National islands plan: annual report - 2020

Health and Social Care and Wellbeing

Strategic Objective 7 - To improve and promote health, social care and wellbeing.

We committed to work with NHS Boards, Local Authorities and Health and Social Care Partnerships to ensure that there is fair, accessible health and social care for those on islands.

Work is ongoing in relation to this commitment.

The Scottish Government's Primary Care Division continues to regularly engage with health boards and Health and Social Care Partnerships (HSCPs), including those covering our island communities, regarding the implementation of the 2018 GP Contract and wider issues such as support to dispensing doctors. Ongoing Consultation with island health boards has reported that regular pharmacy cover was difficult to achieve for GP practices geographically distant from centres of population, and highlighted challenges in moving staff between practices in rural areas.

The GP Contract is a substantial reform programme that requires some services to be delivered differently. In some cases, these will be moved out of general practice into community settings and the primary care workforce will adopt expanded and enhanced roles, which could be crucial for our more remote island communities. Additionally, a fund of £117,252 has been set up to directly support the three island health boards and HSCPs with adminstrative and project management or quality improvement support required to implement the GP Contract. NHS Orkney, Shetland and Western Isles are each allocated £39,804.

The Scottish Government has allocated £200,000 to support Rural Relocation expenses, and £400,000 to fund Golden Hellos as set out in the Statement of Financial Entitlement. These initiatives will help address workforce challenges across remote, rural and island general practice. For 2020/21, the Scottish Government is allocating £72,050 to NHS Shetland to support the Rediscover the Joy in General Practice Project. The Scottish Government has also offered support to dispensing practices with delivery of prescriptions to patients during the pandemic up to March 2021. Currently, the Western Isles have accepted support whilst we are awaiting confirmation from Shetland, Orkney and Argyll & Bute health boards. A pharmacotherapy service, which provides pharmacist support to every GP practice across Scotland, has also been implemented.

Additionally, NHS Pharmacy First Scotland was launched on 29 July 2020 in all community pharmacies. This service provides extended access to advice and treatment for minor illnesses and common clinical conditions and is for everyone who is registered with a GP practice in Scotland or who lives in Scotland, including those living on our islands. The NHS Near Me video call service has also been rolled out to all community pharmacies and can be used for NHS Pharmacy First Scotland, enabling pharmacists to hold a video consultation with patients at home. Collaborative work with health boards continues with eHealth to determine models of remote access to GP practice systems so that elements of the pharmacotherapy service could be delivered remotely in future.

We committed to identify and promote good practice, especially as regards the improvement of services in islands and other remote areas.

Work is ongoing in relation to this commitment.

Primary Care Improvement Plans (PCIPs) are an annual reporting tool which health boards provide Scottish Government with an update on progress towards the implementation of the GP Contract and health boards can share comments on best practice within their area. Due to COVID-19's impact on resources, a condensed version of the PCIPS were returned from all boards. The analysis of these plans was presented to the National Oversight Group in January 2021.

For 2020/21 Scottish Government is also allocating £342,218 to NHS Highland to support the Scottish Rural Medicine Collaborative. The Scottish Rural Medicine Collaborative (SRMC) is funded by Scottish Government to develop ways to improve the recruitment and retention of people working in Primary Care.

We committed to support the extension of NHS Near Me/Attend Anywhere, and other digital health initiatives, to reduce unnecessary travel and enable more care to be delivered on Islands.

Work is ongoing in relation to this commitment.

We have launched the Near Me video consulting service, to enable people to have planned health and social care appointments from home or ideally, wherever is convenient and practical. This is a free and confidential web-based platform.

For rural and island communities, further work is required to assess how people feel about social isolation and use of remote consultations.

We committed to work with stakeholders to develop propositions for a national centre for excellence in remote, rural and island health and social care.

Work is ongoing in relation to this commitment.

Scottish Government aim to build on the work of Shaping the Future Together: Remote and Rural General Practice Working Group report to establish a formal proposal for a National Centre for Remote, Rural and island Healthcare in Scotland that is inclusive of the needs, opportunities and models of excellence from the whole remote and rural health and care workforce. The Primary Care Division within Scottish Government is developing a proposal for how the centre for excellence should look, and will shortly be engaging with stakeholders.

We committed to work with stakeholders to ensure that we develop a plan to adequately support the ageing population of island communities so that they remain active, connected, engaged and have access to suitable, quality opportunities.

Work is ongoing in relation to this commitment.

In the creation of the A Fairer Scotland for older people, A Framework for Action we consulted and listened to the voices and experiences of older people in the Older People's Strategic Action Forum.

Integration authorities continue to work closely with their communities to develop strategic plans for delivery of health and social care services most suitable to the specific needs of their communities.

