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Sorton Report  -  Consultation into Multi Use Building and Requirements for Shapinsay.

 

Shapinsay Development Trust (SDT) – Shapinsay Multi Purpose Building Project
Introduction

The basis for this document is the information contained in the preliminary document prepared by Sorton for consideration ahead of preparing this full and final report along with the outline business plan based on the community consultation process and its content is detailed below.
Appendix A, attached, is the summary report from the questionnaire including initial comments written by Sorton before the community consultation meetings were held. We used this summary at the consultation meetings to introduce the main themes arising from analysis of the questionnaire results.

Consultation

Two consultation meetings were held – one with the 9 – 12 year olds on June 27th and one with business community and community group representatives on June 28th.
The children were focused on 3 main themes:

• provision of a central space for them to ‘chill out’
• a swimming pool
• provision of an area and equipment for outdoor activities


Improved connectivity through high speed broadband and Wifi were considered to be essential.
At the community and business group meeting the overwhelming theme was that of care provision for the elderly of the community on Shapinsay and how to enable them to remain on the island as their care needs become more complex.
Other subjects – a swimming pool, for example – were discussed, however when asked directly if provision of care facilities were more important, the meeting agreed unanimously that they were (one interesting comment was to the effect that ‘ it’s what we need not what we want that matters’ this statement received very strong support from the meeting).

This response, in conjunction with the 85% support for care provision from the questionnaire responses leads us to the view that enhanced care services should be the priority for this capital project but that thought must be given to potential on-going revenue funding – for example could turbine revenue act as leverage to attract other public funding?
At the beginning of the meeting concern was raised about the project delivering a new building that could become a ‘white elephant’ and that there was already provision of  spaces locally (the Community Centre, The Kirk, the school, etc.). A discussion followed during which it was concluded that that the term ‘Hub’ could be misleading and that whilst the project could deliver a ‘bricks and mortar’ solution the thinking should be broader and that outcomes may include the project utilising Shapinsay’s existing assets or developing some form of multi-use facility for the community. During the discussion one key theme for the use of this facility would be the development of enhanced care provision and the outline Business Plan for this consultation exercise will focus on what level of provision might be achieved. The meeting’s opinion on what should be addressed ranged from the provision of a fully- fledged residential care home through to the provision of additional care hours to supplement the statutory care provision obligation from Orkney Islands Council. We believe that some solution can be developed that provides some enhancement of services however expectations as to what this initial capital funding and any on-going turbine funding can achieve will need to be managed – consideration will also have to be given as to how any proposals will be developed to ensure they provide an addition to the statutory provision and don’t replicate, replace or threaten services provided through public provision.
The consultation meeting focussed almost entirely on the theme of care of the elderly from the outset and despite specifically moving the discussion onto other subjects the attendees kept returning to this theme. Given that all those present agreed that this was the most important need of the community we were happy to allow full discussion of the topic to inform the further development of the ideas. We also considered that as about 30% of  those invited to attend were at the meeting, this was a representative group (indeed when asked if they felt they reflected the views of the wider community those present agreed that they did).

Preferred Options for development

At this stage we feel that the report on the consultation process should therefore focus on:

• how the available funding could be used to provide enhanced care facilities for the elderly and what other conditions this may require to be met going forward (revenue funding etc.)

Also, to consider as complimentary suggestions,

• how the available funding could be used to support the younger population through provision of additional ‘outdoor activity’ facilities
• the provision of better internet connectivity (this suggestion could impact on the younger generation’s experience of living on Shapinsay, the success of businesses and also the reality of being able to provide enhanced care of the elderly)
With overwhelming support for the care of the elderly we feel this must be the first issue to be addressed, there remained considerable support for provision that could make Shapinsay life more equal for the younger generation and we feel that the nature of the available funding may be sufficiently flexible to allow some investment to achieve this.
The outline business plan will consider the first option of enhanced care facilities for the elderly in Shapinsay. The other options for supporting the younger members of the community and the provision of improved internet connectivity for the island are addressed in the final section of the outline business plan.

Outline Business Plan Introduction

What type of facility is it realistic to provide?

