National Islands Plan: annual report 2021

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.

All of the islands are attached to Integration Authorities which serve the specific needs of those island communities. Integration Joint Boards continue to work closely with Health and Social Care Partnerships to ensure each island is recognised within their unique circumstances.

An additional £250 million is being invested over the lifetime of this Parliament to reduce the number of drug-related deaths in Scotland and improve lives. A significant portion of this funding has gone directly to local areas via local Alcohol and Drug Partnerships. Island Boards have received around £686,00 of this investment and are also benefitting from additional funding to implement the Medication-Assisted Treatment (MAT) Standards via the MAT Standards Implementation Team (MIST). MIST have been in contact with all ADPs, including Island ADPs, to offer tailored support based on their needs. Local organisations can also apply to the Corra Foundation operated grant funding schemes. This funding is to expand and improve availability of all types of drug treatment, including residential rehabilitation.

Scottish Government has funded community pharmacy test of change pilots in three NHS boards (NHS Forth Valley, NHS Highland and NHS Tayside) to enhance early detection and early intervention in diagnosis of type 2 diabetes. Two of the boards (NHS Tayside and NHS Highland) have procured 'roaming' blood testing machines that can move between sites, supporting remote and rural healthcare delivery. The NHS Highland roaming analyser is currently on the island of Tiree and will move on to other neighbouring islands in the health board area to provide point of care testing.

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.

Islands Integration Authorities are represented on the Strategic Planning and Performance Officers Group (SPPOG), the Chief Officers' Network for sharing good practice. There are also regular updates with Scottish Government, the Cabinet Secretary for Health and Social Care and monthly meetings with the Minister for Mental Wellbeing and Social Care.

ADPs were given £3 million from the Drug Deaths Taskforce to implement improvements in line with the Taskforce's six evidence based strategies. Information on what proportion of this funding went to each area and where it was spent is available at https://drugdeathstaskforce.scot/about-the-taskforce/funding-and-key-projects/. This page also includes the projects funded through the innovation fund.

ADPs are encouraged to share learning and all projects will produce an evaluation which will inform future Taskforce recommendations. The Taskforce is producing a thematic evaluation which will feed in to their final report in December 2022.

Work is ongoing to implement the recommendations from the 'Shaping the Future Together: Remote and Rural General Practice Working Group' report, including scoping work for a Centre for Excellence for remote and rural health and social 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.

NHS Near Me has been implemented and is being utilised across every Health Board in Scotland with upwards of 1.3 million appointments undertaken using the platform since early 2020. This continues to provide greater flexibility, whilst supporting remote working, reducing the need to travel and promoting greater access to specialist services. We also continue to support people to manage their condition from home with a new digital platforms established for things like blood pressure and COVID-19 monitoring being rolled out across the country.

Procurement of a 'once for Scotland' digital solution for the education and management of type 2 diabetes is being considered. This will improve equity of access to type 2 diabetes services in remote and rural areas, ensuring consistency in type 2 diabetes education across Scotland and promoting self-management of the condition, as patients will have regular digital access to the content available. NHS Highland are using the digital programmes 'Second Nature' for weight management, 'MyDesmond' for type 2 diabetes and Momentum from Beat for support for those with binge eating disorder. The feedback from patients is excellent in that it reduces travel, provides immediate high quality care and avoids the specific challenges of remote and rural life which often mean it is difficult to maintain confidentiality due to small communities and how well people tend to know each other. Digital self-management is completely confidential as is not group based.

SG Digital Transformation Service (DTS) will undertake a research and service design project into type 2 diabetes and weight management services. This will identify patient needs, the gaps in current services and how these can be addressed. The focus will primarily be on those living with overweight or obesity (including those with type 2 diabetes) in areas of higher deprivation (SIMD1 and SIMD2) to focus on how we avoid further widening existing health inequalities. This project would provide evidence of what people need throughout their care journey to co-produce new ways of working. This would help us to identify the change required in a way that ensures equality of access by putting the patient at the centre of the co-production and service design journey. Further, it would provide us with vital knowledge and understanding of the current landscape and provide recommendations for next steps to transform the pathways of care to effectively meet the needs of individuals, including those in remote and rural areas. This project is a first step in understanding how we create our own services which can be tailored to meet the needs of the Scottish population.

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.

The Scottish Government continues 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 of Scottish Government is currently developing a proposal for how a centre for excellence should look, and will be engaging with stakeholders shortly.

