Annual Performance Report 2023/24

Orkney Integration Joint Board

IMAGE: Cover page for the Annual Performance Report 2023/24, showing the Orkney coastline with sea stacks and cliffs, the title “Annual Performance Report 2023/24”, the subtitle “Orkney Integration Joint Board”, and the logos of NHS Orkney, Orkney Health and Social Care, and Orkney Islands Council.

Contents

• Foreword
• Overview
• About Orkney
• Our Localities
• Key Achievements Over 2023/24
• Key Challenges Over 2023/24
• Strategic Priorities
• Priority Area 1 – Unpaid Carers
  • What Have We Done During the Last Year?
  • What Will We Do During the Coming Year?
• Priority Area 2 – Supporting Older People to Stay in Their Homes
  • Care at Home
  • Telecare and Mobile Community Responder Service
  • Aging Well Service
  • Occupational Therapy
  • Home First
  • Rheumatology Service
  • Dementia
• Priority Area 3 – Community Led Support
  • Island Wellbeing Project
  • Community Link Practitioners
• Priority Area 4 – Mental Health and Wellbeing
  • Mental Health Officer
  • Psychological Therapies Service
  • Child and Adolescent Mental Health Services (CAMHS)
  • Orkney Blide Trust
• Priority Area 5 – Early Intervention and Prevention
  • Speech and Language Therapy
  • Infant Feeding Team
  • Health Visiting
  • Vaccination Service
  • Diabetic Eye Screening
  • School Health
  • Neurological Services
• Priority Area 6 – Tackling Inequalities and Disadvantage
  • The Isles
  • Oral Health
  • School Nursing
• Financial Performance and Best Value
• Audit and Inspection Reports
• Inspection of services
• Local Government Benchmarking Framework
• SW01 - Home care costs per hour for people aged 65 and over.
• SW02 – Self-directed Support spend on adults aged 18+ as a percentage of total social work spend on adults aged 18+.
• SW3a – Percentage of people aged 65 and over with long term care needs receiving personal care at home.
• SW05 - Residential costs per week per resident for people aged 65 or over
• SW06 – Rate of re-admission to hospital within 28 days from discharge per 1,000 discharges.
• SW07 – Proportion of care services graded ‘good’ or better in Care Inspectorate inspections.
• SW08 – Number of days people spend in hospital when they are ready to be discharged, per 1,000 population aged over 75.
• Health and Wellbeing Indicators
• Looking Forward
• Contact Us

Foreword

I am delighted to present the latest annual performance report for the Orkney Integration Joint Board. As Chair of the Board, I would like to take the opportunity to thank fellow Board members and officers for their tireless work over the last year in ensuring that we continue to try and do the right thing for the people of Orkney. There is always much more for us to do and, hopefully, the report presents a balanced overview of the areas where we continue to make headway alongside some areas where we must still do better.

The quality of our island life can be significantly enhanced by the health and social care provision.

IMAGE: Portrait of Rachael King, Orkney Integration Joint Board Chair.

The quality of our island life can be significantly enhanced by the health and social care provision and the fact that many of us are living longer means that we require to retain a focus on how we support older people and also those who care for them. In addition, for parents and carers of people with physical and learning disabilities, mental health or addiction issues, it is vital that we find effective and creative ways of caring for the carers as well as those who require care.

With the ongoing cost of living crisis, reducing public sector investment and increased demand on mental health services it will be crucial that we continue to focus on our priorities in the coming year and build upon the progress made in 2023/24.

Rachael King, Orkney Integration Joint Board Chair.

This is the third annual performance report of the Integration Joint Board since I arrived in Orkney three years ago.

The purpose of the report is to provide an insight into our progress over the last year, highlight areas of improvement, and capture the challenges we face in delivering the best quality health and care provision possible to the people of Orkney. I think this report does a really good job of doing all of this. In relation to our strategic priorities, we have made really good progress in some areas of work, for example, in developing how we engage with and support unpaid carers and in reducing unmet need for older people in relation to Care at Home Services.

Our biggest challenge (albeit not unique to Orkney) remains our workforce gaps. There are nationwide issues in recruiting to the social care workforce and we also have a number of vacancies across our health services too, most notably within our Allied Health professions. It is testament to our existing staff teams across Orkney that we have managed to not only keep services operating but, in many instances, still managed to make improvements. There is, of course, still much to do and the financial challenges faced by all public sector bodies in the years ahead will be a real test of how we work with our communities and those who need our support.