A Care Home

A condition of the award of this lottery funding is that it has to be used for capital  investment so whilst it could be spent on a purpose built care facility the on-going staffing and running costs would have to be met by other means. Complex legislation would make it very difficult for a community to set up and run its own care home. Providing a building, however, that could host even just a 4 bed Orkney Islands Council run care home facility would still be fraught with difficulties – financial and practical. The type of care required will vary given the current circumstances of each individual and how many individuals are required to be looked after at any given time. For example during one year, the facility might have to act as a care home for one generally infirm patient, a dementia home for a patient that has become mentally infirm but is still active, a palliative care home for a patient who has developed cancer and so on. The following year, circumstances might dictate that there may be nobody requiring the care facility but the facility would still have to pay its staff and overheads. The dilemma is how do you support all these individual needs and where must the line be drawn on what can and cannot be provided for and for whom? If, for example, 6 people require to be accommodated but there are only 4 beds, the fairest way might be to allocate places on a first come first served basis but that could lead to ill feeling in the community. Crucially, such a facility could never be flexible enough to be able to provide one

solution for all. 24 hour nursing care especially in a small facility would be prohibitively expensive for the local authority and would not be something that it could consider.

The rather harsh reality today is that care facilities throughout Scotland are inadequate. In a recent case in the Central Belt a patient who had complex (but not unique) needs and had more than sufficient money to pay for their care could not find an available place in a residential care home. The problem is that real multi-need facilities do not exist and in the care homes that do exist there are no places available so a patient invariably ends up stuck  in hospital on a waiting list. If this is the case nationally, the local authority is unlikely to give priority to the needs of a small island population like Shapinsay’s when it has to consider the needs of a bigger population on, say, the mainland.

A government report on Evaluation of the Operation and Impact of Free Personal Care (FPC) re-enforces this experience:
4.23 One hundred and thirty nine people across 20 local authorities who had been assessed as self-funders were waiting for discharge from hospital for six weeks or more. Six authorities reported that the delays were caused by lack of vacancies in care homes. Fourteen local authorities reported that the delays were due to clients exercising their statutory right to choose their own care home and there being no vacancies in the client’s home/s of choice.

In addition, using the lottery money for building a care home to host care provision on the island would only be the beginning. The building will then require the facility to be created, be maintained and have substantial funding committed to it, over and above what Orkney Islands Council might contribute, on a permanent on-going basis – the reality would be that SDT funding would not get anywhere near being able to find the amount required.

A government report ‘Evaluation of the Operation and Impact of Free Personal Care (FPC)’ states that there is also an issue with personal care provision nationally.
4.25 Nine local authorities reported a total of 391 people waiting at home for any personal care services to be provided. The main reasons given by local authorities for these people waiting for personal care services to be delivered related to lack of capacity to provide the service due either to staff shortages or to difficulty in sourcing a provider to deliver a service at the time required. Providing services in rural areas was noted as a particular difficulty.

Investing the lottery money in the procurement of land, design and build of a care home would be achievable but there would have to be a clear understanding of how the facility would work. As was discussed at the public meeting, this would involve understanding and ‘nailing down’ exactly what the local authority contribution would be to the care home going forward. This is likely to take much longer than the period of time left to spend the lottery money which to all intents and purposes rules it out as an option.

So whilst provision of a care home that would always struggle to provide a solution for all needs may not achievable, provision of an enhanced care initiative that would buck the national trend and provide a greater range of facilities allowing folk to stay at home for much longer would not only be achievable and but could be affordable to SDT from turbine revenue funding. The allocated lottery money would be used to purchase a house/s that would become a care ‘base’.

The proposed model for the outline business plan, therefore, is for SDT to purchase an existing building/s and set up arrangements with OIC to add incentives and additions to the Home Care Package.

For example, an elderly couple that are having difficulty staying together because one is infirm and the other falls ill meaning that they can no longer look after one another could be offered additional support from the community care base so that they could stay at home together.

Enhanced Care in the Community

A suggestion was made at the public meeting that a house could be purchased by SDT and  be offered as part of an incentive package that would make the employment equation more attractive for a care worker to move to the island. That is to say that SDT could fund extra hours for each customer on top of their statutory entitlement. The carer would find the job much more doable if rather than having half an hour twice a day with a customer, they were allocated, say, an extra 1.5 hours each day, funded by SDT, to spend with them and offer a much higher care quality. Such a package also makes the job much more attractive and job satisfaction is likely to improve accordingly.

