Developing a community driven health and social care system on the Orkney Islands

The ihub worked with the Orkney Island’s HSCP to develop flexible health and care services that are more closely aligned to local needs.

Home to around 21,000 people and spread over 70 isles, the Orkney Islands are unique in Scotland’s health and social care system. These are mostly rural communities, diverse in size and setting, with fewer than 20 residents on some of the smaller islands.

With this uniqueness comes the ‘square peg, round hole’ way of working that the HSCP sometimes struggles with in trying to deliver on national NHS Scotland priorities.

The question for the HSCP was how to develop a more singular, flexible and community driven approach that matches their health and social care resources with community needs and priorities?

The HSCP approached the ihub’s Strategic Commissioning team to support them in considering different approaches to commissioning care and support.

Sharing and evolving learning from previous work with Inverclyde HSCP, the Strategic Commissioning team designed and facilitated a learning session in October 2017, to spark discussion around best practice in the Orkney Islands, and what the community’s priorities were. From these conversations it became clear the current structure of health and social care services, which work well in a variety of settings across Scotland, don’t make best use of resources and people on the Orkney Islands.

Using a technique developed by the ihub called Integrated Systems Mapping (ISM), the team, alongside local NHS analysts, the local authority, and third sector organisations, built a picture of the various connections between the Orkney Islands’ current health and social care services.

John Trainor, Head of Health and Community Care, Orkney Islands HSCP noted that “The ISM has pulled the intelligence together in a way we haven’t done before, and it is a really useful way to present and share with others.”

As Zaid Tariq, ihub’s Strategic Planning Portfolio Lead explained, “Working together to create the ISM allows us to link together this knowledge, in the context of local insight, and enables the development of a whole-system view of services, associated activity, and capacity. By identifying local solutions to local needs, community is at the very centre of an integrated health and social care system.”

In addition to the ISM, the ihub introduced the Neighbourhood Care, or ‘Buurtzorg’ model, which it’s testing and adapting to the Scottish context across five sites. This is a new model of person-centred care that was developed in the Netherlands. Des McCart, from the ihub’s Transformational Redesign team said, “The ihub is working with the Care Inspectorate, Scottish Social Services Council and others to share learning from the Neighbourhood Care (Buurtzorg) model, where the key is flexible working, to begin shaping a new system for the Orkney Islands. This greater flexibility will offer opportunities for more non-formal providers, self-management for workers, and the use of funds to better meet individual and service outcomes in line with self-directed support and person centred care.”

The ihub continues to work with the Orkney Islands HSCP in designing working practices that are community supported; testing new models of care and building on the connections between the HSCP’s priorities and the ihub’s improvement programmes. This approach delivers sustainable long term solutions for addressing key challenges around the delivery of health and social care. One of the benefits of national support, working in partnership with local services, is it enables rapid cross fertilisation and sharing of learning. This is illustrated by the ability of the ihub to share relevant learning with Orkney from the current work elsewhere in Scotland to test Neighbourhood Care models.

The ihub is helping to ensure that health and care services continue to improve and evolve all over Scotland, so that they meet the changing needs of people that use them.