This report focuses on Dumfries and Galloway HSCP’s engagement activity (December 2023 to May 2024) and subsequent public consultation on the future use of the 4 cottage hospitals in Kirkcudbright, Moffat, Newton Stewart and Thornhill. The consultation period was extended as it began before the pre-UK general election period. The consultation ran from 17 May to 27 September 2024. Activities included local and social media, online and face-to-face methods for sharing information and opportunities for people to ask questions and give their views via anonymous survey responses. Dumfries and Galloway HSCP consulted on 6 options on the future of the cottage hospitals in Kirkcudbright, Moffat, Newton Stewart and Thornhill. The inpatient services at these 4 cottage hospitals are currently suspended. The 6 options, which were developed with people previously involved in engagement on Right Care, Right Place were:

1. Option 1: Status quo (services currently offered in 2024)
2. Option 2: Status quo plus (Near Me Suite and small number of additional services with respect to each location)
3. Option 3: Community Health and Social Care Hub (option 2 plus potential additional services)
4. Option 4: Re-establish inpatient services (inpatient services suspended since 2020)
5. Option 5: Community ownership
6. Option 6: Close the site

The option appraisal process carried out in May 2024 focused on approving the criteria for non-financial benefits (important factors that are not capable of being measured in money terms); considering benefits and risks (the potential pros and cons of the option); ranking and scoring each of the 6 options.

Recommendations for Dumfries and Galloway HSCP

We recommend that, as part of its decision-making process on the future use of the 4 cottage hospitals, Dumfries and Galloway Integration Joint Board (IJB) should:

1. Analyse and consider the feedback from people and communities, recognising that although the options for each cottage hospital were considered as part of one public consultation exercise, there are different nuances and contexts for each individual cottage hospital location and therefore the decision the IJB makes for each may be different. A respondent to our phone interview stated: “There are four hospitals involved in the consultation but they’re not all the same. Not one size fits all”.
2. Explain how the hybrid model (a combination of options 3 and 4) put forward during the option appraisal will be considered alongside the consultation feedback.
3. Consider how it can address concerns raised around the capacity for people to receive inpatient care at Dumfries and Galloway Royal Infirmary (DGRI) and the remaining cottage hospitals. An attendee at the Kirkcudbright in-person event observed “There’s people in the DGRI who don’t need to be there [DGRI] but there’s nowhere else for them to go”. Similar concerns were also raised at other in-person events.
4. Ensure that additional impacts for each locality, identified through the option appraisal and consultation process, are included in the updated impact assessments and are fully considered throughout the decision-making and implementation processes.
5. Demonstrate how the board has taken into account (through the Fairer Scotland Duty), the concerns people have raised about challenges to accessing services due to limited public transport, travel, distance and costs.
6. Recognise the concerns expressed by some people during the consultation around the perceived ‘erosion’ of local services and consider how these concerns may be addressed.
7. Acknowledge that during the consultation people have consistently expressed the importance and high value attached to inpatient beds in their local communities.
8. Feed back to communities on each of the decisions reached, how the IJB conscientiously considered people’s views, and financial considerations have impacted on the decision-making process and how the issues identified, for example travel and access, may be addressed moving forward.

If the proposals are approved, then we recommend the following areas are considered during implementation:

9. Continue to co-design solutions, with agreed timescales, with people, communities and partners to help mitigate adverse impacts identified through the consultation responses, impact assessments and Fairer Scotland Duty, for example, transport and access.
10. Recognise that the commissioning process ran in parallel with the public consultation. This may have resulted in some changes to how the intermediate care model will be implemented. If the changes are substantially different, there may be a need to consider further communication and engagement with affected stakeholders.
11. All stakeholders are offered the opportunity to be meaningfully involved in the implementation of the IJB’s decision.

We will seek assurance from Dumfries and Galloway IJB on how these recommendations are taken forward as part of the decision-making process and implementation of approve options/model.

With the aim of contributing to continual improvement in the quality of public engagement activities in NHS Scotland, we have identified points which we hope will inform future practice and be considered as part of the evaluation. These are summarised in the report as areas of good practice and learning points.