We published an implementation plan (covering the period 2019-2021) for the overarching Self-directed Support Strategy in June 2019. The implementation plan set out actions required to drive forward the changes necessary to fully implement and embed self-directed support across Scotland.

Ministers have also recently extended funding for independent support and advice through Support in the Right Direction for people navigating social care until the end of March 2022.

Support in the Right Direction, a key action in the implementation plan, funds projects worth over £588,265 across all of the 6 island local authority areas who provide independent information, advice and advocacy to people and carers accessing and managing their social care care, as well as supporting them them to exercise choice
and control over that care and support.

We committed to support relevant local authorities to plan and develop sports facilities on the islands that respond to the needs of communities.

Work is ongoing in relation to this commitment.

We continue to work with colleagues in SportScotland who are engaged in regular discussions with Comhairle nan Eilean Siar, Orkney Islands Council and Shetland Islands Council regarding current and future opportunities for the development of sports facilities. Similar discussions are also being held with the other local authorities which include island communities.

SportScotland are also in active discussions with Orkney Islands Council in relation to working strategically to put in place facilities that will link to the needs of hosting the Orkney 2025 International Island Games. This will ensure a quality environment that will provide more opportunities for people in Orkney of all ages to participate and be active, as well as providing the best opportunity for young people to develop and perform on local, national and international stages. This project will leave a visual and inspirational legacy from the Orkney 2025 Games.

We committed to promote participation in sport and physical activity by ensuring national programmes such as Active Schools and Community Sport Hubs are serving island communities, and continuing the Island Athlete Travel Award Scheme.

This commitment has been fulfilled.

The COVID-19 pandemic and related restrictions have significantly impacted on sporting participation across Scotland, including island communities. However, Scottish Government and Sportscotland have continued to encourage islanders to be physically active in line with the public health guidance and have provided support to sport organisations to operate through and out of the pandemic.

Sportscotland is currently investing in four year Partnership Agreements (2019-23) with Comhairle nan Eilean Siar, Orkney Islands Council and Shetland Islands Council. As part of these agreements, Sportscotland is providing annual financial investment to support the delivery of Active Schools and Community Sport Hubs across each island local authority.

This investment continues to support the employment of 15 (FTE) Active Schools staff covering every Secondary school cluster from Unst to Barra. There are also Active School staff working with the island schools in Highland, Argyll and Bute and North Ayrshire, through our investment in those local authorities. Our investment in the three island authorities supports the employment of six Community Sport Hub Officers supporting local communities to develop better connected pathways.

Sportscotland continues to support those with athletic potential through the Athlete Travel Award Scheme (ATAS). Athletes can benefit from up to £1,500 per year from the programme to help with travel and accommodation costs when attending training and competitions on the mainland. The programme has supported 56 island athletes over the past three years, however the programme paused in 2020/21 and will recommence when travel restrictions are lifted.

Sportscotland will continue to support and contribute into each local authority to deliver the aims set out in their respective sport and physical activity strategies including 'Active Hebrides Strategy', 'Active Shetland Strategy' and 'Orkney Physical Activity and Well-being Strategy', with the latter currently in development.

Sportscotland will also continue to be represented on each Island Community Planning Partnership (and sub-groups) and will contribute to shared outcomes in relation to sport, physical activity, health and well-being as required.

We committed to work with Orkney Islands Council and other partners to use the hosting of the 2023 Islands Games by Orkney to strengthen sports development on the island.

Work is ongoing in relation to this commitment.

As a consequence of the Guernsey Games being cancelled in 2021 due to Covid-19, Orkney will now host the games in 2025. Sportscotland will continue to support Orkney Islands Council, Orkney Islands Organising Committee and local sports associations to add value to Orkney hosting the 2025 International Island Games through the development of the local infrastructure of people, places and pathway opportunities. Sportscotland will continue work with the Community Sports Hub Officer and with the Orkney Islands Games Organising Committee to deliver a needs based programme of coach education for coaches and officials.

We committed to work with our partners to eliminate unlawful discrimination, harassment and victimisation and take steps to assist with promoting equality and meeting people's different needs.

Work is ongoing in relation to this commitment.

Scottish Government continues to fund the Improvement Service to provide support to all multi-agency VAW Partnerships across Scotland to help them measure the progress being made to implement Equally Safe at a local level and identify any areas for improvement.

Scottish Government, COSLA and the Improvement Service published the Equally Safe Delivery Plan 2 year report.

We committed to address any equality, health and wellbeing related data gaps that exist in respect of, for example, women and girls, pregnancy and maternity, gender reassignment and sexual orientation.

Work is ongoing in relation to this commitment.

Scottish Women's Aid published the findings from their Participating-in-Equally-Safe-in-the-Highlands-and-Islands consultation with 188 women in the Highlands and Islands about the barriers women in rural areas face in participating in local action to end violence against women and girls. We will be working with our partners on how to implement the recommendations following the report.

