering group

Consultant psychiatrist 3rd JuneLocal GPs various ongoingAnnual Review 9th June Local stakeholders met

with the MinisterSouth and midoperational unitmanagement teammeetings/ LocalPartnership

1st May, 23rd June Ongoing

Raigmore seniormanagement team

16th July Ongoing

NHS Highland seniormanagement team

25th September Ongoing

Highland health andsocial care committee

1st May, 10th July,11th September

Ongoing

NHS Highland Board 3rd June, 12th

August,7th October

APPENDIX 4 Summary of points raised at meetings, events and drop-in. Themed and ranked based on the frequency of times raised atdifferent events

Notes

After the consultation closed comments were categorised to allow some high–level groupings (Table). For instance additional services inthe 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

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Category Points raised NHS Highland Response

1.1 Additionalservices

Will there be additionalservices in the new hospital?

Yes. But the detail will come later when the full clinical specification will be required tobe 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 (seealso below)

1.2 Will there be greater use ofnew technology and tele-medicine consultations?

The new facility will be fully equipped to take advantage of new and emergingtechnologies including allowing for increased use of tele-medicine consultations withconsultants/specialist nurses.

1.3 Will the x-ray service beenhanced?

New more modern x-ray equipment will provide an overall improvement. While therewill no longer be an x-ray service in Grantown it will release radiographer travellingtime to enable more examinations to be carried out in Aviemore. The currentarrangements are not satisfactory and in particular for in-patients (see notes below).Moreover the equipment is at the end of life.

NotesCurrently St Vincent's patients can't have an x-ray unless they are put in an ambulanceand transported to Aviemore (and back). Ian Charles patients can have an x-ray (butmachine 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 mustclose 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 thepreferred option would vastly improve this situation.

The equipment was installed in 2002 beginning to fail and no longer possible to coverit with a service contract as spare parts are no longer available. The equipment alsodoes not have automatic exposure control devices, available on all other NHSHgeneral X–ray equipment and considered as a standard feature for the optimisation ofmedical exposures.’

1.4 We need a 24 A&E service.Current out of hours cover isnot enough?

Local doctors say that the current service is more than adequate for current case mixthat they look after. It would not be appropriate to do more complex cases as staffingis by GPs not specialists. The level of activity does not warrant the necessary back-uprequired for more complex care such as theatre/anaesthetics, CT, MRI and 24/7 x-ray.Out of hour - In-patientsThe proposed arrangements will improve out-of-hours nursing and medical coverbecause all the inpatient care would be co-located.

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Category Points raised NHS Highland Response

NotesThere are 50 hours (Mon - Fri 8am to 6pm) when a GP provides cover during the weekin each hospital. In the evenings, weekends and overnight periods medical cover isprovided from the Out of Hours service based in Aviemore. Local GPs provide thisservice.This means that our hospital in-patients are at a distance of either 10 or 15 miles fromthe doctor during these periods of time. Under the new arrangements all inpatients willbe located in the same place (gets round the difficulty that arises when both hospitalsneed the doctor at the same time) and delays due to loading up plus journey time willbe eliminated.

TerminologyThe 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 forconsultant-led departments with all the necessary back-up; trauma teams; theatres andso on. Traditionally the term A&E/ casualty has been used for many of our communityhospitals which really provide GP or Nurse led minor injury/ailment services. Adding topublic confusion is that the sign outside the hospital says A&E.

1.5 Need an enhanced A&Eservice to better treat fractures

As above plus the numbers don't justify this.

1.6 Will there be a pharmacy on-site?

There will be a hospital pharmacy on site but there are no plans to relocate the currentcommunity pharmacy.

1.7 There is not enough detail inthe 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 BusinessCase.

1.8 Will there be a handymanservice?

The Handyman Schemes elsewhere in Highland involves Third Sector, Councilservices etc with very clear community roles for the Handyman in terms of care andrepair, adaptations etc There is currently not a service like this in Badenoch andStrathspey but we will be looking to develop something along the above lines.