Additionally, the Programme for Government states that 'We will also ensure that our islands and rural areas are not left behind as we work to improve health services by creating a centre of excellence for rural and remote medicine and social care, with scoping work starting this year.' We will continue to scope and engage with stakeholders for this Programme for Government year and beyond.

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.

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

Additionally, funding provided via the Type 2 Diabetes Prevention Framework contributes towards resource in local leisure centres focused on long-term condition management which often affects those in older age groups.

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 engage strategically with local authorities (through their capital planning processes) and island communities with regards to opportunities to deliver improved local facility provision for sport and physical activity.

In April 2021, sportscotland made an award of £30,000 to Shetland Golf Club to support the development of an indoor three bay practice facility providing a quality training facility which will allow the local population to learn, develop and patriciate in golf all year round. In particular, the facility will support and improve coach education and increase training opportunities on the islands, during winter months and inclement weather.

In December 2021, sportscotland made an award of £20,000 to Orkney Amateur Weightlifting Club to support the development of a quality weightlifting training facility. The facility development will significantly improve the Club's offer to members, both in terms of time and equipment available to train and develop. It will allow the Club to work with targeted groups including young people, women and girls, as well as those with disabilities. In addition, this facility will provide better access to a gym facility in a rural area where access to this type of facility is a challenge.

sportscotland are currently engaged in conversations with regards to cycling facility projects in the Western Isles, Orkney, Argyll and Bute and North Ayrshire as part of the national Cycling Facilities Fund which will potentially see applications for investment into Island communities.

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 was fulfilled in 2020. Please see the National Islands Plan Annual Report 2020 for further details.

Furthermore, sportscotland have worked with local partners to support sport to restart safely as COVID-19 restrictions have been lifted. With restrictions easing more quickly for Scotland's islands, more sports activity was able to resume earlier in island communities than on the mainland. More Active Schools activity resumed in terms one of 2021/22 academic year, although the pace of restart was considered against local needs including the wider educational requirements of school settings.

Additionally, sportscotland invested £70,184 into the three islands authorities to deliver sport and physical activity opportunities to children and young people during the summer of 2021 as part of Scottish Government's Get into Summer programme. Islands in other local authority areas also benefitted through this programme, although with funds distributed through the local authority it is not possible to provide a financial value for these other islands.

The Athlete Travel Award Scheme (ATAS) also resumed following the lifting of travel restrictions, with up to 32 athletes from across the four Highland and Islands local authorities benefitting from support in 2021/22.

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.

sportscotland are working with Orkney Islands Council and the Orkney Island Games Organising Committee to look at a two-day planning summit with the 13 Governing Bodies of Sport that will be involved in the Orkney 2025 Games. This summit will begin the process of ensuring that Orkney have in place, the right facility infrastructure, well trained people and the volunteers, coaches and athletes that will not only host and contribute to a successful Games but will also inspire and provide a sustainable infrastructure for the people of Orkney to thrive and lead active lives.

Additionally, Orkney Islands Council and sportscotland presented a joint approach to strengthening the role of sport and physical activity in terms of reaching out to the less active and supporting physical and mental health initiatives in Orkney to the Living Well Community Planning Partnership sub-group. This was well received by elected members, the NHS Director of Public Health and other key stakeholders and has opened up opportunities for further engagement. sportscotland have also held strategic discussions with local partners to develop a capital programme that will deliver improved local facility provision for sport.

sportscotland also continue to support the development of a Physical Activity and Wellbeing Strategy for Orkney which is aligned to local and community priorities. There has been strong stakeholder engagement and input from key partners including Orkney Islands Council, NHS Orkney Pickaquoy Trust, sportscotland and third sector organisations. An initial draft has been completed with the final document progressing to final sign off by Community Planning Partnership partners in early 2022.

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.

We remain committed to investing in interventions which provide evidence of being able to change the attitudes of offenders. We will expand the availability of the Caledonian System, and increase our investment to £10 million over the next two years. This is an internationally recognised behavioural change programme for perpetrators of domestic abuse which involves working with the whole family to reduce the risk of harm to women and children. We will progress work over the next two years to support the national roll-out of the system, with the aim of making it available to all 32 Scottish local authorities by the end of the parliamentary term.

Further, as highlighted in A Fairer, Greener Scotland: Programme for Government 2021-22, we aim to ensure that all eligible children who are victims or witnesses to abuse or violence will have access to a 'Bairns' Hoose' by 2025. That means the services they need will all be available via a coordinated approach designed to reduce the number of times children have to recount their experiences to different professionals. Children below the age of criminal responsibility, whose behaviour has caused harm, will also have access to the services it will provide.