We have already begun to engage with staff and communities in considering our new strategic plan which will run from 2025-2028. It will be vital for us to ensure that our priorities and our focus continue to be on the things that matter most to the people of Orkney. I look forward to developing the new plan in collaboration with as many of you as possible over the coming months.

IMAGE: Portrait of Stephen Brown, Orkney Health and Social Care Partnership Chief Officer.

Stephen Brown, Orkney Health and Social Care Partnership Chief Officer.

Overview

The integration of health and social care allows us to improve the wellbeing of people who use these services, in particular people with complex needs that involve support from health services and social care services at the same time.

Scottish Government has set out nine National Health and Wellbeing Outcomes which describe the improvements that can be made by integrating health and social care. The outcomes are:

1. People are able to look after and improve their own health and wellbeing and live in good health for longer.
2. People, including those with disabilities or long-term conditions or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community.
3. People who use health and social care services have positive experiences of those services, and have their dignity respected.
4. Health and social care services are centred towards helping to maintain or improve the quality of life of people who use those services.
5. Health and social care services contribute to reducing health inequalities.
6. People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing.
7. People using health and social care services are safe from harm.
8. People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care, and treatment they provide.
9. Resources are used effectively and efficiently in the provision of health and social care services.

IMAGE: A numbered graphic presents the nine National Health and Wellbeing Outcomes, covering personal health, independent living, positive experiences, quality of life, health inequalities, unpaid carers, safety, the workforce, and effective use of resources.

NHS Orkney and Orkney Islands Council established the Orkney Health and Social Care Partnership (HSCP) in 2016 to collaborate more closely on the National Health and Social Care Outcomes.

The Orkney Integration Joint Board (IJB) is responsible for planning, resourcing and monitoring health and social care services. The IJB is accountable to Scottish Government and is required to produce an Annual Performance Report to evidence progress towards their delivery.

This Annual Report shows the progress made against the Strategic Priorities, set out in the Orkney HSCP Strategic Plan 2022–2025, for the year 1 April 2023 to 31 March 2024.

About Orkney

Our Localities

Scottish Government asks that IJBs divide the area for which they are responsible into at least two separate localities. Orkney is divided into three localities: the Isles, the West Mainland, and the East Mainland.

It makes sense for us to take this approach and work together with communities for planning and delivery purposes, as other services within Orkney Islands Council have plans and services based upon a locality model.

Orkney is divided into three localities: the Isles, the West Mainland, and the East Mainland.

The tables below give some information about the make-up of the population of the Orkney Islands, split across the three localities, and shows how they compare against the overall population of the HSCP, as well as giving a comparison with the whole of Scotland.

IMAGE: Map of Orkney showing the Isles, Orkney East, and Orkney West localities, with inset maps for Stromness and Kirkwall. The map also marks GP practices, care homes, emergency departments, and minor injury units.

Locality indicators

Source - PHS LIST Locality Profile December 2023.

Note: *SIMD – Scottish Index of Multiple Deprivation.

Source - PHS LIST Locality Profile December 2022.

Key Achievements Over 2023/24

We were delighted to hold the Orkney Unpaid Carers’ Conference, the first of its kind in Scotland. This day-long event saw over 100 people come together to hear about the challenges facing our unpaid carers, as well as planning how services can be improved for carers over the coming years.

The Carers’ Conference led to the publication of the partnership’s new Carers Strategy.

Kirkjuvagr House has been selected by the staff and residents of St. Rognvald House as the name for Kirkwall’s new care home. Construction continues and will be completed by Spring 2025, with the residents and staff expected to move in shortly afterwards.

The new Children’s Services Plan was approved by the Orkney IJB, NHS Orkney and Orkney Islands Council and was published in February 2024.

Key Challenges Over 2023/24

As in previous years, and in common with our colleagues across Scotland, our greatest challenge remains the recruitment and retention of our workforce, along with the impact this has on our ability to deliver services.

It is no secret that all public services, across the country, face significant pressures on the money they have to provide quality services to their communities. These pressures are occurring in tandem with unprecedented demand for services, not to mention the ongoing cost of living crisis.

Strategic Priorities

The Orkney HSCP Strategic Plan 2022–25 was approved in June 2022 and identified six priority areas to address the most pressing health and social care issues in Orkney:

1. Unpaid Carers.
2. Supporting Older People to Stay in Their Homes.
3. Community Led Support.
4. Mental Health and Wellbeing.
5. Early Intervention and Prevention.
6. Tackling Inequalities and Disadvantage.

IMAGE: Diagram showing six strategic priorities arranged around a central space. Early Intervention and Prevention is at the top; Tackling Inequalities and Disadvantage is at the bottom; and the central blocks are Mental Health, Carers, Older People, and Community Led Support.

