Strategic Plan

2022–2025

www.orkney.gov.uk

IMAGE: Cover photograph of a rocky Orkney coastline and sea at sunset. A dark panel reads “Strategic Plan 2022-2025”; the Orkney Health and Care logo appears at lower left, and “www.orkney.gov.uk” appears at lower right.

Contents

• Introduction
• What is Health and Social Care Integration?
• Orkney Integration Joint Board, and Orkney Health and Social Care Partnership
• What is a Strategic Plan?
• Our Pandemic Experience
• How We Can Work Together
• Localities
• Our Priorities
• Facts and Figures
• How housing sevices will help
• Financial implications
• Get involved

Introduction

Chair of the IJB

It is with great pleasure that I introduce the third strategic plan of the Orkney Integration Joint Board. Working in partnership with Orkney Islands Council, NHS Orkney, and a range of other partners across the statutory and third sector, the Integration Joint Board oversees the commissioning and development of community health and care services across our islands.

There are some key areas of focus for us over the next three years and we will look to explore and strengthen the services we deliver in these areas in order to meet the needs of our communities.

Over the last two years, staff working in health and social care have consistently gone above and beyond to deliver services in the most challenging of circumstances. Throughout that time, however, many of the developments planned in our previous strategy had to take a back seat as we responded to the pandemic.

With this new plan, we have taken the opportunity to assess the impact of the pandemic and the new and emerging need across our communities. In conjunction with our communities, we hope to continue to develop and evolve a health and social care system that Orcadians can be proud of.

Issy Grieve – Chair of the IJB

Chief Officer

At the time of writing, we are two years into a pandemic, with Orkney feeling the impact of the Coronavirus more now than ever before. Our staff have worked tirelessly to support people through lockdowns, to deliver a hugely successful vaccination programme and to develop and adapt to new ways of working.

Our communities have done all that has been asked of them and more, assisting one another and ensuring that the most vulnerable were protected and supported. All of our statutory agencies, third sector partners and communities across Orkney should be proud of our local response to the global pandemic.

As we emerge from the worst of the virus, and we inevitably will, it is crucial that we focus our efforts on the most significant challenges we face. The priority areas in this plan have been identified following extensive analysis of the health and care profile of our islands and in consultation with communities through various engagements.

As we continue to design and deliver services to meet the needs of our entire population, these priorities will help inform not only what we do but how we do it.

Stephen Brown – Chief Officer, IJB

IMAGE: The introduction page presents the Chair of the IJB’s message and the Chief Officer’s message in two side-by-side text panels.

What is Health and Social Care Integration?

Health and Social Care Integration is when councils and health boards work together to jointly plan services.

Integration is about making sure that every person who uses health and social care services gets the right care and support, at the right time, and in the right place, for them.

The government passed a new law in 2014. This was called the Public Bodies (Joint Working) (Scotland) Act 2014. This law required most adult health and social care services to be integrated or brought together.

In Orkney there was a decision to include not only services for adults, but also many of the services that used to be delivered separately by NHS Orkney and Orkney Islands Council.

These services are now delivered jointly by the Orkney Health and Social Care Partnership. The services delegated to the partnership include adult health and care services, primary care (GP surgeries and community care), children’s health and social care services, and criminal justice services.

You can find the full list of services, here.

IMAGE: Photograph of a masked healthcare worker standing with four young children wearing sunglasses in a childcare or clinical setting. The image illustrates health and social care support for children.

Orkney Integration Joint Board, and Orkney Health and Social Care Partnership

In April 2016, the Orkney Integration Joint Board (IJB) was formed. This is a legal body, separate from both NHS Orkney and Orkney Islands Council (OIC), with responsibility for planning, resourcing, and overseeing integrated health and social care services.

The Orkney IJB is made up of members from NHS Orkney, OIC, and the third sector, as well as staff, unpaid carers, Union, and service user representatives.

The Orkney IJB meets regularly to discuss, plan, and monitor how integrated health and social care services are delivered in Orkney. (You can find a full list of Orkney IJB members here).

The Orkney IJB makes decisions about integrated services at each meeting. The Orkney Health and Social Care Partnership (the Partnership) are then directed to deliver services based on those decisions.

Our Workforce

The Partnership has over 1000 staff working for either from NHS Orkney and OIC. This includes staff who provide frontline care services, business support staff, and senior and operational managers.