1.9 Will there be a hydrotherapypool?

No. There are no plans for a hydrotherapy pool.

1.10 Will there be an operatingTheatre?

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 moreminor surgery to be carried out

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Category Points raised NHS Highland Response

1.11 There should be an on-sitefacilities for laundry?

A laundry could be provided but at a cost. This will need be considered alongsideother priorities but local people will have an opportunity to influence thesediscussions/priorities. Other services like café/ dining facilities will be discussed. Inthese deliberations we will seek to balance patient/visitor requests with costs andimpact on local providers.

Notes:The context for this query was that it was raised at a meeting that there was no laundryin Migdale (Bonar Bridge) and the inconvenience this causedThe 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 patientsmay have no visitors/ relatives.

2.1 Transport andAccess

Transport infrastructure mustbe in place to supportrelocation 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 tofacilitate joint working across various partners. In terms of NHS Highland’scontribution, the proposals make provision for further investment into communitytransport. A working group on transport has been established and an initial Transportsurvey has been completed.

Notes:From the survey we note that the majority of people don’t use public transport to cometo hospital or for GP appointments. Arguably this is because the service is verylimited. People who are visiting the hospitals generally come by car. Extremely fewwalk up the hill from Kingussie to St Vincent's and a very small number of people walkto the Ian Charles. Inpatients mostly arrive by ambulance and occasionally by privatetransport.

More generally further steps need to be taken to reduce people having to travel in thefirst place. In the future more outpatient consultations will be replaced with Video-conferencing, Skype, or telephone and e-mail. Making sure we have the rightcommunity and home based service in place will also mean people have to spend lesstime in hospital further reducing the need for travel.

2.2 Traffic flow/jams will affectability for ambulances to gainaccess to and from thehospital?

This was raised as a concern and is something we will look into in collaboration withothers including Police and Ambulance. However, busy towns and cities manage flowof ambulance traffic. The steering group will consider when assessing sites.

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Category Points raised NHS Highland Response

2.3 There is no taxi service inKingussie?

This was confirmed during the consultation process. It must have a number ofimplications for local people. In terms of NHS services it poses a problem with thecurrent remote location of St Vincent's Hospital. It is intended that any retainedservices in Kingussie will be more centrally located and any wider access and transportissues will be improved.

2.4 Will dualling of the A9 impacton site selection?

We have met with Transport Scotland representatives, and believe one of the fourshortlisted sites could potentially be affected by A9 dualling. This will be noted duringthe site selection process. Moreover the dualling has not actually started and time-scales are somewhat uncertain. It is recognised that there will always be someuncertainties to contend with.

2.5 Will there be access to the A9to the new hospital?

This is unlikely, two of the shortlisted sites lie adjacent to the A9 but TransportScotland has indicated that they are unlikely to approve any further junctions. Theambulance service have also indicated that this is not a requirement

3.1 Clarification onexistingservices andbuildings

Will physiotherapy services beretained at Kingussie/Grantown?

Yes that is our intention

3.2 Will ambulance services remain inGrantown and Kingussie?

There are no plans to alter the current ambulance services apart from relocating theAviemore Ambulance station

3.3 Will GP services remain inKingussie/Grantown?

There are no plans to alter the current distribution of GP practices

3.4 Will children’s services be co-located in the new building?

Children's services staff might be, but the children's services themselves wouldcontinue to be delivered closer to home (schools, health centres, homes)

3.5 Can the existing buildings last thefive years until the new hospital isbuilt?

We are required to maintain our current buildings in a safe condition and will do this forthe remaining life of these properties

3.6 Will dental service remain inGrantown?

Yes there are no plans to remove dental services

3.7 Will minor injury service remain inGrantown

Yes the minor injury service will remain in Grantown

3.8 Will the out-of-hours (OOH)services be located in the newbuilding?

Yes OOH will be located in the new development in Aviemore

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Category Points raised NHS Highland Response

3.9 What will happen to the existingbuildings

There is no NHS use identified for buildings that might be vacated, Should this be arequirement, NHS Highland will be asked to declare them surplus to requirementsonce vacated. NHSH will then follow the prescribed procedures for disposal thisincludes checking if there are any public sector uses for the buildings. Scottish FuturesTrust and the Cairngorm National Park Authority have been consulted regardingpossible community benefits which might be derived from the disposal of anyproperties 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 TherapyGarden in St Vincent’s? Can it bere-provided at the new hospital?