For each of our priority areas we asked a selection of services to provide some information about what their service has been doing, during the last year, to contribute towards our Strategic Priorities.

But this is by no means exhaustive: there are many other teams who contribute daily to supporting our communities.

The Performance Management Framework 2021–2025 helps the Orkney IJB to assess how effective the Orkney HSCP is in achieving the objectives highlighted in the Strategic Plan 2022–25.

We have also designed an Action Plan to help us measure our progress. Each of the Strategic Priorities includes several Milestones, or things we must achieve to deliver our objectives. Each of these Milestones also include at least one Action and a description of how that Milestone will be delivered.

We provide an update to the IJB’s Performance and Audit Committee on the progress we have made, at each meeting, updating every Priority twice a year.

This all sounds a bit complicated, but the table at the beginning of each Strategic Priority description should make this a lot clearer.

Priority Area 1 – Unpaid Carers

Key to Tables

Scottish Government tell us there are around 800,000 unpaid carers in Scotland, providing support to their loved ones worth around £12.8 billion, whilst Oxfam Scotland analysis, in 2020, estimated this figure to be nearer £36 billion. Whichever is more accurate, these are staggering figures, especially if we consider that the Institute for Fiscal Studies calculated Scotland’s social care budget, in 2022/23, at £4.3 billion. This means, of course, that unpaid carers account for between three and eight times the total national spend on social care.

So, what does all this mean for Orkney? Well, with a population of just over 22,000, this means there are around 3,500 unpaid carers in Orkney, which will include more than 100 young carers. Even if we assume the lower estimate for the value of unpaid care in Scotland, this means unpaid care in Orkney is worth around £56 million.

It is difficult to comprehend these enormous sums of money. Perhaps it is easier just to say that, without the care delivered every hour of every day, up-and-down the land, social care services would collapse.

What Have We Done During the Last Year?

We are currently supporting around 400 unpaid carers, meaning around 3,000 carers in Orkney are unaware of the services available to them, so we have worked hard this year to reach these “unknown carers”.

Spreading the Message – The Unpaid Carer Conference. A continuous campaign of publicity, through social media, The Orcadian, and Radio Orkney, has delivered a much higher profile for unpaid carers in Orkney, and has ensured more people are aware of the support available to carers.

This publicity campaign culminated in the inaugural Orkney Unpaid Carers Conference, held in Kirkwall, in May 2023. We welcomed more than 150 delegates, including speakers from across Scotland, as well as key local folk, and, most importantly, unpaid carers from across Orkney.

IMAGE: Photograph of people attending the Unpaid Carers Conference, including attendees conversing in a meeting room.

We heard how unpaid carers are the essential strand that hold social care services together, as well as some of the great ideas that are improving the support for carers. The conference was a great success, with excellent feedback from those that attended.

The main session of the afternoon was given over to speaking to carers, where we learned exactly what they felt were the most important ways that services could improve their lives. These conversations led directly to the priorities in the new Unpaid Carers’ Strategy, launched earlier this year.

Whilst the Conference was the highlight of the year, colleagues at Crossroads Care Orkney, as well as Age Scotland Orkney, have continued to speak to carers daily, ensuring they know how and where to get support.

There has been a consistent increase in the number of people contacting Crossroads Care Orkney and identifying as a carer, for the first time. There were 36 new contacts in 2021/22, 54 new contacts in 2022/23, and 76 new contacts in 2023/24.

Frontline Worker Training. We have been working with our partners at NHS Orkney to develop a training programme for all frontline workers, equipping them with the knowledge they need to recognise unpaid carers, as well as advise on where they can seek support. This programme will begin later this year.

What Will We Do During the Coming Year?

Carer Lead and Carer Support Worker. We have decided to create two new jobs: a Carer Lead and a Carer Support Worker. Both brand-new roles will mean that there are two staff who will spend all of their time working for the benefit of carers.

Support Assessments. We are working on the assessment process to make sure that our carers can get the help and support they need, more easily.

Carer-Friendly Employee Policies. We are working with Orkney Islands Council to ensure the Employee Policy is a carer-friendly policy. This will make sure carers who work for the Council can balance their work and their caring responsibilities. This will be the first step in developing a carer-friendly accreditation scheme for employers across Orkney.