The care worker, in return for, living in the rent- subsidised* accommodation would not only play the role of carer but could also co-ordinate the other carers in the community and thus ensure continuity of the care service and its quality.

Buying a house (or 2) on the island with the lottery funding would not only give SDT a sellable asset/s but would provide a cost effective way for the trust to support all care workers in the area. Once the building is purchased, the financial impact for the Trust boils down purely to the number of care hours provided. There may even be potential for the building/s to accommodate some form of day care facility with the care co-ordinator taking on a warden role as part of their accommodation package.

The UKHCA (the professional association of homecare providers from the independent, voluntary, not-for-profit and statutory sectors) Summary Paper ‘An Overview of the UK domiciliary care sector’ July 2012 states that in Scotland:
• The pattern of intensity of homecare is one of increasingly intensive packages of care for those most in need. On average, households received 10.1 hours of homecare per week. In 1999 the average was 5.1 hours.
• The majority of service users receive homecare provided by in-house teams but the use of the independent sector is growing, particularly for more intensive packages of care. In 2011 46% of publicly funded homecare was provided solely by the independent sector, with 10% a combination of service from local authority and the independent sector. The remainder, 44% was provided solely by local authorities.

*We have used the term ‘rent-subsidised’ to indicate that the building is being used as an incentive to encourage care workers to operate in the community. We have not specified how this subsidy will actually work and consider that the practical realisation of this will be an important consideration in the full feasibility study.

Customer Base

The most recent (2008) NHS population statistics for Shapinsay show that there were 111 people aged between 45 and 64 and 66 people aged 65 and upwards. This demonstrates sufficient numbers to assume that, at any given time, there will be a reasonable percentage of these residents who will be entitled to the Government’s Social Care Commitment which varies from up to 14 hours per week for high priority cases to 5 hours a week for medium priority cases to no care for low priority cases. There are, however, no national guidelines for prioritising the delivery of care services.

If the Statutory Provision is, say, 30 minutes per day and SDT offered an enhanced care provision of 1.5 hours per day extra per customer it would cost the Trust £54,600 per year (assuming am hourly rate of £10) for 10 customers plus any building maintenance costs.

Anecdotal figures currently vary from 2 residents requiring enhanced care to 8 depending on who is asked.

Important points for further investigation in a Feasibility Study/ Final Business plan

Whilst this report and outline business plan identifies an ‘in principle’ way forward for the use of the existing lottery funding and the development of enhanced care services, we believe that an in-depth feasibility study resulting in a detailed business plan will need to be completed to establish the exact means of delivering the outcomes. The following points are listed as the key considerations that this study will need to resolve prior to any further commitment to the project.

• To negotiate ‘up front’ with the statutory bodies to set the parameters of what can be provided, how they will support the proposals and secure agreements relating to on-going care provision.
• It would be essential to establish that everyone was happy with the purchase of a house for use as an incentive to potential/existing care workers/ co-ordinator.
• To define the best and most practical way in which the property can fairly be used to support enhanced care provision in Shapinsay.
• The opportunities, beyond accommodation, that the building/s could exploit to support the elderly community.
• Identify the type of accommodation provided (rental property, ‘self-catering’ model, B&B model, etc.)
• Explore the type of day care and service facilities that might be provided from a care base – lunch provision, shopping assistance and so on.
• Establish the exact role of any new position developed as the result of this project. (Care co-ordinator, warden, etc.)
• Develop safeguards to ensure that what SDT does won’t lead to OIC unintentionally or inadvertently reducing its statutory contribution.
• To develop a financial model that will inform SDT of the continuing financial impact of the development.
• Secure agreement from Lottery that the funding can be used for the final proposal.
• Identify the best way to keep the property/ies as flexible as possible to ensure the realisable value is maintained/increased and that it/they can be developed to meet changing care needs.

