Coronavirus (COVID-19) community resilience in Scotland's islands: research

Curious Pilgrims (Bressay)

Introduction

Bressay is an island on the east coast of Shetland. It is connected to mainland Shetland by a short ferry journey. The island is around seven miles long by three miles wide and has a community of around 360 people.^[22] The Noss nature reserve on the neighbouring island is renowned for birdwatching in the summer months. Shetland has an older age profile than Scotland as a whole and this is reflected on Bressay. One of the community responses to COVID-19 on the island was the establishment of a prescription delivery service by a group called Curious Pilgrims which ran from March to October 2020. The organisation also delivered some arts projects later in the pandemic.

Who was involved

Curious Pilgrims is a small community interest company (CIC) based in Bressay. The aim of the organisation is "to merge the arts and the natural environment for the wellbeing of people in Shetland or with an interest in Shetland." Curious Pilgrims was founded in early 2020 just before the first national lockdown. The joint co-founders and co-directors moved to Shetland in 2019 after spending time in the Islands for work.

When the pandemic struck, Curious Pilgrims started a prescription delivery service in Bressay. In doing so, it was drawing on the ethos of the organisation and adapting to the needs of the community to provide immediate assistance, improve wellbeing and reduce possible negative effects of isolation.^[23] The service was available to anyone on the island who needed it. While it was mainly used by people with long-term conditions and who have repeat prescriptions, it was also available to people who required short-term treatment for acute conditions.

Why the project happened

Bressay is generally well-connected to mainland Shetland. There are normally regular ferry sailings between Bressay and Lerwick with a journey time of under 10 minutes. Residents usually have to travel to a pharmacy in Lerwick to collect medicine or rely on family or friends to do this for them, as there is no pharmacy in Bressay nor a pharmacy that delivers prescriptions to the island.

Early in the pandemic, the physical distance from the pharmacy in Lerwick presented a number of challenges for people in Bressay. For instance, people may have felt uncomfortable travelling to the mainland to collect prescriptions due to perceived risks of contracting the virus and because of guidance to stay home and avoid public transport. It should be noted that Shetland was affected relatively early in the pandemic with the first cases recorded on 8 March 2020. People who were shielding or isolating and did not know anyone nearby who could bring essentials to them would also have struggled to access their prescription. It was not until 14 April 2020 that the national helpline for those at higher risk from COVID-19 who did not have family or community support was launched.^[24] The sense of worry being felt at this time was highlighted by Curious Pilgrims:

"The uncertainty around how long the pandemic would go on for brought about a high degree of stress and anxiety, particularly in people who lived alone or who depended upon support of others to have their medication delivered to them in a timely fashion. The situation worsened when the ferry service to Lerwick was subjected to various restrictions."

One of the co-directors of Curious Pilgrims is a locum qualified health professional who was working in a pharmacy at the beginning of the pandemic. It is common for locum healthcare staff to come to Shetland to work for periods of time, but travel restrictions soon reduced numbers arriving. Curious Pilgrims felt there was no plan in place to ensure essential medicine reached Bressay residents so began offering a prescription delivery service.

"We immediately realised that the physical detachment from mainland along with a restricted ferry service and no emergency plan in place to address the needs related to people's healthcare were likely to bring about a major issue."

What the project involved

The prescription delivery service worked by people getting in touch with Curious Pilgrims to let them know that they had ordered a prescription from a pharmacy in Lerwick and when it would be ready for collection. Curious Pilgrims would collect the prescriptions during working hours or would take the ferry over specially to collect them. They would then take the prescriptions back to Bressay on the ferry and drive around to deliver them. This was done in a non-contact way by placing the prescriptions inside the door.

Curious Pilgrims advertised the prescription delivery service on social media and placed notices in the passenger lounge of the ferry. The adverts made clear that the service was free of charge and included the co-directors' email addresses and mobile phone numbers so people could get in touch any time (see figure 1.3 below).

"We invited people to get in touch with us at any time to let us know that their prescription was due for collection, and there were situations when people would contact us in the early hours of the morning or late at night because all of a sudden they realised that they had forgotten to notify us in advance. This did not cause any problem for us."