Priority Area 2 – Supporting Older People to Stay in Their Homes

Whenever we hear from older people, we are told that they would prefer to stay in their own homes, in their own communities, for as long as possible, rather than move into supported accommodation, extra care housing, or residential care. Whilst we have invested significantly in improving supported accommodation, extra care housing, and residential care for our most frail and vulnerable older people, such as Hamnavoe House in Stromness, and the nearly completed new care facility in Kirkwall, Kirkjuvagr House, we recognise people want to receive support, wherever possible, at home.

Care at Home

The number of people receiving support in their own homes from our Care at Home service continues to increase significantly. In April 2023, there were 128 people receiving Care at Home services; this has increased by 27.3%, to 163, a year later.

The service has been trying to increase the number of people who receive packages of care exceeding 10 hours per week. This means people are receiving care in their own homes, rather than in residential care. In April 2023, there were 39 people receiving more than 10 hours of care per week. By April of this year, this had increased by 48.7%, to 58 people.

Telecare and Mobile Community Responder Service

The Telecare equipment allocated to our service users is based entirely upon their individual needs, as equipment suitable for one person may be completely inappropriate for another.

The Telecare team maintain a knowledge of the most up-to-date models and products available, ensuring there is a comprehensive range of equipment and peripherals available to meet the varying needs of Orkney's population.

The commitment to keeping apace of technology resulted in a 20% increase in Telecare/Digital equipment purchased to support people in Orkney, between April 2023 and April 2024, whilst the service now supports 876 people, up from 838 in April 2023.

The service offers a range of practical solutions for frail and older people, enabling them to live meaningful lives and offering peace of mind both to the user and their family.

By April 2023, 98 people had switched from analogue to digital equipment. By April of this year, that number had increased to 159, an increase of 61.6%. The full switchover is planned for December 2025. In March 2024, the project received the Bronze Accreditation Award from the Scottish Digital Office.

Aging Well Service

One of our Aging Well Team was recently at the Picky Centre, assisting two of their recently graduated patients. Whilst she was there, four of the service’s previous patients approached her and thanked her for assisting them to attend the class. They said they had continued to attend and that the class had improved their strength, mobility, and confidence.

Occupational Therapy

The Occupational Therapy service helps people to stay in their own homes, rather than having to move to residential accommodation.

The service has successfully implemented the Scottish Government initiative to supply people with short-term loan wheelchairs. They have made 41 wheelchair loans in the 12 months since the service commenced, in May 2023. They offer an initial maximum loan period of six weeks, which can be extended.

In early 2024, the service provided environmental control technology to four people. Environmental controls allow people with complex physical disabilities to control devices around the home, such as mobile phones, tablets and computers, door intercom systems, lights, home entertainment equipment, community alarms, profiling beds, riser-recliner chairs, door openers, and other home automation equipment.

Home First

The Home First initiative looks to get people home from hospital as soon as possible, and referrals to the service have seen a big increase over the last 12 months. The team has recruited to the Social Work, Physio and Co-ordinator vacancies, improving its ability to reable people and get them home.

Moving with Dignity

The Moving and Handling OT, working with colleagues from the Care at Home service, has continued to train and develop the workforce with the skills and knowledge needed to use new equipment and techniques to support people with significant problems with moving. Formal Moving with Dignity training is planned for 32 staff.

Rheumatology Service

The Rheumatology Service has been reconfigured following training from the Grampian Specialist Team. This will address current waiting times and offer earlier preventative intervention.

Dementia

Some of the challenges the service faces in Orkney are the same as those across the country: people are often reluctant to seek diagnosis; there is a lack of Consultant Psychiatry services for older adults; and there are continuing difficulties with recruitment.

There is a lot of good news, too. We have made good progress with the aims of Orkney’s Dementia Strategy 2020-2025:

• We have recruited a GP with Special Interest to support diagnosis of dementia.
• There is immediate access to post-diagnostic support.
• We deliver open-ended support from immediately after diagnosis, and before treatment, throughout the course of the illness.
• We provide carer support.
• We support or signpost people with all aspects of dementia from a single point of access to services.

Age Scotland Orkney delivered and assessed a pilot programme involving Cognitive Stimulation Therapy. Scottish Government funding is supporting continued therapy, which has recently increased to two sessions per week.

The growing number of people attending has increased opportunities for social activity at the Age Scotland Orkney Dementia Hub in Kirkwall. The Hub continues to support a one-stop shop for accessing support and services after diagnosis.

Age Scotland Orkney has been given funding to design and develop a dementia-friendly, all-weather outdoor garden space within the grounds of their building in Victoria Street, Kirkwall.

A new two-year dedicated dementia nurse post has been funded by Dementia UK, the Orkney HSCP, and Dementia Friendly Orkney, and is hosted within Age Scotland Orkney.

