Proposals to redesign health and social care services in Caithness
Draft Report on the formal public consultation
20th August to 23rd November 2018
18th January 2019
www.nhshighland.scot.nhs.uk
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This Report has been produced and published by NHS Highland
Prepared by: Eric Green (Head of Estates) Michelle Johnstone (Area Manager, Caithness and Sutherland) Christian Nicholson (Quality Improvement Lead) and Maimie Thompson (Head of Public Relations and Engagement) For further information contact: Michelle Johnstone North Area Manager North & West Division Lawson Memorial Hospital Golspie Sutherland KW10 6SS 0797 374 7688 [email protected] Christian Nicolson Quality Improvement Lead North & West Operational Unit Lawson Memorial Hospital Station Road Golspie Sutherland KW10 6SS 01408 664078 0787 051 3114 [email protected]
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CONTENTS Recommendation with supporting rationale Acknowledgements Info graphic on the public consultation survey results Executive Summary 1 Background 2 Management of the consultation process 3 Communication and engagement plan 4 Analysis of feed-back from meetings and events 5 Analysis of responses to public consultation survey 6 Views on Riverview (Wick) and Riverbank (Thurso) moving 7 Views of young people on the NHS and the consultation 8 Other feed-back 9 Scottish Health Council Assurance Report 10 Conclusions, recommendations and next steps Appendices
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Recommendation with supporting rationale The move to implement the proposed Care Hub / Care Villages in Thurso and Wick and investment in Caithness General Hospital, as part of wider redesign, is formally recommended to the Board as the preferred way forward. In endorsing the recommendation the board would be agreeing that the strategic case for change has been clearly made and that due process has been followed in consulting with local people, partner agencies including staff. However, the Project Team are of a view that it has not been possible to arrive at a strong enough consensus on the preferred site for Wick, or whether Riverview (Wick) and Riverbank (Thurso), both salaried GP Practices, should form part of the proposed Care Hubs. We have considered both the quantitative and qualitative feed-back and the overall narrative reveals that these aspects would benefit from further work. Importantly if the board endorse the recommendation it should not delay the submission of the Initial Agreement (strategic case for change). Any outstanding issues including site location and overall affordability would have to be resolved by submission of Outline Business case in summer 2020. The Scottish Health Council carried out their own Independent Assurance and they endorsed the consultation process (HERE)
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Acknowledgements The authors believe this has been the most comprehensive public consultation carried out by NHS Highland. The thorough and thoughtful approach was, in part, in recognition of the significant concerns expressed by local stakeholders, particularly in recent times. It was also an acknowledgement by the board that trust had broken down and that going forward there was a clear need to take further steps to rebuild confidence. We hope the engagement that took place throughout 2018 has helped to build more positive relationships. We warmly thank all members of the Project Team for their ongoing efforts and how they embraced the challenge with enthusiasm and without prejudice. They went above and beyond what was reasonable to expect. It was a measure of their professionalism and personal commitment to support the people of Caithness and the board of NHS Highland to try and arrive at an informed, safe and sustainable solution. Contribution from members of the consultation group, elected members, Gail Ross MSP and partner agencies have all been constructive and added value. Their regular input helped to guide the consultation and ensured it was in line with local views and feelings. Thank you. Organising and participating in over 100 events was a logistical challenge, as was disseminating the consultation materials across the area. However, the people the team liaised with to secure venues, together with their willingness to display materials, can only be commended and we record our grateful thanks. Youth Development officers facilitated three meetings and surveys with local youth representatives and some of the findings were revealing. Alan Hendry, the editor of the local papers, gave a commitment to cover the public consultation. We thank him and his team for balanced coverage sustained throughout the consultation. Our feed-back shows that the local media was a very important source to find out about the consultation. Within NHS Highland many departments and colleagues contributed significantly. The robust nature of the preparation, execution of the engagement plan, analysis and write up would not have been possible without their expertise. Particular thanks are due to Carolyn Hunter-Rowe for her analysis and report on the public consultation survey responses. Senior clinicians and managers gave up their evenings to be part of the clinical panels to support four public meetings. These were key events that allowed the public to hear directly from frontline staff. These meetings, at times challenging for all concerned, were facilitated by Norman Sutherland, Higher Ground. His input provided independence and skill to help make best use of time and inform discussions. As a Project Team we would like to formally express our respect for Norman’s independence throughout the process. We are also grateful to Neil Pettinger, Kurtosis, for his help to develop a process to ensure we redesign services with the right capacity, in the right place.
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The Scottish Health Council provided advice and guidance throughout the process and we thank them for turning around their Independent Report to meet with board deadlines. Finally, and most importantly, to the residents of Caithness and local staff who rose to the challenge to engage with the process Their active input ensured that the consultation was meaningful, responsive, respectful and we hope, ultimately positive. Thanks to the 2,107 people who took the time to respond to the survey; over 1,000 who attended events and the scores of people who were in direct contact with queries, suggestions or concerns. Staff delivered their day job and engaged with the consultation process even though it is an unsettling time. What was abundantly clear from throughout the community was the wide-spread respect for colleagues and the care they deliver, which was another positive output from the process.
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Executive summary Background
1. In November 2017, the board agreed a fresh approach to the redesign of services in Caithness.
2. Between May and June 2018 stakeholders developed and scored possible
future solutions through an independently facilitated options appraisal process.
3. The board of NHS Highland approved the options appraisal process in July 2018. They agreed that views would be sought on three options
• Status quo – current arrangements • Care Hubs/Villages Dunbar (Thurso) and Wick Town & County (Wick) • Care Hubs/Villages Dunbar (Thurso) and Pulteney House (Wick)
4 The proposals were considered to represent major service change, and
therefore the requirements, as set out in the Chief Executive Letter CEL (2010) 4, were followed.
5 In advance of the public consultation a range of materials were prepared in collaboration with local stakeholders and the Scottish Health Council. It was made clear in the documents that the board was looking for feed-back on the options, any specific elements of the options or any other proposals.
6 The aims, objective and scope of the consultation are set out.
7 The public consultation ran from 20th August to 23rd November 2018.
NHS Highland management of the consultation process 8 The leadership and management arrangements are described, as well as
internal and external governance to provide assurances around the consultation process.
9 A Project Initiation Document on the survey analysis was prepared by Carolyn Hunter-Rowe (Senior Epidemiologist of NHS Highland). This was done in advance of the analysis and set out how the survey analysis would be carried out. The document was shared with the Caithness consultation group and was also available on NHS Highland website.
Communication and engagement plan 10 The approach to developing and executing the communications and
engagement plan is detailed including evidencing that it was a very responsive process.
11 The public consultation got underway with two well attended public launch
events in Wick (20th August) and Thurso (21st August). This was a new approach taken by NHS Highland and was intended to further shape the consultation process from the outset.
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12 Throughout the consultation there was a regular flow of information available for the public through local media, social media, direct contact from the project team, distribution of documents, posters and displays.
13 During the consultation 14,529 summary consultation documents and survey
forms (with freepost envelope) were distributed to homes in Caithness (and relevant post codes in Sutherland), as part of two Royal Mail drops.
14 The Project Team attended 105 meetings and events for members of the public,
carers, service users and relatives. This included four facilitated public meetings each with a clinical panel.
15 Meetings were also held with residents, and relatives in care homes and day
services.
16 A comprehensive engagement programme with staff, including GP Practices, was also carried out.
17 There was active engagement from some, but not all, community councils, local
groups, local councillors, and members of the public. There was also wider engagement with partner agencies and elected members.
18 As part of the consultation survey respondents were asked about their
awareness of the public consultation.
19 Almost two thirds of those who responded indicated that they had sourced information from the NHS Highland consultation document (51%) and other NHS Highland materials (12%). Information from the local media (43%) and social media (27%) were also important sources of information.
Qualitative analysis of feed-back from meetings and events 20 The location and type of consultation activities which took place is summarised. 21 The public meetings were the best attended with three of the six having over
100 participants. It is estimated that around 1,250 individuals attended a consultation event.
22 More meetings were held in Wick and East Caithness (N=57) than in Thurso
and North West Caithness (N=46). In terms of numbers of people participating, more people attended the events in Thurso and North West Caithness (720 v 648). This reflected higher attendance at public meetings in Thurso.
23 The methodology used for carrying out the qualitative analysis is described. Ten
themes were identified and ranked in order of the frequency they were mentioned:
• Access and Transport • Concept of Care Hubs and Care Villages • Location and Site Issues • Medical Centres and GP Practices
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24 Qualitative feed-back from meetings and survey responses were important determinants in coming to the final recommendation about sites and whether Riverview and Riverbank Practices should be located as part of the Care Hubs.
25 All the feed-back was also used to produce a Frequency Asked Questions document with responses.
Analysis of responses to the public consultation survey 26 NHS Highland’s Senior Epidemiologist was responsible for carrying out and
writing up the Public Consultation Survey analysis.
27 Their report was prepared as a standalone document and is included in full in this report. The author summarised their findings as follows:
Views on Riverview (Wick) and Riverbank (Thurso) Practices moving
28 As part of the consultation proposals it was highlighted that ideally NHS
Highland salaried Practices Riverview (Wick) and Riverbank (Thurso) would move to be part of the proposed Care Hubs.
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29 It emerged through the consultation that the potential moves was an issue of
some concern. There was a request to ask patient views on this specific issue.
30 Accordingly this was responded to by preparing surveys and summarising other feed-back on this matter.
31 Although concerns were consistently raised about lack of public transport and
the issues this would cause if the Practices re-located to the Care Hubs, in both Practices, over 90% of their patients attended by car or walked, which strongly resonated with what staff had argued.
32 There were also some comments on this specific issue from the main
consultation survey. A meeting was held with Riverbank Patient Participation Group.
Views of young people on the NHS and the consultation 33 During the consultation the Project Team collaborated with the Youth
Development Officers in Caithness. A short questionnaire was prepared to facilitate discussions at three local events.
34 There was less support for appointments by video conference or telephone than perhaps might have been reasonably anticipated, and didn’t reflect the wider feed-back from the older age groups. Views expressed on being seen by an advanced practitioner as opposed to a GP were mostly very positive.
Other feedback 35 During the consultation contact was made with various partner organisations
requesting their input to the consultation. Responses received are summarised and all were positive around the process and the proposals.
36 13 Community Councils (including the Association of Community Councils) in Caithness were contacted to request to meet during the public consultation process. Seven community councils requested meetings and all took place within the consultation period. No response was received from the other community councils and one formal response was received from the 12 community councils.
37 After the consultation had closed the Caithness Councillors brought a motion on
the redesign proposals to the full Highland Council asking for support for the proposals.
38 The motion was unanimously supported. The Link to the motion and councillors and transcript of the relevant contributions is included in the report.
39 One GP Practice (Canisbay and Castletown) submitted a formal written
response which is included in full as part of the Report.
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Scottish Health Council Assurance Report 40 The Scottish Health Council produced a detailed report on the process for
involving and informing people. In their summary they stated: “Based on the evidence outlined in this report, the Scottish Health Council’s view is that NHS Highland has met the national guidance outlined by the Scottish Government. The engagement process and the range of consultation activities undertaken by NHS Highland enabled local people to be informed about and give their views on the proposals to develop a care hub in Thurso and Wick and refurbish the Caithness General Hospital. NHS Highland demonstrated that it was listening and responding to views and suggestions expressed during the process and adapted its communication and engagement plans in response”. Conclusions, recommendations and next steps 41 The public consultation in Caithness was one of the most extensive and
comprehensive ever carried out by the NHS Highland, and arguably by any NHS or public sector organisation in Scotland.
42 During the three month process, over 100 meetings were held and 2,017
responses to the consultation survey were received. 43 The consultation survey achieved an overall response rate of 9% of adults or
14% of homes who were sent a survey form. Response rates were higher in Thurso and Northwest Caithness (10%) than Wick and East Caithness (7%).
44 Through this extensive process there is broad support from a wide range of
stakeholders for the: i) case for change, ii) proposed Care Hub/Care Village model in Thurso and Wick, and iii) investing in Caithness General Hospital.
45 Seven out of ten people who responded to the consultation survey selected
option 2 or option 3, in supporting the case for change. 46 The process has been endorsed by the Scottish Health Council. 47 The move to implement the proposed Care Hub / Care Villages in Thurso and
Wick and investment in Caithness General Hospital, as part of wider redesign, is being formally recommended to the Board as the preferred way forward.
48 In endorsing the recommendation the board would be agreeing that the
strategic case for change has been clearly made and that due process has been followed.
49 The Project Team are of a view that at this point it has not been possible to
arrive at a strong consensus on the preferred site for Wick, or whether Riverview and Riverbank should form part of the proposed Care Hubs. These aspects would benefit from further work including fuller technical assessment and overall affordability considerations.
50 Should the board endorse the recommendations the next steps in the business
case process, including indicative time-scales, are set out.
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1 Background 1.1 Introduction The Project initiation Document approved by the board on 28th November 2017 HERE clarified arrangements to oversee a fresh approach to the engagement around the redesign work in Caithness. In particular it was highlighted that: “Despite all the efforts to date, NHS Highland appears not to have been successful in communicating the case for change and /or there not being acceptance for the case for change”, and that: “Going forward there will need to be a clear focus on explaining the case for change and a more inclusive approach as to how together we can design models of care which are fit for the future. “Greater Involvement of clinical leaders and other influences would help with explaining why changes are required and wider collaborative approach is likely to yield more innovative solutions.” Following on from the November 2017 board meeting, the Project Team embarked on further significant engagement to explain the case for change and develop possible future options with local stakeholders. This took place between March and June 2018 and culminated on 24th July 2018, with a paper presented to the board on some proposals to redesign health and social care services in Caithness (HERE). The paper set out the following:
• Local and strategic context • Some of the drivers for change • Informal engagement with local stakeholders already carried out • Outline of the local services • Description of the options appraisal process • Summary description of the short list of options (Box 1)
Box 1 | Summary of scores for each option short listed Description Score Rank Status Status quo – current arrangements 277 4 Carry forward Care Hubs/Villages Dunbar and Wick Town & County
683 2 Carry forward
Care Hubs/Villages Dunbar and Pulteney House
783 1 Preferred
Care Hubs/Villages Dunbar and Caithness General Hospital
510 3 Reject
The key steps in the NHS service change process are summarised (Appendix 1a & 1b). Having given due consideration to the options appraisal process, the recent history and the wider context, the board considered the proposals to constitute major service change. This was a view shared by the Scottish Health Council who had also
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independently endorsed the engagement and the options appraisal process (Appendix 2). 1.1.1 Conclusion of options appraisal For ease of reference the extract from the board paper presented on 24th July on the conclusion to the options appraisal is set out below: “The status quo (Option 1) received a low score of 277 out of 1000 confirming that Participants’ did not feel it was a good fit to address the challenges for the future. “Option 3 (Wick Hub in Pulteney House) scored as a preferred option with 783 out of 1000, and Option 2 (Wick Hub at Wick Town and County), scoring 683. Caithness General Hospital as the location for the Hub in Wick scored 510 out of 1000. “At the conclusion of the Workshop on 12th June 2018 it was proposed to consult on the preferred option (Option 3) but views would also be sought on Wick Town and County as potential for the location for the Care Hub in Wick. The status quo (Option1) also has to be included as the bench mark against which other options can be compared. “There was a general feeling from participants and senior managers that having the Care Hub / Care Village at Caithness General Hospital was not a practical option in terms of: constraints relating to the site, and it being a busy acute site it did not fit with Care Home/Care Village concept.
“The operational unit is therefore recommending that this option is not included as part of the public consultation. “Views will be considered on the opportunity to move NHS Highland salaried GP practices into the Care Hubs in Thurso and Wick.” 1.2 Public consultation The Chief Executive Letter CEL (2010) 4 “Informing, engaging and consulting people in developing health and community care services” sets out clear requirements to support a public consultation into NHS services in Scotland. The CEL also clarifies the role of the Scottish Health Council which is to ensure that the Board’s public involvement activities are in line with the guidance. In this regard proposals which are considered to be ‘Major’ require a period of formal public consultation lasting for a minimum of three months. Following the conclusion of the Options Appraisal process, the Scottish Health Council also made a number of recommendations to be considered as part of NHS Highland’s proposed public consultation (Appendix 2).