The Orkney Health and Social Care Partnership recognises that people are at the heart of everything we seek to achieve. Through the hard work, dedication, and commitment of NHS Orkney and OIC employees, we maintain a focus on contributing to the health and wellbeing of the people who live in our communities.

There are workforce capacity issues being experienced in health and social care, locally and nationally, in relation to having the right staff with the right skills, in the right place, at the right time.

We are in the process of writing our new health and social care workforce plan. This will show how we will work with our staff to deliver the priorities in this Plan.

We will also consider how we can attract younger people into a career in health and social care, as well as train and support our people to use technology and innovation to constantly improve the care we give to people in Orkney.

IMAGE: Photograph of a smiling healthcare worker in blue scrubs seated at a computer workstation, using a video consultation system. The image illustrates staff delivering health and social care through technology.

What is a Strategic Plan?

The Scottish Government asks each Integration Joint Board to have a Strategic Plan for the services that they deliver. The plan must:

• Show how the nine National Health and Wellbeing Outcomes for Health and Social Care Integration will be delivered locally. (You can see a list of the Scottish Government’s nine health and wellbeing outcomes here.)
• Clearly set out the Orkney IJB’s priorities and explain how it will deliver those priorities.
• Identify different ‘localities’ included within the local authority area.
• Be developed in collaboration with ‘stakeholders’ such as patients, people who receive services, staff, third sector providers and Orkney IJB members.
• Be used as the basis for an ‘Implementation Plan’ which will set out how, when and by whom, the aims set out in the plan will be achieved.
• Be regularly monitored and evaluated, including clearly showing how its aims are being achieved in the Orkney IJB’s Annual Performance Report.
• Be updated every three years. (You can see the Orkney 2016 – 2019 and 2019 – 2022 Strategic Plans here: 2016 – 2019. 2019 – 2022.)

Our last Strategic Plan ran from 2019 – 2022, with two of those years heavily impacted by the COVID-19 pandemic. Although we were unable to deliver on all the priorities, we continued to provide services for those in need of health and social care services.

(You can see our Annual Performance Report here.)

IMAGE: Photograph of an older couple looking at and using a tablet computer together. The image illustrates service users using digital technology.

Annual Delivery Planning and Performance Review

Each year, the Orkney IJB will identify and agree actions in support of this three-year Strategic Plan and include these in an Annual Delivery Plan, which will be costed and prioritised. We will report on progress towards each Annual Delivery Plan, and this overarching Strategic Plan, every year through our Annual Performance Report. More regular quarterly performance reports will also be provided to the Orkney IJB and thereafter to the Health Board and Council.

The Annual Delivery Plan will be published on the Council’s website, once approved.

Our Pandemic Experience

We couldn’t write this plan without acknowledging the considerable challenges that we all faced, and continue to face, owing to COVID-19. We are extremely grateful for the kindness, collaboration, flexibility, and speed of the response of our staff, partners, and communities, which ensures that support continues to the most vulnerable in our communities.

We have been forced to adapt quickly, adopting new approaches and flexible, remote working, reducing the need for people to be in a specific building. We have become better at information sharing, across all our partner organisations, and supporting adults and young people to manage their own conditions safely at home. We will continue to use and further develop new approaches as part of transforming how we deliver our services.

IMAGE: Group photograph of healthcare staff wearing medical scrubs and face masks in a hospital corridor. A colourful mural is visible behind them.

How We Can Work Together

What WE will do to make a difference

• Work with communities to ensure their voice is heard.
• Focus on prevention and enablement.
• Be realistic: provide safe and effective services in an increasingly challenging financial environment.
• Be more creative, courageous, and innovative.
• Build for a future where digital technologies are more integrated in our work and used more widely by the population.
• Deliver on our plans.

What YOU can do to make a difference

• Take control of your own health and wellbeing.
• Keep active whatever your stage in life.
• Be informed about how to best address your health concerns.
• Be mindful of the wellbeing of others in your community.
• Get involved in your local community.
• Join our conversations to help shape health and social care services for the future. (Please see the final section of our plan, “Get Involved”.)

IMAGE: Photograph of two people’s forearms and hands joining in a supportive clasp, illustrating cooperation and working together.

