National Islands Plan: annual report 2023

Health and Social Care and Wellbeing

Strategic objective 7 – Improve and promote and health and wellbeing

Commitment 7.1 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.

Implementation Route Map 2023

• All of Scotland’s islands are attached to Integration Authorities which serve the specific needs of those island communities. Integration Joint Boards will continue to work closely with Health and Social Care Partnerships to ensure each island is recognised within their unique circumstances. Scottish Government has also drafted a Transport to Health delivery plan.

The Scottish Government recognises the distinct challenges facing island communities and over the past year of ongoing National Islands Plan delivery we have remained committed to supporting and developing rural Primary Care.

In early 2023, the Scottish Government prepared a Transport to Health Delivery Plan that sets out the high-level actions focused on access to healthcare, with commitments across the work of Health and Social Care and Transport Scotland. Funding activities include an ongoing commitment to the Income and Expenses Guarantees for General Practice. We invested an additional £23 million to ensure no practice saw a reduction in their income.

We also continued to fund Island Boards to support implementation of Primary Care Improvement Plans as well as funding to the BASICS Charity (British Association of Immediate Care) to deliver pre-hospital emergency care training and support, a vital resource for those medical staff practising in rural areas. Funding was provided tor NHS Highland to support delivery of pre-hospital emergency care in Argyll and Bute.

We have also provided support to dispensing practices, a particularly important resource in rural areas. The Dispensing Deep Dive Report was commissioned in 2022 and a working group formed to take forward recommendations. The first of these, the development of teaching resources for dispensers in Scotland, is a good example of the practical work of the National Centre.

National Drugs Mission

In 2023, we marked the halfway point of the five-year National Mission on Drugs which aims to reduce deaths and improve lives by reducing harm, promoting recovery, and ensuring that access is available to the right form of treatment and recovery at the right time and for as long as it is required all across Scotland.

This year there has been a shift in the mission delivery from setting the foundations towards sustainable implementation and delivery of some key programmes as reported in the National Mission on Drugs: annual report 2022-2023.

The Scottish Alcohol and Drug Partnership (ADP) annual survey provides information on the activity undertaken by each Alcohol and Drug Partnership (ADP) and evidences the progress of the National Mission. The commitment to provide £250 million of additional funding over the lifetime of this Parliament to reduce the number of drug- related deaths in Scotland and improve lives has continued and gone directly to local areas via local ADPs.

Over the course of the 2023 calendar year, Island Boards have collectively received approximately £1.7 million of investment, to support alcohol and drug services including implementation of the Medication-Assisted Treatment (MAT) Standards, Residential Rehabilitation and Lived and Living Experience panels. The Corra Foundation administer funds on behalf of the Scottish Government to support the National Drugs Mission, the National Drugs Mission Funds Report 2021-2023 highlights the outcomes, progress, challenges and successes of the projects. Five projects in the Islands received funding totalling £324,000 in 2023-24.

Commitment 7.2 Identify and promote good practice, especially as regards the improvement of services in islands and other remote areas.

Implementation Route Map 2023

• We will continue to implement the recommendations from the ‘Shaping the Future Together: Remote and Rural General Practice Working Group’ report.
• Work is continuing to finalise the business case for the National Centre for Remote and Rural Health and Social Care, which was one of the recommendations from the Shaping the Future together report.

Since 2018, we have delivered the innovative ScotGem programme – Scotland’s first Graduate Entry Medicine programme – in partnership with St Andrews and Dundee Universities. ScotGem has had a focus on general practice and rural working. We have also delivered our £20,000 GP Speciality Training Bursary (sometimes called the ‘TERS’ Targeted Enhanced Recruitment Scheme), which incentivises training in ‘hard-to-fill’ and often rural locations. In addition, we continue to deliver our standard GP rural fellowship, providing extra training and support for GPs who wish further experience in rural practice.

A credential in rural health (unscheduled and emergency care) has been developed by NHS Education for Scotland and subsequently approved by the General Medical Council (GMC). The credential has now been added to the GMC website and work is underway to move to the delivery stage.

Boosting workforce capacity

A number of mechanisms are in place to support the recruitment and retention of staff within our island areas. The Scottish Distant Islands Allowance is a non-superannuable payment paid to NHS Staff who work on islands. It is paid to assist with travel costs to and from the mainland and is a lever that can encourage people to take up employment within those communities. The allowance is uplifted in line with the AfC pay increase each year. Effective from April 2023, it amounts (per-annum) to:

• £2,256 for Shetland
• £1,504 for Orkney
• £1,279 for Western Islands, Tiree, Jura, Islay, Coll and Colonsay

NHS Boards have the facility (in line with HMRC rules) to reimburse relocation expenses. This is a lever that Boards can use to encourage individuals to move home from elsewhere in the UK. The decision to offer relocation expenses lies with individual Boards.