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It is highlighted that the board could not have moved to public consultation without the Independent endorsement of the options appraisal process and support from Scottish Government. 1.2.1 Public consultation materials A range of public consultation materials were prepared including:
• Summary consultation document
The summary document was prepared in collaboration with local stakeholders. This took some time but it did lead to a fundamental re-write of the initial drafts. Typically the documents start with explaining the case for change and conclude with an outline of the proposals. Local Caithness stakeholders, however, felt it would be better to start with setting out the proposals and conclude with explaining why changes were necessary. This was seen as being more positive and might encourage more people to readily engage in the process. Other information was made available on the NHS Highland website and at meetings, including all the considerations in developing and appraising options. Specifically to support the public consultation additional materials prepared included:
• Full consultation document
• Animation on the process
• Animation on the proposals
• Frequently Asked Questions 1.2.2 Aims The aims of the consultation were to ensure that as many people as possible were able to contribute to the public consultation process in an informed way by:
• Being aware of the consultation • Understanding the options being considered • Understanding the consultation process and how to get in touch
1.2.3 Objective The overall objective was to arrive at a position where the project team could evidence, with independent scrutiny, that NHS Highland took reasonable and proportionate steps to raise awareness and engage with a wide range of stakeholders. In doing so it would allow an informed and evidenced recommendation to be made to the board of NHS Highland.
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1.3 Scope of report This report specifically covers the findings from the formal three month public consultation (20th August to 23rd November 2018) and describes:
• How the consultation and engagement plan was prepared and implemented • The range of ways that views were gathered • Analysis of 2,017 responses to the main NHS Highland consultation survey • Analysis of other supporting surveys, view meetings and correspondence • Responses from Partner Agencies, Groups and Community Councils • Feed-back from a motion to support the proposals from the full Highland
Council • The Scottish Health Council Independent Assurance Report
Based on an assessment of all the feed-back and supporting information, a recommendation to the Board is made on a preferred way forward in terms of:
• Case for change • Model of service • Location of Care Hubs
The report also sets out further work that would be required should the proposed Care Hub/Care villages in Thurso and Wick be implemented as part of the wider redesign proposals.
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2 NHS Highland management of the public consultation process 2.1 Leadership and management support The public consultation was led by Michelle Johnstone, the area manager for Caithness and Sutherland and director for the re-design project. She was supported in the design and delivery of the consultation and public engagement plan by a core project team1 and other staff (Box 2). Box 2 | Core team members and lead responsibilities Name Designation Responsibilities Michelle Johnstone
Area Manager, North
• Project Director – lead overview of all responsibilities of team members
• Point of contact for public • Attend meetings and respond to queries
Alison Brooks
GP Thurso & Halkirk Medical Practice, Clinical Lead Dunbar Hospital and Out of Hours Clinician
• Clinical leadership and advice • Point of contact for public • Attend meetings and respond to queries • Member of clinical panel
Christian Nicolson
Quality Improvement Lead (North and West)
• Lead on public consultation process • Project management • Preparation of consultation materials • Point of contact for public • Attend meetings and respond to queries • Review of all feed-back • Analysis of themes • Support for preparation of consultation report
Eric Green Head of Estates • Estates leadership and advice • Highland lead on Capital Investment Manual
and Business Case Process • Point of contact with Capital Investment
Group • Point of contact for public • Attend meetings and respond to queries
Kay Allan Area Support Manager
• Administrative Support • Minute taker for public meetings and
consultation group Maimie Thompson
Head of Public Relations and Engagement
• Lead on service change process and public consultation
• Point of contact for Board, Scottish Government, MSPs, Scottish Health Council
• Attend meetings and respond to queries • Preparation of consultation materials • Review of all feed-back and data input • Drafting of consultation reports/papers
1 No member of the project team was full-time on the project and maintained their full range of other duties throughout the process, though prioritisation took place on an ongoing base.
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Box 2 Contd. Name Designation Responsibilities Naomi Watson • Distribution of
consultation materials • Support programme of
meetings • Attend meetings and
respond to queries • Review of all feed-
back • Analysis of themes • Support preparation of
consultation report Pam Garbe Rural General Hospital
Manager (Caithness General)
• Attend meetings and respond to queries
• Facilitate staff meetings
• Member of clinical panel
Zhen Ron Tan Project Manager
• Project Management (Estates)
• Attend meetings and respond to queries
The core team were supported by: Name Designation Claire McIntosh Manager, Bayview House Lesley Martin Acting Care at Home Manager, North Lesley Kinloch District Manager, Caithness (from 29/10/2018) Mike Flavell
District Manager, Caithness (until 03/09/2018) Advanced Physiotherapy Practitioner (Riverview, Riverbank and Lybster Medical Practices)
Nikki Mackenzie Integrated Team Lead West Caithness Penny Cormack Manager, Pulteney House Teresa Green Integrated Team :Lead , East Caithness
Executive leadership was provided by Elaine Mead (chief executive) and the senior responsible officer was David Park (chief officer for North Highland Health and Social Care Partnership). Non executive input was through Deirdre Mackay, Ann Clark and Adam Palmer who attended some of the meetings and provided support and advice. 2.1.1 Pro-active management
The consultation process was pro-actively managed and led. A member of the core project team was present at all of the meetings or events held during the consultation. This was to provide consistency in approach. The core team also
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provided responses to any correspondence or queries. They were also responsible for writing up notes from meetings and for identifying and summarising themes from meetings (Section 4). Survey responses and other feed-back was looked at, in as close to real time, as possible by a member of the Project Team 2.2 Public Health Directorate The senior epidemiologist from the Public Health Epidemiology and Health Science was responsible for carrying out the Public Consultation Survey analysis and write up of the final report (Section 5). Advice on the overall approach to the analysis was provided by Dr Cameron Stark (Consultant in Public Health Medicine (Health Services)), who line manages the Senior Epidemiologist. On his recommendation a project plan and approach (Project Initiation Document) was agreed prior to the analysis taking place (Appendix 3). He also proposed that a full audit trail of the decisions and choices made for both quantitative and qualitative data analyses should be maintained. Ian Douglas (senior health intelligence specialist) prepared maps to support the consultation:
• Consultation events, by location • Consultation responses, by location
He also prepared reports on travel times to inform discussions around whether GP Practices should form part of the Care Hubs or remain in existing locations (Section 6). 2.3 Service planning Service Planning Analyst, Morag Bramwell, Planning & Performance Directorate, has a lead role in supporting work to look at capacity modelling. 2.4 Clinical governance team Colleagues in the Clinical Governance Team set up survey monkey questionnaires and provided advice on design of surveys, including required data collection on Equality Monitoring. They also carried out the analysis on the findings into survey on possible move of GP surveys as part of the proposed Care Hubs (Section 6). 2.5 Communications team All four members of the public relations and engagement team played an active part in supporting the process including: handling media inquiries, issuing media releases, promoting the consultation through social media, carrying out social media polls and management of the NHS Highland dedicated website pages.
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2.6 Other advice, support and leadership 2.6.1 Independent consultancy support
The four public meetings were independently facilitated by Norman Sutherland Director (Health), Higher Ground Health Care Planning Ltd. Neil Pettinger, Kurtosis, provided independent analytical expertise. 2.6.2 Clinical and senior management panel
To support the four main public meetings, clinical panels were established. Membership was based on clinicians who were able to respond to the emerging topics of particular interest, as well as the availability to attend evening meetings. A list of all participants is provided (Appendix 4). 2.7 NHS Highland governance of process Update reports were considered by the Highland Health and Social Care Committee on 8 November 2018, as part of the Chief Executive’s Reports:25 September 2018 and 27 November 2018 and the local North Highland Local Partnership Forum. A draft of the full consultation report was considered by the Highland Health and Social Care Committee meeting held on 15 January 2019. NHS Highland’s engagement process, including the approach taken in Caithness, was also subject to Internal Audit. A copy of the report can be found HERE 2.8 External governance The Scottish Health Council attended a number of meetings and conducted their own independent review of the process including issuing surveys, holding focus groups and other activities. A copy of the draft report was shared with the Scottish Health Council. A copy of the Scottish Health Council Independent Report is HERE. 2.9 Scottish government NHS Highland kept in regular contact with the relevant departments of the Scottish Government during the consultation process and shared a copy of the draft report.
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3 Communication and engagement plan 3.1 Introduction Being able to validate the extent and effectiveness of the communications and engagement plan is important. It provides the context and evidence from which to assess whether the board has met the requirements of delivering an effective public consultation process in Caithness. As such it should be able to withstand external scrutiny and any reasonable challenge. 3.2 The approach to developing the consultation plan The initial elements of the plan were co-designed at a stakeholder event held in November 2017 where many ideas were put forward. These suggestions were written up after the event and published on the NHS Highland website HERE. Although this event took place in advance of the options appraisal process, NHS Highland had been consistent in stating that, at the appropriate point, there would be a public consultation on the future proposals for health and social care services in Caithness. Following the conclusion of the options appraisal process, and the board decision to move to public consultation, all the suggestions put forward in November were carefully considered by the Project Team. Accordingly, NHS Highland’s consultation and engagement plan was specifically designed to include local suggestions. It was structured to have a balance of events and activities scheduled in advance of the consultation launch (20th August), but with sufficient time and capacity available to respond to requests for information or further activities. This approach and plea to develop the consultation in partnership was further promoted at two well-attended public launch events held on days one and two of the public consultation. The approach taken also built on:
• Input from members of the local Caithness Consultation Group; • Responding to requests including through social media during the
consultation; • NHS Highland’s experience from previous public consultations; • Ongoing discussion with Scottish Health Council colleagues.
Activities and supporting actions were set out in a communications and engagement plan, prepared in advance of the consultation, and approved by Scottish Health Council HERE. 3.3 Execution of the consultation plan Meetings and events were set out in a diary format available on NHS Highland website, included in the full consultation document and promoted through media and social media. It was refreshed every week as more events were added to the plan. A programme of activities was designed to promote awareness. Some of the main activities are summarised (Box 3) and described in sections 3.3.1 to 3.3.10:
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Box 3 | Summary of consultation activities A Responsive process In response to local feedback, or at request of the Scottish Health Council, additional activities were organised which were not in the original plan (Appendix 5): Raising awareness
• Feedback questionnaire with freepost address and envelope to all homes • Mail drop of summary consultation document to all homes • NHS Highland website regularly updated • Paid adverts in local newspaper • Posters and flyers distributed • Regular media and social media outputs
Engagement activities
• 1:1 communications (letters, e-mails, phone-calls and face-to-face) • Attendance at over 100 meetings • Caithness Youth Parliament and Question Time events • Collaboration with partner agencies • Displays and staff presence in supermarkets • Local walk about in villages • Meetings with families and relatives of residents in NHS Highland care homes,
day care services • Meetings with local NHS Highland staff • Pop-up shops in Thurso & Wick • Pre arranged and promoted drop-in events
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3.3.1 Door to door distribution of documents 14,529 summary documents were distributed to all homes in the area via Royal Mail. This got underway during the week beginning of 10th September. A second mail drop was carried out in the week beginning 24th September to distribute the consultation survey form which could be returned via Freepost2. This was deliberately planned to take place after the first mail drop but before the public meetings held at the beginning of October. 3.3.2 Distribution (other) The documents (summary, full consultation document and survey forms) were also widely distributed. This was done in a planned way and was actively managed and co-ordinated by two members of the Project Team (Appendix 6). Throughout the consultation checks were put in place to raise awareness, as inevitably not everyone received the consultation documents or were not aware of their delivery. 3.3.3 Calendar of activities There was ongoing liaison with the community councils and local groups to support organising of meetings, promoting events and public meetings. Information was documented on the village facilities and the reasoning behind why a particular day/ time was decided upon (Appendix 7). The detail of venues and type of activities is provided (Appendix 8). The number of people attending the meetings was recorded where possible. To support presentation of some of the information, activities were grouped as follows:
• Community • Library • Pop-up Shops • Public launch • Public meetings • Residents/Families • Statutory Groups • Supermarket • Walkabouts
3.3.4 Face to Face meetings service users There was ongoing information sharing and discussion with service users and their families at Bayview, Pulteney House and Thor House. The existing monthly meetings and newsletters for residents and service users were also used to share information. One-to-one follow-up sessions, either in person, or via telephone call (for family members) was also offered by managers or depute managers. 2 The survey form, freepost envelope and online version were also available from 20th August
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3.3.5 Local consultation group The make-up of the group and Terms of Reference is available on the NHS Highland website HERE Many members attended one or more events and also brought queries to the attention of the core team throughout the consultation period. A well-attended mid-review meeting took place on 04/10/18. This was to get feedback from members on the process and to allow time to incorporate their suggestions to promote and support the consultation. A further meeting was held with the Group on 22/11/18 to reflect on the process and to set out the next steps. The notes of the meeting are available HERE. The full draft report was also shared with the group and discussed at meetings held on 9th and 17th January 2018. 3.3.6 Community councils On 14th August all 13 Community Councils (including the Association of Community Councils) in Caithness were written to by a member of the project team offering for NHS Highland to attend a community meeting during the consultation: 1 Association of Community Councils 2 Berridale & Dunbeath Community Council 3 Bower Community Council 4 Caithness West Community Council 5 Castletown Community Council 6 Dunnet & Canisbay Community Council 7 Halkirk Community Council 8 Latheron, Lybster & Clyth Community Council 9 Sinclair’s Bay Community Council 10 Tannach & District Community Council 11 Thurso Community Council 12 Watten Community Council 13 Wick Community Council
This was followed up after the consultation closed (20th November and 6th December) encouraging community councils to formally respond to the consultation. 3.3.7 Local elected representatives
Monthly meetings with local elected members have been underway since September 2017 and this continued during 2018 including throughout the period of the public consultation. All councillors were also invited to an informal meeting on the last day of the consultation to reflect on the process. There has also been regular contact with Gail Ross local MSP as well as with list MSPs. Gail Ross also attended the informal meeting on 23rd November.
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3.3.8 Planning partners, other business and groups During the consultation contact was made with senior officials of the following organisations: • Caithness Chamber of Commerce • Caithness Rural Transport • Caithness North Sutherland Regeneration Group • Caithness Voluntary Group • Highland Hospice • Highlands and Islands Enterprise • North Highland College • Police Scotland • Scottish Ambulance Service • Scottish and Fire and Rescue Service • Stagecoach, North Scotland • The Highland Council
The purpose was to make them aware of the consultation, to offer to meet and to encourage them to formally respond to the public consultation. 3.3.8.1 Caithness planning partnership The Project Director also attended a Community Planning Partnership meeting and a Health Inequalities workshop on 21/11/18. 3.3.9 Staff meetings
Around 28 meetings or drop in sessions took place between 20th August and 23rd November 2018 for staff across the spectrum of community based services (community nurses, community mental health team, care at home team, GP practice) and hospital based staff (nursing, laboratories, and pharmacy). Meetings were led by a senior manager supported by a member of the core team. The detail of date, time, venue and whether it was a meeting with a specific staff group or a drop-in session is provided (Appendix 9). Where possible the number of people who attended the meetings was recorded. 3.3.10 GP Practices Five out of six Caithness GP practices were visited in person to discuss the proposals. One of the practices (Canisbay and & Castletown) was offered a visit but it was not possible to arrange a mutually convenient date during the consultation period and so a VC meeting was arranged. Discussions are ongoing. 3.4 Media The media releases issued to support the consultation and next steps are summarised (Box 4).
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Box 4 | Summary of media releases issued during the consultation Date issued Title 01/08/2018 NHS Highland launches redesign consultation 16/08/2018 Residents to help decide when consultation events take place 04/09/2018 Public choose best times for consultation events 12/09/2018 Residents can provide redesign consultation feedback online 19/09/2018 Care home manager ‘positive’ about relocation plan 27/09/2018 First of public meetings to be held 03/10/2018 Delight at turnout for third consultation public meeting 04/10/2018 Assurance issued on palliative care in Caithness 08/10/2018 Feedback prompts drop-in sessions 10/10/2018 Board seeks views on moving medical practice 12/10/2018 Student survey reveals views on healthcare services 18/10/2018 AHPs Day: Mike Flavell, first contact physiotherapy practitioner 22/10/2018 Make sure your voice is heard during consultation 25/10/2018 Wick GP Practice pilots innovative NHS Near Me service 26/10/2018 New district manager for Caithness appointed 31/10/2018 Caithness: drop-in sessions to be held before consultation meetings 31/10/2018 Move ‘should aid recruitment’ at short-staffed GP practice 05/11/2018 Plans to expand NHS Near Me service 06/11/2018 Latest figures address NHS bureaucracy myth 12/11/2018 Residents asked to help Primary Care staff recruitment 20/11/2018 Residents to have their say by returning feedback forms In addition, local reporters attended a number of the Public Meetings, including the launch events (Boxes 5 and 6). There was regular coverage in the Caithness Courier and John O’Groat Journal, as well as occasional coverage in other media (Northern Times, Press & Journal, Moray Firth Radio, STV and BBC Scotland).
