The National Plan for Scotland's Islands

Health and Social Care and Wellbeing

Access to health and social care should be as local as possible for the whole population of Scotland, no matter where they live. We recognise that the changing nature of care and the increasing complexity of needs are just some of the challenges that must be met to ensure fair and accessible healthcare for those on islands. By focusing on a more joined-up, anticipatory and preventative care model based in the community, the aim is to improve care and support for people to live active healthy lives in their communities for as long as possible. Whilst health and social care integration requires services to be redesigned so that we can continue to maintain our focus on reforming and improving people’s experience of care and achieve better outcomes, this will be done in response to the needs and choices of people and communities, based on real local understanding.

Having access to good quality health and social care services underpins living on Scotland’s islands and is important to both maintain population and attract new residents. We recognise that everyone in Scotland, including residents of island communities, has a right to the highest attainable standard of physical and mental health. Ensuring that health and social care services are readily accessible and are of a high standard, will involve building on the current policy frameworks for health and care services in Scotland which are designed to ensure sustainable services which are safe, effective and person-centred. This includes, but is not limited to, the Quality Strategy, the National Clinical Strategy and the Health and Social Care Delivery Plan and Digital Health and Care.

Many respondents to the consultation highlighted strengths of local healthcare provision including the building of new hospitals and the personalised service given by their community General Practitioners (GPs). A range of good examples of local healthcare initiatives were identified including the Grubby Huts initiative on Shetland focusing on mental health stigma, befriending initiatives on Lewis, Arran and Lismore, and care for the elderly provision on Westray, Barra, Bute, Arran, Lismore and South Uist. 

However, the consultation also highlighted concerns from islanders about perceived centralisation of healthcare services; both in terms of access to certain services being moved to the mainland or the population centres of larger islands. Some islanders told us that there were a limited number of health and social care professionals whose skills and expertise often needed to be shared if communities are to have local access to the widest possible spectrum of care. For example, local access to services was an important issue for many women who reported having to travel long distances for appointments. In island communities, there was a desire to have as much care as possible provided locally, although women did recognise the need to ensure that services were safe and sustainable. Travel challenges leading to lengthy periods away from home were particularly difficult for families with other children or caring responsibilities.

The Scottish Government is committed to improving the experience of victims of sexual crime throughout their health and justice journey. Access to appropriate healthcare and forensic medical services is vital for adults and children who are victims of rape or sexual assault, or child sexual abuse. We are clear that everyone who needs it should have access to a forensic medical examination, wider healthcare interventions and support, whether or not they have reported the crime. The Forensic Medical Services (Victims of Sexual Offences) (Scotland) Bill was introduced to the Scottish Parliament in November 2019. It provides a clear statutory duty for Health Boards to provide forensic medical services for victims, and will provide for consistent access to “self-referral” so that a victim can access healthcare and request a forensic medical examination without first making a report to the police. 

The Scottish Government are investing significant levels of funding to support victims through a range of front line specialist services. The Rape Crisis Specific Fund ensures that local rape crisis services currently in receipt of funding can continue providing direct support to victims, this includes core funding for rape crisis centres in the Western Isles, Orkney and Shetland. We also recognise that advocacy services play a key role in providing survivors with information and support at all stages of their journey, and fully supports the Rape Crisis Scotland National Advocacy Project (NAP). In 2019/20 the Justice budget provided around £950,000 to provide a key support worker in centres across Scotland, including in Orkney and Shetland. These advocacy workers can support survivors to give a statement to police, attend appointments and meetings related to the justice process with survivors, get updates on the progress of cases, provide information about special measures, attend court and provide emotional support throughout the process. 

The Scottish Government continues to consider equality of access to services and support for survivors of gender-based violence in all areas of the country, and will continue to listen to the experience of victims and their families and consider further improvements that can be made.

“Consultants and surgeries are now all based on the mainland making for a lot of worry and stress especially for families with young children and our older population. Not everyone can afford a car to travel to appointments.”
(Consultation participant, Arran)

SG Policy - Permanent and rotating island GPs and community nurses also require different skills from those working in more urban settings. They are likely to do a wider range of work whilst often working in isolation. In addition, on a small island, they can be on call 24/7 for weeks at a time. The 2018 General Medical Services Contract sets out a new direction for general practice in Scotland which aims to improve access for patients, address health inequalities, improve population health, and reduce GP workload through the expansion of the primary care multidisciplinary team. However, the Scottish Government recognise that remote, rural and island communities face distinct challenges in delivering primary care services, particularly in recruiting and retaining clinicians, and in ensuring sustainable service delivery.

The Scottish Government established a Remote and Rural General Practice Working Group, chaired by Sir Lewis Ritchie, in June 2018 to provide advice and develop recommendations on ways to ensure that the views of island-based clinicians and communities are better recognised in primary care policy development. The Group supports a range of initiatives including “Golden Hellos” (which provide financial incentives to work in remote and rural communities), Rediscover the Joy in General Practice, a programme to attract GPs to work across Orkney, Shetland, Western Isles and Highland communities by tailoring posts to suit the candidate, as well as funding digital developments such as Attend Anywhere (also known as NHS Near Me), a programme for supporting the roll-out of technology and training to enable web-based video consultations and access to specialist services without the need to travel.