The £10,000 Golden Hello payment incentivises GPs to take up eligible posts in rural practices, while the Rediscover the Joy GP cover boost scheme – currently operational in Shetland, Orkney, Western Isles and Highland – provides GP covers to practices with sustainability issues.

Our current GP Retention Working Group is considering retention issues and may recommend changes to the national approach. We anticipate this will include specific retention initiatives for GPs in rural areas.

We continue to invest in education and training routes for individuals wishing to live and work in rural areas.

The Open University provides a pathway for Scottish healthcare support workers to train to become registered nurses while remaining in the workforce in their local Board area.

In January 2024, a third cohort of students from across Scotland will start a shortened midwifery distance learning programme at Edinburgh Napier University. This programme allows existing adult nurses to fully qualify as midwives in just 20 months while continuing to work in their home regions, including northern Scotland’s Health Boards.

In the National Workforce Strategy for Health and Social Care, published in March 2022, we committed to developing a Rural Workforce Recruitment Strategy by the end of 2024. This strategy will provide a framework which will support employers to ensure that the health and social care needs of the people who live in our rural communities are met by supporting health boards and social care employers in those communities to recruit and retain staff.

Please see commitment 7.4 for information on the National Centre for Remote and Rural Health and Care.

Commitment 7.3 Support the extension of NHS Near Me, and other digital health initiatives, to reduce unnecessary travel and enable more care to be delivered on Islands.

Implementation Route Map 2023

• NHS Near Me will continue to be utilised across every Health Board in Scotland to provide greater flexibility, whilst supporting remote working, reducing the need to travel and promoting greater access to specialist services.
• Procurement of a ‘once for Scotland’ digital solution for the education and management of type 2 diabetes is ongoing and is forming part of wider digital transformation work being led by ANIA which will explore a potential value case for Digital Solution to support T2 Diabetes and prevention agenda.

We continue to promote the need for the public to have a choice and a say in how they receive care. That means having a variety of options available to them.

Near Me video consultations provide general benefits through saving time and money by reducing the need to travel. They are available for use in all Health Boards. Other condition management initiatives including Connect Me for monitoring conditions from home and digital therapies continue to be rolled out at scale to support more people to take control of their wellbeing at home.

The development of the Rural Centre of Excellence for Digital Health and Care in Moray is significant in looking to address health and care issues across rural areas including addressing citizen data requirements and supporting place-based care in the community. There is an opportunity for island and other rural areas to ensure this realises its potential and can attract investment and economic growth in the future.

The Digital Health and Care Delivery Plan for 2023/24 sets out the ambition for digital services across Scotland with a refreshed plan expected in 2024.

Commitment 7.4 Work with stakeholders to develop propositions for a national centre for excellence in remote, rural and island health and social care.

Implementation Route Map 2023

• In the 2022 Programme for Government we have committed to ensuring 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. A final business case has been progressed.

The National Centre for Remote and Rural Health and Care launched in October 2023, and is being delivered by NHS Education for Scotland (NES). The Scottish Government is providing funding of £3 million until 2026.

The development of a National Centre was a recommendation made in the Shaping the Future Together Report, published by the Remote and Rural General Practice Working Group in January 2020. The Group, chaired by Sir Lewis Ritchie, was established to support the implementation of the 2018 GP contract in rural and island areas. The Report was informed by extensive workforce and user engagement across rural communities.

Both the Scottish Government and NES engaged with stakeholders throughout the scoping and development of the Centre and NES will continue that engagement as the Centre delivers its work.

The Centre has been established as a Proof of Concept, with an initial focus on Primary Care. It is intended to generate innovative rural and island solutions and delivery models through four workstreams with a specific rural and island focus. These are Education and Training, Recruitment and Retention, Research and Evaluation, and Leadership and Best Practice.

The Centre will provide a resource to support Health Boards and Health and Social Care partnerships in their responsibilities and drive essential improvements in sustainability, whilst improving the capability of rural and island primary and community care-based service delivery.

Commitment 7.5 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.

Implementation Route Map 2023

• Integration Authorities will 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.

Integration Authorities have continued 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.