Localities

As we mentioned earlier, the Public Bodies (Joint Working) (Scotland) Act 2014 requires the Orkney IJB to identify localities for the planning and delivery of services at a local level.

The development of localities supports the principle of collaborative working across primary and secondary health care, social care, and third and independent sector services. There is a strong focus on community involvement and engagement, which is at the heart of one of our Priorities, Community Led Support.

We have identified two localities in Orkney, one across the Mainland and linked south isles, and one across the ferry-linked isles. These two localities are sufficiently large to allow us to plan and develop services, whilst also allowing local involvement and recognising that every parish, and every island, is different.

IMAGE: Photograph of a rural Orkney landscape with green fields, scattered houses, a winding road, and coastal water on both sides. It illustrates the island communities and localities served by the Partnership.

Our Priorities

Listening to and engaging with our communities is very important to us. The priorities for this Strategic Plan came from a number of consultation exercises that have taken place, across Orkney, in recent months. We used these to help us identify our six Priorities, rather than run another consultation at a time when we are still managing the challenges of the pandemic.

We have compared these consultation responses with a Joint Strategic Needs Assessment (JSNA) that we undertook in the autumn of 2021. (This is an assessment we do regularly, identifying where there is the most need for health and social care services.)

This allowed us to identify themes that were consistently highlighted by you, the government, and our staff, and then compare this with the information we had collected for the JSNA.

Consultations that we have taken consideration of are:

• NHS Orkney Clinical Strategy 2022 – 2027.
• The Island Wellbeing Survey 2022.
• The Draft Child Poverty Strategy 2022 – 2026.
• The Orkney Mental Health Strategy 2020 – 2025.
• Dementia Strategy 2020 – 2025.

IMAGE: Photograph of a green road sign reading “Priorities” against a blue sky.

Our Priorities

• Unpaid Carers.
• Supporting Older People to Stay in Their Homes.
• Community Led Support.
• Mental Health and Wellbeing.

Two overarching Priorities encompass our approach:

• Early Intervention and Prevention.
• Tackling Inequalities and Disadvantage.

IMAGE: Diagram showing four central priority blocks—Mental Health, Carers, Older People, and Community Led Support—surrounded above by “Early Intervention and Prevention” and below by “Tackling Inequalities and Disadvantage.”

Tackling Inequalities and Disadvantage

We recognise and acknowledge that each of our priorities has the potential to be affected by the inequalities and disadvantages that some people in our community experience. To address this, we will:

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

Prevention and Early Intervention

Prevention and Early Intervention, across the lifespan, is vital to all of our priorities. We want to empower people to be more aware of, and responsible for, their health and wellbeing, whatever their age or background.

We are committed to improving the overall health and wellbeing children, young people, and adults, in Orkney. Communities and the local environment play an important role in promoting good health and providing opportunities to be active, to be involved, and to connect with others.

What are we doing now?

Health and social care services are required to work within a clearly defined set of rules and regulations. Some of the services we provide are statutory (meaning we are required to deliver these services, by law). Some examples of statutory services include protecting vulnerable children, young people, and adults, or delivering primary care and community services, such as GP and Care at Home services. We continue to deliver high quality core services, while exploring how we can change the emphasis of our services to preventing crises from happening.

What do we plan to do?

We aim to redesign how we deliver services so that people get the right advice and support, meaning they need crisis services much less often: we want to avoid, where possible, people waiting until they have a crisis in their life before they seek and have access to support.

Our strengthened focus on prevention and early intervention will promote good, positive, physical, and mental health and wellbeing, for all people, whatever their age.

One such initiative is our Frailty Project. We estimate there are more than 2500 people in Orkney living with frailty. This project will improve awareness and understanding, enabling the identification of frailty at an earlier stage, and enable people to better manage their condition.

How will we know we have made a difference?

Prevention and early intervention can take place at different stages of the progression of a person’s condition, including before it has developed, when it is in its early stages, or when it is more established. At every stage this can improve a person’s condition by slowing down, or stopping, further development or complications.

We will strengthen our approach to prevention and early intervention by further developing multi-professional teams in primary care. This means that physiotherapists, mental health nurses, pharmacists, community link workers, and other specialist nurses and practitioners will work alongside GPs and practice nurses. This will see patients able to receive support from the most appropriate professional, at the earliest opportunity, and help support adults and young people to adopt healthy lifestyles, reducing their risk of developing a wide range of health problems.