In its first year, the Group has carried out an extensive programme of engagement across Scotland. This shows that despite significant challenges, rural healthcare providers are delivering high quality care by embracing progressive, innovative solutions and adapting clinical roles to maximise recruitment and retention. The Group is considering opportunities to develop a national centre for excellence in remote, rural and island health and social care, that will build networks and share knowledge with and from other countries who face challenges in delivering high quality, person centred and sustainable care for patients living on Scotland’s islands.

Many of Scotland’s island residents are getting older. In 2011, 21 per cent (21,600) of island residents in 2011 were aged 65 and over, an increase of 2.5 percentage points on the 18 per cent recorded in 2001. Nationally, 17 per cent of the population was aged 65 and over in 2011. We know most older people wish to remain in their own home as they age, but islanders told us that a lack of available on-island support in terms of home care and assisted living or care homes can result in older residents having to leave the island in their later years. Consequently, much of the heritage and culture that the older population bring to the community is being lost, whilst family units are also being put under strain due to being separated from their older relatives. 

Tagsa Uibhist is a voluntary organisation in the Southern isles of the Outer Hebrides providing support for carers, people living with dementia and vulnerable people, allowing islanders to live well in their own homes for as long as they want and can.  The organisation also continues to develop Community Growing hubs across the islands as part of the Government’s Climate Challenge Fund project “Grow your own community”.

https://www.tagsauibhist.co.uk

Mental health was frequently mentioned during the consultation as being an area of crucial importance that can often be overlooked and under resourced in relation to wellbeing and health care on islands. Although there are many good examples of services and initiatives such as HebAlpha on Lewis which aims to help people who are living with addiction, the Plan recognises that there is a need for adequate mental health care on our islands that takes into consideration the uniqueness of each community. 

Mind Your Head provide a free service to local employers on Shetland called Grubby Hut Sessions, where staff visit businesses and workplaces to talk to employees about the importance of looking after not only their own mental health, but that of their colleagues. 

https://www.mindyourhead.org.uk

Wellbeing is at the heart of the Plan and we want people on our islands to be able to make daily choices that keep them fit and well, both physically and mentally. Whilst the high quality natural environment on our islands is acknowledged in National Planning Framework 3, our approach to new development and improving our places remains strongly supportive of the provision of places for children to play safely, places for recreation and high quality design which makes places attractive to be in and well connected by walking, cycling and public transport.

SG Strategy - The Planning (Scotland) Act 2019 will require, once the relevant section is commenced, planning authorities to prepare and publish open space strategies. These will set out a strategic framework of the planning authorities’ policies and proposals for the development, maintenance and use of green infrastructure in their area. They will have to include an audit of existing open space provision, and an assessment of current and future requirements. The Act also introduces a new duty on planning authorities to undertake an assessment of the sufficiency of play opportunities in their area for children, to inform their local development plan.

During the consultation, islanders told us that in many instances sports centres act as community hubs, which improve both the physical and mental health of island residents. The Community Sport Hub programme brings together sport clubs and community organisations to develop and grow sport at a local level. There are already established Community Sport Hubs on many islands. The Scottish Government believes that there should be no barriers at all to participating in sport and physical activity – everyone should be able to access opportunities to be active, whoever they are, wherever they live and whatever their background.

Our Active Scotland Outcomes Framework sets out the shared vision and goals which have shaped the approach the Scottish Government and a wide range of partner organisations, have taken to supporting and enabling people in Scotland to be more physically active. The Outcomes Framework is supported by our Active Scotland Delivery Plan which aims to cut physical inactivity in adults and teenagers by 15 per cent by 2030 using wide-ranging approaches including active travel funding, support for both formal sports and informal physical activity, and partnership working across the transport, education, health and planning sectors.

Strategic Objective 7

To improve and promote health and wellbeing we will:

• 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. 
• Identify and promote good practice, especially as regards the improvement of services in islands and other remote areas.
• 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 with stakeholders to develop propositions for a national centre for excellence in remote, rural and island health and social care.
• Work with stakeholders to ensure that we develop a plan to adequately support the aging population of island communities so that they remain active, connected, engaged and have access to suitable, quality opportunities.
• Support relevant local authorities to plan and develop sports facilities on the islands that respond to the needs of communities.
• 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.
• 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 with our partners to eliminate unlawful discrimination, harassment and victimisation and take steps to assist with promoting equality and meeting people’s different needs.
• 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.
• 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. 
• Ensure that health, social care and wellbeing services are available through the medium of Gaelic to support Gaelic speaking island communities. 
• 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 impacts. 
• Work alongside national partners, continuing to share good practice identified across Scotland which could be applicable to child poverty in our island communities. 
• 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 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.