Islands Programme – Tiree Community Care Hub

We granted Argyll and Bute Council up to £450,000 through the 2023-24 Islands Programme for the Tiree Community Care Hub project, focusing on modernising and reconfiguring the Tigh a Rudha Care Home. This project aims to better address current and future care needs, supporting population growth plans. Tigh a Rudha will be transformed into a modern, flexible hub with key worker accommodation, care facilities, and GP beds.

Commitment 7.6 Support relevant local authorities to plan and develop sports facilities on the islands that respond to the needs of communities.

Implementation Route Map 2023

• sportscotland will continue to engage strategically with local authorities (through their capital planning processes) and Islands communities with regards to opportunities to deliver improved local facility provision for sport and physical activity.
• sportscotland and the Scottish Government Islands team are continuing to have discussions with Orkney Islands Council regarding strategic facilities investment that would deliver improved local facility provision in preparation for the 2025 Orkney Island Games and beyond.

sportscotland, our national agency for sport, continues to engage strategically with local authorities and island communities to identify opportunities to deliver improved local facility provision for sport and physical activity.

In June 2023, sportscotland granted £55,000 to the Isle of Gigha Heritage Trust for an outdoor floodlit multi-use games area (MUGA) facility. The community are working closely with the Argyll and Bute Sports development and Active Schools team to design a programme of activity from school through to adult usage and to develop coach education opportunities. The new MUGA will greatly impact activity levels on the island. The nearest alternative facility requires a two-hour public transport journey via ferry and bus to Tarbert or Campbeltown.

In November 2023, sportscotland granted £50,000 to the North Ronaldsay Trust in Orkney via their Sport Facilities Fund. The facility, in collaboration with Orkney Islands Council, will enhance the island community’s access to a range of physical activities and events to help promote connectivity and wellbeing.

sportscotland has also invested a further £29,138 via its Cycling Facility Fund to the previously funded Arran High School Mountain Bike Facility. This supplementary award will help alleviate the additional costs experienced when developing a capital project on an island. It will also ensure that the project can realise its full potential of creating a sustainable cycling facility, which can be accessed by the pupils and the wider community and visitors to Arran.

Commitment 7.7 Promote participation in sport and physical activity by ensuring national programmes such as Active Schools and Community Sports Hubs are serving island communities, and continuing the Islands Athlete Travel Award Scheme.

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

Commitment 7.8 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.

Implementation Route Map 2023

• sportscotland will continue to support Orkney Islands Council, Orkney Islands Organising Committee and local sports associations to add value to Orkney hosting the (rescheduled) 2025 International Island Games through the development of the local infrastructure of people, places and pathway opportunities.
• sportscotland will continue work with the Community Sport Hub Officer and with the Orkney Islands Games Organising Committee to deliver a needs based programme of education and development for coaches and volunteers.

In 2025, Orkney will host the 20th International Island Games. There is clear alignment between the successful delivery of the Games with sportscotland’s commitments to the Active Scotland Outcomes Framework and National Islands Plan.

sportscotland provides technical expertise and staff support, and hosts Scottish Governing Bodies of Sport (SGB) planning events to strengthen partnerships required to deliver sports event action plans. In November 2023, they invited all 13 competing SGB sports to Orkney for a two-day visit which provided representatives with a chance to meet organising clubs and Sports Competition Managers. SGB representatives undertook site visits to improve understanding of the support required for the Orkney Games. sportscotland now sit on the Orkney 2025 Committee which is critical in terms of both continuing to add value and in having oversight on any confirmed investment that will support the delivery and legacy of hosting the Island Games.

Orkney Islands Council, SGB and sports clubs and sportscotland have confirmed a package of investment and resource of up to £850,000 across four thematic areas:

• Partnerships – Governance, political, and strategic input;
• People – Subsidy for training and development of volunteers, coaches and officials;
• Places – Major facilities upgrades, equipment and technical support; and
• Performance – Athlete and coach support.

This additional capacity, resource and strengthening of infrastructure will enhance the games, create a lasting positive impact, and encourage more participation in sports and physical activities.

Commitment 7.9 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.