The Orkney Emotional Wellbeing Service, delivered on behalf of the Partnership by Action for Children, provides a support service to young people and their families. The service receives regular praise, with young people saying that they feel they are heard in meetings, whilst parents have seen the positive impact upon their children. This service allows the NHS, the council and other services from across Orkney and beyond, to build an effective network of support around young people and their families, ensuring they get the right service at the right time.

Unpaid Carers

Unpaid Carers are at the heart of everything we do. The fact is, without Unpaid Carers, the social care system in Scotland would fall apart. There are simply not enough people to look after everyone who needs some help with their care.

This was recognised by Scottish Government in the Carers Act. This act, introduced in 2018, entitles Unpaid Carers to get help from their local authority. But sadly, most people providing this incredible support for their loved ones don’t even know they are entitled to support!

What is an Unpaid Carer?

An Unpaid Carer is anyone looking after a loved one who needs help with their care. It could be a family member, friend, or a neighbour. They might have an illness, a disability, a physical or mental health problem, or an addiction. And Unpaid Carers can be any age, too. For example, many young people look after parents and other family members.

You do not have to be related to, or live with, the person to be a carer. You do not need to be registered as a carer.

Did you know, in 2020, Oxfam calculated the value of work done by Unpaid Carers in Scotland to be £36 billion!

It is estimated that there are between 700,000 and 800,000 Unpaid Carers in Scotland. This was before the pandemic – some polls suggest there could now be more than 1 million.

GILL’S STORY

Gill provides care for her elderly mother. But the COVID-19 pandemic caused all sorts of problems.

“We had planned for our children to be able to provide some support but, of course, that could not happen during lockdown. As a carer you were simply locked down with your beloved family.”

With Parkinson's, Dementia and other conditions, Gill’s mother can find life challenging and frustrating, being unable to carry out some of her own personal tasks, which can have a knock-on effect for those doing the caring.

Crossroads were able to help, not only through advice and information, but by providing respite care each week – allowing Gill to have a short break out of the house.

Gill explained: “Mum’s carer is called Morag and she comes every Monday for two hours. When mum sees her coming her face lights up like a Christmas tree! Knowing we can leave mum with someone she really likes and feels comfortable with is such a blessing.”

IMAGE: A page panel headed “GILL’S STORY” presents Gill’s account of caring for her elderly mother during the COVID-19 pandemic, including the support and respite care provided by Crossroads.

What are we doing to help Unpaid Carers?

We recognised the extraordinary work of Unpaid Carers in our last Strategic Plan, making their support one of our strategic priorities. Some of the things we have been working on to support Unpaid Carers during the last three years include:

• Developing an Adult Carer Support Plan for adult carers, and a Young Carer Statement for young carers.
• Improving ways to identify carers.
• Development of a short break statement, showing how we will work with carers to ensure they get a break.

But there is so much more to do. We think there are around 4000 Unpaid Carers in Orkney, and we want as many of them as possible to recognise that they are an Unpaid Carer, and seek the support that is available to them.

What are our plans to continue supporting Unpaid Carers?

Along with our third sector partners, we will:

• Continue to work hard publicising the support available to our Unpaid Carers.
• Further invest in services that allow Unpaid Carers to take a break from their caring responsibilities.
• Train our staff to identify Unpaid Carers and help them to access support.
• Offer an assessment (called an Adult Carer Support Plan or Young Carer Statement) to everyone who wants one.
• Develop a strategy to specifically address the needs of young carers.
• Speak to Unpaid Carers regularly and record how they feel about the support they are receiving to carry on with their caring role.

How will we know we are making a difference to Unpaid Carers?

As more people become aware of the support available to Unpaid Carers, we expect to offer more Adult Carer Support Plans and Young Carer Statements. We will also record how many staff are being trained to identify Unpaid Carers.

The ultimate test is to ask people whether they feel they are supported. The more people who say they do, the better our support will be.

Where can I find out more about Unpaid Carers?

We have published a strategy explaining how we will help Unpaid Carers. You can find it here.

Additional information for Unpaid Carers can be found on the Carers Trust website here.

The carer support service in Orkney is delivered by Crossroads Care Orkney. You can find their website here. They are able to offer a number of services for Unpaid Carers, including information, advice, emotional support, advocacy, and training, as well as respite care.