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Box 5 | John O’Groat Journal, 22 August 2018
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Box 6 | John O’Groat Journal, 24 August 2018
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3.5 Social media Events and materials were promoted through NHS Highland twitter account @NHSHighland (Box 7), as well as through head of public relations and engagement @nhshmt. In addition local stakeholders were active on social media Box 7 | Summary of posts on social media before & during the consultation, from NHS Highland accounts Dates Number of tweets Postings on Facebook 11/08 – 18/08 9 4 19/08 – 25/08 10 3 26/08 – 01/09 7 8 02/09 – 08/10 36 8 09/09 – 15/09 20 3 16/09 – 22/09 8 4 23/09 – 29/09 29 5 30/09 – 06/10 21 12 07/10 – 13/10 16 2 14/10 – 20/10 2 2 21/10 – 27/10 18 5 28/10 – 03/11 7 3 04/11 – 10/11 24 1 11/11 – 17/11 15 2 18/11 – 23/11 6 2
A series of social media polls also took place to gain feed-back after events such as public meetings; clinical panel, drop-in events and pop-up shops. During the first series of meetings word clouds were put out on twitter as another way to raise awareness. An example from Thurso public launch event is shown below:
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3.5 Analysis of responses on awareness and information source As part of the consultation survey respondents were asked about their awareness of the public consultation. The full write up and analysis is included in the stand alone document (Appendix 10) with key findings summarised below: 3.5.1 Consultaion awareness Respondents were asked about their awareness of the public consultation (Table 1). Almost half of responders (45%) indicated that they had become aware of the consultation from friends and family, and 16% indicated that they had attended a NHS Highland consultation event. Awareness of the consultation from local groups (11%) and NHS Highland staff (10%) was also indicated. Table 1 |Respondents awareness about the public consultation
Consultation awareness Number of respondents
% of respondents
As part of Community Council 97 4.8% Attended NHS Highland event 318 15.8% Friends and Family 915 45.4% Local Group 215 10.7% Met with NHS Highland staff 209 10.4% Other / Not given 679 33.7% Base: All (2,017) Responders could select more than one category so the percentages do not equal 100% This is referenced as table 8 in standalone report (Appendix 10 ) 3.5.2 Consultation information source Almost two thirds of responders indicated that they had sourced information from the NHS Highland consultation document (51%) and other NHS Highland materials (12%). Information from the local media (43%) and social media (27%) was also selected as a source of information. There were 55 respondents (3%) who indicated that they were part of a group that developed the options (Table 2). Table 2 | Respondents source of information about the public consultation
Information source Number of respondents
% of respondents
NHS Highland consultation document 1029 51% Other NHS Highland materials 239 12% Part of group that developed options 55 3% Place of work 223 11% Local media 875 43% Social media 545 27% Other 118 6% Base: All (2,017) Responders could select more than one category so the percentages do not equal 100% This is referenced as table9 in standalone report (Appendix 10)
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4 Analysis of feedback from meetings and events 4.1 Introduction The total number of meetings and events held during the public consultation (excluding events specifically for staff) was 105. Meetings were evenly distributed throughout the consultation period and included events on the first and last day of the consultation. The location and type of public consultation meetings which took place are shown in Map 1 and Figure 1 Map 1 |Type and location of public consultation meetings
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Figure 1 | Breakdown of the type of meetings held during the public consultation
4.2 Attendance at meetings Attendance at meetings and events was variable ranging from ranging from zero (N=1) to over 50 (N=5) (Figure 2). The public meetings, including the launch events, were the best attended with three meetings having over 100 participants. The public meeting in Thurso on the 1st of October had the highest number of people attending (N=150). Overall a total of 1,377 attendees were recorded as attending events excluding members of Project Team / Scottish Health Council. Project Team members were aware that some people attended multiple events. Therefore the number of attendees does not equate to the number of individuals participating. The project Team estimate that around 1,250 people participated at an event during the consultation.
6259%
22%
22%
11%
1211%
44% 6
6%
55%
33%
87%
Community Launch
Library Partner Group
Pop up Public Meeting
Residents/Family Engagement Statutory Group
Supermarket Walk about
Total number of events = 105 Label shows number and percentage of events
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Figure 2 | Distribution of the number of people attending at meetings and event
4.2.1 Attendance at meetings by ward area More meetings and events were held in Wick (N=46) than in Thurso (N=35). When broken down by Ward area 46 meetings were held in Thurso and North West Caithness compared to 57 in Wick and East Caithness (Figure 3). Figure 3 | Number of consultation meetings by council ward area
0
5
10
15
20
25
30
Num
ber o
f Mee
tings
Number of People Attending
Caithness Redesign Public Consultation Meeting Numbers*
* from information available at 19/12/2018
57
46
2 0
10
20
30
40
50
60
Wick & East Caithness Thurso & Northwest Caithness Outwith Caithness
Num
ber o
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tings
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In terms of the number of people participating, however, more people attended the events in Thurso and North West Caithness than in Wick and East Caithness (Figure 4). This primarily reflected higher attendance at the public meetings. Figure 4 | Number of participants at meetings by council ward area
A full breakdown of the number of people participating at each event is available. 4.3 Methodology 4.3.1 Process for documenting feedback and identifying themes Public meetings (six) were formally documented and made available on the NHS Highland website. See below for ease of reference: Public launch event Wick, 20th August 2018 Public launch event Thurso, 22nd August 2018 Public event with clinical panel in Thurso, 1st October 2018 Public event with clinical panel in Wick, 11th October 2018 Public event with clinical panel in Wick, 6th November 2018 Public event with clinical panel in Thurso, 8th November 2018 For the majority of the other meetings listed (Appendix 8), notes were taken and subsequently typed up. This was done as close to real time as possible.
648 720
9 0
100
200
300
400
500
600
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800
Wick & East Caithness Thurso & Northwest Caithness Outwith Caithness
Num
ber o
f Mee
tings
Caithness Redesign Public Consultation Number particpants at meetings by Council Ward
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Given the number of meetings and the volume of other work to support the public consultation, these were not published during the consultation but were available on request. As part of the final report a master file has been prepared and is available. 4.3.2 Summarising feed-back as themes 4.3.2.1 Qualitative analysis As part of the survey analysis all comments and viewpoints expressed in the survey responses were coded by Carolyn Hunter-Rowe (CH-R). She up-loaded the comments into a qualitative analysis software package (Dedoose). Themes and sub-themes were summarised using a standard framework. This identified ten themes summarised in the full report and included in Appendix 10 of this report. A detailed summary of the identified themes is shown in Appendix 2 of Carolyn Hunter-Rowe’s full report. Sentiment analysis was also carried out to categorise comments as positive, neutral or negative. At this stage that analysis has only been used to ensure a range of viewpoints could be selected to use as quotes. Due to the timescale required to complete the report further sentiment analysis was not carried out, though this could be prepared, especially for purposes of any research. After the consultation closed three members of the project team undertook a desk top exercise to review the feed-back from the 105 meetings. This was to allow full familiarisation with the content of the meetings prior to theming.
A member of the project team then coded all the comments and allocated them to the ten categories prepared by Carolyn Hunter-Rowe. Each theme was only documented once per meeting. 4.4 Themes
4.4.1 Responses made in the survey forms There were a total of 731 comments made by respondents on the public consultation survey form. The main themes identified were associated with accessibility and transport, the model of care, site and environment, location of some GP Practices, the consultation process, staffing, governance, the range of services, quality of care and technology (Figure 5). The author has also summarised the narrative relating to each theme.
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Figure 5 | Summary of themes identified from meetings
4.4.2 Meetings From the desk top exercise 468 comments were made. The main themes identified in are shown in Table 3 and (Figure 6). Table 3 | Identification of themes based on comments made at meetings Ranking: Theme: Number Percent
1 Hub concept and model of care 77 16.5% 2 Range of services and facilities 67 14.3% 3 Medical centres/ GP practices 55 11.8% 4 Access and transport 52 11.1% 5 Staffing 44 9.4% 6 Governance 40 8.5% 7 Quality 38 8.1% 8 Site and environment 37 7.9% 9 Consultation process 33 7.1%
10 Technology 25 5.3%
468 100.0%
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Figure 6 | Summary of themes identified from meetings
4.5 Conclusions There was consistency in the themes being raised throughout the consultation. However, some differences in ranking of the themes were evident from the survey compared to feed-back from meetings. In many cases views were contradictory. Different respondents were both positive and negative about issues, for instance, about the consultation materials and process. Responses from the survey were one way where as the feed-back from meetings was two-way and with an opportunity to have a discussion about the issues. It was also possible to explore issues in more detail. Often the discussions ranged far and wide and related to day to day issues and not just the specific redesign proposals. In some cases it was a matter of explaining the issues to support greater understanding. For other areas, however, a level of detail was being requested that the Project Team were not yet at a stage in the process to respond to. This included further detail on site assessments, reassurances around access, transport and parking and the number of community beds. The feed-back from the meetings and survey were used to develop Frequently Asked Questions with responses. This evolved throughout the consultation and the most up to date version is HERE. A more detailed document on feed-back from meetings is also available. The nature of the feed-back and range of views expressed helped to interpret views on the proposals and in particular the potential sites in Wick.
16%
14%
12%
11%
9%
9%
8%
8%
7%
5%
0% 2% 4% 6% 8% 10% 12% 14% 16% 18%
Hub concept and model of care
Range of services and facilities
Medical centres / GP practices
Access and transport
Staffing
Governance
Quality
Site and environment
Consultation process
Technology
Themes raised at consultation events (%)
Cross reference with table 3 – differences below reflect rounding
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5 Analysis of responses to the public consultation survey 5.1 Introduction The analysis of all the survey response forms was carried out by NHS Highland’s Public Health Department. This was done in accordance with the specification set out in the Project Initiation Documents, previously highlighted (Appendix 3). The report was deliberately prepared as a standalone document as the analysis was independent from the Project Team. It is included in full in Appendix 10. Key points are summarised below but the full report should be read and considered by decision makers. 5.2 Summary of who responded There were 2,017 responses to the public consultation feedback survey. Of these 1,878 (93%) were written responses to the survey delivered to homes, 32 (2%) were written responses from surveys available at meetings and on the website, and 107 (5%) were responses to the online survey3. Consultation respondents were asked to state the nearest town or village where they lived, with responses assigned to one of the two Highland wards in Caithness. The distribution of survey respondents by self-reported place of residence across the Caithness public consultation area is shown (Map 2). There were 170 responses (8%) where the respondent did not provide a town or village and 57 responses (3%) from out with Caithness (e.g. Helmsdale, Melvich). Map 2 Distribution of survey respondents by location
3 All three surveys were identical.
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There were 1,046 responses (52%) received for Thurso and Northwest Caithness Ward, and 744 responses (37%) for Wick and East Caithness Ward (Table 4). Table 4 | Response rate by consultation area
Consultation area Number of responses
Responses (%)
Population aged 16
and over1
Response rate (%)
Thurso and Northwest Caithness Ward 1,046 51.9% 10,337 10.1% Wick and East Caithness Ward 744 36.9% 11,016 6.8% Total Caithness 1,790 88.7% 21,353 8.4% Outwith 57 2.8% - - Unknown 170 8.4% - - Total responses 2,017 100.0% 21,353 9.4% Source: Caithness Public Consultation Survey 1. NRS Small Area Population Estimates (2017), best fit to Caithness Electoral Ward boundaries This is referenced as table 2 in standalone report (Appendix 10) Three quarters of those who responded described themselves as a member of the public. A higher percentage of responses were by females, 57% (cf 31%). This difference was similar in both Thurso and Northwest Caithness and Wick and East Caithness. There were also a higher percentage of responses from those in the age groups 50-59, 60-69 and 70-79 years. Similar proportions of older people responded in both Thurso and Northwest Caithness and Wick and East Caithness. Overall, less than one tenth (9%) of the population living in Caithness responded to the consultation survey. The response rate for Thurso and Northwest Caithness (10%) was greater than the response rate for Wick and East Caithness (7%). 5.3 Case for change
The results of the public consultation survey demonstrate broad agreement for a case for change. Seven out of every ten respondents (70%) indicated a preference for the proposals for change as outlined in option 2 and option 3 (Figure 7).
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Figure 7 | Percentage of responses, by options
Notably, Wick and East Caithness residents were more likely to select the status quo than those in Thurso and Northwest Caithness, 23% compared to 16%. 5.4 Preferred option Four out of every ten people who responded to the survey (39%) selected option 3 and three out of every ten people (31%) selected option 2 as their preferred option (Table 5). Of the remaining respondents, one fifth of people (19%) selected the option to maintain current arrangements (option 1). A further 5% of respondents suggested a different option and 4% indicated no preference. There were 51 survey forms (3%) where the respondent did not select an option. Table 5 | Feedback on overall preferred option Option Description Number Percent
Option 1 No change – current arrangements continue 385 19.1%
Option 2 Care Hub/Village at Dunbar Hospital site (Thurso) and Town & County site (Wick) 635 31.5%
Option 3 Care Hub/Village at Dunbar Hospital site (Thurso) and Pulteney House (Wick) 777 38.5%
No preference No preference 76 3.8% Other Respondent could suggest a different option 93 4.6% Not given Respondent did not select an option 51 2.5% Total responses 2,017 100.0% This is referenced as table5 in standalone report (Appendix 10)
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5.5 Sensitivity analysis Given more people responded in the Thurso and Northwest Caithness area than Wick and East Caithness sensitivity analysis was carried out, split by geographical area. 5.5.1 Location | preferred option by consultation area In Thurso and Northwest Caithness there was stronger support for option 3 (42%) compared to Wick and East Caithness (36%). For Wick and East Caithness residents opinion was fairly evenly divided between option 2 (33%) and option 3 (36%). Table 6 | Feedback on preferred option by consultation area
Consultation area Option 1
Option 2
Option 3
No preference Other Not
given
Total Number of Responses
Thurso and Northwest Caithness
15.5% 31.5% 42.0% 3.5% 6.1% 1.3% 1,046
Wick and East Caithness 22.8% 32.9% 35.5% 3.2% 3.4% 2.2% 744
Outwith 14.0% 22.8% 50.9% 5.3% 3.5% 3.5% 57
Unknown 26.5% 27.6% 26.5% 7.1% 1.2% 11.2% 170
Total 19.1% 31.5% 38.5% 3.8% 4.6% 2.5% 2,017 This is referenced as table6 in standalone report (Appendix 10) 5.5.2 Preferred option by consultation area, Caithness only
The analysis was further refined by looking at feedback on the preferred option for Caithness residents only. These data exclude respondents from outwith Caithness and those who did not give a response. The overall percentage of Caithness residents preferring option 3 was 40%. This is significantly higher than the percentage selecting option 2 (33%) or option 1 (19%) (Table 7). In Thurso and Northwest Caithness there is a stronger preference for option 3 (43%), which is significantly higher than the overall percentage preferring option 2 (32%). Wick and East Caithness residents also selected a preference for option 3 (37%) compared to option 2 (34%), although this difference was not significant.
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Table 7 | Feedback on preferred option by consultation area, Caithness residents only1 Consultation area Option 1 Option 2 Option 3 No
preference Other Total Number of Responses
Thurso and Northwest Caithness 15.7% 32.0% 42.5% 3.6% 6.2% 1,032
Wick and East Caithness 23.4% 33.7% 36.3% 3.3% 3.4% 728
All Caithness 18.9% 32.7% 39.9% 3.5% 5.1% 1,760 1 Excludes responders outwith consultation area (outwith/unknown) and blank responses This is referenced as table7 in standalone report (Appendix 10) 5.6 Conclusion on preferred option The sensitivity analysis on responses to the preferred option is summarised (Table 8). Table 8 | Summary of sensitivity analysis on the preferred option Options Area Analysis Type Option 1 Option 2 Option 3 Caithness • All 19.1% 31.5% 38.5%
• Caithness residents
19.0% 33.0% 40.0%
Thurso and Northwest
• All 15.5% 31.5% 42.0% • Caithness
residents 15.7% 32.0% 42.5%
Wick and East • All 22.8% 32.9% 35.5% • Caithness
residents 23.4% 33.7% 36.3%
In all cases Option 3 received a higher number of responses than Option 1 or 2. Strongest support for Option 3 was in Thurso and North West and this was significant when compared to Option 2. In Wick and East Caithness opinion was fairly evenly split for both sites. Moreover, this area had stronger support for the status quo when compared to Thurso and Northwest.
