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NHS Shetland Programme Initial Agreement (PIA)


NHS Shetland




May 2021- March 2024

B+A have been working with NHS Shetland to take 

forward investment plans for the islands, commencing with a Strategic Assessment and Initial Agreement in 2021/2022.


Following a major change in capital planning guidance in 2023 this changed to supporting the development of a Programme Initial Agreement (PIA).  We have worked closely with Board and Scottish Government to establish the requirements to encompass whole system planning requirements for all health and care services. 

Image by Don Lodge

Essential streams of work

 Some of the main areas we have supported NHS Shetland with during this project are outlined below.

Approved and supported Strategic Assessment

We facilitated several stakeholder workshops to enable the development of the Strategic Assessment, which was approved in 2021.

Whole System Demand and Capacity planning model

Modelling the current service configuration across health and care services within Shetland including hospital and locality-based services, and developing a robust demand and capacity model providing strong evidence base and audit trail behind investment proposals.

Programme Initial Agreement (PIA)

We worked with a range of stakeholder groups across multiple work-streams to ensure engagement to all aspects of the PIA development and

created the Strategic Case component of the Whole System PIA in line with latest framework.

Project outcomes and next steps

The Strategic Assessment was approved by Scottish Government at the end of 2021 and progressed to Initial Agreement in 2022. Following a major change in capital planning  guidance in 2023 by Scottish Government, this changed to supporting 

the development of the Programme Initial Agreement (PIA), which is due for submission in two phases in January 2025 and January 2026.


The outcomes the B+A team achieved, to enable the NHS Shetland team to continue development of the PIA include: 

  • Engaged clinical and service teams across NHS Shetland and partner organisations.

  • An agreed approach and document structure for PIA developed through close working with Scottish Government

  • Well-developed Strategic Case which received very positive initial feedback from Scottish Government.

  • Establishment of core services which could shift to locality-based model; shifting care closer to home

  • An understanding of key areas of Do Minimum investment which would improve clinical service delivery.

The Numbers

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