Word of mouth was also very important, and most people who made use of the service did so because they heard about it from other residents.

"In hindsight, and now that we understand the dynamic of the place that much better, we think that word of mouth was critical in people getting to know about the service that we were offering. When people contacted us they would say 'I was told that you were doing so and so, would you mind doing this for me? We could see an increase in demand for our service as days went by."

At one stage in the pandemic, Curious Pilgrims were collecting and delivering prescriptions every day, making sure they delivered on the day or the next day if the beneficiary's door was closed. Over six months they delivered 490 items to 68 residents.

Confidentiality of the service was important. The organisers felt that people were reassured about confidentiality because of the co-director's training and background as a health professional and also because the co-directors were relatively new to the community and "neutral" in a way which may have increased trust in confidentiality.

"Usually, in small communities, there's so much going on in terms of talk and gossip. We had the feeling that since, at that stage, we barely knew anyone, we weren't involved or aware of people's history or background. For us it was a very straightforward situation – we need to deliver to a, b and c, and that was it."

After about a month of meeting costs themselves, Curious Pilgrims applied for funding. The organisation was successful in an application to The Prince's Countryside Fund, which awarded emergency grants to help communities respond to the impact of COVID-19. This funding meant that their expenses were covered from May to October 2020. The co-director has experience of applying for funding for arts and wellbeing projects so found the application process "fairly straightforward". On reflection, they felt that securing grant funding had been important for continuation of the service because it mitigated some uncertainty about how the service could be sustained in the medium to long-term.

"Without grant funding, we think that the situation would have been more challenging because we couldn't anticipate how long the pandemic would last. We think that a lot of people – and probably governments too – might have said 'oh, it will just be two or three months and then we'll be back to normal'. So in hindsight we think the grant has made a significant difference for us to be able to carry on with the service for as long as we did."

Curious Pilgrims did not have direct experience of running a service like this but overall found the process smooth and did not experience significant issues or problems. The biggest challenge they faced was finding addresses for the first time. No other organisations were involved in the development or running of the service. Curious Pilgrims did not feel the need to involve others like the local authority or NHS because they were confident in taking the initiative to organise it and noted that other bodies were focussed on other issues.

"We didn't feel the need to say 'oh we can only do this if we're supported by so and so'. That's our nature too, we're very pragmatic. We say 'okay what needs to be done? Can we do it? And if so, let's just get on with it.'"

Curious Pilgrims planned to run the prescription service for as long as it was needed. Demand was based on people's perception of risk so it came to a natural end as coronavirus restrictions eased. People began to look forward to being able to leave Bressay after so long, even just to collect their prescription, or family and friends were able to visit again.

"For some people, being 'stuck' on Bressay for a prolonged period of time without crossing to Lerwick was starting to have a certain negative impact. So as soon as restrictions started easing there was a natural transition from dependency on our service, to people resuming a more 'normal' state of affairs. People took the chance to cross over even if it was just to go to the pharmacy."

What next?

Curious Pilgrims continue to deliver prescriptions for a small number of Bressay residents but there are no plans to re-start the prescription delivery service more widely. It was felt to have come to a natural end as COVID-19 restrictions eased and there is a sense that measures are unlikely to be so restrictive in future. That being said, if a similar emergency arose and the service was needed Curious Pilgrims would be prepared to offer it again.

Curious Pilgrims is currently working on a project to record experiences of the pandemic. The 'Community Voices' project invites people of all ages and from all backgrounds and who have a strong connection to Shetland to creatively share their experiences of life during the pandemic. The project will show how COVID-19 affected people in different ways.

Reflections

Appreciation for the service was clear from the 'thank you' messages and gifts people would leave to be picked up when their prescription was dropped off. It was also demonstrated by the Community Spirit award Curious Pilgrims received from Voluntary Action Shetland in September 2020 (see figure 1.4 below).

It was not possible to speak to anyone who had received prescription deliveries due to patient confidentiality. However Curious Pilgrims collected the following feedback from people who had used the service which highlights the mental health benefits for residents of knowing that someone was available to help them and of reducing their potential exposure to COVID-19.