Implementation Route Map 2023

• 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 via a coordinated approach designed to reduce the number of times children have to recount their experiences to different professionals. Bairns’ Hoose provides Scotland with an opportunity to provide a genuinely child-centred approach to delivering justice, care and recovery for children who have experienced trauma, including, but not only, child sexual abuse. Children below the age of criminal responsibility, whose behaviour has caused harm, will also have access to the services it will provide. Implementation of the Bairns’ Hoose is a key action identified in our Keeping The Promise Implementation Plan. National Bairns’ Hoose Standards were published on 31 May 2023. Standard 3.4 states that “Children in rural and island communities can access Bairns’ Hoose in a way that is right for them.” From September 2023, these National Standards will be implemented across Scotland by several Pathfinder partnerships. As described in our Bairns’ Hoose Project Plan Progress Report and Pathfinder Delivery Plan (2023–25), the Pathfinders will act as proof of concept and form part of a quality improvement and service design process. The Pathfinders will identify how the Standards may be applied to different contexts, including remote or islands areas. The Pathfinder phase will be followed by pilot phase, then national rollout.
• 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. A Remote and Islands Subgroup sat throughout 2021 and it was useful in bringing together those with island communities to consider what some of the key challenges were in implementing the Scottish Child Interview Model. The national JII Team recognised that the solutions to implementation challenges were bespoke to each local authority so, since early 2022, have worked on an individual basis with each of the areas represented on the Remote and Islands Subgroup (which were Highland, Argyll and Bute, Western Isles, Orkney and Shetland) and have not re-convened the subgroup. The national JII team continue to engage with each of these areas, plus Orkney and Shetland, on an individual basis, supporting them to consider how to ensure children living in remote and island communities have access to the Scottish Child Interview Model.
• The Caledonian System is an internationally recognised behavioural change programme for perpetrators of domestic abuse which involves working with woman and children to reduce the risk of harm that domestic abuse can have. Consideration is being given to the lessons learned during COVID and the needs of island communities. We remain committed to investing in interventions which provide evidence of being able to change the attitudes of offenders. We will continue to explore with Community Justice Scotland the safest, most effective way in which we can increase the availability of the Caledonian System across Scotland.

Child Protection

We are committed to ensuring that robust child protection measures are in place across Scotland, and continue to be followed at all times. The Scottish Government published revised National Guidance for Child Protection in Scotland in August 2023. The guidance describes the responsibilities and expectations of everyone who works with children, young people and their families in Scotland. It was revised to ensure it is consistent with the legislative and policy framework and current practice developments. It includes updates derived from learning from implementation of the 2021 Guidance.

Bairns’ Hoose

National Bairns’ Hoose Standards were published on 31 May 2023. Standard 3.4 states that “Children in rural and island communities can access Bairns’ Hoose in a way that is right for them”.

Delivering on one of the commitments made in our Programme for Government, in October 2023 we launched Bairns’ Hoose Pathfinders, which will be implemented across Scotland by several Pathfinder partnerships. The latter include Aberdeen City, Aberdeenshire, Fife, North Strathclyde, the Outer Hebrides, and Tayside.

Ayrshire, Dumfries and Galloway, Sycamore Partnership (Edinburgh, East Lothian and Midlothian), and Highland have become Affiliates Partnerships.

These partnerships will identify how the Standards may be applied to different contexts, including islands areas.

Commitment 7.10 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.

Implementation Route Map 2023

• Scottish Women’s Aid published the findings from their Participating in Equally Safe in the Highlands and Islands consultation. This report will be considered as part of next iteration of Equally Safe. We will be working with partners to consider the recommendations in the report.
• A priority of the Delivering Equally Safe Fund is working with those in remote or island communities. The fund will run from October 2021 to March 2025.
• Additionally, the Scottish Government 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. The findings of this review were published on 6 June 2023 and we will now consider, along with COSLA, local authority partners and wider stakeholders, to ensure a stable footing for funding in the future is developed.

Scotland’s Equally Safe Strategy was refreshed in December 2023 and sets out our vision for a flourishing Scotland where women and girls live free from all forms of violence, abuse and exploitation – and the attitudes that help perpetuate it.

Equally Safe acknowledges that women living in different geographical communities – including island communities – may experience different challenges. For example, the distance between houses in rural settings are often greater than in urban areas meaning that victims/survivors of abuse may be further isolated with abuse and its harms more hidden. Help-seeking and service interventions can be more challenging as services may be located many miles away. Women may face greater risks in small rural or island communities when seeking support, or when leaving abuse, through lack of privacy and anonymity, with limited and highly public routes to reach safety, heightening chances of surveillance and interception. Women may lack places where they can seek refuge or assistance in times of danger.

We will publish an Equally Safe Delivery Plan in spring 2024.