Age Scotland Orkney has also secured funding to deliver innovative befriending, helping people living with dementia and their carers to connect with others and reduce isolation and loneliness.

Dementia information, advice and support specific to Orkney is now available on the Right Decisions App.

Plans are developing to link with people with dementia in the isles. Connections have been made with existing support and services, and the next step will be to work with isles-based colleagues to build services designed specifically for people in the isles.

The current Dementia Strategy is reaching the end of its life. The service is considering its next steps, including speaking to local people with dementia and their carers and considering the content and direction of the new National Dementia Strategy.

Priority Area 3 – Community Led Support

Community Led Support (CLS) in Orkney had initially developed through embracing connections, co-production, and collaboration. Our Blethers had taken place in Kirkwall and St Margaret’s Hope, but weather and the COVID-19 pandemic caused us to halt our programme and further planning.

A lack of resources during the last few years has meant it has not been possible to build on the early success of the initiative; nonetheless, CLS remains at the heart of the Partnership’s planning and remains one of the six Strategic Priorities in the Strategic Plan 2022-25.

IMAGE: Community Led Support logo featuring a multicoloured linked-shapes symbol and the words “Community Led Support an NDTi programme”.

Island Wellbeing Project

The Island Wellbeing Project is a partnership between Voluntary Action Orkney (VAO), Highlands and Islands Enterprise (HIE), The Orkney Health and Social Care Partnership, and the Development Trusts of Hoy, Sanday, Shapinsay, Stronsay, Westray, Rousay, Egilsay and Wyre.

The project is managed and administered by VAO and is currently funded by Esmée Fairbairn Trust, The Tudor Trust, the Integration Joint Board, and the Island Development Trusts.

On each project island, the Development Trusts employ a Community Wellbeing Coordinator. Their role is to support community-led initiatives and provide generalised one-to-one support.

Over the last year the Community Wellbeing Coordinators have supported 197 individuals over 773 separate support sessions. They have also supported 36 groups, including yoga groups, chair-based exercise, lunch clubs, knitting groups, and family fun activities.

IMAGE: Island Wellbeing Project logo with the words “ISLAND WELLBEING PROJECT” and “a partnership project”.

The project has developed case studies regarding care provision and the unique challenges faced by island residents with care needs. It has also engaged with NHS Orkney to support development of its new Corporate Strategy.

An Options Appraisal conducted by Robert Gordon University has been completed. The project partners will consider its recommendations to identify and build an operating model that will allow the Island Wellbeing Project to continue.

Community Link Practitioners

Community Link Practitioners (CLPs) in Orkney work within GP Practices and are part of the practice team. Funded by the Primary Care Improvement Plan and employed by VAO, they bridge the gap between GP Practices and communities.

Working one-to-one with clients referred from GP Practices, CLPs can link clients with community groups, services and resources available locally and nationally. They support people with issues such as debt, housing, social isolation, loneliness, and low mood.

During the last year, the CLP Team has worked with 293 people in the GP Practices of Heilendi, Skerryvore, Daisy Villa, Dounby, Stromness, Westray, and Papa Westray.

Priority Area 4 – Mental Health and Wellbeing

Mental Health Officer

We have four Mental Health Officers (MHO) who provide a service 24 hours per day, 365 days per year, in addition to their main jobs, and who fulfil the statutory responsibilities of the Council. These include:

• Undertaking statutory duties under the Mental Health (Care and Treatment) (Scotland) Act 2003.
• Protecting health, safety, welfare, finances, and property.
• Safeguarding of rights and freedom.
• Duties to the Court.
• Public protection in relation to mentally ill offenders.

Approximately 100 people required support by MHOs from the Adult Social Work team, whilst 40 people who did not require a MHO were supported by a Social Worker from the Community Mental Health Team.

Please note that * indicates a number less than 5, which cannot be published.

Psychological Therapies Service

The Psychological Therapies (PT) Service provides a range of psychological services to all age groups in Orkney, including Children and Adolescents, and Adults and Older Adults, to alleviate distress, improve mental health and promote psychological wellbeing.

In addition to direct individual and group psychological assessment and treatment, staff in the service have a consultative role, providing teaching and supervision for others employed in psychological interventions in Orkney HSCP and NHS Orkney, and supporting service evaluation.

Child and Adolescent Mental Health Services (CAMHS)

CAMHS has been undertaking Save a Life Suicide and Awareness Training for all administrators. This will ensure staff can direct service users to the correct professional and services.

