North Skye Workshop
NHS Highland “A Vision for Skye” Workshop 27th October 2021
Workshop Feedback as Summarised by HGHCP Ltd
(Independent Facilitators)


A virtual workshop was held by NHSHighland on 27th October 2021 with a mixed group of stakeholders. The purpose of this workshop was to discuss and agree “A Vision for Skye”, the draft strategic vision for health and social care services on the island generated by NHS Highland at the request of community groups engaged in the wider services planning process.

The specific objectives of the session were:

* To allow NHSH to respond to an earlier community request to outline their “Vision for
Skye” in light of recent challenges
* To discuss this vision more widely
* To develop it into “our” shared vision for health and social care services in Skye (With
caveats if required)
* To find common ground - and the basis for a way forward
* To re-build trust and start to make real progress
* To allow the development of a programme(s) of change

The discussion element of the workshop was facilitated by Norman Sutherland from Higher Ground
Health & Care Planning (HGHCP) and structured around four primary questions:

1) What do we welcome in the vision?
2) What concerns do we have about the vision?
3) Is anything missing from the vision?
4) What changes do we propose to make it “our” shared (collective) vision?
The sections that follow were compiled by the facilitator and document the summarised responses
to each of these questions in turn as discussed and reported at the workshop. These are presented
for approval by participants in the first instance.

1) What do we welcome in the vision?

Collectively we welcome:

* The fact that there is a vision
* The term “vision” – which we are grateful for and find exciting
* That it gives us the opportunity to move forward – we need a new starting point
* That it features a 24 hour hub – with beds and urgent care in North Skye
* The chance to start fresh with a centre for local acute care, longer term care, end of life care
and out-patient clinics
* Joined-up thinking and improved communication
* The multi-agency approach proposed (including the community, third sector and social care
* The interventional approach proposed – not waiting until something has happened to
intervene and keeping people healthy and safe
* That elements of it are similar to the Howard Dorris Centre – that we see as a positive
example of how some things could be done
* That it minimises duplication of effort in order to maximise the impact of existing resources
and any new investment
* The fact that young people and investors can see a bright future working in this sector or
this part of the country through this vision
* That it broadly reflects community thinking up to this point
* That the wider population are likely to support it as a concept
* That it presents an opportunity to consider different ways of working and delivering care

2) What concerns do we have about the vision?

Whilst we all acknowledge that this is just a vision at this time, we note that there is still much to do
in order to understand how it will work and what it might look like. The specific concerns we
highlight include that:

* It doesn’t include any dates/a programme or timescales at this time (When?)
* It doesn’t include any numbers or sense of size (How much?)
* It lacks clarity on terminology and consequently risks miscommunication through people
using the same terms to mean different things. One specific example of this we identified
was the use of the term “Acute beds” vs an alternative such as “community access beds”
* We have not yet seen any developing data about need and are concerned about what it
does/does not include. E.g. Do projections account for factors such as new housing
developments, new jobs and new opportunities on the Island?
* It doesn’t explicitly recognise recommendations from the Ritchie Review
* It doesn’t include detail in key areas such as staffing; recruitment and retention;
sustainability; and accommodation requirements/proposals
* Despite significant advances locally, on-going challenges associated with recruiting and
retaining staff – which remains a huge national problem - persist
* NHSH’s ability and willingness to deliver this vision is still being questioned
* NHSH’s credibility and management continuity locally will have an impact on delivery if not
* The vision must reflect needs across Skye – not just in the North
* It needs to move away from a historical focus on acute/un-scheduled care with even more
focus on long-term social care
* The vision does not explicitly mention the role of and support for relatives and unpaid carers
* It is not clear on the nature of any future partnering relationships, what NHS Highland are
going to be doing themselves to deliver this vision and what they are expecting others to do
in support of it
* Others will have to adopt, “buy-into” or otherwise support this vision for it to be successful
* There is still a practical challenge associated with finding/agreeing upon the right
area/location for the proposed development. (This will need to be large enough, suitable for
the development and accessible. But – o a positive note - this group could be an important
help in this important decision-making process!)

3) Is anything missing from the vision?

The concerns that we have already highlighted summarise much of what we think is missing from
the vision

* The biggest single thing missing from the vision at the moment is a timescale - or any kind of
programme with key delivery dates. (We need to begin to define what will happen and
* We also need a programme that we can all be held accountable for delivering. This will help
to build trust and credibility
* The other big thing missing is detail!
* We understand that not all of the detail is available now and should not be – but this
programme must identify when it will be available
* The vision does not specifically mention mental health services
* The vision does not mention X-ray services within the care village
* The vision does not mention funding (capital or revenue) and any expectations of business
case development or availability in this regard
* The vision does not recognise the need for sustainability from an environmental perspective
* The vision does not acknowledge the need for space within a Care Village to support
relatives and un-paid carers to allow them to stay close 24/7
* The vision does not mention housing for staff
* The vision does not mention the additional 10 bed community unit discussed previously in
north Skye. There needs to be clarity within the community about what happened to this
* The vision does not mention the additional pressure placed on services by tourism
* The vision lacks positive re-enforcement that shows that NHSHighland are serious about
delivering it. (This is essential to overcome a sense that remains in some areas that this is
not real – and merely a means of keeping the community happy in the short-term)

4) What changes do we propose to make it “our” shared (collective) vision?

In order for us to move forward with a version of this vision as a “shared” vision we must:

* Work through the comments summarised in this document as part of the process for
refining “our” vision
* Be part of the process that refines the vision, develops the programme and holds it to
* Develop a managed action plan/tracker that documents issues identified here/during the
process and ensures they are appropriately addressed collectively before being closed down
or otherwise incorporated in the developing plan
* Clearly document the “what if’s” (risks) to ensure that we have plans in place to mitigate
them and deal with them if they occur
* Address the need to deliver optimal health and social care to the entire local population of
Skye & Lochalsh – recognising that the danger of focusing on the huge demographic
challenge is the risk of forgetting the needs of the wider vulnerable population, including
those with specific needs, children and younger people
* Ensure that the process is supported by a robust communication strategy. This has been the
cause of significant concern and frustration in the past
* Provide clarity on how this links to previous proposals, historic decisions and on-going
processes to demonstrate continuity or (where appropriate) a change in direction
* Acknowledge a number of relevant local and national documents within the vision, including
the Independent External View of Skye, Lochalsh and South West Ross (“The Ritchie
Review”) and The Independent Review of Adult Social Care (“The Feeley Report”)
* Address transport issues within the vision, which is essential to us to getting this right
(Patient transport, community transport and linking with public transport)
Ensure the vision, and any modelling done in support of it, recognises the needs assessment
work undertaken previously by Drs Crichton, Macdonald, McLeod and others locally in Skye
and Lochalsh
* Ensure the vision, and any facility planning done in support of it, recognises the work
highlighted by Dr Caroline Gould with respect to the local and national access panels as well
as national strategy and wider inclusive agenda for people with disabilities
* Consider use of the word “village” in the vision which may or may not be appropriate. The
term may cause concern as people might think that it means everything will be in one place
in Portree and we should be prepared to change this
* Consider alternative terminology such as “campus” or “hub”
* Consider the need for “outreach hubs” in addition to a “main site”
* Ensure that the vision/project is not focussed on Portree, although it has to located
* Work with us to help find and agree the preferred site(s)
* Translate our collective thinking into a refined vision document that can be shared more
widely in order to explain the vision in clear language that everyone will understand –
whether they have been part of the process to date or not (Including examples from other
areas of what we may want to think about)
* Seek and take into consideration wider community feedback on this document/the vision
and modify as appropriate