Some early discussions have been held with some of those involved with the TherapyGarden and it would be our intention to support the group to provide a therapy gardenat the new Aviemore facility and also at an alternative location within Kingussie.Discussions ongoing.

4.1 Bed numbersand provision

Are enough beds included in theproposal?

The final number of beds has not yet been decided on though we have done someinitial work to inform the public consultation. Our Health Intelligence Unit will becarrying out further modelling work to assist in any final decision. Local medicalexperience; bed experts; service planners will work out the right number which willtake into account flexibility and future requirements. The current stated estimatedprovision is between 20-25 beds. The number will be based on the optimumrequirement; not the exceptions.

Notes:Identifying the right number of beds requires specialist expertise, modelling and isdependent on many factors. The number we have now is on the high side with bedsoccupied with patients who would be better served in other settings. This is due to alack of home care. For instance recently 8 out of 23 beds in the valley had people inthem 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 fouror six. This may not always suit the mix of males and females. It can also meanwhole bays have to be shut when there are infection outbreaks. The new hospital willhave all single room; bringing a wider range of benefits including higher occupancy.

4.2 Will mental health/dementia bedsbe included in the new hospital?

We would want the building to be suitable for dementia patients in ways that thecurrent buildings are not. (As many as half of our GP inpatients have a degree ofdementia, it co-exists with the physical conditions that affect older people.)

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Category Points raised NHS Highland Response

Discussions are ongoing with consultant colleagues from New Craigs who manage thebed to identify the clinical need and what is required going into the future.

4.3 Will the rooms in the ward besingle 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 havingall single rooms. In addition single rooms also help with bed management e.g. thegender of a patient does not matter when an admission is required, currently if there isonly one bed available in a multi-bedded female ward then only a female patient canbe admitted and vice versa. Space for patient socialising and dining (should they sowish) will also be provided.

Notes:With regard to single rooms, CEL48(2008) “Provision of Single Room Accommodationand Bed Spacing” refers. It states “For all new-build hospitals ….. there should be apresumption that all patients will be accommodated in single rooms, unless there areclinical reasons for multi-bedded rooms to be available.”

5.1 Site proposal Are the proposed sites bigenough?

One of the short-listing criteria for the sites was that they had to be a minimum of threeacres in size or be capable of being made so. It takes into account the likely buildingsize, parking, gardens and a 20% expansion capability. Further work will be requiredonce it has been determined exactly what will be provided from the new facilityincluding the number of staff likely to be working in the new facility

5.2 Will the site/building beexpandable in the future?

The development will allows for 20% future expansion which is what is recommendedfor NHS planning purposes. Over and above this there has been some discussionabout 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. Forinstance the available evidence (including for Highland) show that we have needed farfewer in-patient beds over the last 20 years. Changes in technology, greater use oftele-medicine, advances in medicines and treatments will all mean people spend lesstime in hospital settings. What is of upper most importance is that any development isflexible and able to respond to changing circumstances – flexing up or down to suitlocal need.

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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 Boardofficers, by contact with architects and other public bodies in the area, by discussionswith steering group members and by an advertisement in the local newspaper. Thisproduced a long list of 10 sites which was reduced to a short list of four by applyingtwo exclusion factors - 1) sites had to be a minimum of 3 acres in size or have thepotential to be made so and 2) be within or immediately adjacent to the Aviemoresettlement boundary. These exclusion factors were drawn up by the steering groupand with advice from the Cairngorms National Park Authority.

5.4 Why is Aviemore selected as thepreferred location?

Because of its central location and proximity to Inverness (Raigmore Hospital).