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6 Views on Riverview (Wick) and Riverbank (Thurso) moving 6.1 Introduction As part of the consultation proposals it was highlighted that ideally NHS Highland salaried Practices Riverview (Wick) and Riverbank (Thurso) would move to be part of the proposed Care Hubs. While initial analysis had shown this would have a minimal impact on drive and walk times (HERE), it became clear during the consultation that this specific element was raising some concerns and splitting opinion. Views were being expressed that current locations were more central and the proposed changes could cause a problem for access, transport and car parking. Equally there were other views supporting the anticipated benefits of having medical input and integrated teams as part of the Hubs. This was a particularly strong feeling from some staff. Moreover some felt that overall the access issues were minimal as a majority of patients already attended the Practice by car. It emerged through the consultation that there was support for asking patients views on this specific issue. NHS Highland clarified that while desirable to have this element as part of the Care Hubs it wasn’t an essential element of the Care Hubs. Accordingly the purpose of the consultation was to seek wider views. 6.2 Methodology A range of feed-back was used to seek opinions on this specific issue, including: • Dedicated questionnaire for each practice • Feed-back from free text comments in main survey • Feed-back from Riverbank Patient Participation Group (Thurso)
6.2.1 Dedicated questionnaire Questionnaires were designed for both practices with advice from the Clinical Governance and the Practice Managers. The thinking behind the questions was to gain feed-back on current experience and to gauge opinion on possible future changes of moving the Practice to be part of the proposed Care Hubs. In Wick views were sought on two possible locations for the proposed Care Hub (Wick Town and County and Pulteney House). Both questionnaires also asked a series of questions about seeing if anything would influence the patient’s decision around co-location. A covering letter from the Practice Managers was prepared to explain why the survey was being carried out. The questionnaires were handed out by reception staff at both practices. It was also
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available on-line and a number of activities taken to promote the survey including, media, social media, practice websites, and at the public meetings in Thurso and Wick in November. The Riverview Practice (Wick) survey ran from 29th October to 23rd November and Riverbank (Thurso) from 1st November to 7th December. Completed responses (hard copies) were either returned to reception or via a Free Post envelope to NHS Highland. The data was entered by Maimie Thompson (Head of PR and Engagement). The Analysis was carried out by a member of NHS Highland’s Clinical Governance Team. 6.3 Results 6.3.1 Riverview (Wick) A standalone report was prepared and is available with a summary of the key findings as follows: • 266 responses were received for the survey • The highest number of patients attended to see a Practice Nurse (38%) followed
by a GP (37%) • The majority of respondents travelled in their own car (70%) with a further 11%
attending in the car of someone else. 14% of respondents walked to and from the practice.
• The majority of people found a parking place without problem • Regarding attending by bus or Caithness Rural Transport, only 28% said that
they could have used one of these as a means of transport. • The primary reason given for not using bus was no local bus service (25%)
followed by times not suitable (20%) with it being not required for 19% as they live local to the practice.
• The biggest proportion of respondents (43%) had visited the practice one or two times in the previous three months.
• Awareness of difficulties in recruitment of GPs was high with 89% saying they were aware of this.
• Regarding moves to Wick Town and County, 51% were in support, with 29% unsure.
• Support for the move increased up to 69% if it was the case that care would improve by having staff located beside each other
• Support was lower for the move to Pulteney House with 40% being in support and 33% unsure.
• Support for the move increased if would be the case that care would improve by having staff located beside each other.
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6.3.2 Riverbank (Thurso) A standalone report was prepared and is available with a summary of the key findings is as follows: • 54 responses were received for the survey. • The highest number of patients attended to see a Practice Nurse (40%) followed
by a GP (31%). • The majority of respondents travelled in their own car (57%) with a further 4%
attending in the car of someone else. • 34% of respondents walked to their appointment • 74% of patients found they were able to find a car parking space without any
difficulty. • Regarding attending by bus or Caithness Rural Transport, 23% said that they
could have used one of these as a means of transport. The two highest reasons given for not using buses were that there was no local bus service (25%) and that bus times were not suitable (25%). 22% of respondents said that they lived local to the practice.
• The biggest proportion of respondents (44%) had visited the practice one or two times in the previous three months.
• Half of respondents were aware that NHS Highland does not own the building. • Difficulties in GP recruitment were very high with 94% saying they were aware of
this issue. • Regarding the possibility of moving to Thurso Dunbar Hospital, 44% were in
support while 25% unsure. • This increased to up to 70% with mitigation: if it would be easier to recruit and
provide more services; and improve the working environment for staff
6.3.2.1 Riverbank Patient Participation Group A meeting was held on Tuesday 4th September with member of Riverbank PPG, Practice Manager and with Scottish Health Council. This included a discussion on the potential of the Practice moving to be located as part of the Care Hub. Points raised were: • Access and Transport to the Hub – how will this be improved. Would need to
have a plan • Efficient: More efficient use of staff - new build element would allow services to
be provided from fewer but better facilities • Current location of GP Practice more central but could see benefits of being in a
new Hub. • Parking at Dunbar can be a problem – how would this be resolved? • Plans for Parking would have to be part of any proposals • Transport: Might be easier to get more regular transport if all services are co-
located (GP, Bayview etc) Catriona McNaughton (Practice Manager) set out issues from a Practice perspective • Being part of new Hub could create opportunities and help with recruitment • Benefits of all staff co-located • Building is leased • It is adequate but out-growing and running out of space
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• Current location good but not great parking • Opportunities to work in different part of the Hub but would not want roles/ identity
to be diluted • Patients could enjoy better environment 6.4 Feed-back from main survey Summary of main points made about Riverview (Wick) and Riverbank (Thurso) GP Practices from the public consultation survey as part of free txt comments 6.4.1 Riverview (Wick) • Currently well situated in central location in town centre • Concerns about accessibility and transport, especially for those who do not drive • Plans for parking need to be explained • More explanation of the benefits of moving GP practice to service users • Unclear of the rationale behind replacing existing buildings “Keep current building at Riverside Wick as parking is an issue at other sites” Respondent 22, Wick “Pulteney House and Town and County are not at all central, whereas Riverside Medical Practice is etc. Why change things at great cost that are working well?” Respondent 500, Wick. 6.4.2 Riverbank (Thurso) • Currently well situated in a central location • Concerns about accessibility, public transport and increased cost to patients
accessing the proposed hubs • Impact on increased traffic on nearby schools, college and public facilities • Concerns about what would happen to empty buildings and how these would be
prevented from becoming an eyesore • Unclear of the benefits of replacing buildings which are seen to be serviceable
and fit for purpose • Unclear how moving the medical practice will address staffing issues • Potential impact on Princes Street Surgery if patients moved practice “Why does the doctors surgery at Riverbank in Thurso need to move to the hub. It is a relatively new central facility. In Thurso going to this Hub will require transport for most.” Respondent 854, Thurso “I am strongly opposed to the proposed move of the Riverbank Medical Practice to the new care hub/village. [It] will generate significantly more traffic on the Princes Street/B874 road from Thurso town centre. The road passes two schools and one college, as well as the railway station, and serious consideration must be given to the effects on road safety in the area.” Respondent 1598, Thurso “To maximise the benefit of the care hub I believe it is essential that both Riverbank and Princes Street surgeries move into the hub.” Respondent 1783, Thurso
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6.5 Conclusions There was smaller number of responses from Riverbank compared to Riverview (N=266 vs. 54). A higher percentage accessed the Practice in Riverview by car (80%) than in Riverbank (61%). In both areas between 70% and 74% reported that they were able to find a car parking space (where applicable). However, 34% of patients in Thurso walked to Riverbank, more than twice that of those who walked to Riverview (14%). Overall, more than 90% of patients in both areas accessed the practice by car or walked. While this will need to be explored further it would suggest, based on current patterns, addressing car parking issues may be more of an issue than access by public transport. Even with mitigation there was lower support for the move of Practice to Pulteney House compared to the other locations. In the main survey 21 comments were made about keeping the practices where they are. Very similar issues were raised for both practices particularly favouring current central location, impact on accessibility/transport and lack of perceived benefits of having buildings. Views from the Riverbank Patient Participation Group indicated they were open to the proposed re-location; however, this was subject to being reassured around more detailed plan to address issues such as access. In general staff were supportive of a move to the proposed Hubs.
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7 Views of young people on the NHS and the consultation 7.1 Introduction During the consultation the Project Team collaborated with Youth Development Officers in Caithness. This included attending three events aimed at seeking input of young people into the consultation and to get a sense of awareness and views around how local health care is delivered. 7.2 Methodology A short questionnaire was prepared to facilitate discussions at the three events: • Freshers Day in North Highland College in Thurso (12/09/18) discussions with
students,, N=60 • Highland Youth Parliament , local conference, Wick Assembly Halls (14/11/18),
N12 Caithness Year of Young people ‘Question Time’, Skinandis Night Club, Thurso (16/11/18) N=25
7.3 Results Feed-back on a selection of the questions is summarised (Table 9). Table 9 | Survey response by group Group Questions 4 Freshers
(16-54 years) Youth (13-18 years)
Question Time (mix of young people)
1. Views on appointments by video conference
61% 50% 4%
2. Views on appointment by telephone
67% 18% 20%
3. Views on being seen by an advanced practitioner
91% 92% 68%
4. Number of times seen a healthcare professional in last three months
61%
45% 28%
5. Awareness of public consultation
39% 42% 29%
7.4 Conclusions There was quite a bit of variation in the responses from the three different groups most probably reflecting the small sample sizes. There was less support for appointments by video conference or telephone than perhaps might have been anticipated. It didn’t reflect the wider feed-back from the older age groups. The young 4 For questions 1-3, percentages relate to responses stated as strongly agree or agree)
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people commented on the importance of body language and eye contact as being important during consultations. Views expressed on being seen by an advanced practitioner were positive. They felt what was important was that the professional had the relevant training and not what they were called. The number of times seen by a healthcare professional in last three months also seems high. Regardless of the redesign proposal it would be worthy of exploring this in more detail through a larger scale sample. If the level of consultation is high it would be important to look at any underlying reasons.
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8 Other feed-back 8.1 Introduction From the outset NHS Highland emphasised the importance of working collaboratively including with partner agencies, local groups and elected representatives. 8.2 Planning Partners, other Business and Groups During the consultation contact was made with various organisations requesting their input to the consultation: Responses received on aspects of the consultation were coded as Positive, Neutral, Negative and Nil and summarised in Table 10 and (Appendix 11). Table 10 |Summary of responses on aspects of the consultation Aspects of the consultation Organisation Process Model Location Other Caithness Chamber of Commerce
Positive Positive Neutral Yes
Caithness Rural Transport Positive Positive Pulteney Yes Caithness North Sutherland Regeneration Group
Positive Positive Neutral Yes
Caithness Volunteer Group Positive Positive Neutral Yes Highland Hospice Positive Positive Neutral Yes Highlands and Islands Enterprise
Nil
Police Scotland Positive Positive Neutral Yes Scottish Ambulance Service Positive Positive Neutral Yes Scottish and Fire and Rescue Service
Positive Positive Neutral Yes
Stagecoach, North Scotland Positive Positive Town and County
yes
The Highland Council, Members Positive Positive Neutral Yes The Highland Council, Officers Nil University of the Highlands and Islands (North Highland College)
Positive Positive Neutral Yes
Further details on the responses are outlined below by alphabetical order of the responding organisation: 8.2.1 Caithness Chamber of Commerce
Welcomes the “ambitious programme of change and commitment to investment in health and social care services in the region” and congratulates NHS Highland on the community engagement throughout the consultation. Encourages the board to choose sites based on patient need, rather than cost. Recognises the significant transport challenges and urges NHS Highland to work closely with transport operators and user groups to address these. Also asks NHS
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Highland to consider bringing more specialists to Caithness instead of patients travelling to Raigmore and further afield. Socio-economic issues specific to Caithness encourages NHS Highland to work in a way that promotes the area positively: to strengthen health services for the population; educational opportunities (links with UHI etc.); and to encourage rural working (recruitment and retention). Also asks NHS Highland to mindful of redundant assets – encourage redevelopment and change of use. 8.2.2 Caithness Rural Transport In favour of the Care Hub/ Village; preferred site in Wick – Pulteney House. Recognise that transport is a big issue in Caithness and is keen to work in partnership to help address this. 8.2.3 Caithness North Sutherland Regeneration Group Welcome the proposals – “the provision of modern, fit-for-purpose health and social care facilities is......a key enabling element of an area economy.” Positive about the work that has already been done with UHI on addressing current and future skills needs – recognises both that work and the proposed redesign as important steps in creating future opportunities and establishing a sustainable model. Highlights the fragile local transport network and encourages closer working with transport providers and service user groups. Welcome the opportunity to continue to work in partnership. 8.2.4 Caithness Voluntary Group Very positive and supportive particularly around the consultation events. Keen for the Third Sector to work in partnership on developing the detailed plans. Recognise the challenges (particularly in Wick) around the location (transport, parking, and access). Appreciates concerns and challenges (ensuring access for all) about moving the medical practices from their current locations, but can see the “medical advantages” of co-location. 8.2.5 Highland Hospice Commends NHS Highland for recognising the importance of palliative/ end of life care. Welcome the proposed co-location of services, although unable to comment on location of Wick site. Keen to work in partnership, providing: advice around “optimising physical environments & appropriate equipment”; training & support (for NHS Highland staff, other health and social care providers and the local community). 8.2.6 Highlands and Islands Enterprise
No response
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8.2.7 Police Scotland Opportunity to “pool resources and strengthen service provision” – positive step for Caithness. Also raised some concerns: • Transport – local transport plan would be beneficial, particularly with an aging
population, reduction in car ownership and location of Care Hub/ Village. Concerned about the adverse affect this may have on people already experiencing inequalities.
• Mental Health provision – significant issue for Officers: this is an opportunity to review current service provision in respect of Out of hours and Place of Safety.
• Drug/ Alcohol addictions – prevalence of addiction locally and links to inequalities – how will this be addressed?
• Forensic Health Care projects –is there an opportunity to incorporate this into the planning, something which could be supported by partners and linked services, as is done elsewhere.
8.2.8 Scottish Ambulance Service Welcome the proposals as a “safe, sustainable and attractive solution” in addressing current healthcare challenges, in addition to the forecast pressures brought on by an aging population. Particularly, positive about the potential opportunities for Scottish Ambulance Service staff (development and enhancement of skills; rotational model of working at hubs) as a result of co-location and greater integrated working. Request around consideration of site location in order to minimise the request for ambulance transport requests due to access difficulties.
8.2.9 Scottish and Fire and Rescue Service Welcome the opportunity to be involved and keen to continue to do so. Positive about the proposals and mentions ongoing talks around co-location of services (SFRS & SAS) at Caithness General Hospital and a possible similar opportunity at the Dunbar Hospital. Makes reference to Out-of-Hospital Cardiac Arrest (OHCA) strategy and the Uninjured Fallers Response pathway – demonstrative of a willingness to work collaboratively in Caithness 8.2.10 Stagecoach, North Scotland As discussed in the meeting held with NHS Highland representatives on 15 November in Thurso, Stagecoach North Scotland is very supportive of plans to centralise and improve healthcare facilities in the Caithness area. The combination of multiple facilities in a single location is likely to drive increased traffic to this location; this should in theory provide sufficient travel demand to justify the provision of local bus services to the new site(s).
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It is the intention of Stagecoach to work closely with NHS Highland and other stakeholders to ensure that any proposed redevelopment of facilities is accessible for public transport facilities. The bus network in Caithness is made up of a mix of commercial and tendered services; therefore, engagement with Highland Council (the contracting authority) will be essential. When considering the physical design of any redeveloped facilities, we would ask that full consideration is given to adequate turning areas, bus stop facilities and bus information infrastructure at each location. There is a real opportunity to create one or two "travel hubs" where customers would be able to connect between services, as well as access the healthcare facilities at each site. With regards to the Options for sites, we would like to state a preference for the Town and County site in Wick. This site appears to be more amenable to future development to support bus infrastructure, and could be more easily accommodated through changes to our existing network of services. Conversely, Pulteney House would pose significant challenges, specifically narrow road width and the lack of turning facilities in this area. Additionally, adjusting the Wick town service to serve a developed Pulteney House site would require us to omit several existing bus stops in the Pulteneytown area, which would reduce public transport access for local users. We are keen to engage with NHS Highland on staff travel to any proposed developments, too. There is an opportunity to mitigate the challenges of providing sufficient staff car parking through the provision of improved bus services as well as potential discount schemes for ticketing. We are keen to remain involved in this process and will happily provide additional information to assist if required. 8.2.11 The Highland Council, Members On Thursday 13th December a Caithness Councillors brought the following motion on the redesign proposals to the full Highland Council. “Highland Council supports proposals currently being developed by NHS Highland and local stakeholders to ensure refurbishment and redesign of Caithness General Hospital and the creation of health care hubs in Wick and Thurso, Recognising that these measures retain existing local services whilst offering a sustainable model to further develop and enhance local provision. Caithness Members will continue to work with NHS Highland and stakeholders to provide more local clinics, reduce unnecessary travel and address ongoing concerns regarding maternity services” The motion was unanimously supported. The Link to the motion and councillors contributions is HERE. A transcript of the relevant contributions is provided at Appendix 12 and local media coverage below:
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Box 7 | John O’Groat Journal, 21 December 2018
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Box 8 | John O Groat Journal, 21 December 2018
8.2.12 The Highland Council, Officers
No response
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8.2.13 University of the Highlands and Islands (North Highland College) Fully endorses the consultation and agrees with the need for change. Acknowledges the existing “solid working relationship” between NHS Highland & UHI and is keen to develop this further. Belief is that the (more) integrated model will create new opportunities for research (innovative rural healthcare) and joint working initiatives to “grow, retain and.....supplement our local skills talent.”