The CAMHS team has grown to 12 over the last year. The service has recruited a Medical Secretary to support consultants, GPs, and psychologists, arrange appointments, and deliver data collation.

CAMHS is also increasing routes into the service via Mental Health services, allowing patients, staff, and users to access services more effectively.

Orkney Blide Trust

Orkney Blide Trust is a charity that provides support for those who currently have, or who have had, experience of mental ill health. Orkney HSCP commissions services from the Orkney Blide Trust.

IMAGE: Orkney Blide Trust logo showing a blue emblem with clasped hands and the words “Together For Mental Health”.

They open every day and, in 2023/24, welcomed 86 new members or service users. They had 240 members at the end of March 2024. On average, they welcomed around 700 members and professionals to their premises each month.

Orkney Blide Trust provided a counselling service, available to anyone in Orkney over the age of 16 on Saturday and Thursday evenings. Members were supported informally and in one-to-one meetings at their premises in Kirkwall and in the community by the Housing Support Service and Befriending projects.

The Trust organised active, therapeutic, and purposeful activities as requested by members to support their mental health recovery.

The Trust also developed a new ‘Men in Mind’ project and continued its service for Care Experienced Young People aged 16 to 25.

The Orkney Distress Brief Intervention service grew significantly, providing timely and compassionate support to over 120 people from the local community who were in distress and had come into contact with the Police.

Priority Area 5 – Early Intervention and Prevention

Prevention and early intervention are vital to all our priorities. We want people to be aware of their health and wellbeing, and take responsibility for themselves, whatever their age or background.

Communities and their local environment play a pivotal role in promoting and delivering good health, and providing opportunities for people to be active, to be involved, and to connect with others.

Speech and Language Therapy

The Speech and Language Therapy service has recently recruited to a new full-time role that will support children and young people. This will help to improve waiting times and assist in delivering universal and targeted services, partnership working, and the Partnership’s commitment to Getting it Right for Every Child (GIRFEC).

Infant Feeding Team

The infant feeding leads, health visitors and maternity staff have worked together to achieve the Gold Standard of the UNICEF Baby Friendly Initiative. Their success has been recognised worldwide, with a case study of their journey published by UNICEF online.

“Our goal was to develop robust systems of working to encourage staff to collaborate innovatively across services. The Baby Friendly culture and ethos underpins all our work, and our staff feel proud to provide responsive and compassionate care. Celebrating improvements, big and small, and having the recognition that mothers, babies, and their families, here in Orkney, feel supported, listened to, and cared for, is hugely satisfying. We’re proud to maintain 100% skin-to-skin rates and have seen breastfeeding rates improve from 61% in 2011 to 73% in 2021.

Our Board Chair and Guardian is a passionate advocate for Baby Friendly and has championed this within our Health and Social Care Partnership.

Continuing to strengthen leadership around Baby Friendly and collaborating closely with community organisations are key priorities for the NHS Orkney team.

Achieving Sustainability has meant focusing on why infant feeding matters and how it improves health and wellbeing. It has provided us with an incredible opportunity to recruit a network of community volunteer peer supporters, truly putting our community at the heart of our Baby Friendly work.

Developing leadership and ensuring staff and volunteers feel valued, respected, and cared for, and that families receive high-quality, compassionate, and evidence-based care across services is important to create an Orkney-wide Baby Friendly culture”.

Health Visiting

The Health Visiting Team support families by delivering Bookbug.

A member of the team in Dounby pulled together an inter-generational Bookbug session which brought together children and their parents, and residents of the local care home. The sessions were attended by more than 75 people and were received positively by both young and older generations.

The Health Visiting team work with families to support the health and wellbeing of young children until they start school. They work with Midwifery teams, Children’s Health Services, Childsmile, nurseries, Home-Start Orkney, Orkney Foodbank, Women’s Aid Orkney, and Social Work.

The team favours the Solihull Approach, which helps parents adapt to how they react to their children and see things from their perspective. They also provide baby massage classes and manage a service where trained volunteers provide confidential one-to-one support to women with infant feeding challenges.

IMAGE: Photograph of a health visitor wearing a face mask examining a young person’s mouth in a school or community setting.

IMAGE: Photograph of a health worker using an oversized model of a yellow animal’s mouth and toothbrush to demonstrate toothbrushing.

Vaccination Service

The Vaccination Service took over responsibility for vaccinating babies from Heilendi, Skerryvore, Dounby, and Daisy Villa GP Practices in April 2023.

Around 900 patients were invited to the Winter 2023 Covid/Flu Programme. Orkney had an uptake of 66.3%, against a national average of 56.6%.