5.5 Will there be a heli-pad close tothe new hospital?

No. Medical advice is that a heli-pad is not required, current arrangements for the useof helicopters will continueNote:

Those who need to be taken off the mountain to data have always need to go direct toRaigmore or further afield for diagnostic purposes and necessary medical and surgicalexpertise. Landing a casualty in Aviemore would only serve to cause delay and addingfurther risks. The same applies to those injured in for instance A9 causalities.

5.6 Co-location is not a significantadvantage to justify a new build inAviemore

Co-location means inpatients will have a doctor in the building with them almost all thetime (as opposed to less than 1/3 the week which is the current situation. This bringswider benefits for multi-disciplinary team working. Professional opinion is that co-location of all health and social care professionals greatly improves communicationresulting in better and quicker outcomes for patients. Other benefits include moreefficient use of buildings and staff time.

5.7 Will sites be compulsorypurchased?

It is not anticipated that this will be necessary, the owners of all four shortlisted siteshave indicated a willingness to sell, subject of course to negotiations on price

6.1 Financeincludingendowments

How much will the building cost? The final figures will not be known until the full extent of the accommodation isdescribed, the site purchase and development costs are known and commercialnegotiations are concluded. However we are working on a budget figure of £12millionto £15million which is based on other similar facilities e.g. Migdale Hospital in BonarBridge and Nairn Town and County. This would include incorporating facilities for newHealth Centre.

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Category Points raised NHS Highland Response

6.2 How will the building be financed? NHS Highland is closely following the Scottish Government process for capitalinvestment. The Business Case process will explore funding options but at this stage itseems likely that the building will be principally financed through the revenue routewhich will involve Hubco

6.3 The building should not befinanced by PFI or similar

NHS Highland is closely following the Scottish Government process for capitalinvestment. The Business Case process will explore funding options but at this stage itseems likely that the building will be principally financed through the revenue routewhich will involve Hubco

6.4 Will there be savings as a resultof 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 currentarrangements with are not efficient or cost effective and by re-designing services thereare opportunities to free up resources. The proposal is to uses these resources toinvest in community services, care-at-home and a contribution to community transportprovision.

6.5 Are you being ambitious enough? Yes. We believe that the proposals will provide the best healthcare for the people ofthe valley which can be staffed and sustained.

6.6 Hubco finance offer is veryexpensive – will cost £30k over25 years for a £12m hospital.Cheaper to upgrade Ian Charlesfor £3m

There is a national shortage of capital funding and it is likely that the revenue modelavailable through hub will be the only viable option in the short to medium term. Anyattempt to upgrade the existing hospitals would result in a less than optimal solutionand poorer services for patients than the preferred option.

6.7 What will happen to the Burrellendowments at St Vincent’s

The Theresa J Burall legacy will continue to be used for the benefit of St Vincent’shospital until such a time that the hospital becomes non-operational and the terms ofthe legacy cannot be met. NHS Highland Endowment Fund Trustees would then needto 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 beused for the benefit of a different hospital and/or the community where the services arecurrently provided to benefit local people in the future. Any future decisions progressedby a local group from within the Kingussie area under the responsibility of NHSHighland and with close reference to NHS Endowment Fund regulations and the legalframework.

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Category Points raised NHS Highland Response

7.1 Care-at-homeand carehomes

Can you recruit more care-at-home staff?

This has been an on-going problem for many years now and we feel this is somethingthat needs to change regardless of anything else. Whether we do or don't build a newhospital in B&S, we want to see greater recruitment and retention of people doing thiskind of work locally. We understand this is a Highland wide problem, although thisLocality 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 ofinvesting further in community staff including care-at-home

7.3 Will there be a care homeattached to the new hospital ?

There are no plans for a care home to be built in Aviemore as part of this project

8.1 Staffing Existing excellent culture of caremust be maintained

Agree. Staff will be fully consulted and involved in the proposals.