"It has been a wonderful help through these difficult times. Always on time and delivered right to our enclosed porch. It has not only been a practical help but mentally lifting to benefit from the kindness offered. Thank you is an understatement."

"The prescription delivery service to our island community has been, and still is, a valuable resource for all. Because of this service we are better able to reduce our potential exposure to the virus by completely avoiding the need for travel and collection ourselves. Stress levels are, therefore, also reduced."

The co-directors also spoke about mental health benefits for themselves from helping their community and from giving them a meaningful way to spend time during such an uncertain period, especially as their normal work had stopped because of pandemic restrictions.

"As a musician working fulltime in the arts, I was suffering from the impact of Covid because all my work was suddenly wiped off my calendar - that's at least two years of planned work which have completely vanished. So, I think in a way, from a personal perspective, I felt that I was offering my time and energy to help people around our island."

Curious Pilgrims felt there were benefits for pharmacies too. The delivery service helped to lower and manage footfall where reduced opening hours would have meant more people inside the pharmacy in a shorter timeframe. This was obviously a period when the virus was still being understood and before the development of vaccines so there was increased emphasis on the importance of physical distancing to control the spread of the virus. A related aspect of the prescription service was that people would ask the co-director for medical advice on minor ailments which reduced demand on overstretched services. The prescription delivery service also complemented the national message not to stockpile medicines. People could be reassured that they would have access to their prescription so did not feel the need to order large quantities in advance.

"The people we were assisting could put their mind at rest that they were not going to run out of medication or be in a situation where medication could not be accessed due to the restrictions, and therefore they did not stockpile medication. If everybody had to stockpile meds the situation quickly snowballs into a major issue, resulting in product shortages even on a national level and other people are left without necessary medication. So, yes, we think that the service did make a difference in this respect too."

Lessons learned

Thinking about what they learned from the experience Curious Pilgrims highlighted the increased importance of community and awareness of the needs of older residents in particular.

"You really get to appreciate how older folk feel and can really become anxious about their supplies and about the need to feel that they're being taken care of. So for me, that was quite a new experience so to speak."

Curious Pilgrims took the initiative to organise and run the prescription delivery service. While they felt in their absence a similar service would have been set up on the island by other residents, this does highlight the importance of individual efforts to community resilience.

"We came up with this idea and just acted upon it. We felt that we could do it on our own because we had the confidence and energy to do so, and we do like to believe that if we hadn't done so, there would have been someone else to come up with this idea or take the initiative"

What community resilience means to Curious Pilgrims

Curious Pilgrims were asked what 'community resilience' means to them. They highlighted that it is about communities having the resources to be able to adapt to situations.

"I would say it's about the community being able to step up or deal with a particular situation in times of need…when an event happens and the community is strong enough or closely knit enough or has the resources to be able to cope and to adapt to a situation."

They had mixed views on how resilience manifests itself in island communities. On the one hand they felt that islanders are perhaps more resilient because they have to be when they cannot access resources as easily as they might on the Scottish mainland. On the other hand, there may be people who feel like they have to manage on their own because they live in more rural areas and might not be aware of support services available to them.

It was felt that the prescription service contributed to community resilience in Bressay by increasing knowledge and awareness that support was available for residents if they ever needed it.

"From the community's perspective it's knowing there's somebody in the community who's going to do something to help if help is needed. Just knowing that you're not alone in a situation offers peace of mind and strengthens a positive feeling, even if you don't need or use a service."

Curious Pilgrims now feel better prepared to respond to emergencies because their experience during the pandemic has given them a sense of what they could expect in future.

In terms of advice for other communities experiencing an emergency Curious Pilgrims highlighted the importance of pooling knowledge and identifying resources or skills gaps to be filled.

"We like to sit down and brainstorm: What can we do to help? What skills, knowledge or knowhow do we possess to be able to set up a new service or activity for the benefit of the community? It's boils down to using skills and resources more efficiently so that one person or organisation can do one thing while another can do something else, rather than everyone trying to do everything. I think that would be a good starting point and seeing what's lacking in a community so you can do something about it."