8.3 Community Councils A member of the project team contacted the 13 Community Councils (including the Association of Community Councils) in Caithness on 14th August. This was to request to meet with them during the public consultation process. Seven community councils requested meetings which took place. No response was received from the other community councils (Table 11): • Castletown Community Council • Dunnet & Canisbay Community Council • Tannach & District Community Council • Thurso Community Council • Watten Community Council • Wick Community Council • Association of Community Councils
Reminder emails were sent requesting formal responses to the consultation but only one was received (Table 11). 8.3.1 Wick Community Council As a Community Council we request that NHS Highland consider the full impact of outpatients travel from Caithness and Sutherland (and Orkney for that matter) to Raigmore Hospital. Our motivation is to minimise cost and wasted time to patients, relatives, medical staff and NHS Highland in general budget. By using IT (e.g. NHS Near Me) and / or cost/ benefit justification for medical staff to conduct local appointments, where appropriate, such as at Caithness General Hospital it could prove to be a more economic option (all other things being equal|). Therefore we are challenging the current Scottish Government and NHS Highland Patient Travel Policy where HMRC Guidelines are used as a minimum. HMRC Guidelines are for Employees and specifically state 'must not be used for any other purpose', which evidently they are. Scottish Government also advise that travel costs should be in accordance with fuel costs or public transport costs (in real terms, the AA advise this as being £0.43p/mile which considers all aspects of vehicle use) It’s blatantly obvious that public transport network frequency and timetables thereof, are inadequate for the vast majority appointments at Raigmore, quite apart from any associated inconvenience and stress for many patient groups. Whilst, we are aware
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that the Scottish Ambulance Service provides Patient Transport for some outpatients who meet their criteria, the turnaround frequency will always be a significant issue. In addition, we have requested how NHS Highland can justify deducting £10 when patients are in employment. This contravenes SG policy that the £0.13 (0.14 NHS Highland) rate should be the minimum paid. It’s bad enough losing a days’ pay to travel to Inverness, pay for lunch then being charged another £10 for the inconvenience. While this may come across as negativity what we are trying to achieve is that all aspects including hidden costs attributable to outpatient travel are realised as this will allow the full picture to be understood. In doing so it will help inform future decision making and make best use of resources including time. Only when all concerns are aired, considered and mitigated can this provide a meaningful input to the overall Redesign and associated business case process. We have requested our Highland Councillors, MSP Gail Ross, CHAT and MP Jamie Stone to progress our concerns with NHS Highland Board and Scottish Government and others as appropriate. Table 11 | Summary of NHS Highland contact with community council and responses Name of Community Council
Date Meeting Requested
Date Meeting Took Place
Date emailed re Formal Response
Date reminder email sent re formal response
Response received
Berridale & Dunbeath
14/08/18 Nil 20/11/18 06/12/18 Nil
Bower 14/08/18 Nil 20/11/18 06/12/18 Nil Caithness West
14/08/18 Nil 20/11/18 06/12/18 Nil
Castletown 14/08/18 27/09/18 20/11/18 06/12/18 Nil Dunnet & Canisbay
14/08/18 29/10/18 20/11/18 06/12/18 Nil
Halkirk 14/08/18 Nil 20/11/18 06/12/18 Nil Latheron, Lybster & Clyth
14/08/18 Nil 20/11/18 06/12/18 Nil
Sinclair’s Bay
14/08/18 Nil 20/11/18 06/12/18 Nil
Tannach & District
14/08/18 04/10/18 20/11/18 06/12/18 Nil
Thurso 14/08/18 25/09/18 20/11/18 06/12/18 Nil
Watten 14/08/18 12/11/18 20/11/18 06/12/18 Nil Wick 14/08/18 03/09/18 20/11/18 06/12/18 Received Association of Community Councils
14/08/18 04/09/18 20/11/18 06/12/18 Nil
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8.4 Other Groups Three responses were received from groups through the main consultation survey response route: 8.4.1 Haven / Stepping Stone This was received through the main consultation survey. In their responses they stated they were not in favour of their services being located in the Care Hubs. 8.4.2 Cancer Support Group for Men While the group acknowledged the potential benefits of the proposal being offered they raised concerns around whether funding would be secured. They also highlighted a number of areas for improvement which would not have to wait for significant capital investment, including: • Travelling to Raigmore for appointments with support to move across to greater
use of Video technology • Prioritisation of effective recruitment, training and workforce planning including
cross-over of some skills • Local delivery of chemotherapy • Closer working across clinical interfaces (GP vs. hospital doctors) • Dignity and respect a fundamental part of care. • All staff working to highest possible standards • Transport and access and suggesting that worthy of an independent study • Thoughts on leadership and management
8.4.3 CHAT During the consultation Caithness Health Action Team (CHAT) were active in promoting and contributing to the consultation process and attended many events. We also hosted a number of our own events where we shared information about the consultation and encouraged people to make their views known by completing NHS Highland’s consultation survey. A survey we carried out in the Wick area, involving 436 folk, highlighted a number of concerns. The results of this survey were submitted to NHS Highland (Table 12). Throughout the consultation we were active on social media (Facebook) sharing information, promoting events and raising queries. CHAT has 3,660 followers on Facebook and has an average of 7,000 visits to our posts each week. Ron Gunn, our Vice Chair, also submitted a series of articles to the local paper in further efforts to represent CHAT members and promote the consultation (Box 9, 10 and 11). On 15/11/18 we met with representatives of NHS Highland where we formally presented our feed-back. Our position is that while overall we are supportive of proposals and the investment, we have some significant concerns around site selection in Wick and feel this needs more detailed assessment before a decision can be arrived at.
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As part of the consultation we submitted a response to the Scottish Health Council. CHAT continues to be actively involved in the redesign including having a representative on the local consultation group. NHS Highland set up the group to support ongoing local engagement as NHS Highland moves through the business case process. Table 12 | Summary of CHAT survey results
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Box 9 | John O’Groat Journal, 14 September 2018
Box 10 | John O’Groat Journal, 14 October 2018
Box 11 | John O’Groat Journal, 26 October 2018
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8.5 Canisbay & Castletown Group Practice The Practice submitted a formal response to the consultation and is included in full with their permission (Appendix 13). Their response highlights changes in the GP contract and some of the implications for the way new primary care services will need to be developed. Whilst they are not advocating for their practices to move to Thurso or Wick, they have sought assurances from NHS Highland that the proposed models of care for the Care Hubs would be transferable and be fair to all populations expected to benefit from the funding of key services to the area. One of their main concerns is with a lack of space and future proofing of both sites. NHS Highland has already confirmed that Castletown, in particular, is in need to be considered for redevelopment to a more suitable sized location. Some of the issues raised would need to be considered regardless of the current redesign proposals. However, the work to support the modernisation of Primary Care combined with the wider redesign proposals presents a positive and timely opportunity to look at everything together as part of a single business case. Such an approach will apply equally across all practices as appropriate. 8.6 Correspondence A small amount of correspondence (letters and emails) was received during the consultation (N=12).
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9 Scottish Health Council Assurance Report The Scottish Health Council produced a comprehensive report on the process for involving and informing people and highlighting any issues raised by local people during the consultation. It was published on 18/01/19 and is available on their website LINK. It is also available on NHS Highland website (HERE) In the executive summary of their report it states that: “Based on the evidence outlined in this report, the Scottish Health Council’s view is that NHS Highland has met the national guidance outlined by the Scottish Government. The engagement process and the range of consultation activities undertaken by NHS Highland enabled local people to be informed about and give their views on the proposals to develop a care hub in Thurso and Wick and refurbish the Caithness General Hospital. NHS Highland demonstrated that it was listening and responding to views and suggestions expressed during the process and adapted its communication and engagement plans in response”. The full report is included as Apendix 14
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10 Conclusions, recommendation and next steps 10.1 Introduction The public consultation in Caithness was one of the most extensive, intensive and comprehensive ever carried out by the NHS Highland, and arguably by any NHS or public sector organisation in Scotland that the Project Team are aware of. 10.2 Conclusions During the three month process, over 100 meetings were held and 2,017 responses to the consultation survey were received. The consultation survey achieved an overall response rate of 9%. Response rates were higher in Thurso and Northwest Caithness (10%) than Wick and East Caithness (7%). Through this extensive process there is broad support from a wide range of stakeholders for the case for change and the proposed Care Hub/Care Village model in Thurso and Wick and investing in Caithness General Hospital. Seven out of ten people who responded to the consultation survey selected option 2 or option 3, and in doing so signalled their support for the case for change. The proposed model and consultation process also received formal support from a wide range of partner organisations. Moreover on 13th December a motion proposed by Caithness Councillors, in support of the proposal, received backing from the full Highland Council. Critically the process has been independently and positively validated by the Scottish Health Council. Themes and issues raised during the consultation included accessibility and transport, the model of care, site and environment, GP services being part of the Hub, quality of care and technology. Specifically concerns about public transport, parking, the concept of care hubs, and having to travel for appointments to Raigmore were commonly raised. There was strong support to reduce travel including through NHS Near Me. During the process it was confirmed that NHS Highland had no plans to move any of the GP Practices in locations outside of Wick or Thurso. As a direct result of feed-back received during the consultation specific surveys were carried out with patients in Riverview Practice in Wick and Riverbank in Thurso. This was to explore in more detail views on these Practices re-locating to the proposed Care Hubs. Based on these findings there was slightly more support for GP Practices to be part of the proposed Hubs. The wider feed-back, however, indicated a range of views with some strong opinions. The possibility of having a hybrid model emerged where by the location of practices could be maintained for Primary Care appointments but the multi-disciplinary team including GPs could be based at the Care Hubs. The Project Team feel this is worthy of consideration and requires further discussion with staff and patients.
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Although concerns were consistently raised about the lack of public transport and the issues this would cause if the Practices re-located to the Care Hubs, in both Practices, over 90% of their patients attended by car or walked, which strongly resonated with what staff had argued. Overall a higher proportion of respondents indicated a preference to option 3 (39%) compared to option 2 (32%), and this difference was significant, the sensitivity and qualitative analysis highlighted concerns. For instance opinion was more evenly split for Wick residents, with 36% selecting option 3 compared to 34% selecting option 2. This was not significantly different. Moreover during the public consultation a new site was proposed that the Project Team believes should be considered. Therefore the process around selecting a site in Wick would also benefit from more detailed work. This would help to further explore the advantages and disadvantages of the different site options in Wick before making a final decision. Work to support the modernisation of Primary Care combined with the wider redesign proposals presents a positive and timely opportunity to look at everything together as part of a single business case. During the consultation a number of areas for day-to-day improvements were highlighted which do not have to wait for capital investment, including reducing travelling to Raigmore for appointments with general support to move to greater use of Video Technology. 10.3 Recommendation The move to implement the proposed Care Hub / Care Villages in Thurso and Wick and investment in Caithness General Hospital, as part of wider redesign, is now being formally recommended to the Board as the preferred way forward. In endorsing the recommendation the board would be agreeing that the strategic case for change has been clearly made and that due process has been followed to consult with the public. However, the Project Team are of a view that it has not been possible to arrive at a strong consensus on the preferred site for Wick, or whether Riverview and Riverbank should form part of the proposed Care Hubs. These aspects would benefit from further work. This would help to build trust and confidence, and ensure that going forward, there continues to be positive and active engagement. Given the overall support for the proposals these specific local elements would be subject to proportionate engagement but would not be classed as major service change. 10.4 Next steps If the board endorse the recommendation then the next step (HERE) would be to progress to Initial Agreement. This would set out the strategic case for change, the preferred model, service specification, workforce plan and high-level costs. This
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would be for submission to the NHS Highland board meeting scheduled for the end of July 2019. By the time the Outline Business Case work is completed work on the "preferred model" including coming to a conclusion on location in Wick and the exact specification of the Care Hubs / Care Village, alongside the work required at Caithness General Hospital will have taken place. This would include completion of technical assessments on all three potential sites identified in Wick; the associated workforce plan and overall affordability of the proposals including sites. Any new or changing circumstances would need to be constantly under review. Specific detailed elements would include the following: 10.4.1 Specification of Care Hub and design of buildings Detailed work to determine the exact specification of the Care Hubs / Care Villages in both Wick and Thurso. Any building and size of buildings would need to fit with the way clinical care is now delivered, be suitable for services users in terms of access and comply with all relevant legislation. Services users, members of the public and relevant experts would be invited to be involved in this work. 10.4.2 Community capacity and bed modelling Work would continue to develop a model to calculate the community capacity required for the future. A range of data supported by a local clinical and care panel will be considered and include:
a. Hospital data (general hospital and community hospital data) b. Care at home data (from the CareFirst system) c. Care Home data (from both nursing homes and residential homes, from both
NHS and independent sector care homes) d. Allied Health Professional data e. Community nursing data
Predictions on future capacity will be developed based on data gathered during the panel discussions, with a range of models based on expected future population change, and realistic expectations of what NHS Highland and other service providers will have available. 10.4.3 Financial and technical appraisal of sites for Care Hub/Care Villages Full financial and technical appraisal of sites will be carried out and completed as part of the business case process. At this stage NHS Highland believes that all potential sites for the Care Hub/Care Villages will have the required space or the potential to purchase additional land.
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10.4.4 Future use of buildings Any NHS Highland or Highland Council building no longer required would be available for alternative use by local communities, through Community Empowerment and Asset Transfer. Alternatively, they could be reused for future purposes or be put up for sale through the required process.
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Appendices
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Appendix 1a | Key Steps in NHS Service change process
STEP 1Undertake pre-engagement activity with key stakeholders
STEP 2Agree the need for service change with stakeholders
‘Case for Change’
STEPS 3 & 4 Development of Options
STEP 5 Appraisal of Options and Scoring
STEP 6 Proposed change considered major?
Step 8Board Decision
No Yes
Step 7Undertake Community
Engagement
Step 7Undertake formal public
consultation
Appendix | 1b Timeline for key steps in Caithness Redesign
Step Process Status 1 • Pre-engagement • 2017 2 • Case for change • 19th March 2018 3 • Agreeing benefit criteria • 18th May 2018 4a • Development of long list of options • 22nd May 2018 4b • Agree short list of options • 31st May 2018 5 • Appraisal of short list of options • 12th June 2018 6a • Highland Health and Social Care
Partnership on preferred way forward • 5th July 2018
6b • Board decision on preferred way forward including major service change
• 24th July 2018
7 • Public Consultation • 20th August to 23rd November 2018
8a • Highland Health and Social Care Partnership recommendation on preferred way forward
• 15th January 2019
8b • Board Decision • 29th January 21019
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Appendix 2 | Scottish Health Council Response
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Appendix 3 | Caithness Public Consultation Survey Project Initiation Document
Background
NHS Highland is running a public consultation from 20th August to 23rd November 2018 on proposed major service change in Caithness. The public consultation is seeking views on some proposed changes to health and social care in Caithness. The proposals were developed in discussion with local people, who took part in developing possible future solutions. The public consultation is gathering feedback in the form of an electronic and hardcopy survey. The Epidemiology and Health Science Team in the Directorate of Public Health have been asked to provide analysis of the survey responses.
Project definition
Aim
To report on the results of the Caithness public consultation survey on proposed major service changes in Caithness.
Objectives
• To analyse the responses from the Caithness public consultation survey using quantitative and qualitative methods.
• To produce a written report summarising the results of the Caithness public consultation survey.
• To produce supporting materials to ensure that the survey analysis is open and transparent.
Project scope
This project will focus on the qualitative and quantitative analyses of the Caithness public consultation survey using a pre-determined analysis plan. Supplementary analyses may be agreed with the project leads as the project develops.
Project approach
Analysis of the survey responses and production of written materials and supporting media.
Constraints
Prioritisation that enables Epidemiology and Health Science team staff to work on the project within the agreed timescales of December 2018.
Assumptions
Epidemiology and Health Science team are in receipt of all consultation responses for 3rd December 2018.