8.2 Will local doctors be providing themedical services at the newhospital?

Yes

8.3 Will local people be employed inthe new hospital?

Existing staff whose jobs will be affected by the proposals will be given the opportunityof moving to the new facilities, any posts remaining unfilled will be filled in the usualway, local people will be given the opportunity to apply

8.4 Will there be any redundancies? he NHS in Scotland has a policy of no compulsorily redundancies, staff will be giventhe 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 isgenerally 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 andtheir representatives to discuss employment issues such as travel to work and how theBoard can assist them e.g. shift times that fit in with public transport. Staff travel towork will also be considered as part of the transport group.

8.7 Will local builders be contractedto build the hospital?

It is likely that the new facilities will be built by hubco under a design, build, finance andmaintain contract. hubco will tender at least 80% of the total work package value tolocal contractors. Hubco will hold local supply chain meetings or 'roadshows' wherethey can come along to hear about hub and what its role is and also meet the buyerevents where they can meet the main contractor.

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Category Points raised NHS Highland Response

9.1 Population Have you considered theprojected population increases?An Camus Mor, seasonal visitors

Yes this is an important point and one which we have and will continue to considerpulling expertise in from our Public health colleagues, service planners andexperienced health care planners.

We know that Aviemore has done the most expanding (20% rise in practice populationin 10 years; yet the over 65-population has not significantly increased (and this is thepopulation that starts to use the hospital in patient facilities more). The majority of thenew housing tends to attract younger people, often families, therefore this hasconsiderations for services for children’s and families (and of course schools). In termsof health these services are usually delivered through health centres and are one ofthe strong arguments for building a new health centre in Aviemore as part of theproposals. Although there has been a lot of focus on the hospitals (and understandablyso) we have been at pains to point out that this is a wide re-design and the primarycare/ health centre element is very important.

10.1 Alternativeproposals

The hospital should remain inGrantown and Ian Charles beupgraded

Upgrading an existing old building will never provide the standards required for modernhealthcare, we are planning services for the next 50 years and we need a new modernfacility 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 bemodernised and would cost less

Modernising within the limited scope available would not bring the benefits of co-locating services or enable the improvements in community care which are required

10.3 Outpatient services should beretained in Grantown

Psychiatry and Medicine for the Elderly visit the three health centres. No changes arebeing proposed although in line with other outpatient services if there are alternativessuch as Video-conferencing.

10.4 There should be a 4th option –upgrade all sites to modernstandards

Clarify if this includes new build in Aviemore

11.1 Servicechangeprocess

The consultation outcome hasalready been decided “done deal”

The consultation process has been open and inclusive, it has been monitoredthroughout by the Scottish Health Council. They will be producing an independentreport.

11.2 What are the time-scales? The results of the public consultation are being analysed, a report will be considered atan NHS Highland Board meeting hopefully in October this year, if not in December.

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Category Points raised NHS Highland Response

Thereafter if the Board approves the preferred option it will go to Scottish Governmentfor a final decision. Only if the SG approve the preferred option will planning for thenew facilities and services begin in earnest Significant work would still be required andcurrent estimates are that construction might start around Summer 2015 with possibleoccupation of the new facilities in December 2018. But it is stressed this is a verytentative time-table at this stage.

12.1 Palliative care Need increased Marie Curie tosupport people at end-of-life todie at home

End of life care will be included in our review of services

12.2 Need to retain palliative care bedsat Kingussie and Grantown toallow people at end-of-life to diein their own town

NotesEnd of life care will be included in our review of servicesHospice outreach = a consultant visiting (e.g. weekly or fortnightly.) Advice availablefor 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 patientgets 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 theevening: both mainly doing the medication side of things. Marie Curie sit with folkovernight so family members can get some sleep. If family not available, not willing ornot capable, admission is required.

13.1 Other (respite,maternity,housing,dementia andintegration

Will respite provision be retainedin Grantown and Kingussie?

End of life care will be included in our review of services, we recognise that thevoluntary sector have an important role to play in the delivery of health services

13.2 Will there be maternity beds? No. There is no proposal to include maternity beds, there is insufficient demand toenable practitioners to maintain their skills.

