NHS GRAMPIAN

Integrated Health and Social Care Hub - Inverurie

Aim

This paper is submitted to the Grampian NHS Board to support the initial agreement for the integrated health and social care hub in Inverurie. The initial agreement sets out the strategic case for the hub which will involve the

·  replacement of the Inverurie Health Centre (and integration with existing services at Inverurie Hospital),

·  establishment of the community maternity service at Inverurie Hospital; and

·  the potential to include the replacement of the community dental facility and energy centre on the hospital site.

Strategic Context

Population Growth

The population of Inverurie has grown steadily over recent years with a rise of 36.3% between 1991 and 2010. Continual improvements to the road and rail infrastructure supports growth likely to continue unabated with the Local Development Plan (LDP), identifying land for development of a further 3,650 houses resulting in an estimated 9,000 additional patients requiring registration with the local medical practice.

Health Centre

The Practice is the largest single practice in Scotland. The number of patients currently registered with the Practice is in the region of 21,000 and despite the addition of temporary accommodation and internal reconfiguration to the original building the Inverurie Health Centre does not meet modern healthcare building standards.

The rate of growth is the fastest of any practice in Aberdeenshire. As a planning assumption, the expected registered practice size is projected to grow to 30,000 patients by 2021. In order to meet current demand effectively and to deal with predicted future additional registrations alternative accommodation needs to be provided for those patients served by the Inverurie Health Centre.

The replacement of the health centre was ranked as the Board’s highest ranked community project, alongside the replacement of the Denburn Health Centre, Aberdeen. This prioritisation was confirmed in the Board’s current property and asset management plan.

Community Maternity Service

A significant public engagement exercise, starting in 2010, was carried out as part of the Maternity Services Review, which led to the recommendation for a Community Maternity Unit (CMU) in Inverurie. The decision to provide a CMU in Inverurie was approved by the NHS Grampian Board in June 2012 and by the Cabinet Secretary for Health and Wellbeing in August 2012.

The proposals for Inverurie are consistent with the NHS Grampian Healthfit 2020 vision and will support the aim of providing better access to care locally and the integration of health and social care.

Discussion

Case for change

The purpose of this Initial Agreement is to set out the case for change and the need for investment which will enable the development of a new Health Centre & Community Maternity Unit, establish a new model of service bringing together and integrating a range of health and social care services and create the potential for a “Care Hub” for the Inverurie community at a future date.

The case for change is influenced by the following key factors:

·  The existing Health Centre does not have sufficient capacity to meet service requirements, is not fit for purpose, and not capable of expansion to support the increasing demand for services.

·  The predicted population growth in Inverurie (based on the local development plan) will result in a potential additional 9,000 persons being registered with the Practice by 2021

·  The establishment of the Community Maternity Unit has been agreed as a strategic priority

·  The current energy plant is assessed to have a high backlog maintenance risk and requires replacement

·  The opportunity to establish an integrated health and social care hub, aligning general practice, community health and care services, diagnostic services and inpatient care.

This Initial Agreement clearly demonstrates that there is a strong Strategic Case for the investment in the proposed service transformation and supporting facilities in the Inverurie area. The proposed new integrated model of service delivery is fully in line with national and local policies and the strategic direction of NHS Grampian and Aberdeenshire Council in the delivery of health and social care

Business Options considered

The Economic Case in the Initial Agreement sets out how the Project Group has selected the short list of options to be taken forward to the next stages of planning (the Outline Business Case). The preferred option (reference project) is for the replacement of Health Centre, establishment of the community maternity unit and integration of both with existing inpatient and diagnostic services at Inverurie Hospital.

Funding

Funding for the project will be provided using the hub revenue model (for an equivalent capital project of approximately £10.1m) and a £0.7m allocation from the Board’s core capital allocation. This funding assumption is in line with our local delivery plan and our property and asset management plan, both previously approved by the Board.

Key Risks

The project has been identified as a priority for development by NHS Grampian and successful implementation will mitigate the risks contained in the strategic risk register as follows:

Risk 851: Delivery Strategies to meet the future needs of the population - delay in implementing the project will result in insufficient capacity in existing services to cope with the increased demand

Risk 855: Infrastructure – current infrastructure is not able to support our objectives for future patient care

Risk 586: Partnership working with local authorities, third sector, independent contractors and community - failure to approve and deliver the project could result in a loss of trust of the general public and service users given the accepted understanding that local facilities are not fit for purpose for the future.

Recommendation

The Grampian NHS Board is asked to approve the initial agreement which will then be forwarded to the Scottish Government Capital Investment Group for its consideration. Following approval by the Capital Investment Group, NHS Grampian will proceed to agree a new project request with hub North Scotland Ltd and develop the outline business case for the project. The timeline for delivery of the project is set out within the Initial Agreement.

Executive Lead

Alan Gray, Director of Finance

Paper prepared by

Adam Coldwells - General Manager, Aberdeenshire CHP

Mike Ogg - Deputy General Manager, Aberdeenshire CHP

July 2013

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