Outline Business Plan – Care Provision
The business

The aim is to purchase and make fit for purpose 1 or 2 buildings on Shapinsay that will:
• Provide rent-supported accommodation to incentivise a carer/warden or other relevant posts.
• Provide a community service base for carers to work from and offer an enhanced care service.
• Provide a base from which other services could be provided – shopping assistance, meals on wheels, drop- in social area and so on.
• To remain flexible, providing the possibility of on-going development to meet the changing needs of care enhancement
• Provide a base and shelter for the Community Mini Bus.
Having 2 buildings provides greater scope and opens up more opportunities by providing the supported accommodation in one and using the other as the community service base.
Business Objectives

• To provide an enhanced care facility that will allow as many people as possible to remain on Shapinsay for as long as possible as they become more vulnerable and their care needs increase.
• To have a base from which to ensure continuity of care for all customers and offer other useful services within the community.
• To run a facility that operates within a financial model that is affordable and can be funded by SDT from the wind turbine revenue and any associated grant funding.


Products and Services

• SDT will provide an enhanced care service that matches what is already provided by OIC. That is to say that any home care need identified in the customer’s Care Needs Assessment carried out by Social Services will be matched by the enhanced care package. This rule will allow SDT to provide a service without having to become involved in an appraisal process themselves and therefore avoid being laid open to accusations of unfairness in terms of what they offer.
• A community care base from which other services for the elderly and infirm can be co-ordinated - for example, assisted shopping, meals on wheels, the community mini bus and so on.
• Financially supported accommodation for a care worker/s who may also take on the roles of warden and community service co-ordinator.
• The ratio of SDT’s offer compared to the Care Needs Assessments would be calculated to fit the available funding. There is an assumption in this proposal that revenue funding to support the provision will be agreed and sourced (possibly from the turbine funding and additional external grants).

Business Structure

SDT will own and maintain the building/s and will set up the necessary arrangements with Orkney Islands Council to use the buildings as an incentive for care provision or to add value to their homecare package. The care services will be provided by OIC and the staff will be engaged by OIC and a mechanism will need to be developed whereby The Trust can fund any additional hours through payments made directly to OIC.

Personnel

The staff profile

To be detailed in the full business plan – however if it does prove possible to ensure that all personnel matters remain within the scope of OIC’s provision the Board of The Trust should be able to look after the buildings side of the proposal within their existing resources.

Marketing Target Market
The most recent (2008) NHS population statistics for Shapinsay show that there were 111 people aged between 45 and 64 and 66 people aged 65 and upwards with 14 of those aged 85+.

The HIE population study carried out by Hall Aitken describes the Shapinsay population as ‘Marginal’. That is to say that although the population is growing or stable, the age structure is poorly balanced.

These figures would indicate that at any given time there will be people in need of home care on the island. These numbers will obviously vary from week to week, month to month and year to year but it is unlikely that there will ever be a time when no-one requires assistance.

Customer Benefits

The service offered by SDT will not be a fixed product. Rather it will be designed to be as flexible as possible in order to meet the vast range of needs that are bound to be required, by the very nature of the service, over time.

The service will also be flexible in how it copes with varying customer numbers. The co- ordinator/warden role will be created to undertake other tasks and offer other services from the care base so that there is also something for those who, although elderly and possibly slightly infirm, do not require home care but could benefit from other services.

There will also be opportunities to support medical interventions, physiotherapy for example, through the use of the building or being able to assist with extra care hours depending on the nature of the situation.

The service will continually strive to identify and develop ways to meet the changing customer needs that will arise over time.

The enhanced carer package of supported accommodation alongside more realistic hours allocated per customer will not only lead to increased job satisfaction but will make the job attractive to more people and should provide an opportunity for residents of the island to retain their independence and remain in their own homes for longer than is possible through statutory provision.

Competition

Care will have to be taken at all times to ensure that providing additional homecare hours does not inadvertently trigger a change of circumstances for a customer. For example, if a physiotherapy or medical care requirement is deemed necessary for a customer by their   care team, and these requirements can’t be met on the island, providing extra care hours  will not help the situation and there may be no option other than for the customer to go into hospital or a care home on the mainland.

SDT will have to find a way to ensure that its provision of an enhanced care service won’t lead to OIC unintentionally or inadvertently reducing its statutory contribution and thereby end up with the Trust footing the bill for all the community care provision.

