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 the Health and Social Care Partnership (HSCP) sometimes struggles with in trying to deliver on national NHS Scotland priorities.

The question for the Orkney Islands 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 Strategic Commissioning team within Healthcare Improvement Scotland’s Improvement Hub (ihub) to support them as they consider different approaches to commissioning care and support.

Sharing and evolving learning from previous work with Inverclyde HSCP, the Strategic Commissioning team facilitated a learning session in October 2017, to spark discussion around best practice in the Orkney Islands, and what the community’s priorities are.

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 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.

As Zaid Tariq, Strategic Planning Portfolio Lead explains:

“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.”

John Trainor, Head of Health and Community Care, Orkney Islands HSCP:

“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.”

In a small island community inward investment is vital to support a thriving local economy, to support the development of integrated services, and to retain a flexible workforce. The Orkney Islands rely on few people having or sharing multiple roles, and flexibility is a welcome foundation. Maximising this inward investment is a key priority for the HSCP.

Des McCart, Senior Programme Manager of the Strategic Commissioning Support Unit said:

“Following the learning session, the ihub’s Strategic Commissioning team is now 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’s Strategic Commissioning team 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 planned programmes.

This approach is a more sustainable, long-term method for addressing recurring issues - both those unique to the Orkney Islands and those seen across Scotland.

BBC Orkney recently interviewed Strategic Planning Portfolio Lead, Zaid Tariq on this support work. Listen to the interview on BBC Radio Scotland (begins at 5:50)

For more information contact:

The Strategic Commissioning Support Unit