Our Delivering Equally Safe fund is providing £19 million per year to 121 organisations to help implement Equally Safe. We are funding ten organisations and partner agencies who provide services to island communities, worth just under £3 million. These organisations include Women’s Aid Orkney, Western Isles Rape Crisis Centre, Shetland Rape Crisis and Argyll and Bute Violence Against Women and Girls Partnership.

It is vital that we make the best use of resources to continue to tackle this issue. The Violence Against Women and Girls (VAWG) Sustainable Funding Project Board is being established to take forward our commitment to develop a flexible and stable funding model that will ensure a focus on prevention and high quality, accessible, specialist violence against women and girls services.

Commitment 7.11 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.

Implementation Route Map 2023

• We 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.

School Age Children

In October 2023, we published the School Age Childcare Delivery Framework which sets out our commitment to deliver affordable and accessible school age childcare, which will be funded for those families who need it most.

The Delivery Framework sets out our action areas for the next two to three years and outlines our people-centred and place-based approach, which will be applied to designing and building a new system of school age childcare. This means that the system and the services that make up the future school age childcare offer will be co- designed with users and providers.

The Framework includes a section on rural and island communities, summarising the evidence we have gathered on the challenges they face in delivering year-round systems of childcare. It sets out our commitment to test solutions that support the sustainability of school age childcare services within rural and island communities.

As part of our people-centred and place-based design work, we have carried out two co-design projects that demonstrate our approach in practice.

The first involved parents and carers who use, or may use, the school age childcare system. This project was carried out in 2022 in Argyll and Bute, Shetland, Dundee, Perth, Fife and Glasgow where 100 parents and carers and 30 providers shared experiences of making complex decisions about work, family, childcare and finances. It provided insight into how childcare can support families to take up or remain in work.

The second included children from schools in urban, rural and island communities, and with diverse experiences across Scotland. It allowed us to co-design a National Children’s Charter for School Age Childcare in Scotland to further understand children’s needs and views about school age childcare. The National Children’s Charter sets out children’s views on why we need school age childcare, how it can be run and by whom, where it should take place, and what activities should be on offer. It also sets out six principles that children agreed should be respected in school age childcare settings. These are kindness, community, fairness, happiness, fun and choice. Local charters have been co-created in a number of areas across Scotland – including Shetland – to support and inform our place-based approach.

Through our Early Adopter Communities, we are testing new models of targeted childcare provision as part of our national mission to tackle child poverty. We have committed to work in specific communities in six local authority areas to develop the local infrastructure and services needed to provide childcare for families who need it most.

In the 2023 Programme for Government, we announced the establishment of a new Early Adopter Community in Shetland, recognising the specific challenges of setting up and sustaining childcare provision in rural and island communities. Within this project, we will work with identified communities in Shetland where there are currently no school age childcare services. A dedicated local co-ordinator has been appointed to undertake engagement and scoping activities to explore and understand the needs within each community. This will include individual childcare needs, specific local infrastructure, and the range of services needed to sustain childcare for families – including in relation to challenges concerning transport and workforce.

We have also invested into our Inspiring School Age Childcare Spaces Capital Fund, which is delivering improvements to the learning estate that will support the provision of School Age Childcare. Successful projects and local authorities are looking at innovative ways to improve the learning estate (both indoor and outdoor) to enhance the experiences of children attending after school clubs, especially for those targeted primary age children from low-income households. Shetland has been awarded funding to improve the facilities and spaces for three services across the islands, which will enable high quality experiences for children and young people in those communities around the school day and during the holidays.

Over 2023-24, we have also continued to support nine Access to Childcare Fund projects. The Access to Childcare Fund was established in 2020 to test innovative models of school age childcare for families most at risk of poverty, providing low cost or free childcare places. The projects are exploring new models of School Age Childcare, including holiday provision, flexible delivery, specialist services for children with additional support needs, whole family support and outdoor provision.

One of those projects is led by Hame Fae Hame, a rural childcare provider located in Shetland. The funding provided has supported them to develop their outdoor space, offer flexible and subsidised places and provide a drop off and pick up service from Scalloway Primary School. This service has hugely benefitted local families thanks to a flexible, short notice booking policy. This is having the most direct effect on family stability and wellbeing, allowing families to tailor their childcare needs to match their working patterns and thus control their finances better. Furthermore, 100% of families who returned a completed survey stated that as a result of Hame Fae Hame’s childcare, they were able to access employment or increase their hours of work, improve their family wellbeing and increase their monthly household income.