Outline Plan - Provision of improved broadband

We consider this as an important proposal that will yield benefits in all aspects of living on Shapinsay. For those who have limited experience of faster connections than those that  they live with it can sometimes be difficult to see where the benefits lie – it is often the case that unless you lose it you can’t see the value in having it, if you’ve never had it you can’t see the point. The problem with this as a general proposal is that there probably isn’t a financially viable solution to providing the island with a real ‘high speed’ connection.
Throughout Orkney the best speeds available are a fraction of those available in more populous areas and the logistics of improving this are probably insurmountable at present. We do believe that there is an opportunity to improve the situation however in one of two general ways.

Improved connectivity to all households

The first option would be to try to develop connectivity that would allow all or nearly all households to benefit from the best available speeds presently existing in Orkney. This could include replacing or re-working the existing network and adding a new line or link to Orkney Mainland. The benefits could be to create greater fairness throughout the community and open up the possible uses of the internet to the greatest number of users. Over time this could then be connected to the faster line that will inevitably become available and could give Shapinsay a huge advantage when the next generation of connection becomes available.

One centrally located fast connection

The alternative to island-wide better provision would be to focus one space providing the best possible connection. This would most likely be one of the existing community facilities and the benefits that would it would yield could include improved video conferencing facilities, a fast WiFi spot, multiuser gaming environment, etc.

For either of these options a full technical review will need to be undertaken and as with all of these projects the starting point will be to define a budget for the preferred option. It will be essential to look at this as funds-bound ie assign a budget and then get an offer as to what could be achieved within that figure. Without taking this approach the range of options will become unmanageable and the review could easily generate a technically attractive but completely unaffordable solution. To progress this project we would suggest that suitably qualified infrastructure companies be contacted with an outline brief of the proposal against which to produce initial quotations and descriptions of the solutions that they could provide within the identified budget.

Outline Plan - Youth Outdoor Activity Facilities

The decision to include some additional facilities for the younger population brings some of the same potential hazards as looking into the possibilities of enhanced care for the elderly. As was raised during the consultation phase there is already provision through the education system and other groups – this project should not duplicate or replace this – therefore the opportunity should be taken to add something to the existing provision that could not otherwise be justified.

One suggestion that we feel could work would be to focus on the ‘outdoor activity’ theme and work with the existing resources to add in some new facilities. The existing playing fields could be the starting point for this with The Trust negotiating with OIC to purchase a small part of these on which to build a ‘club hut’ type space that could be used for storing equipment and as a club space. Archery was one well supported proposal as was the provision of canoes – the exact mix of what would actually be used and those types of equipment that will be relevant to the users will require further research, but we feel that a bespoke facility, utilising the existing playing fields would be a cost effective way of adding to the experience of growing up on Shapinsay without committing The Trust to an unbearable on-going revenue cost.

We believe that this project should be considered as a funds-bound exercise – in the same way as the Broadband provision should be viewed, with a budget allocated from the  available funding that will allow the purchase of any land, the erection of the ‘hut’ and the purchase of the identified equipment. From that point on this reserved budget should be used only for this project and if possible a reserve would be maintained to allow the future purchase of equipment if trends or identified needs changed. Given the negligible running costs of this facility and the real possibility that it could draw future funding from external sources, we do not feel that a business plan or further feasibility study is required, but rather that a basic capital proposal be developed and further analysis of what would be most welcomed by the users is undertaken.

Financial Model
Given the number of outstanding details that need to be considered in a further feasibility study we do not feel that full financial projections are appropriate or meaningful at this stage. We would suggest that for the Broadband project and the Youth Outdoor facilities a single budget figure should be assigned to each and the purchases made to fit within these. The broadband could yield some benefit for an investment of £30-50,000 and the youth facilities could be in the region of £10-20,000. The remaining budget could be matched to suitable properties where the purchase price together with required upgrading would fit within budget. The proposal for the revenue cost of the properties would be to achieve a cost neutral situation with rents and/or other income (or grants) covering sufficient maintenance and upgrading to secure the asset value. The remaining elements of financial modelling will need to be addressed in the final feasibility study, once the nature of roles and incentives have been defined and the long term revenue funding streams have been agreed.

