Honouring the lived experience: Rape and Sexual Assault‎ Victims Taskforce option appraisal report

5. Option Appraisal Stages

5.1 Stages of Option Appraisal

The standard option appraisal process is relatively straight forward and comprises five key stages.

Stage 1; Rationale for Intervention

• Research and understand the current position - business as usual
• Establish rationale for change
• Identify objectives (outcomes and outputs) to support the need for change

Stage 2; fully describe each option which can deliver the model

It is a requirement to also include a 'do nothing/do minimum' option at this stage for comparative and reference purposes only. Develop a long list and appraise this to reach a short list of viable options for multi-criteria decision making appraisal.

Stage 3; identify the benefits criteria

These are the measurable outcomes of the project which will allow the level of compliance of each option to be determined objectively and presented as a numerical score. It is a requirement to apply a weighting to each Benefit Criteria in order to reflect relative importance.

Stage 4; Option Appraisal process and assessment of non-financial benefits

A process where each option is considered against the agreed benefits criteria and a score allocated against the multi criteria with agreed weightings. The conclusion of this stage is to provide a tabulation of the relative scores which in turn identifies the relevant ranking of the non-financial benefits for each of the options.

Stage 5; Formal appraisal of the financial benefits

The financial appraisal stage sits out with the formal group decision making process and is carried out on the viable, deliverable options as recommended through the stakeholder engagement and scoring process.

Once the preferred service model and configuration are approved by the Taskforce, Health Boards will be expected to work with their multi-agency partners to develop costed plans for implementation, which will need to look at the aspects of the service to be planned and delivered on a local as well as a regional basis.

5.2 Event Approach and Methodology

The aim of the event was to measure all options, including the status quo against the agreed benefits criteria and scoring process to reach viable, feasible and deliverable service options and service configuration models.

5.3 Scoring Process and Methodology

All new policies, programmes and projects, whether revenue, capital or regulatory, should be subject to comprehensive but proportionate assessment, wherever it is practicable, so as best to promote the public interest. Core guidance is contained in the Green Book^[3].

The option appraisal approach taken utilises best practice from decision making frameworks applied in major service change. The approach has at its heart the best interests of the service user whilst also ensuring the right service elements and crucially the right workforce model is in place to deliver the highest quality services across the range of disciplines.

5.4 Long List of Options

Table 1- Long List of Options (service delivery for adults, children and young people)

Number	Title
Option 1	Status quo (current service and considering the consequences of inaction)
Option 2	Improvement of existing services (Do minimum)
Option 3	Health Board specific approach with some elements of regional collaboration.
Option 4	Sexual Assault & Referral Centre (SARC)
Option 5	Multi-Agency Centre for adults, children and young people who have experienced rape and sexual assault
Option 6	Integrated Gender Based Violence Services
Option 7	Private Sector/Out Sourcing the service delivery

The short life working group conducted a fit for purpose analysis of the long and short-list using multi-criteria decision analysis techniques to assess benefits, costs and risks.

The list was filtered down by assessing how well they meet the quality criteria and the following critical success factors;

• Strategic fit - how well does the option meet agreed objective and fit with the wider organisational or public-sector objectives?
• Service user requirements - how well does the option meet the requirements of the service users?
• Potential affordability - how will the option be financed and is it affordable with existing budgets?
• Potential achievability - how likely is it that an option can be achieved given organisational capacity, capability and skills (workforce) available?

Other factors may be relevant to assess the long-list and affect which options are feasible:

• Constraints - such as legality and ethics
• Dependencies - such as infrastructure
• Risk - there is a risk that the option will take too long making it undeliverable within a reasonable timeframe for the project requirements.

Options discussed and ruled out at that stage: out-sourcing service provision to private sector (not palatable/inconsistent with delivery of public services in Scotland); integrated gender based violence services incorporating domestic violence services for adults and wider (non-sexual) child neglect and abuse (out with scope of the Taskforce / ability to manage demand).

It was agreed that the Taskforce remit and the options appraisal exercise excludes services for perpetrators in police custody (custody healthcare services).

5.5 Short-list of Options

On the basis of the above assessment of the long-list options (by critical success factors), the following short-listed options were selected for final appraisal to reach a preferred option.

Table 2 Short List of Options (service delivery for adults, children and young people)

Number	Title / summary
Option 1	Status quo or do nothing (retained as a baseline comparator) This option would mean that existing services largely remain as they are (good practice in places but inconsistent and fragmented picture across the country).
Option 2	Status Quo Plus: Implementation of HIS Standards for children young people and adults. This option would mean that Health Boards focus on improving the existing model of service delivery, in order to provide national consistency in the quality of forensic medical and health care services (as set out in the published HIS standards).
Option 3	Sexual Assault Referral Centre (SARC) - for Forensic Medical and Health Care Services (acute and historic) for adults and adolescents. This option would mean that a specialist, age appropriate forensic medical and health care service is provided by an appropriately trained mix of staff. It would provide equitable access to an individually tailored care package based on a comprehensive needs assessment, with a choice of action at every stage of care (whether clinical or non-clinical).
Option 4	Multi-Agency Centre/Co-ordinated services for adults, children and young people who have experienced rape and sexual assault (acute and historic). This option would provide the opportunity to co-locate those health services with other agencies and partners to help deliver a holistic, smooth pathway. For example, social work, criminal justice, advocacy and third sector services for the individual and their family all under the one roof.

The above service options were subject to option appraisal assessment at the stakeholder event on 27th June 2018.

The Benefits Criteria are set out at Appendix 1.

5.6 Ranking and Weighting the Criteria

The 'weighting and scoring' method, is a form of multi-attribute or multi-criterion analysis. This involved identification of all the non-monetary factors (or "attributes") that are relevant to the service change process; the ranking and allocation of weights to each attribute to reflect their relative importance; as it relates to the service change. This is then used at the event to allocate scores to each option to reflect how it performs in relation to each of the benefit criterion.

• The SLWG (07 June 2018) confirmed the list of benefit attributes.
• The SLWG developed the options and assessed the relative importance of the benefits criteria
• The group of subject matter experts met on the 15^th June, 2018 to agree the ranking and weighting of the benefits criteria.
• Those present reported this to be a transparent, rigorous and robust process of exploring the case for change and the rationale behind each criterion as it applied to the service change and the aims of the Option Appraisal process.
• The meeting was chaired by an objective service change facilitator (Kate Bell).

5.7 Final Ranking and Weighting

This process was split into two stages:

• The sub-group of the SLWG ranked the benefits criterion in order of importance.
• The SLWG gave a weighting to each of the benefit attributes in line with the ranking.

Table 3 - Ranking and Weighting

Benefits Criteria 'Attributes'	Final Ranking	Final Weighting
Person-Centred	1	2.0
Safe	2	0.8
Effective	3	0.6
Equitable	4	0.4
Timely	5	0.2
Efficient	6	0.1

5.8 Service Configuration Models

The SLWG developed the list of service configuration options and the essential, desirable and important factors to guide the decision making process as part of the option appraisal event. The participants score sheet for the afternoon session includes all 23 factors.

Service Configuration Models for consideration were:

Model A - Status Quo - services remain in existing geographic locations with some regional collaboration

Model B - Status Quo Plus - services remain in existing geographic locations with enhanced regional collaboration

Model C - Regional service / centre of excellence with supported island services.

Model D - Regional service / centre of excellence with supported island, as well as rural/remote and mainland services which are owned and driven by the relevant Health Board (s).