The table below sets out funding provided to projects based on Scottish islands since the National Islands Plan was published in December 2019.

Hame Fae Hame

• 2020-2022 (Phase one of project) - £88,400.00
• 2022-2023 - £58,399.63
• 2023-2024 - £63,352.00

Mull and Iona Community Trust

• 2020-2022 (Phase one of project) - £174,440.83

ISACS capital fund: Sandwich Junior HS

• 2023-2024 - £131,000.00

ISACS capital fund: Scalloway School

• 2023-2024 - £34,550.00

Shetland Islands Early Adopter Community

• 2023-2024 - £12,956.50

Yearly Total

• 2020-2022 (Phase one of project) - £262,840.83
• 2022-2023 - £58,399.63
• 2023- 2024 - £241,858.50

Total

£563,098.96

Commitment 7.12 Ensure that health, social care and wellbeing services are available through the medium of Gaelic to support Gaelic speaking island communities.

Implementation Route Map 2023

• NHS Highland commitments to Gaelic will be outlined in its revised Gaelic Language Plan, 2023-2028.
• NHS Western Isles is currently revising its Gaelic Language Plan and will submit it to Bòrd na Gàidhlig soon. NHS Western Isles commitments to Gaelic will also be set out in its Gaelic Plan when approved. BnG has also commissioned a study looking at Gaelic and wellbeing. This will be available later this year with recommendations.

Health and education are areas where Gaelic can be encouraged and commitments set out in Gaelic plans demonstrate how local authorities and public bodies can provide support for Gaelic.

As a result of progress achieved so far, local health boards are able to offer patients services such as speech assistance technology through Gaelic. Bòrd na Gàidhlig, through its scheme of community grants – Taic Freumhan Coimhearsnachd – has funded projects like Alzheimer’s Scotland’s Còmhraidhean Gàidhlig and Fàs na Gàidhlig. These projects used Gaelic to create a link between people in Skye, Lochaber and Wester Ross living with dementia and the region’s Gaelic primary schools. Gaelic served as a medium for reducing the social isolation of a particular group and allowed for the fostering of intergenerational links within the community. These examples provide foundations for further work as well as evidence for the social and health benefits of Gaelic.

In addition to existing services, the Report on Economic and Social Opportunities for Gaelic, published in June 2023, contains recommendations for the greater use of Gaelic in the health and social care sectors. The recently introduced Scottish Languages Bill also has the potential to improve provision in island areas.

Commitment 7.13 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.

Implementation Route Map 2023

• We published the second Tackling Child Poverty Delivery Plan in March 2022. The Plan outlines the transformational actions we will take alongside our delivery partners – including island local authorities and health boards – to deliver on our national mission to tackle child poverty.
• Island local authorities and health boards will continue to be required to produce Local Child Poverty Action Reports under the terms of the Child Poverty (Scotland) Act 2017, and the work with national partners set out below will continue to help to inform local action.

Tackling Child Poverty – Rural and Island Activity

During 2023, the Scottish Government continued to work in partnership with the Improvement Service to support island local authorities and health boards to build on their understanding of child poverty in their areas. Following on from the Design Based Approach to Understanding and Tackling Rural Child Poverty in 2022, work has continued to support and exchange good practice on data sharing and use of data to inform services. This has included work with a small number of local authorities and the Scalable Approach to Vulnerability through Interoperability (SAVVI) initiative to explore how rural and island authorities could approach data sharing.

The Remote, Rural and Island Child Poverty Network continued to meet in 2023 to discuss issues of interest to these authorities and health boards and to share interesting practice and learning. The group has maintained a strong emphasis on data sharing while expanding its focus to facilitate discussions on issues such as transport and ensuring the voice of direct experience is heard and acted upon in rural contexts.

Through the Child Poverty Practice Accelerator Fund (CPAF), the Scottish Government is supporting areas to test some of the solutions emerging from the network. This includes supporting Argyll and Bute to test the usefulness of third-party datasets for identifying communities in need of financial support.

The Islands Cost Crisis Emergency Fund

In 2023-24, the Scottish Government has provided an additional £1 million for the Islands Cost Crisis Emergency Fund to support islanders facing high fuel, food and energy costs in order to help meet cost of living pressures. This built on the £1.4 million provided in 2022-23.

Commitment 7.14 Work alongside national partners, continuing to share good practice identified across Scotland which could be applicable to child poverty in our island communities.