NotesThere are national rules about how many deliveries a unit must be doing so thatmidwives and doctors maintain their skills and experiences. Back up facilities requiredwould include emergency facilities, theatres, team of obstetric doctors, anaesthetists,theatre staff etc For these reasons a maternity unit would not be viable.

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Category Points raised NHS Highland Response

13.3 We need cluster housing forlearning and physical disabilitypatients. There is nothing in theStrath

Housing lies within the responsibility of the Local Authority and is outwith the remit ofthis project but all four shortlisted sites provide the opportunity for supported housingby others

13.4 Will there be supported housing Housing lies within the responsibility of the Local Authority and is outwith the remit ofthis project but all four shortlisted sites provide the opportunity for supported housingby others

13.5 Integration of health and socialcare services are important

NHS Highland manages the entire adult health and social care budget for the localityproviding far greater opportunities to make best of all resources, skills and talents.

13.6 How will people with dementia becared for in the future?

Need a clinician to answer this one but presumably there will be mention of anenhanced community service? Would it be worth quoting some stats about the homeaddresses of patients in that specialty at St Vincent’s?

APPENDIX 5 – Further work identified to understand future bed numbers

Ian Douglas, Health Intelligence Specialist (Directorate of Public Health) and FrancesMatthewson, Senior Planning Analyst (Service Planning Team) were asked todevelop ‘bed modelling’ to help the project team understand future bed requirementsbased upon drivers of service demand. This work will have five components:

I) Understanding baseline activity and capacity (bed numbers, trends inoccupied bed days for patient groups/specialties, throughput and occupancyand 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 supportingcommunity 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

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APPENDIX 7 – Option appraisal process to support site selection

The preferred service model option included building a new community hospital in acentral location (Aviemore). As part of the overall process NHS Highland wasadvised to identify possible sites in Aviemore to include as part of the consultationmaterials.

The process from identifying sites through to selection of a preferred site isdescribed. This is based on quality factors which included access. Further workwould still be required to consider any technical consideration should the decision betaken to progress with the preferred option.

Method

The Options Appraisal work followed a well established process recommended byScottish Government in the Scottish Capital Investment Manual – Business CaseGuide. Through this process four short-listed sites (see map) were assessed againsta number of quality criteria. These had been agreed by the group in advance of theconsultation, 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 as60:40.

Phase I – Identification of potential sites

This involved undertaking a search of possible sites within or close to the Aviemoresettlement boundary (as per Cairngorm National Park Authority plan).

Sites were suggested by members of the project group, visits around Aviemore byNHS Highland staff, contact with architects and liaison with partner agencies. Fromthis process seven sites were identified. An advertisement was also placed in theStrathspey and Badenoch Herald which produced a further three sites. This meantthere 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 serviceusers. The majority had participated in the earlier option appraisal events.

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The purpose of this specific event was to agree high-level factors to allow a shortlistof sites to be agreed, and then to agree criteria and weighting (relative importance ofeach criterion) which would be applied to the shortlist of sites to allow NHS Highlandto identify a preferred site(s). This was the same methodology used for previousoption appraisal and so participants were familiar with the approach.

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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 ofthe site locations were shared. This was to avoid any bias.

Participants at the workshop were asked to consider important factors for serviceusers accessing the services. These were criteria that service users and public couldreasonably have a view on and therefore could reasonably influence. Afterconsiderable 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 theconsultation)

Environmental considerations (outlook, location, green space, impact ofdevelopment)

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 ofequal importance i.e. some were more important than others and therefore thecriteria were weighted to reflect this. The process to do this was to first agree themost important criterion. The group decided that this was Access and it was rankedas 100. The group then agreed that the second most important criterion - PublicPreference and gave it a ranking of 85 and so on. These rankings were thenconverted to percentages (Table below)

Assessment Criteria Ranking Weighting (%)

Access 100 27.03Public preference 85 22.97Environmental factors 75 20.27Proximity to other services/Potential for expansion 65 17.57Planning acceptability 45 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 excludethe site from further consideration.