The Spring 2024 Covid Programme began in April with around 3,300 people invited. Practitioners also made just under 200 home visits.

Planning has continued for the new Respiratory Syncytial Virus vaccination programme, due to begin in August 2024.

Diabetic Eye Screening

The Diabetic Eye Screening service checks people over 12 years of age who have type 1 or type 2 diabetes for diabetic retinopathy and maculopathy.

The service saw 146 high-risk patients in 2023/24, with seven patients referred to Eye Clinic for treatment. This saved 139 eye clinic appointments.

The eligible screening population is 1,355, of which 884 were screened in the past year, a take-up rate of 85.8%. All Key Performance Indicators were met and exceeded.

School Health

The School Health team offer Sleep Action, previously known as Sleep Scotland, to all school-age children in Orkney.

All three members of the School Health team are trained to deliver Sleep Action, offering advice and support on good sleep practices. Since April 2023, they have met with 11 young people who identified that they required support with their sleep regime.

Neurological Services

There are named points of contact at NHS Orkney for people affected by Multiple Sclerosis, Motor Neurone Disease, and Parkinson's Disease.

These services offer comprehensive assessments and reviews to guide plans for treatment, care and support. Plans are developed through shared decision making, with the person and their family or carers at the centre.

This approach supports:

• Improved symptom management.
• Reduction of risks.
• Early intervention.
• Reduction in, or avoidance of, hospital admission.
• Supporting people to live as meaningful a life as possible.

Priority Area 6 – Tackling Inequalities and Disadvantage

Tackling inequalities and disadvantage is something that links with all the other five priorities.

We will continue to address this by:

• Working to keep children, young people, and vulnerable adults safe.
• Making sure everybody can access the service or treatment that they might need.
• Working to remove barriers to accessing services.
• Partnering with other agencies and services to address financial hardship.
• Working with our partners to ensure Orkney is a safe and happy place to live for everyone.

The Isles

We want to specifically mention the challenges people in the isles face in accessing some services. We have made considerable effort to bring services to the isles, and will continue to do so, although this is not always possible.

Often, this will mean isles residents have to travel to Kirkwall, or the Scottish mainland, to use our services. We will continue to identify opportunities to take services to the isles, use technology to reduce the need to travel, and arrange mainland-based appointments around convenient travel schedules.

Oral Health

The Oral Health Team works with partners throughout Orkney to reach out to more vulnerable families. The Childsmile Team regularly visits community groups, including local toddler and young families nurture groups, to provide oral health advice and support.

The latest National Dental Inspection Report 2023 shows that Orkney has a small cohort of children with obvious decay experience. Reaching and supporting these children and families to improve oral health routines and access dental treatment is a priority.

No Health Without Oral Health

Oral health is important to general health. Poor oral health is linked with poorer outcomes for people with diabetes or heart disease and with dementia.

The team provides oral health products to the local Foodbank, schools, care homes, and hospital wards. The Dental Department is signed up to provide alcohol brief interventions and smoking cessation advice.

School Nursing

The School Nursing team regularly visit schools in the Isles to try to ensure equity of provision for children and young people.

Financial Performance and Best Value

The IJB agrees a budget and commissions a range of services within the functions delegated to it. IJB financial governance includes:

• Approval of high-level strategies and plans.
• Quarterly financial monitoring reports.
• Publication of the annual Statement of Accounts.

In 2023/24 the IJB controlled the direction of £61,273,000 of financial resource to support the delivery of its strategic objectives.

The Scottish Government requires Public Authorities to assess whether Best Value has been achieved in terms of the planning and delivery of services. Best Value ensures that services are efficient, economic, sustainable, and deliver improved outcomes for Orkney.

Revenue Expenditure Monitoring Reports were presented at Orkney IJB meetings throughout the year. The purpose of the reports is to set out the current and projected financial year-end out-turn positions.

Budget

The draft outturn position showed an overspend position of £5.609 million. The total Orkney IJB approved budget was £67.612 million and the draft outturn spend is £73.221 million.

Confirmation is still awaited from NHS Orkney regarding approval of additional payment from the Board of NHS Orkney to cover the overspend so the Orkney IJB can report a break-even position.

The options available to Orkney Islands Council include:

• Make additional one-off payments to the Integration Joint Board; or
• Provide additional resources to the Integration Joint Board which are then recovered in future years, subject to scrutiny of the reasons for the overspend and assurance that there is a plan in place to address this.