Implementation Route Map 2023

• We will continue to work with national partners to ensure knowledge and good practice is shared and to support and improve local responses to tackling child poverty, including in our island communities.
• The Scottish Government Islands Team committed to working closely with Child Poverty colleagues to adapt the wider measuring framework for island policy delivery – ensuring that evidence is robust and aligns with and forms part of the work and reporting being led by the Tackling Child Poverty Unit and led by the new Tackling Child Poverty Development Plan.

The Scottish Government has continued to work with national partners – including Improvement Service, Public Health Scotland, COSLA, Scottish Poverty and Inequality Research Unit, Child Poverty Action Group and the Poverty Alliance – to support local authorities and health boards to strengthen their approach to developing Local Child Poverty Action Reports.

In September 2023, the Cabinet Secretary for Rural Affairs, Land Reform and Islands hosted a roundtable discussion on child poverty in rural and island communities to identify best practices, gaps and opportunities for greater collaboration between delivery partners to improve outcomes for families.

In 2022-23, the Scottish Government provided £29,000 to support the evaluation of the Shetland Anchor project. The success of this community-based model resulted in Anchor for Families being rolled out to the whole of the Shetland Isles. The third and final evaluation to understand the impact of the project, how sustainable that impact is and how learning can be shared more widely, concluded in January 2024. A ‘blueprint’ to enable shared learning with rural and island areas will be published following internal review in early 2024.

Commitment 7.15 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).

Implementation Route Map 2023

• We continue to learn from and collaborate with other countries and organisations through WEGo, and more broadly, to transition to a fair, green, wellbeing economy that puts people first, serving current and future generations. That means empowering our island communities to take a greater stake in the economy, tackling inequalities, and aiming to ensure that they can seize the opportunities from the just transition to net zero to deliver greater prosperity and increased wellbeing.

A fair, green, and growing economy, which benefits all of Scotland’s communities and people, is critical to the Scottish Government’s three interconnected missions of Equality, Opportunity and Community. Economic success means making the most of the incredibly rich resources we have and using them to build an economy that works for people, not the other way around. As we create a Wellbeing Economy, we will engage directly with communities and continue to learn from and collaborate with other organisations to support our island communities and provide opportunities for all.

Commitment 7.16 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.

Implementation Route Map 2023

• We have committed to reviewing the Mental Health Strategy 2012-2027. Reviewing the Strategy 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.
• We will continue to work with the National Rural Mental Health Forum to ensure to understand the emerging needs of island and rural communities around Covid-19 recovery and in particular to share community based solutions to support good wellbeing. This will look at the role of place and future Community Led Development opportunities to support resilience in our Communities in partnership with others.

Mental Health and Wellbeing Strategy

We published our new Mental Health and Wellbeing Strategy, developed jointly with COSLA, in June 2023. It was followed, in November 2023, by a Delivery Plan and Workforce Action Plan. The Strategy sets out a vision of a Scotland free from stigma and inequality, where everyone fulfils their right to achieve the best mental health and wellbeing possible. The accompanying plans lay out actions designed to make progress towards this vision and tackling mental health inequalities.

We worked closely with stakeholders to gather evidence and agree actions that have equalities and human rights at their core, recognise the importance of taking a trauma- informed approach and are informed by lived experience. This has included working closely with our Equality and Human Rights Forum, with members including the National Rural Mental Health Forum.

We know we need support, services, care and treatment that are person-centred, culturally sensitive, age-appropriate, fully inclusive and in a range of formats. That is why we included an Inequality Action Table in our Delivery Plan, recognising that different people have different needs. The table highlights three keys areas that are known to impact the mental health and wellbeing of people who live in rural areas: loneliness and isolation, stigma and geographical inequalities. The Delivery Plan includes several actions to help tackle these challenges, such expanding community mental health provision, improving mental health support in primary care and broadening the range of ways people can access help when they need it.

Creating Hope Together, our 10-year Suicide Prevention Strategy with COSLA, aims to reduce the number of suicide deaths in Scotland, whilst tackling the inequalities that contribute to suicide. One of the guiding principles in the strategy is our commitment to ensuring our work is relevant for urban, rural and island communities.

We are currently taking forward intensive work with Samaritans Scotland in West Highlands and Skye to improve our understanding of help-seeking among isolated workers in rural and island areas, and using that to design future models of support. Additionally, suicide bereavement service pilots are underway in the Highland, Ayrshire and Arran regions reflecting the increased suicide rate in those communities. This work will provide insights about how we can adapt our suicide prevention approach for island communities.