We committed to consider our consultation on out of school care through which we have gathered views from parents on the challenges of accessing childcare and range of activities for school age children in island communities. Responses to our consultation will, together with continued engagement, inform development of a future strategic framework which will be published before the end of this parliamentary term.

In July 2020, we opened our £3 million Access to Childcare Fund which will test new models of school age childcare that will be more accessible, flexible and affordable for low income families. 15 projects have been awarded funding, including Hame Fae Hame in Scalloway, Shetland.

Work is ongoing in relation to this commitment.

Responses to our 2019 consultation on out-of-school care were independently analysed and a full report of the findings was published in November 2020.

Our consultation question on rural provision received 833 responses, and issues relating to rural childcare availability were highlighted. Issues relating to transport and location of services were raised. It was felt that a one-size-fits-all approach would not work in rural areas, and local consultation on services was important. The Scottish Government are currently developing potential rural childcare projects in island communities which aim to explore models of delivery that can provide the flexibility required by the local workforce, including women in agriculture.

We committed to ensure that health, social care and wellbeing services are available through the medium of Gaelic to support Gaelic speaking island communities.

Work is ongoing in relation to this commitment.

The NHS Trusts of Highland and Western Isles are aware of the benefits for patients of being able to use Gaelic when these services are being offered. NHS Highland commitments to Gaelic are outlined in its Gaelic Language Plan, 2017-2022.

NHS Western Isles, who are a large employer of Gaelic speakers on the islands, has the potential to make a significant contribution to the use of Gaelic in health, care and well-being services. NHS Western Isles is currently revising its Gaelic Language Plan.

We committed to align our ambition to eradicate child poverty with the Plan by continuing to work with island local authorities and health boards to build on their understanding of child poverty in their areas – helping to focus efforts on lifting families out of poverty and mitigating against its damaging impact.

Work is ongoing in relation to this commitment.

The Child Poverty (Scotland) Act 2017 requires local authorities and health boards to jointly produce annual Local Child Poverty Action Reports, setting out the action taken locally to tackle child poverty and the future action planned for this purpose.

Through this focus local areas are building their understanding of child poverty and the action needed to tackle it. Key Scottish Government investment in new support, including the Parental Employability Support Fund, is helping local areas to tackle poverty and enhance the support available for parents and families. £7.35 million was provided for the Parental Employability Support Fund in 2020-21.

We committed to work alongside national partners, continuing to share good practice identified across Scotland which could be applicable to child poverty in our island communities.

Work is ongoing in relation to this commitment.

Scottish Government continue to provide funding to the Improvement Service for a national child poverty coordinator to support local officials in the development of action on child poverty and in preparation of Local Child Poverty Action Reports. This support includes a peer support network, online resources and webinars for local child poverty leads, senior officials and elected members – helping to share practice and raise the profile of child poverty across Scotland, including in island communities.

The Scottish Government also continue to provide funding to the Scottish Poverty and Inequality Research Unit (SPIRU) to provide analytical support to local authorities.

The Scottish Government works closely with Public Health Scotland, COSLA and other national partners to share and support development of good practice. Islands Integration Authorities are represented on national fora such as the SCIN and the Chief Officers' Network, for sharing learning.

We committed to work with islanders to contribute, where we can, to the creation of a fairer, healthier, happier nation for all of Scotland by supporting the work of the group of Wellbeing Economy Governments (WEGo).

Work is ongoing in relation to this commitment.

The Wellbeing Economy Governments group (WEGo) met virtually in policy labs in 2020 to share ideas on how a Wellbeing Economy approach can help guide response to COVID-19 and economic recovery. The focus, due to the pandemic, was on the economic recovery, which is covered in the CWB data in Strategic Objective 2, relating to sustainable economic development.

We continue to learn, and to engage and collaborate with other countries and organisations to creating an economy that supports all of our communities across Scotland, including our island communities, to access opportunities that deliver local growth and wellbeing through tackling inequalities.

We committed to work with our partners to consider a range of options to ensure that adequate mental health care is available, whilst taking into consideration the uniqueness of our island communities.

Work is ongoing in relation to this commitment.

Scottish Government continues to support and fund the National Rural Mental Health Forum, which was established following the Mental Health Strategy 2017-2027. The Forum membership continues to grow with a network of 180 organisations, with an outreach to 500,000 people in rural Scotland, including those in our island communities.

In 2020, the Forum researched the possible impact on the mental health and wellbeing of rural communities and businesses in Scotland from Brexit and most recently how COVID-19 has impacted on marginalised communities throughout rural Scotland, specifically young carers, refugees and asylum seekers and LGBT+. The Marginalised communities Report was published in February 2021. The Scottish Government looks forward in exploring this report with the Forum and helping deliver and fund potential projects on our islands from its outcomes.