Budget Reconciliation

Audit and Inspection Reports

The IJB’s Performance and Audit Committee met on the following dates over 2023/24:

28 June 2023

• Safeguarding Adult Support and Protection - NHS audit carried out by Azets.
• Joint Working - NHS audit carried out by Azets.
• Performance Management – IJB audit carried out by Azets.
• Internal Audit Annual Report and Opinion by IJB Chief Internal Auditor.

6 December 2023

• External Audit Annual Report by KPMG.

13 March 2024

• Internal Audit Strategy and Plan by IJB Chief Internal Auditor.
• Direct Payments – Orkney Islands Council audit carried out by the Council’s Audit Team.

Inspection of services

Health and social care services delivered by statutory providers, such as the Council and NHS Orkney, and non-statutory providers, such as Crossroads and Age Scotland Orkney, are monitored and inspected in a range of ways to give assurance about the quality of care.

During 2023/24 there were 18 inspections of care services, undertaken by the Care Inspectorate, whilst there were no inspections of hospital services. The aim is to have all regulated services graded at good or above, with scores of 4, 5 or 6.

Local Government Benchmarking Framework

The Local Government Benchmarking Framework (LGBF) brings together a wide range of information about how all Scottish councils perform in delivering services to local communities. It breaks down the information into four family groups of eight, depending on which performance figures, or metrics, are being looked at.

The Adult Social Care Services information is grouped by affluence of each partnership.

The least deprived Partnerships are shown on the left, the most deprived on the right.

For the Self-directed Support metric, rural partnerships are to the left and urban partnerships to the right:

Of the 11 indicators reported by the Improvement Service, seven were updated. Indicators SW04a, b, c, and d were not updated for this reporting period.

Health and Wellbeing Indicators

Nine National Health and Wellbeing Outcomes have been set by the Scottish Government and each IJB uses these outcomes to set their local priorities.

There are 23 indicators but four of them — indicators 10, 21, 22 and 23 — have not yet been finalised for reporting. Indicators 1 to 9 are based on the Scottish Health and Care Experience Survey (HACE), which is carried out every two years.

National indicators 1–9 as reported for 2023/24

Please note that results for questions have been suppressed where there were fewer than 20 responses as they may be unrepresentative and may risk identifying respondents.

National Indicators 11–20

Source: Public Health Scotland Core Suite of Integration Indicators.

Looking Forward

The provision and delivery of health and social care services continues to be profoundly affected by significant demographic changes, both in Orkney and throughout the rest of the country. In 2018, the number of people aged 75 and over was 2,345, or 10% of the population, but is predicted to increase to 20% of the population by 2043. Over this period, demand for care services for older people will inevitably increase.

These anticipated increases in demand sit within a landscape of a reducing working population: the number of people aged 16–65 is forecast to fall by 1,656. Innovative and creative solutions for delivering services will be needed to ensure appropriate care for an increasing number of service users, by a decreasing number of staff.

Technology will deliver some solutions, but initiatives such as Community Led Support will undoubtedly be needed to ensure people receive the care and support they need, especially within the context of an increasingly challenging financial environment.

The Scottish Government’s plans for delivery of the National Care Service continue apace, and services will continue to adapt and evolve to meet these new challenges.

The term of our current Strategic Plan ends in 2025, and work will begin shortly to compose our new plan, paying particular attention to our existing Strategic Priorities and their relevance to our community.

In the meantime, all six Priorities will continue to be a focus for us, and we will endeavour to work with and alongside our communities and partner organisations to achieve our delivery aims.

Contact Us

If you need this document in another format or language, please contact us at OHACfeedback@orkney.gov.uk or telephone 01856873535 (extension 2601).

Jeśli potrzebujesz tego dokumentu w innym formacie, skontaktuj się z nami pod adresem OHACfeedback@orkney.gov.uk lub telefonicznie 01856873535 (zwiększenie 2601).

Якщо вам потрібен цей документ в іншому форматі або мовою, будь ласка, зв'яжіться з нами за адресою OHACfeedback@orkney.gov.uk або телефоном 01856873535 (збільшення 2601).

Si necesitas este documento en otro formato o idioma, póngase en contacto con nosotros en OHACfeedback@orkney.gov.uk o en el teléfono 01856873535 (extensión 2601).

Please tell us your story - good or bad - about your experience of Orkney HSCP services.

www.careopinion.org.uk

For further information:

Website: https://www.orkney.gov.uk/Service-Directory/S/OHSCP

Telephone: 01856873535 extension 2601

E-mail: OHACfeedback@orkney.gov.uk

Mail: Orkney Health and Social Care Partnership, School Place, Kirkwall, Orkney KW15 1NY.