National Care Service: island communities impact assessment

Data and Evidence

The availability of data and evidence for social care and community health in island communities is mixed. A lot of information on social care is available at local authority (or Health and Social Care Partnership) level. This includes information on overall social care recipients;^[i] those receiving home care;^[ii] care home residents;^[iii] people receiving direct payments;^[iv] people receiving free personal and nursing care;^[v] criminal justice social work;^[vi] looked after children, child protection registration, care leavers, and children in secure care;^[vii] and on workforce.^[viii] Information on mental health and other community health services is available at the Health Board level.^[ix] This data provides important background information on the state of social care across Scotland, but has some shortcomings. For local authorities or Health Boards that encompass islands only – Orkney Islands, Shetland Islands, and Western Isles – data at the local authority level covers all of the islands within those areas, but does not differentiate between larger settlements and more remote island communities. For those areas that contain islands alongside areas of mainland Scotland – Highlands, Argyll and Bute, and North Ayrshire – data are likely to be skewed by larger proportions of their population living on mainland Scotland.

The Heath and Care Experience Survey also reports findings at Health and Social Care Partnership level. The latest survey, which provides insights into people's experiences of health and social care services, was published in May 2022.^[x] Question topics included: care, support, and help with everyday living; experiences of carers; GP practice; treatment or advice from the GP practices; and Out of Hours Healthcare. Respondents in island-only areas (Orkney Islands, Shetland Islands, and Western Isles) generally reported similar or higher positive responses than for Scotland as a whole.^[xi]

The National Islands Plan Survey 2020,^[xii] which was undertaken as part of the Scottish Government's National Islands Plan, provides more in-depth data on islands and allows some differentiation between larger and smaller island communities. Respondents are broken down into sub-regions covering: Argyll Islands; Arran, Bute, and Cumbraes; Skye and the Small Isles; Lewis and Harris; Uist and Barra; Orkney Mainland; Orkney outer isles; Shetland mainland; and Shetland outer isles. However, this is not a regular survey and covered a large variety of topics. As an island-only survey, it also does not allow direct comparisons to non-island communities. It asked a series of questions about access to health and social care, though only a few questions covered social care specifically.

Data on unpaid carers is more limited when it comes to island communities. The Scottish Heath Survey^[xiii] provides the most up to date data on unpaid carers by local authority and Health Board, but only provides information on the proportion of people providing unpaid care and their sex at this level. Further information regarding people's experience of caring responsibilities is available at Health Board and Health and Social Care Partnership level in the Health and Social Care Survey, as highlighted above. There is also information available from Shared Care Scotland about funded short break projects^[xiv] and organisations providing Time to Live grants^[xv] for flexible breaks, including on the islands. There is also data available from Family Fund about the number of Take a Break Scotland^[xvi] grants (for flexible breaks) provided to carers looking after disabled or seriously ill children, broken down by local authority. Local authorities and Integration Authorities have responsibility for commissioning local short break services and for publishing a Short Breaks Services Statement, which detail services available locally.

There is also a lack of data when it comes to Personal Assistants (PAs), both across Scotland and in island communities. PAs are amongst the most disparate and difficult to reach workforces both in terms of geography and complexity. In April 2022, the Scottish Government completed the first ever annual PA survey and will publish the report providing analysis of the responses in summer 2022.

The above data provides key insights and background on community health and social care, but the gaps in data availability, particularly in relation to islands data at a more detailed level than local authority level, raise the importance of directly engaging with island communities. The responses to the NCS consultation and the further engagement that has taken place since have provided further insights into care in island communities and that engagement will continue as NCS policy is developed within the framework of this Bill. Consideration will also be given to ways to access more islands-level data on community health and social care, including the possibility of targeted questions in future islands surveys.