Mind to Mind

Launched in May 2022, Mind to Mind is a digital resource that aims to support the mental wellbeing of the general population in Scotland, including in rural and island communities.

It showcases reliable advice from people with lived experience of mental health and wellbeing challenges, highlighting the practical things people can do to help themselves regardless of where they live or work. It is designed to complement in-person mental health and wellbeing services across Scotland. It is not meant to replace them.

Mind to Mind is hosted on NHS Inform which is a whitelisted site. Visitors do not use their mobile or internet data when visiting the site. Officials in the Scottish Government and NHS 24 have been working with organisations across Scotland, including in island areas, to develop content and identify further resources for inclusion.

Communities Mental Health and Wellbeing Fund for Adults

Since 2021, we have invested £51 million in our Communities Mental Health and Wellbeing Fund for adults, with approximately 3,300 grants made to local projects across Scotland in the first two years alone to help tackle the impact of social isolation, loneliness and mental health inequalities made worse by the pandemic and the cost-of- living crisis.

The Fund has a strong focus on prevention and early intervention, prioritising a range of ‘at risk’ groups including those people disadvantaged by geographical location (particularly islands and rural areas). It has a focus on those facing socio-economic disadvantage made worse by the cost-of-living crisis.

The Fund supports grassroots community groups in building resilience and aims to reduce the need for clinical interventions by supporting community-led initiatives and local support services.

The Year 2 Monitoring Report shows that people disadvantaged by geographical location were among the most common target groups, with 1,239 projects including a focus on social isolation and loneliness.

More than £4.8 million has been allocated to supporting projects in areas covered by the National Islands Plan, since the Fund was set up in 2021.

Over 700 awards have been made to community projects supporting people disadvantaged by geographical location (including rural areas). For example, the Assist Project, based in Bernera in the Western Isles focuses on reducing social isolation and loneliness.

National Rural Mental Health Forum

Since 2016, the Scottish Government has offered annual grants of £50,000 to Change Mental Health to support the work of the National Rural Mental Health Forum. The latter focuses on exchanging knowledge, experience and learning about mental health and wellbeing in rural areas, enabling participants to better understand and support rural communities. The Forum openly shares ideas and good practice, building an evidence base that feeds into policy.

In partnership with the Forum, we are working to ensure rural communities have equal and timely access to mental health service and we are supporting efforts by NHS Boards to promote the use of digital access to services for rural communities.

The Forum are supporting innovative practice through, for example, the Rural Community Engagement Project, which promotes mental health recovery for people who face additional inequalities, including refugees and asylum seekers, young carers and the LGBTI+ community.

Community Mental Health Support for Children and Young People

The Scottish Government provided local authorities with a further £15 million this year to continue delivering community-based mental health supports and services for children, young people and their families. These services are focused on prevention and early intervention and include support for positive mental health and wellbeing as well as emotional distress. The funding enables councils to implement supports and services on the basis of local priorities, which means that the specific needs of island communities can be better addressed.

Examples of the supports and services in place include art therapy in the Western Isles to help children and young people aged 5-18 work through difficulties while providing a safe space for them to communicate issues that they may not be able to verbalise, and mental health training for staff and volunteers at Skye Camanachd to build confidence and self-esteem through sport.

Mental Health Services and Performance

The Scottish Government remains committed to supporting Island Boards’ mental health services to develop their workforce, increase service provision and ensure that those who need care can receive it, at the right time and in the right place.

Scottish Government officials regularly meet with Mental Health Leads in the Island Health Boards to review performance against mental health waiting times standards. We recognise that, although local performance varies, there are shared challenges for rural boards. Officials facilitate access to professional advice, and support island mental health colleagues to work together to implement best practice.

In 2022-23, we allocated funding of £46 million across Scotland via the Mental Health Outcomes Framework to improve the quality and delivery of mental health services for all. This included a critical resource floor for Island Boards so they can continue to recruit and maintain well-staffed services.

Supporting people in distress

Our innovative Distress Brief Intervention (DBI) support model offers compassionate community-based problem-solving support for people in distress. It is nationally available through NHS24 (for anyone over 16) and we also continue to support NHS boards to have the DBI model embedded into local services, including in island communities.

The DBI model is already in place in Arran, Orkney and Shetland, and will shortly be offered in the Western Isles. The DBI support model can be adapted to suit the needs of local communities, as shown by the innovative partnership between Blide Trust and Penumbra to deliver the Orkney DBI service.