Project organisation / roles and responsibilities
Project Team
The following roles are identified: Project leads – Maimie Thompson, Head of Public Relations and Engagement Michelle Johnstone, Project Manager
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• Senior Users – NHS Highland Board, Highland Health and Social Care Partnership, Caithness Redesign Project Board
• Senior Suppliers – Public Health Epidemiology and Health Science team • Project Manager – Carolyn Hunter-Rowe
Stakeholder Group (if appropriate)
This work will be conducted independently by the Public Health Epidemiology and Health Science team. Additional analyses may be agreed with the project leads upon receipt of a first draft report, where it is agreed that these would add value to the work.
Communication/Publicity Plan
This work will report to: Maimie Thompson, Head of Public Relations and Engagement, and Michelle Johnstone, Project Manager. The work will feed into the NHS Highland Board and Highland Health and Social Care Partnership. This work will be published on the NHS Highland and Public Health websites.
Risks
There are time risks if resources get diverted onto other priorities. There are reputational risks if the survey analyses are not open and transparent.
Resources
Expected Public Health Epidemiology and Health Science team input is 14 – 21 days.
Outputs
A 10 – 20 page report for a public audience suitable for publication on the NHS Highland website.
Quality Assurance
Products will be quality assured within the Epidemiology and Health Science team.
A full audit trail of the decisions and choices made for both quantitative and qualitative data analyses will be maintained.
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Time table (Gantt Chart)
12 Nov 19 Nov 26 Nov 3 Dec 10 Dec 17 Dec 24 Dec
Development of PID
Public consultation closes
Consultation data entry complete
Data preparation
Data analysis
Report writing
Finalise report
The Project Initiation Document prepared also included details on report structure and contents. The full PID was published on NHS Highland website HERE
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Appendix 4 | Clinical Panel - Public Meeting attendance Name: Designation: Thurso:
1st Oct. Wick: 11thOct.
Wick: 6thNov.
Thurso: 8th Nov.
Anne Fraser Mental Health Advanced Practitioner/ Professional Lead (Caithness & Sutherland)
x
Catriona Naughton
Senior Practice Manager, Riverbank Medical Practice, Thurso
x
Claire McIntosh
Manager, Bayview Residential Care Home
x
Dr. Alison Brooks
GP, Thurso & Halkirk Medical Practice & Clinical Lead, Dunbar, Hospital
x x x
Dr. Boyd Peters
GP (Badenoch & Strathspey)/ Associate Medical Director for Mental Health Services, NHS Highland
x
Dr. Duncan Scott
Consultant Physician, Raigmore Hospital (Rotational Consultant to Caithness General Hospital) / Associate Medical Director of Medical Education, NHS Highland
x
Dr. Grant Franklin
Consultant in Acute Medicine, Raigmore Hospital (Rotational Consultant to Caithness General Hospital)
x
Dr. Katherine Jones
GP & Clinical Director for North and West Operational Unit
x
Dr. Sarah Rootes
GP, Riverview Medical Practice, Wick x
Michael Loynd
Macmillan Advanced Practitioner x x
Mike Flavell Advanced Physiotherapy Practitioner, Lybster, Riverbank & Riverview Medical Practices
x x
Nova James Advanced Nurse Practitioner, Riverview Medical Practice
x
Pamela Garbe
Rural General Hospital Manager, Caithness General and Town and County Hospitals
x
Penny Cormack
Manager, Pulteney House Residential Care Home
x
Teresa Green
Integrated Team Lead (East Caithness) / Community Mental Health Team Manager / Practising Clinician
x x x
Also participating on the panel Eric Green
Head of Estates, NHS Highland x x x
Maimie Thompson
Head of Public Relations & Public Engagement, NHS Highland
x x x x
Michelle Johnstone
North Area Manager, North & West Operational Unit
x x x x
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Appendix 5 | Responsive process: summary of adjustments to the engagement plan: Theme Activity/Issue NHS Highland Response Consultation Programme
Ask people for their views Held two public launch events (Wick and Thurso)
Publish responses Request that all consultation responses should be published
Agreed this will happen after analysis has taken place with each record being anonymous
Cost Criticism over cost of the consultation
Agreed to publish costs
Local media Promote the consultation using local media
Discussed with editor regular coverage
Timing of events Public Meetings Changed time from 6-7pm Walk about / drop-ins: Have some events in the morning – better for mums with toddlers
Accommodated requests, including morning and Saturday meetings Attended young mums and baby/toddler groups in Murkle; Thurso & Wick in the mornings
Meetings / Events Events requested in Keiss, John O’Groats, Thurso MS Group
Meetings arranged
Go where the people are Events held in Tesco Pop up shops in Thurso and Wick Scrabster Lifeboat open day, Walkabouts Careers Fair (Wick)
Public Meetings Being ‘talked at’ Shortened presentation for second meeting and didn’t present at final
Session too long Put in comfort break Request to hear views of local clinicians
Final panel was all local clinicians
Can the meetings be filmed? Filmed public meeting in Wick Find the public meetings intimidating and don’t like to ask questions
Held drop-in meetings in advance of final two public meetings Emphasised most meetings were smaller Used some of Frequently Asked Questions (FAQ) to put to the panel
FAQ would be helpful Produced and issued Follow up Queries to FAQ Responded and updated on
website Share FAQ more widely Social media, media, direct
mailings to contacts Mental Health There should be specific
meetings for mental health services
Two meetings arranged (held either side of county)
GP Practices moving to the Hubs
Suggested that this should be looked at in more detail
Surveys prepared and issued for Riverbank and Riverview Media releases prepared on the specific issue Met with PPG (Riverbank) Met with staff (x2) Discussed in more detail at Public meetings and other meetings
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Transport A key theme emerging was concerns around transport
Practice survey included questions on how people currently travel to Practice Prepared and shared more detailed analysis to look at walk and drive times for both NHSH Practices Meeting with Stagecoach and Cllr Sinclair. Stagecoach to formally respond to consultation Expand NHS Near Me and reduce the need for travel
NHS Near Me Consider establishing NHS Near Me with large employers
Confirmed happy to explore
Planning Permission, access, car parking
Concerns around Planning etc Process explained and Highland Council formally written to seek response to consultation
Empty buildings Concerns around empty buildings Will discuss with councillors, HIE, local MSP etc
Sites Views on sites Process explained and highlighted any new sites would be considered A new site identified by a member of public and site assessment carried out
Maternity Should be part of the public consultation
Explained why it was not but will be holding some focus groups Fuller response and discussion by clinical panel when raised at second public meeting in Thurso A meeting had been scheduled with Chief Medical Officer but got postponed
Website Couldn’t find information on NHS Highland website
Put the consultation nugget as the main image on Home Page
Visuals (Maps etc) Scottish Health Council suggested that some of the visual materials used at meetings
Suite of materials and banners prepared and used at meetings; and as fixed displays
Management Costs
Suggestion of too many mangers too much
Issued a media release with the details of costs
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Appendix 6 | Distribution list of consultation documents This list is not exhaustive. While every effort was made to ensure that the consultation documentation was widely available, we were made aware that documents and materials may have been removed from the locations below after they were delivered. Place: Location: Materials Distributed: Canisbay GP Surgery 2 x Full Consultation Document
1 x Public Meetings poster Castletown GP surgery 2 x Full Consultation Document
1 x Public Meetings poster 1 x Castletown Walk-about/ Drop-in poster
Post Office 2 x Full Consultation Document 1 x Public Meetings poster 1 x Castletown Walk-about/ Drop-in poster
School 1 x Public Meetings poster 1 x Castletown Walk-about/ Drop-in poster
Dunbeath Health & Wellbeing Hub 1 x Full Consultation Document 1 x Summary Document 1 x Public Meetings poster
Heritage Centre 1 x Full Consultation Document 1 x Summary Document
Post Office 1 x Full Consultation Document 1 x Summary Document
Shop 1 x Full Consultation Document 1 x Summary Document
Halkirk GP surgery 2 x Full Consultation Document 1 x Public Meetings poster 1 x Halkirk Walk-about/ Drop-in poster
Post Office 1 x Full Consultation Document 1 x Public Meetings poster 1 x Halkirk Walk-about/ Drop-in poster
Shop 1 x Public Meetings poster 1 x Halkirk Walk-about/ Drop-in poster
Ulbster Arms Hotel 1 x Summary Document 2 x Halkirk Walk-about/ Drop-in poster (bar & hotel)
School 1 x Public Meetings poster 1 x Halkirk Walk-about/ Drop-in poster
John O’Groats Natural Retreats Cafe 2 x John O’Groats Walk-about/ Drop in poster Post Office 1 x Full Consultation Document
1 x Public Meetings poster 1 x John O’Groats Walk-about/ Drop in poster
Seaview Hotel 2 x John O’Groats Walk-about/ Drop-in poster (bar & hotel)
Lybster Lybster, Latheron & Clyth Community Development Company
2 x Full Consultation Documents 2 x Summary Documents 1 x Public Meetings poster 1 x Lybster Walk-about/ drop-in poster Display of A2 plans
Lybster Medical Practice 2 x Full Consultation Documents 1 x Public Meetings poster 1 x Lybster Walk-about/ drop-in poster
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Place: Location: Materials Distributed: Post Office 2 x Full Consultation Documents
1 x Public Meetings poster 1 x Lybster Walk-about/ drop-in poster
Primary School 1 x Public Meetings poster 1 x Lybster Walk-about/ drop-in poster
Reay Village Hall 2 x Full Consultation Documents 2 x Summary Documents 1 x Public Meetings poster 1 x Reay Walk-about/ drop-in poster
School 1 x Public Meetings poster 1 x Reay Walk-about/ drop-in poster
Thurso Library 2 x Full Consultation Documents 2 x A2 Public Meetings posters 2 x A4 Public Meetings posters 2 x Thurso Library drop-in posters
Post Office 2 x Full Consultation Documents 2 x A2 Public Meetings posters
Princes Street Medical Practice
2 x Full Consultation Documents 2 x A2 Public Meetings posters
Riverbank Medical Practice
2 x Full Consultation Documents 2 x A2 Public Meetings posters
Thurso Health Centre 2 x Full Consultation Documents 2 x A2 Public Meetings posters
Watten Post Office 1 x A2 Public Meetings posters 1 x Watten Walk-about/ drop-in poster(*asked to take Full Consultation document, but nowhere to store it)
School 1 x Public Meetings poster 1 x Lybster Walk-about/ drop-in poster
Wick East Caithness Community Facility
2 x Full Consultation Documents 2 x A2 Public Meetings posters 2 x A4 Public Meetings posters 2 x Wick Library drop-in posters
Post Office (PPP) 5 x Full Consultation Documents 2 x Summary Documents 1 x Public Meetings poster Display of A2 plans
Riverview Medical Practice
2 x Full Consultation Documents 1 x Public Meetings poster
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Appendix 7 | Overview of local facilities and timing of events A member of the Project Team collated information on town/village facilities and the reasoning behind why a particular day/ time was decided upon. Date Town/Vi
llage Local facilities and opening hours
Venue Comments
N/A Thrumster
• School – 09:30 to 15:00 (P1 – P3) 09:30 to 15:30 (P4 – P7)
• Village Hall • Smiddy Inn
N/A Contacted Cllr. Bremner: 19/09/18; 24/09/18; 8/10/18 – he felt that the NHSH meeting with Tannach & District Community Council on the 4th October was sufficient, as the community was well represented at this and had fed into the consultation process.
Friday 28th September, (afternoon)
Dunbeath
• Dunbeath Health & Well-being Hub
• GP Surgery • School – 09:30 to 15:30 • Post Office & shop (not in
the centre – on the other side of the A9)
• Dunbeath Heritage Centre
• Community Hall • Harbour • RBS Mobile Banking
Service – Thursdays 15:40 to 16:00
Dunbeath Health & Well-being Hub
This was organised to fit in with an earlier meeting with the Dunbeath Health & Well-being Hub.
Saturday 29th September, 11:00 to 14:00
Co-op (Thurso)
• Supermarket Store • Post Office • Cash machine • Tow centre location
Store Entrance
This was organised with the Store Manager to maximise footfall, as Saturday morning/ early afternoon is one of their busiest periods.
Monday 1st October
Castletown
• GP Surgery • Post Office & shop &
busy butchers (all in the same area)
• Fish & Chip Shop & Chinese Takeaway
• Hotel • School – 09:00 to 14:45
(P1 – P3) 09:00 to 15:15 (P4 – P7)
• Castletown Heritage Centre
• Castletown Drill Hall • Youth Club • RBS Mobile Banking
Home-Start Family Group – c. 10:00, Free Church Hall Afterwards, Castletown Hotel, 11:00 to 13:00.
A session was held with the Home-Start Caithness Family Group (parents & carers with young children) and then held a drop-in session/ walk-about immediately after this in the Castletown Hotel.
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Service – Wednesdays, 10:55 to 12:25
Tuesday 2nd October – 12:00 to 15:00
Reay • School – Mon. To Thurs: 09:15 to 15:00 (P1 – P3) 09:15 to 15:30 (P4 – P7) Friday: 09:15 to 14:00 – ALL
• Shop • Village Hall
Reay Village Hall 12:00 to meet with Play Group parents & then 14:00 to speak with “A Cuppa and e’Craic” group.
This session was organised with the Play Group & local monthly social group leaders to engage with as many people as possible. We held a drop-in session for the parents/ carers of the Play Group children to coincide with pick-up time, held an open drop-in session between 12:15 & 14:00 and then met with the attendees of the social group from 14:00 onwards.
Saturday 6th October, 11:00 to 14:00
Co-op (Wick)
• Supermarket Store • Cash machine
Store Entrance
This was organised with the Store Manager to maximise footfall, as Saturday morning/ early afternoon is one of their busiest periods.
Tuesday 9th October – 11:00 to 15:00
Lybster • Lybster, Latheron & Clyth Community Development Company (LLCCDC)
• GP Surgery • School – 09:10 to 15:10 • Post Office & shop • RBS Mobile Banking
Service – Wednesdays, 14:10 to 15:40
Training Room, LLCCDC
LLCCDC is an effective community organisation based in the centre of Lybster, providing a wide range of opportunities for local people including: formal training classes; allotments; community growing; Men’s Shed. The drop-in session/ walk-about was organised to coincide with an art class, & to fit in with school pick-up times. LLCCDC advertised the session by displaying posters around the village (GP surgery, Post office, Hotel, School), as well as on their premises and website. They also leafleted all houses in Lybster.
Wednesday 10th October, 14:00 to 16:00
Watten • School – 09:00 to 14:30 (P1 – P3) 09:00 to 15:00 (P4 – P7)
• Shop & Post Office • Hotel • RBS Mobile Banking
Service – Fridays, 12:30
Watten Village Hall
This was organised to coincide with the weekly Parent & Toddler Group & the Watten Art Group, both of which were taking place in Watten Hall while the drop-in session was taking place.
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to 12:45
Tuesday 16th October – 11:30 Caithness Stroke Group
Halkirk • GP surgery • Post Office • Shop • Hotel • School – 09:15 to 14:45
(P1 – P3) 09:15 to 15:15 (P4 – P7)
• RBS Mobile Banking Service – Mondays, 09:45 to 10:00
Ross Institute, Halkirk
This was organised in conjunction with the local branch of Chest, Heart & Stroke Scotland.
Monday 5th November – 09:30 to 12:00
Halkirk • GP surgery • Post Office • Shop • Hotel • School – 09:15 to 14:45
(P1 – P3) 09:15 to 15:15 (P4 – P7)
• RBS Mobile Banking Service – Mondays, 09:45 to 10:00
Ross Institute, Halkirk
This was organised to fit in school drop-off time & the weekly RBS Mobile Bank visit (outside the Ross Institute 09:45 to 10:00)
Tuesday 6th November, 09:30 to 12:30
John O’Groats
• Hotel • Post Office • School (Canisbay – c. 2.6
miles) – (P1 – P3) – 09:15 to 14:45 (P4 – P7) – 09:15 to 15:15 • RBS Mobile Banking
Service – Mondays, 14:25 to 14:55
Seaview Hotel
This was organised at the request of a local councillor to enable parents with young children to attend an event locally.
Tuesday 6th November, 13:30 to 15:30
Thurso Library
• Library facilities • Book Bug • Art gallery
Thurso Library
This was organised with the Senior Librarian to coincide with their weekly Book Bug session (14:00 to 14:30) & Miller Academy School finishing time (14:45 & 15:15).
Wednesday 7th November, 09:30 to 12:30
Wick Library
• Library facilities • Book Bug • Leisure facilities
Wick Library
This was organised with the East Caithness Community Facility Manager to coincide with their weekly Book Bug session (11:00 to 11:30) & Splash Dance session.