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Application of process to identify shortlist

From the 10 sites initially identified, six were excluded on the basis of not being bigenough or were out with the Aviemore settlement boundary. The remaining four siteswent forward as part of the public consultation to seek the views of the public (Box)

Summary description of shortlisted sites

Site A Grainish FarmOn the eastern side of the B9152 travelling north leaving the village.

Site B MiltonBeside the A9 underpass (north side) leading to Upper Burnside.

Site C Technology ParkLand between the 2 rail lines beyond the closed call centre.

Site D Pony FieldThis is beside the Macdonald Aviemore Resort and lies between the A9 and newhousing 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 madeavailable in the public consultation document.

Site Estimates of population within a 15 minute walk of each site

A 1,800B 1,820C 2,340D 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 onlybe completed after the consultation had closed.

The steering group held a further meeting on 27th August 2014 to complete theoptions qualitative appraisal process on potential sites. 29 attended the meeting andincluded local service users, councillors, community councillors, local access panel,Cairngorms National Park Authority, Ambulance Service, Friends of Ian Charles andSt Vincent’s Hospital, Aviemore GP Practice, NHS Highland staff includingpartnership representative.

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Quality versus Cost

It was recognised at the 3rd April meeting of the group that in addition to thequalitative criteria regarding site selection, cost would also need to be taken intoaccount. These were described as technical or quantitative criteria and could includesuch things as, site purchase cost, cost of developing the site i.e. ground conditions,availability of utilities, access arrangements, etc This quantitative assessment andscoring 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 onthe balance between quality and cost. The group agreed that the final decisionshould 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 performedrelative to each other. In considering the options they were asked to consider thepotential advantages for people travelling to Aviemore (i.e. hospital services) andthose travelling to GP Practice.

This allowed each of the sites to be scored out of 10 for each of the criteria. Thepreviously agreed weightings were then applied to these scores to arrive at a finalqualitative 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 afterthe other criteria had been scored:

Site Name Votes %A Grainish Farm 18 18B Milton 1 1C Technology Park 64 63D Pony Field 19 19

Notes160 expressions of preference were noted through the consultation process including51 “no preference” There were also 7 responses which suggested other unidentifiedsites but for the purposes of determining the scoring “no preference” and “other” wereexcluded.

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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

NotesScores 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 particularcriterion skewed the decision. Further analysis was carried out by scoring thepreferred choice – Site C Technology Park at 0 for each of the criteria in turn. TheTechnology Park remained the highest scoring site in each of these scenarios.

The mechanics of the process are being independently audited by the Head ofeHealth.

Conclusion

Both the public preference and the working group’s deliberations came up with thesame conclusion (site C, Technology Park). The sensitivity analysis also showedthat this was a robust choice.

Next Steps

This preference is based only on qualitative factors. Other important factors such asdevelopment costs, land purchase and the suitability of the land for construction alsohave to be considered. This work which will be carried out by technical advisors nowneeds to take place.

The reason that it is not carried out for all the short-listed sites is because it is costlyand time consuming. It is only appropriate to carry out this level of work on one ortwo sites. This work will only be taken forward should there be a decision to progresswith implementation of the preferred option..

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APPENDIX 7 Update on local care-at-home activities

NHS Highland is working with all sectors to coordinate and collaborate on recruitmentand to make home visits work as well as possible. We have made progress and arestarting to develop some innovative ways to address the issue of home carerrecruitment.

This includes becoming the first Health Board in Scotland to achieve the living wagefor carers in the independent sector. This means that through our contract we haveincreased the hourly rate and directed that this should be passed onto the carers.

In addition, NHS Highland is developing a modern apprenticeship scheme – inpartnership with the Job Centre, Inverness College, Highland Council’s EducationDepartment 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 asan opportunity for each trainee to develop specific skills based on their experience ofyears’ one and two. The scheme would be modular and it is proposed that overyears’ one and two, each trainee would undertake six, three month placements in avariety of care settings.