Appendix A – Questionnaire data analysis Community Consultation Questionnaire June 2012
There were a total of 43 responses from 144 questionnaires giving a response rate of 29.8%. 3 of these replies, however, cannot be considered relevant to the scope of the questionnaire because they only desired the provision of a resident GP. This is obviously a major and emotive issue that does merit separate discussion (it may be discussed that the lottery money could potentially be used to fund the capital investment required to build a doctor’s surgery but there will still be the on-going problems incurred because doctors are no longer willing to work 24/7, the salary will have to be funded and cover found for annual leave and so on). For the purposes of the statistical analysis, therefore, we will consider the total responses to be 40

3 respondents did not support the development of any type of Island Facility – 7.5%.
8 respondents were in favour of every element explored in the questionnaire – 20% 29 respondents (72.5%) both agreed and disagreed with various elements – these are
explored further as follows (the bracketed figures take account of the yes responses from the 8 who agreed with everything and the no’s from the 3 who do not want an island facility):

NO YES
An informal drop in centre for young people 5 (8 -20%) 24 (32- 80%)
A day care facility for the elderly and infirm 3 (6 - 15%) 26 (34 – 85%)

A base for community carers & service providers    6 (9 – 22.5%) 23 (31 – 77.5%) (2 respondents specifically said no to the handyman/gardening service)

A base for supported employment focusing on traditional skills

11 (14 -35%)

18 (26 – 65%)
Affordable space for new start-up businesses 11 (14 -35%) 18 (26 – 65%)
Business Support Services including IT 16 (19 – 47.5%) 13 (21 – 52.5%)
Serviced bed and breakfast accommodation 17 (20 - 50%) 12 (20 – 50%)
Storage for community organisation records 11 (14 – 35%) 18 (26 – 65%)
A base for the Shapinsay Ranger 9 (12 – 30%) 20 (28 – 70%)

A creative Arts and Music centre

SUGGESTIONS FOR OTHER FACILITIES  13 (17 – 42.5%) 15 (23 – 57.5%)
Supported Housing 1 
Residential Care 4 
Help with shopping 4 
Meals on Wheels/ Lunch Club 2 
Cross Roads type service 1 

Hostel/Self- catering facility

Camping/ Caravan park 2 
Craft Outlet/ Gallery 3 
Gardening centre 2 
Plant/equipment hire 2 
Alternative therapy / Spa centre 3 
Small swimming pool 4 
Furniture recycling/ 50:50 shop 2 
Games centre 2 
Garage for community bus 2 
Venue 2 
Internet café 2 
Child minding facility 2 
Annual turbine credit for whole community
Shelter area for visitors Pier waiting room Visitor transport Cinema
Squash Court Soft Play area
Make community bus available for hire
Financial incentive for house owners to improve spare rooms for renting out

Training centre course suggestions

Training for carers
MiDAS equivalent
Accountancy
Tour Guide skills
ECDL
Dry stone walling 2
IT 5
Habitat/wildlife 3
Health and Safety
Fork Lift training
First Aid


Sorton Comment

It would appear from the valid response level that there is interest and support in having a community facility on Shapinsay. The recognised average response level for organisations sending out consultation documents or mail promotions is only 10% so to have achieved 29.8% is encouraging. The viability of the facility, however, will be reliant on it meeting the needs of the population as a whole rather than catering purely for one or two segments. From the nature of the responses and wide range of suggestions made in them, we see the following as potential requirements for follow up at this stage:
• A centre offering assistance to the elderly and infirm and providing a base for a care team and service providers that may or may not include supported employment
• A training and business centre – the HIE Orkney Population Change Study carried out by Hall Aitken states that the Shapinsay population is ‘marginal’ – that is to say that the population is growing or stable but with below average economic activity, poorly balanced age structure and is reliant on in-migrants to sustain population. Offering support for new and growth businesses on the island would be an effective way to attract new people and improve the balance of the population’s age in the future.
• An office base for the community transport scheme to include a shed for the bus and provide an island information office that would also accommodate the Shapinsay Ranger.