Bairns' Hoose – based on an Icelandic model Barnahus – will bring together services in a 'four rooms' approach with child protection, health, justice and recovery services all made available in one setting. A key aim of the model is to reduce the number of times children have to recount their experiences to different professionals. A new National Bairns' Hoose Governance group is currently being established and will consider issues around implementation in rural and island settings.

The new Scottish Child Interview Model for Joint Investigative Interviews is being introduced nationally from 2021 to 2024 and will be seen as the 'justice room' of the Bairns' Hoose. The National JII Governance Group has established the Remote and Islands Joint Investigative Interviewing Implementation Subgroup in recognition that a particular focus on the implementation challenges in remote and island contexts will help realise our shared ambition that all children in Scotland have access to the Scottish Child Interview Model for joint investigative interviewing where this would best meet their needs.

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.

The Scottish Government has committed to an independent strategic funding review to look at how national and local specialist services for women and children experiencing gender based violence are commissioned and funded across Scotland, which will commence in spring 2022.

Additionally, we are currently in the process of developing a First Data Strategy across health and care, with delivery expected later in 2022.

Furthermore, the Delivering Equally Safe Fund helps to implement Equally Safe, Scotland's strategy to prevent and eradicate all forms of violence against women and girls, by supporting frontline organisations and projects that broaden access to support survivors. A priority area of the fund is working with those in remote or island communities. The fund will run from October 2021 to September 2023.

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.

Work is ongoing in relation to this commitment.

In March 2021, we published our School Age Childcare Progress Report. The report captures what has been learned from our public consultation and sets out the steps we are taking to move closer to our vision for school age childcare in Scotland.

The Progress Report announced a number of school age childcare pilot projects, including a project with Mull and Iona Community Trust (MICT). MICT are working to test new models of childcare provision on Mull, utilising local partnerships and existing community resources where possible. MICT will look to develop and deliver childcare provision using, but not limited to: regulated out of school care; organised children's activities, and; the establishment of a network of childminders, nannies and babysitters to offer flexible childcare solutions. Crucially, as well as helping us develop our policy, MICT will produce a resource in an appropriate format which can be used to share the learning from this project, thus enabling other communities to learn from the approaches taken.

Additionally, impact assessments will be carried out throughout the programme to deliver a system of school age childcare, including an islands impact assessment.

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.

NHS Highland commitments to Gaelic are outlined in its Gaelic Language Plan, 2017-2022. NHS Western Isles is currently revising its Gaelic Language Plan, with the understanding that it will soon be submitted to Bòrd na Gàidhlig, which will outline its commitments to Gaelic when approved. Both NHS Gaelic plans contain a number of commitments to the use of Gaelic within the functions of the NHS trusts, with both trusts operating in island areas. The aim is both to encourage and increase the use of Gaelic in health, care and wellbeing services.

There is no additional funding for these services, however small project funding could be applied for through the Bòrd's GLAIF stream.

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.

During the course of 2021/22, the Scottish Government has continued to work with island local authorities, as part of the national Tackling Child Poverty Delivery Plan, in order to ensure successful delivery of key commitments. This includes delivery of 1,140 hours of funded Early Learning and Childcare and support delivered through the Parental Employability Support Fund.

Together with national partners, including the Improvement Service, Public Health Scotland and the Scottish Poverty and Inequality Research Unit, the Scottish Government have worked with island authorities and others to support development of Local Child Poverty Action Reports and development of effective action to tackle child poverty in our islands communities – where poverty can often be hidden in national level statistics due to the higher cost of living experienced.

Key Scottish Government investment in new support, including the Scottish Child Payment – which is already supporting 106,000 children under the age of 6 – and the Parental Employability Support Fund, is helping local areas to tackle poverty and enhance the support available for parents and families. We have already made up to £23 million available for our Parental Employability Support Fund between 2019 and 2022, and have committed a further £15 million in the next two years.

To support the tailoring of action on child poverty in island communities, the Cabinet Secretary for Rural Affairs and Islands, Ms Gougeon MSP, instructed Rural and Island officials in August 2021 to commission a 'deep-dive' into current child poverty data, evidence and research, specific to rural and island communities. Ms Gougeon has instructed officials to be bold and ambitious in their work to tackle child poverty – where every effort will be made to ensure that future projects and interventions align with, and form part of, the work being led by the Scottish Government's Tackling Child Poverty Unit.

These approaches align with our wider child poverty responsibilities and have strong synergies across four key COVID-19 Recovery themes:

• person centred services;
• creating good jobs;
• tackling poverty; and
• improving wellbeing of children and young people.