At the end of year three, trainees will be encouraged into mainstream posts, or makea choice about specialist training; e.g. Health or Social Work.

Our position is beginning to improve with the implementation of these ideas and weare also trialling different ways to managing runs with the independent sector –including a move away from 15 minute time slots.

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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 HSCPareas and the Argyll and Bute CHP

These were compiled by NHS Highlands Public Health Department and launched inDecember 2012 for adults and in June 2013 for CAYP.

They were designed to assist services in the assessment of the health and socialcare needs of the populations within the geographies of the Operational Units andwithin Argyll & Bute CHP. The measures used were selected to inform each of fouraspects 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. Lifestylerelated measures such as hospitalisation rates for alcohol-related conditions or theaverage life-expectancy will be amongst others in the potential for healthimprovement category. Relative uptake of screening programmes is an example ofthe protection of health category whilst the prevalence numbers with long-termconditions is in the need for health & social care.

These measures are available at different geographical levels from intermediategeographies, districts (localities in Argyll and Bute CHP), areas and OperationalUnits/CHP. They are also accompanied by comparator measures at National, HealthBoard; and Operational Unit/CHP level.To help users identify where strengths and weaknesses lie in their area, one pagesummaries were compiled which identified particular challenges, examples of goodpractice and areas for improvement across each operational unit. These togetherwith the profiles themselves can be accessed both on the internet:

Adults: Adult_Profiles (internet)

CAYP: CAYP_Profiles (internet)

Notes

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APPENDIX 9 – Feedback on aspects of the proposals

Table Feedback on aspects of changes being proposed as part of the service re-design

AspectResponse group Number of

responses

Positive neutral Negative

Improving communitytransport

94.2% 3.5% 2.3% 171

Improving out-of-hoursinpatient medical cover

94.1% 4.7% 1.2% 170

More efficient use ofresources

94% 2.4% 3.6% 168

Better joint working 93.4% 4.2% 2.4% 167

Improving publictransport

93.4% 4.2% 2.4% 167

Developing care homes 89.4% 7.1% 3.5% 170

Providing more care-at-home (homecare)

88.4% 7.5% 4% 173

Retaining GeneralPractice Health Centres

at Grantown andKingussie

86.8% 13.2% - 174

Providing services frommodern buildings

86% 7.6% 6.4% 171

Developing new hospitaland resource centre in

Aviemore81.8% 5.9% 12.4% 170

Retaining someoutpatient services at

Grantown and Kingussie77.8% 18.1% 4.1% 171

Retaining NHS DentalServices at Grantown

73.4% 24.9% 1.7% 173

Moving Aviemore HealthCentre into new facility

68% 20.3% 11.6% 172

Closing in-patient beds inSt Vincent’s hospital

54.5% 24.6% 21% 167

Moving Glen day centrein Aviemore into new

facility54.4% 28.7% 17% 171

Closing in-patient beds inIan Charles hospital

53.8% 21.9% 24.3% 169

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Making decisions

The Board of NHS Highland will consider the recommendation at theirmeeting to be held in Inverness on 7th October 2014.

This is a meeting held in public and papers for the meeting are availableon the NHS Highland website, one week in advance of the meeting.

http://www.nhshighland.scot.nhs.uk/Meetings/BoardsMeetings/Pages/Welcome.aspx

If you have any queries about the Board meeting, please contact

kenny.oliver@nhs.net or maimie.thompson@nhs.net

NHS HighlandAssynt House,Beechwood Park,Inverness, IV2 3BW

01463 717123

How to find out more

For any further information, please get in touch with:

Dr Boyd Petersclinical lead

Tel 01479 811792

boydpeters@nhs.net

Nigel Smalldirector of operations

Tel 01463 704622

nigel.small@nhs.net

Maimie Thompsonhead of public relations

Tel 01463 704722

maimie.thompson@nhs.net

Local contacts

Contact details of the members of the steering group are also availableon the NHS Highland website.

www.nhshighland.scot.nhs.uk