Tuesday 13th
Keiss • School – 09:00 to 14:30 (P1 – P3)
Keiss Village
This event was organised to fit in with school closing
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November, 14:00 to 16:00
09:00 to 15:00 (P4 – P7)
• Hotel • Community Hall • RBS Mobile Banking
Service – Mondays 13:40 to 13:55
Hall times.
Monday 12th November, 09:00 to 13:00
Tesco, Thurso
• Supermarket Store • Cash machine • Cafe
Check-outs
This was organised with the Tesco Community Champion to maximise footfall. We were somewhat constrained with dates in Tesco due to their commitment to the Poppy Appeal from the end of October through to 10th November.
Wednesday 14th November, 11:30 to 14:30
Dounreay Site
• C. 1,000 staff plus 1,000 contractors on site
Canteen This was organised in conjunction with Dounreay Occupational Health Department to enable Dounreay staff & contractors to be able to engage with the process.
Friday 16th November, 11:00 to 16:00
Tesco, Wick
• Tesco Extra Supermarket Store
• Cash machine • Cafe
Check-outs
This was organised with the Tesco Community Champion to maximise footfall. We were somewhat constrained with dates in Tesco due to their commitment to the Poppy Appeal from the end of October through to 10th November. We also had a second date arranged for Saturday 27th October, however, Tesco Wick cancelled it due to Halloween and the Community Champion was on leave, so an alternative date could not be arranged.
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Appendix 8 | Calendar of activities: 20th August to 23rd November 2018 August 2018 Date Event Name Time Location 20/08/18 Consultation Group 3:00pm Conference Room, CGH 20/08/18 Launch Event – Wick 6:00pm PPP, Wick 21/08/18 Launch Event – Thurso 6:00pm Caithness Horizons 22/08/18 Thor House Stakeholders 1:30pm Thor House 31/08/18 Hearing & Sight Care 2:00pm PPP, Wick September 2018 03/09/18 Wick Community Council 7:00pm Assembly Rooms, Wick 04/09/18 Caithness Mental Health Group (The
Haven) 10:30am The Haven, Wick
04/09/18 Riverbank Patient Participation Group
2:00pm Riverbank Surgery, Thurso
04/09/18 Caithness Mental Health Group (Stepping Stones)
4:00pm Stepping Stones, Thurso
04/09/18 Association of Caithness Community Councils
7:00pm Ross Institute, Halkirk
04/09/18 Presbytery of Caithness 7:00pm Thurso West Church 10/09/18 KLICS (Young Caters) 3:00pm Roxburgh Road, Wick 11/09/18 Highland Senior Citizens Network,
Caithness Branch 12:00 Norseman Hotel, Wick
11/09/18 Caithness Diabetes Group 7:00pm Nethercliffe Hotel, Wick 12/09/18 Independent Providers (Caithness)
(Care at Home) Group 11:30am Multi-purpose Room, CGH
12/09/18 North Highland College Fresher’s Event
11:00am – 3:00pm
North Highland College, Thurso
13/09/18 MS Therapy Group 1:00pm Therapy Centre, Smith Terrace, Wick
16/09/18 RNLI Fun Day 12:00noon – 4:00pm
Scrabster
18/09/18 Murkle Toddlers 10:00am – 11:30am
Murkle Community Hall
19/09/18 “Befrienders Coffee Morning”` 12:00– 2:00pm
Mey Community Hall, Mey
25/09/18 CVG Building Users 9:30am CVG 25/09/18 Thurso Community Council 7:00pm United Reform, Thurso 26/09/18 Caithness Disabled Access Panel 12:00 -
2:00pm) PPP
26/09/18 Keiss Group 3:30pm – 4:00pm
Keiss Hall
27/09/18 Caithness & North Sutherland Regeneration Partnership
10:30am – 12:30pm
Norseman Hotel, Wick
27/09/18 Generations Working Together (Caithness & Sutherland Group)
12:00pm Brora Learning Zone (5 Carol Crescent, Brora)
27/09/18 Castletown Community Council 7:30pm Drill Hall, Castletown 28/09/18 Dunbeath Centre (staff, board and
users) 11:30am Dunbeath Centre
28/09/18 Dunbeath “Walk About” PM Dunbeath 29/09/18 “Supermarket Stall” 11:00am –
2:00pm Co-op, Thurso
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October 2018 Date Event Name Time Location 01/10/18 Home Start Caithness 10:00am –
11:00am Castletown
01/10/18 Castletown “Walk About” 10:00am – 1:00pm
Castletown
01/10/18 Public Meeting Thurso 7:00pm Thurso High School 02/10/18 PPP CEO Meet 12:00 noon
– 2:00pm PPP, Wick
02/10/18 Reay “Walk About” 12:00noon – 2:00pm
Reay
02/10/18 Reay Cuppa & e Craic group 2:00pm – 3:00pm
Reay
02/10/18 Men’s Shed & Hobbies Group 2:30pm – 3:00pm
PPP, Wick
02/10/18 Knit & Natter 3:00pm – 3:30pm
PPP, Wick
04/10/18 Consultation Group 2:00pm – 4:00pm
Seminar Room, CGH
04/10/18 Helmsdale Community Council 7:00pm Community Centre Helmsdale
04/10/18 Tannach & District Community Council
7:00pm Thrumster Hall
05/10/18 Wick Living Better Group 10:00am PPP, Wick 05/10/18 Older Adults Network Forum 2:00pm Pentland View Nursing Home 06/10/18 “Supermarket Stall” 11:00am –
2:00pm Co-op, Wick
08/10/18 CGH Patients Council 2:00pm CGH 08/10/18 Thor House Stakeholders 2:00pm Thor House 08/10/18 Bayview Stakeholders 2:00pm Bayview 09/10/18 Lybster “Walk About” / Drop In
Session 11:00am – 3:00pm (flexible)
Lybster, Latheron & Clyth Community Development Company (LLCCDC)
10/10/18 Watten “Walk About” 2:00pm – 4:00pm
Watten
11/10/18 Caithness U3A (third age trust) 2:00pm West Church Hall, Thurso 11/10/18 Public Meeting Wick 7:00pm Assembly Rooms, Wick 16/10/18 Caithness Stroke Group 11:30am –
1:00pm Ross Institute, Halkirk
29/10/18 LGoWIT 11:00am to 12:00noon
United Reformed Church Hall, Thurso
29/10/18 Dunnet & Canisbay Community Council
7:30pm Mey Hall
30/10/18 MS Group (Thurso) 2:00pm Rugby Club , Thurso 30/10/18 Labour Party 7:00pm Park Hotel, Thurso
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November 2018
Date Event Name Time Location 01/11/18 Tenant’s Participation Group 10:0am Wick Youth Club 01/11/18 Wick Young Mums 12:30pm Wick Youth Club 05/11/18 Halkirk “Walk About” 9:30am –
12:00pm Halkirk
06/11/18 John o’Groats Drop In Session 9:30am – 12:30pm
Seaview Hotel, John o’Groats
06/11/18 “Drop In Session” (Book Bug”) 1:30pm – 3:30pm
Thurso Library
06/11/18 CMH Patient Meeting 1:30pm – 3:30pm
Conf Room, CGH
06/11/18 Pre Public Meeting “Drop In Sessions”
5:00pm – 7:00pm
Breadalbane Hall, PPP, Wick
06/11/18 Public Meeting, Wick 7:00pm Breadalbane Hall, PPP, Wick
07/11/18 “Drop In Session” (Book Bug) 9:30am – 12:30pm
Wick Library
07/11/18 Caithness Visual Impairment Group
2:00pm RBLS, Thurso
08/11/18 NHC/NHS Liaison Group 10:30am – 12:30pm
North Highland College, Thurso
08/11/18 Pre Public Meeting “Drop In Sessions”
5:00pm – 7:00pm
Thurso High School
08/11/18 Public Meeting, Thurso 7:00pm Thurso High School 12/11/18 “Supermarket Stall” 9:00am –
1:00pm Tesco, Thurso
12/11/18 CMH “Service User” Meeting 2:00pm – 3:30pm
Pentland Hotel, Thurso
12/11/18 Watten Community Council 7:30pm Watten Hall 13/11/18 Keiss “Walk About” 2:00pm Keiss Hall 14/11/18 Youth Development Forum 9:30am –
3:00pm Wick Assembly Rooms
14/11/18 Dounreay 12:00pm – 2:00pm
Canteen, Dounreay
15/11/18 Stagecoach 9:00am – 10:00am
Meeting Room, Dunbar
15/11/18 Wick Macular Group 11:00am PPP, Wick 15/11/18 CHAT Committee 1:00pm –
3:00pm Shilling Room, PPP, Wick
16/11/18 “Supermarket Stall” 10:00am – 4:00pm
Tesco, Wick
16/11/08 Year of Young People Consultation Event
4:00pm - TBC
Skinandis, Thurso
20/11/18 Thurso Young Mums Group 12:30pm Ormlie Centre, Thurso 21/11/18 Caithness CCP (Health Inequalities
Workshop) 9:30am – 12:30pm
Pentland Hotel, Thurso
21/11/18 Caithness Community Partnership 2:00pm – 4:00pm
Pentland Hotel, Thurso
22/11/18 Consultation Group 2:00pm – 4:00pm
Conference Room, CGH
23/11/18 MSP / Highland Councillors 1:00pm – 3:00pm
Smith Room, PPP, Wick
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Appendix 9 | Summary of main staff consultation events September 2018 Date Event Name Time (of Event) Location 25/09/18 Care at Home Staff Thurso October Date Event Name Time (of Event) Location 02/10/18 Care at Home Staff Thurso 03/10/18 Care at Home Staff Wick 04/10/18 Care at Home Staff Thurso 17/10/18 CGH Staff Meeting 2:00pm – 3:00pm Caithness General
Hospital (CGH) 18/10/18 Care at Home Staff Thurso 18/10/18 CGH Pharmacy Staff
Meeting CGH
22/10/18 Improving End of Life Care Group
2:00pm – 4:00pm
23/10/18 Oral Health Improvement Staff
10:00am Meeting Room, Dunbar
23/10/18 Care at Home Staff Wick 25/10/18 Staff Meeting T&C 2:00pm – 3:30pm Town & County,
Wick 26/10/18 CGH (Surgical Suite)
Staff Meeting 1:00pm – 3:00pm CGH
26/10/18 CGH (ED) Staff Meeting
3:00pm – 4:00pm CGH
26/10/18 CGH (Rosebank) Staff Meeting
4:00pm – 5:00pm CGH
29/10/18 CGH Staff Drop-In 1:00pm – 2:00pm Postgraduate (PG) Office, CGH
29/10/18 Bayview Staff Meeting
2:30pm Bayview House, Thurso
30/10/18 CMHT Staff 1:30pm Conference Room, CGH
November 2018 Date Event Name Time (of Event) Location 02/11/18 CGH Staff Drop-In 1:00pm – 2:00pm PG Office, CGH 05/11/18 CGH Staff Drop-In 1:00pm – 2:00pm PG Office, CGH 08/11/18 CGH Staff Drop-In 1:00pm – 2:00pm PG Office, CGH 14/11/18 Admin Staff 11:00am – 12:00pm Conference Room,
CGH 15/11/18 CGH Staff Drop-In 1:00pm – 2:00pm PG Office, CGH 16/11/18 CGH Staff Drop-In 1:00pm – 2:00pm PG Office, CGH 16/11/18 CGH (Bignold) Staff
Meeting 4:00pm – 5:00pm CGH
19/11/18 CGH Staff Drop-In 1:00pm – 2:00pm PG Office, CGH 20/11/18 CGH Staff Drop-In 1:00pm – 2:00pm PG Office, CGH 22/11/18 CGH Staff Drop-In 1:00pm – 2:00pm PG Office, CGH 26/11/18 CGH Medical
Records Staff Meeting
1:30pm – 3:00pm Seminar Room, CGH
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Appendix 10 | Analysis of responses to the public consultation survey on the proposed health and social care changes in Caithness
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Appendix 11 | Summary of responses received from partner organisations
Agency: Name & designation of responder:
Date of Response:
Caithness & North Sutherland Regeneration Partnership
Eann Sinclair, Programme Manager
23rd November 2018
Caithness Chamber of Commerce
David Swanson, Marketing & Communications Manager
22nd November 2018
Caithness Rural Transport Coreen Campbell, Manager
16th October 2018
Caithness Voluntary Group Allan Tait, Senior Development Officer
21st November 2018
Highland Hospice Kenny Steele, Chief Executive
19th November 2018
Highlands and Islands Enterprise
Nil
Police Scotland Chief Insp. Iain MacLelland, North Highland Area Commander
20th November 2018
Scottish Ambulance Service Pauline Howie, CEO
22nd November 2018
The Highland Council, Members
Full council support for motion (see Appendix 12)
13th December 2018
The Highland Council, Officers
Nil
Scottish Fire and Rescue Service
Rab Middlemiss, Area Manager, Highland
4th December 2018
Stagecoach, Stagecoach North Scotland
Daniel Laird Commercial Director
22nd November 2018
University of the Highlands and Islands (North Highland College)
Donald MacBeath, Principal
19th November 2018
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Appendix 12 | Transcript of motion on redesign proposals to full Highland Council, 13th December 2018 Item 13 Notices of Motion / Motion 3 - Signed by Councillors Rosie, Bremner, Sinclair and Reece Councillor Rosie My aim with the motion request is one to receive Chamber support for the Redesign Proposals and to the support of my Caithness colleagues to provide future ward discretionary funding to the Caithness Community Partnership. Members, I regularly tell the general public in Caithness that our opportunities far out way our challenges and none of us can underestimate the level of challenge that we face in the west of the County with the rundown of the nuclear industry and I cannot overstate the difficulty of the position of Caithness with regards to Health and Social Care in the spring of 2017. A health redesign process has been going on for a number of years with no tangible outcomes, the issue was prominent to the point of being a main issue during the elections and again we cannot underestimate the importance and significance of the community finding a solution with these proposals over a relative short period of time. This involved a huge commitment of time and energy from everyone involved and none of us should underestimate how important the community views are in regard to health and social care services in underpinning our need and desire to Caithness to its full potential. Over recent months we have seen new business investment in the west of Caithness and North Sutherland and that is very welcome indeed, the other really encouraging thing is the level of activity in the community itself who play their part in developing our community, and let’s not kid ourselves on that and that for years there was an expectation on this Council to do many of these things. Over the past 18 months we have seen the emergence of development trusts and community organisations, each of them setting about establishing amenities which will benefit the whole of Caithness. Without exception of these groups organisations have a mantra of producing things that are financially viable, sustainable and of real benefit to the people of Caithness. My experiences in working with any of these groups is that by acting as a conduit to connect them to Highland Council Officers, HIE, the Caithness North Sutherland Generation Partnership and other agencies a pathway is found to progress their projects. Again let’s not underestimate the desire to ensure that the vision focuses on people’s general health and wellbeing. And this lists the key to many of the issues that should not be the sole responsibility of NHS Highland and that takes me to the question by Caithness Councillors to consider the funding of the Caithness Community Partnership. I was heartened to attend the recent meeting of the Caithness Community Partnership and it was clear that partners around the table recognised the opportunity that the redesign proposals presented; there is a real enthusiasm and desire to start getting to grips with the challenges that remain in our County. Again please do not underestimate the level of intelligence, resource experience and match funding potential and crucially an understanding of the problems that we need to address within that partnership, this is a forum which is inclusive of the point it does
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not exclude any, it has business acumen, multi agencies, third sector and most importantly a direct link to public participation that can in turn empower our communities. The potential/can provide meaningful localism and fulfils the undoubted desire of the Caithness community to form collaborative and solution focused partnerships. Make no mistake the public expect us as Caithness Councillors in particular to fulfil our commitment to work together for the benefit of Caithness. To recap I seek support for the redesign proposals and from my Caithness colleagues to fund the Caithness Community Partnership with future ward discretionary funding. Thank you members and I welcome your contributions. Councillor Bremner Thank you for the opportunity to speak to the motion and I am very happy to support it. I’m going to come at it from a different angle. I recall over a year and a half ago some of us were re-elected or newly elected on the very issue of health service delivery in Caithness and the ability to bring this motion to Council gives the indication of the work of many partners have been attending to since then, we have all worked as a team to get where we are. Every single Caithness Councillor in here to our grade or lesser extent has been involved in that and it would be good to see where we’ve been and where we are now. The refurbishment and redesign of Caithness General Hospital, 18 months ago I chaired a seminar, Caithness Councillors sat down with senior NHS Management and Board Members amidst the rumour that was doing the rounds at that time that the General hospital was going to shut. I was even at a meeting back in February with locals and senior NHS Management where the statement was made the public thought that the NHS Management had a vision and or intention to close two hospitals and reduce CGH to a cottage hospital that is the kind of time we have been through. By that time we all had commitments from the NHS Management that CGH was at that time, one of six key rural hospitals in Scotland and they had already said categorically that hospital was not going to shut. What we have now at the end of a very long consultation one that I have to say was fully incorporated of views from a huge cross section of the community some of stakeholders that my colleague was referring to here just now and some others will refer to, the detail of it being finalised for a submission to go to the Scottish Government for support and an investment programme of around £30 million pounds in our local health services in Caithness, and if that comes off then that is an achievement, I see a lot of nodding heads because if that is working for us and you have recognised it then we have done something. Speaking to the staff that is very important, speaking to the staff in some of these places is really important you will realise how keen they are for this internal redesign to take place because the facility they have at the moment needs to be redesigned, a lot to that reason is because medical practices have changed since built back in the 1980’s. That is a good news story because if we are going to be redesigning we have changed medical practice to provide a better and improved health Service then surely that is something that is going to be good for our communities. The hubs in Wick and Thurso have been discussed fully during the consultation and a considerable number of Caithness Councillors have been in attendance, nearly
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every community meeting, working group meeting, management meeting and discussion held over the last 18 months and I can’t think of one single stone that hasn’t been overturned in looking at what will best suit and I look forward to the proposals that are due to come to our attention as a result in January. I am also not just talking about Caithness Councillors that are in this chamber here but that Caithness Councillor that is here by VC as well. The motion refers to recognising the measures taken to date looking to retain existing local services whilst offering a sustainable model to further develop and enhance local provision. I personally have taken a great interest in the NHS Near Me some of you may have heard of that and what it seeks to deliver. The ways NHS Highland are looking to tackle some of the issues we have in trying to deliver our Health Services in rural areas, including recruitment, now there’s a problem not just for Caithness, up skilling and ongoing discussions with UHI and our local Northern Highland College. These very actions seek to reduce the need to travel which as detailed in this motion which is a common name both for us as Councillors representing our local communities and NHSH providing accessibility to Health Services in rural communities. Finally we know there are still difficulties and considerations ahead including maternity services, mental health service provision and delivery and others which remain a focus of us all, but when we look back at what we had with no real clarity in where our health services were destined, and a lack of assurance for the future of the health service infrastructure in Caithness we have through the hard work of a lot of people, a bid that will be going to the Scottish Government to the tune of £30 million for the investment of the health service in our local area in Caithness, we didn’t have that or anything like that 18 months ago, that to me is a result of hard work and determination, we are not done and there are remaining challenges ahead and plenty of opportunity for those who would say yes but that’s exactly what it’s going to be, we are looking to focus on what we have got in this motion, I’m sure a lot of you are looking to support it by the nods of your head and if that’s the case I commend the motion to the chamber and urges to support it. Councillor Sinclair Last year I stood up and talked about the protests going on in Caithness. On the eve of the full Council meeting there was a candlelit vigil to show support for the Town & County Hospital in Wick and a few days later there were two public marches in Wick/Thurso to protest against the potential closure of the T&C hospital and the Dunbar. I had no idea at the time that those marches would attract such a credible turnout of over two thousand people. At that time NHS Highland a year ago presented to stakeholders 3 options for the future of adult health and social care in Caithness, to close inpatient bed in the Dunbar in Thurso, to close entirely T&C or to close both and of course the public demanded better. When NHSH called the next stakeholder meeting in the wake of the protests to their credit they recognised that a complete change was needed. A public apology was issued and a commitment was made to go off and pull together the facts and information and come back to make an informed decision with a clean sheet of paper ready to think again. I can’t believe that after a year I am standing here bringing a motion of support for those proposals for NHSH. It’s not an easy motion for be to bring and there will be