Collectively, and as part of a government-wide focus, our work on child poverty across rural communities and on our islands will support:

• the next Tackling Child Poverty Delivery Plan (2022-2026);
• our PfG commitments on child poverty;
• COVID-19 Recovery; and
• the identification of future interventions to tackle and child poverty.

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.

In 2021, Rural and Islands officials commissioned a 'deep-dive' research project, which will be published in March 2022. This will help Scottish Government to improve our understanding of child poverty in rural and island areas and will establish what we can learn from existing evidence, in addition to identifying where data and information gaps might exist so that they can be addressed.

This piece of work will help us understand what support and interventions will most effectively meet the particular needs of children and young people across all our unique rural and island communities. It will also establish whether we have the correct mechanisms in place to hear and capture the stories and evidence from children and young people regarding their specific needs, and if those mechanisms are not in place we will work collaboratively to establish how we can deliver this more effectively in coming years.

Other workstreams that we know will impact on child poverty in the longer-terms include:

• the Mull and Iona Community Trust Out of School Care Trial;
• Accessing School Age Childcare in Scotland's Rural and Island Regions research; and
• feasibility and software development work with ZetTrans and HiTrans to develop our understanding of how we might utilise Demand Responsive Transport (DRT).

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.

We continue to learn and collaborate with other countries and organisations to create an economy that supports our island communities, aiming to ensure that they have access to opportunities that deliver local growth and wellbeing through tackling inequalities.

The Community Wealth Building (CWB) model of economic development acts as a tool or framework against which our local authorities can work with the private, third and community sectors to deliver a genuine, tangible wellbeing economy. The model is a strategic one – designed to add value and influence the activities of the landscape of partnerships we already have in place.

At the heart of the CWB approach and our ethos is a recognition that redistribution of wealth, while necessary to tackle poverty head on and in the short term, only goes so far. The model seeks to 'pre-distribute' wealth by growing the number of Scots who have a greater ownership stake in the Scottish economy, and in so doing tackle structural inequality. We are taking a broader view of what it means to be a successful economy, society and country and putting people and the planet at the heart of our economy – moving away from more traditional attitudes and measures of growth.

Our new 10-year National Strategy for Economic Transformation will build on the COVID-19 Recovery Strategy to create a greener, fairer and more inclusive wellbeing economy, and allow us to address some of the longstanding issues that have been exacerbated by the pandemic, such as child poverty. Mainstreaming the CWB model as a practical model to deliver a tangible Wellbeing Economy at a grassroots level will lay the groundwork for a more equitable and resilient economy for the future – on our islands and across all parts of Scotland.

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.

We are committed to reviewing the Mental Health Strategy 2012-2027 at its halfway point in 2022. Since the publication of the Mental Health Strategy in March 2017, we have accumulated a significant number of additional commitments and actions relating to mental health. Several of these commitments overlap significantly, some have been completed outright, and some have been superseded by more recent or relevant commitments. Reviewing the Strategy also provides us with an opportunity to systematically review all of our other existing commitments and make sure that our policies around rural mental health are current and appropriate for those living throughout rural and island areas in Scotland.

Scottish Government is supporting GP Practices across Scotland to increase mental health support within primary care settings. We are working with Primary Care partners to introduce Mental Health in Primary Care Services. These services will support GPs by providing mental health assessment, treatment, care and support. This builds on examples of good practice already implemented through the Primary Care Improvement Plan, and through our work on Action 15 of the Mental Health Strategy both initiatives have increased the mental health workforce within primary care.

In February 2021, we announced an additional £120 million for a Recovery and Renewal Fund to ensure the delivery of the commitments set out in the Mental Health Transition and Recovery Plan. A portion of the Fund will support development of an integrated culture of mental wellbeing and prevention within local communities and across Scotland, and promote the capacity of community organisations and grass roots groups as supported by the third sector. We are keen that this benefits communities across Scotland, including our island communities. Supporting those living in remote and rural communities is one of the fund criteria.

Additionally, via the Framework for Type 2 Diabetes prevention, funding has been provided to health boards to enhance psychology provision in type 2 diabetes and weight management. This has allowed NHS Highland and NHS Western Isles to commission Beat to provide remote guided self-help for binge eating disorder. NHS Highland and NHS Orkney have placed two health psychology trainees within the weight management and type 2 diabetes prevention services working together with NES to meet the needs of the respective populations and to enhance psychological knowledge and education across NHS teams.