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critics that will say we should still be fighting for things to stay the same but the simple and honest conclusion I have come to is that by campaigning to the status quo we stand to lose far more than to gain. For me there are key salient facts that make me want to support this. By sighting two health centre hubs in east and west of the county we will retain all the services we currently have locally the only thing that is going to change here are the buildings. The care delivered by our fantastic local staff will not change. Manager of Pulteney House came along to the many stakeholder meetings and she put it really well when she said we don’t care where we are we will still give our residents our absolute best care that we can. Not only will we retain those services but they will actually be improved. For example our GP’s can’t currently admit to inpatient beds and that’s going to change. The beds will be flexible so that they can be used for residents; respite care, palliative care and step up and step down care as required. The proposal also includes the refurbishment of CGH, doubling the outpatient department and emergency department and increasing the surgical wing and providing a purpose built maternity unit. Crucially this is a £30 million investment in the county and a much needed economic boost. And most of all above all else this is a model that NHSH has bought into that we all arrived at together. It seems the public agrees, the massive response to consultation events and the door drops and want to take a moment to say thanks to the local teams who worked tirelessly to pull this off and the staff who have been really patient through all of this process and the public who have shown again how much they value their health service. Our jobs as Councillors now is to listen to them, but that is just the first step, the devil is in the detail and as elected members now work closely with NHS Highland to ensure the detail is correct and appropriate for Caithness that we have enough beds, that we have enough staff, that the staff are well supported, the site is perfectly chosen and planned, that there is somewhere to park and a decent public transport service. Most of all the patients get the care they need and deserve and I know that we will all work hard together to deliver that. I do however want to take the rough with the smooth and want to point out the redesign is one piece of a much larger jigsaw in terms of Caithness health services, my support for the hubs in no way overshadows the issues that are still there and concerns of the public that still approach me with. There are still far too many patients going down the A9 for 10 minute appointments at Raigmore. The latest figures suggest that 12,000 Caithness appointments at Raigmore a year. If your child needs to have their brace tightened, you need to take a day of work to take your child on a 5 hour trip to get their brace tightened. Or if you take the train or attempt it 9.5 hours, I don’t think it is even possible to do it in a day. We need to repatriate as many local clinics as possible. The NHS Near Me video consultation a fantastic innovation will bring numbers down significantly but its one part of a solution and not appropriate for every specialty, certainly not right for mental health patients and I know they are strained to breaking point. Finally there is maternity, people still talk to me about this every single day it is an issue not going away. Since we are changing our maternity model we are entirely
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valid but as I consistently said for two years the new model carries new risks, risks of helicopters being scrambled half way down the A9 as labour has progressed too quickly, risks of snow gates closing and transfer being delayed, risk of babies being born in a minor injuries unit because mother nature doesn’t confirm to a timetable and I state those risks specifically because they have all happened more than once and recently, I don’t need a survey to tell me that is true as I know the families personally. I don’t want to end on a negative note what I wanted to say is that we have shown that we care about our health care services and we are willing to pull together and fight for them. We have a strong sense of local identity and community spirit in Caithness and we fight for what is right, we are not afraid of change but it has to be the right change, change that has been done thoughtfully and respectfully. I truly believe that NHS Highland has managed that with this redesign proposal and urge them to maintain that spirit, respect and co-operation as our health care continues to evolve. Councillor Reiss “As part of the redesign in the Caithness every home received a leaflet, it was a very good, short to the point, and written in plain English that folk could understand leaflet. One very sobering fact in the leaflet is NHS Highland’s own figures that show our population is predicted to fall by a further 14%, not 4%, 14% in next 20 years. The evidence is all around us. In Thurso High we used to have over 1,300 students, it’s now just over 700 now. So we have a totally different problem to Inverness. How do we reverse this? Four things briefly that can attract people to come and settle in Caithness, it is a great place to live. Firstly the schools, we’ve cracked that one, we have really good teachers and largely we have good school buildings including some really excellent new ones; connectivity, we are slowly getting there, but there is still a way to go; our natural environment, I personally think that within this chamber people are starting to realise that our natural environment, we can’t take it for granted, it’s something that is the best in the UK,, probably the best in Europe; as well and of course our hospitals, you have to have good hospitals, we have fantastic staff, this redesign could do a great deal to further enhance the reputation of the NHS in the far north so I am very pleased to lend my support and just to finish off I particularly ask you to bear in mind my colleague Nicola’s practical speech there talking about the theory, which is great and we really hope that this money comes but there are practicalities, no system is perfect but the risks have not gone away, thank you folks.” Councillor D Mackay “Thank you convenor, I stand to speak this afternoon as the NHS Board Member on Caithness Community Partnership but also and as importantly a former Caithness Councillor so these issues are very close to my heart and indeed close to my family. I want to speak about what I regard as the missing link in this whole process, we know that prevention is better than cure and we know that our NHS is extremely good at curing ills but as we have heard over the course of today and yesterday it is up to the rest of us to look and deal with prevention and to cure these ills, and this has to be a priority if we are to improve the health and the life chances of the people
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of Caithness. Prevention and addressing the root causes of poverty really has to be a priority. As you know Caithness has the highest levels of chronic disease, mental health, obesity, drugs has recently become really a serious issue. There’s a lot happening and Karl alluded to the re-set button being set on the Community Partnership so I won’t talk about that. What we know is that for years considerable resources have been pumped into deprivation programmes in Caithness, there’s a lot of excellent work taking place but what we don’t know, we don’t have a holistic overview of how that work is bearing out, we don’t know what’s working well, what’s not, what needs to be improved, where the opportunities are and where the weaknesses are and so on? I therefore think that what’s needed now is a poverty summit, a multi-agency get-together with the community. We had a health summit and the natural move is to have a poverty summit to address these root causes of poverty and pull all these strands together and really get to the bottom of things. It’s the time to be impatient with the barriers which have been standing in the way of breaking the cycle of deprivation which has persisted in the area for literally generations and what it will also do is provide us with the opportunity given all we’ve learned today to ensure that trauma informed services are at the heart of what we do going forward. I feel to do this will be the final link in the chain and will tie in with the work that that has taken place over the past months. Thank you” Councillor Davidson “Thank you, I just like to say that over last three/four months I have had two requests from the NHS to contribute to the Caithness review and on both occasions I have said I feel this is for the people of Caithness. I think the motion in front of us today is the people of Caithness speaking so I believe this council should now get behind what you are doing and what you aspire to because I think as yourself Raymond, Nicola and Karl said you’ve come an extraordinary way in a year, what you now need to do is deliver of course, and the delivery is really important, you don’t just sit and wait for it, you actively engage in the delivery and making sure that it comes towards you. I would also really advocate what Nicola said, don’t forget the day job, don’t forget the things that are driving people mad, day after day after day, the travelling, the uncertainties around delivery, maternity still worries me a lot, not the service, at the core of it, the travel associated with it, that’s the oddest thing which is not well catered for and I feel there is a long way to go. Trust is earned and I believe the NHS in Caithness has started back on that track but there is a long way to go and concentrating on the day job will actually help them to get there because that will touch many people. I hope that as we as a Highland Council work with the NHS to really bump up how we shift the balance of care that that too becomes part of what you are doing in Caithness, building up right from the bottom the home care services, the support services that you need to keep people out of hospital, to avoid all of these issues. I have never been anything but impressed with the presentation, the ability of the people of Caithness to make their point and to get it through; we’ve all learned lessons from that. I think that Caithness and Skye, I think we learned the really strong lesson of independent facilitation when you’re just doing this [motions knocking fists] with an organisation. I think in both cases the people that have done that have been outstanding, so yes the NHS needs praise for going back to the drawing board on this and of course there is a long way to go but I believe this is truly the voice of the people of Caithness and we should get behind it. Speaking to Cllr Mackay’s thoughts about a poverty summit when we have the poverty and equality working group meeting early in the new year, I was thinking
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of clearly saying that we shouldn’t be doing this but we should be having a community planning group on poverty and inequality and being part of that we could start that programme with a summits speak to me about it please, thank you” Convenor “Councillor Rosie, thank you for brining this to us, I think you will find there is a 100% support across the chamber for you so members the motion is carried”
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Appendix 13 Formal response from Canisbay and Castletown Group Practice Statement As a practice we have been watching with interest the redesign process and what it may mean for the people of Caithness. We are very keen for progress to be made to improve health care for all and for access to services to be equal. As one of the most rural and northerly practices in Caithness we are very mindful as to how the redesign process will affect our patients and practice. We have been informed by NHSH that the idea of two HUBS based in Thurso and Wick, was born out of public meetings and ideas generated for redesigning health care in Caithness. NHS Highland (NHSH) has run a campaign to promote the redesign process with options that include the incorporation of some GP practices within each HUB. Practices that are based in Thurso and Wick who are not NHSH owned or run by the health board have been able to consider options to incorporate with NHSH plans. The potential benefits of joining proposed HUB services have been clarified in statements to the public and also from practices that have been heavily involved in the redesign process. With the new GP contract, delivery of some primary care services is set to change. In the HUB design integration of such services would likely occur with a closer working between GP practices and access for services offered to patients of those practices. We do not wish for our patients to miss the opportunities to access such changes or care through virtue of being a little more remote from these centres. During the redesign process, NHSH had taken an assumption that our practice and patients would remain status quo with no change. In recent communications with NHSH we have highlighted the need, as we see it, for the redevelopment process to encompass the whole Caithness area. We would see it crucial to ensure services are the same for all patients with such changes. With changes in the GP contract, there will be changes to the way new primary care services are developed. Whilst we do not advocate for either of our practices to move to Thurso or Wick, we have tried to seek assurances from NHSH that the proposed models of care for the HUBS would be transferable and fair to all populations expected to benefit from the funding of key services to the area. As well as covering a significant area of Northern Rural and Remote Caithness, our population of almost 3000 includes a demographic proportion of more elderly and frail patients. We have concerns that some of our population may struggle to access services based solely in Thurso and Wick HUBS and see potential disadvantages if our practice is not able to access the same level of service as those practices around or within the HUBS. As such, we have envisioned and requested for NHSH to consider that the redesign process outreaches and includes our populations. This could be facilitated through the use of our premises to deliver provision of care by NHSH to our patients in the same way those of practices in the HUBS would benefit. We would hope that the development of any services provided by NHSH to benefit patients in our primary care area would be readily accessible and transferable to our practice sites in a fair manner. We see our patients as being entitled and dependent upon accessing the same level of care and services being being made available and delivered locally through health board developments. Recognised as one of the practices in most need for redevelopment in Caithness, we have approached NHSH to consider adaptations to accommodate future developments in care. As an independent practice, we are contracted with the NHS to provide services and have a lease in place reliant on NHSH support for continuation of services in accommodation that is fit for purpose. The survival of our practice and any future change is very much in the hands of NHSH with the honouring of new GP contract changes. These changes are aimed to protect general practices such as our own and safeguarding from financial losses and risks with changes which would otherwise not be conducive to current or future recruitment into such practices.
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With recognised difficulties in recruitment of general practitioners to the area, preserving and supporting independent practices benefits patients and local health boards. We have sought reassurance from NHSH that protection will be in place if relocation or adaptations to premises are required. Reviewing our practice, the main issue is with lack of space and future proofing both sites for potential integration and development of primary care with re-development of outreach services to our local population. NHSH understand the difficulties in relocating and hopefully appreciate and understand needs for our population to retain the surgeries based in Castletown and Canisbay. With any proposed changes, we would want to ensure benefit would be for all our patients and not at the loss of any services our community values that are currently provided. Under the new GP contract, it may be that allied professionals will be placed alongside practice staff to deliver services such as medication checks, physiotherapy, psychiatric and counselling, pre-clinic and surgical treatments and assessments. We would not wish our patients to miss out on such valuable services which NHSH may make available to other practices based in the HUB. Being able to invite such services to our sites would serve our patients well. It would promote closer working effectiveness between NHSH and our practice as well as allow the practice to develop and perform other duties and skills to benefit the care for our patients. In recent years our practice has become accredited as a teaching practice. We have aspirations to build upon this and contribute to the concept of ‘home grown’ professionals to remote and rural areas recognising recruitment problems. Unfortunately space is a limiting factor for this. NHSH are aware of our predicament, as we have had to turn down opportunities to help train NHSH healthcare practitioners because we have no room. Day to day consultation space at both sites is already in urgent need of expansion not only to accommodate clinical staff already working within the practice but also allied professionals who visit patients on site. With the advent of near-me clinics and virtual clinics as part of future developments in health care, we see an additional need for private space so opportunities exist for our patients to benefit from this technology. In order to offer training and other services on the potential horizon, the practice would require adequate space on both sites. Whilst recognising any of this could mean potential expansion to both sites, NHSH have highlighted that Castletown is in particular need to be considered for redevelopment to a more suitable sized location. We have asked both our Primary Care Manager, NHSH Estate Manager, and Clinical Director/Lead for further discussions and assurances such changes would not disadvantage our patients or practice. We have also highlighted the importance of keeping our patients needs central to these areas and this would include siting a potential new surgery to remain in Castletown. NHSH have acknowledged our circumstances and given assurance that our practice needs will not be excluded in the redesign process.
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Appendix 14 Independent Assurance Report by Scottish Health Council
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