IMAGE: Photograph of two people holding hands across a table beside a cup of tea, illustrating personal support and caring relationships.

Supporting Older People to Stay in Their Own Homes

Whenever we hear from older people, both here at home and further afield, 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 sheltered or residential care. Whilst we have invested significantly in improving sheltered and residential care for our most frail and vulnerable older people (such as the new care home in Stromness, and the planned new care facility in Kirkwall), we recognise people want to receive support, wherever possible, at home.

What have we done?

In an effort to meet the demand for the Care at Home Service, the Partnership has recently adopted a new fast-track recruitment procedure that saw the appointment of 12 new carers in a single day.

We have recognised that technology, too, will play a crucial part in helping people to stay at home, for as long as possible. For example, we are using digital technology to deliver speech and language therapies, via Attend Anywhere, which allows patients to have an appointment where they want and not be dependent upon attending a healthcare facility.

What we plan to do?

As the cost of living continues to rise, we recognise that fuel poverty will become an increasing challenge for families throughout Orkney. We will take every opportunity to identify people using our services who can benefit from the national support initiatives available to them, as well as publicising how people can seek support.

The Partnership has been following some exciting developments in The Hope and Sanday, where they are pursuing co-housing projects. These initiatives look to tackle loneliness and isolation among older people by building rented homes, where people can live independently, but within a supportive community. By supporting each other, this innovative approach will mean people can stay at home longer, and we will continue to support these groups as they look to bring their plans to fruition.

In terms of wider housing development, the Council’s Strategic Housing Investment Plan is looking to develop 328 social rented and affordable home ownership properties over the next five years, between OIC and Orkney Housing Association Limited. We will work closely to ensure that affordable housing helps to support older people and provide the housing that is necessary for Orkney’s ageing demographic. Several of Orkney’s island development trusts are utilising funding from the Scottish Land Fund and the Rural and Islands Housing Fund to develop affordable housing in their communities. Some of this housing will be aimed at older people.

More help is available to help people remain in their homes for longer from the Care and Repair Orkney service, which contributes towards the installation of adaptations at home, such as stair lifts and hoists, as well as small repairs.

We are aware that many people will be in or faced with fuel poverty and we will look to work with partners to help these households access the funding and support that is available. This is increasingly important in light of the huge rise in energy prices.

Another initiative, looking to get people home from hospital as soon as possible, is the Home First Service. This allows for a period of safe assessment and reablement, within people’s homes, where we can more accurately look at their long-term needs, and ensure we can deliver the right support to enable them to be at home, rather than in hospital, or a residential care home.

Technology is also helping us to keep people at home. We will be trialing the use of tablet computers to carry out reviews with people who use services, when it is not always possible, or safe to carry out a visit, such as during the COVID-19 pandemic.

We will also be using an app that enables people to keep in touch with family and friends. This will enable us to send messages to people who, for example, are unable to answer a phone. The ability to communicate with them this way will be very helpful.

How will we know we have made a difference?

We understand the unique challenges of an ageing population, and recognise the importance of the way we need to adapt and change how we deliver services now, in order to make them sustainable for the future. We will speak to older people and make sure they have been given every opportunity to stay at home, and expect to see the proportion of people who are looking to move into one of our residential care facilities, to fall, with more people able to receive support in their own home.

Last year, the Care at Home Service:

• Made 160,160 visits (more than 400 per day).
• Spent a total of 88,342 hours with people who receive services.
• Staff covered 564,000 miles visiting folk.
• We currently have 36 teams of carers.

IMAGE: A text panel quotes people describing how receiving support at home made them feel more independent and helped them achieve more after leaving hospital.

Community Led Support (CLS)

What have we done?

From the summer of 2019 we talked to our communities about what is important, what would help, and what matters to them. From that we opened up Blether spaces in Kirkwall, Sanday, and St Margaret’s Hope, where people could come and find out what support was available if they were struggling, or if they were worried about a loved one.

We delivered workshops in ‘Good Conversations’ to share understanding about framing conversations to capture what’s important to people. Unfortunately, the pandemic struck just as the Blethers were becoming established and resources had to be redeployed to meet the needs of those most vulnerable in our communities. The Covid Community Support Hub, hosted at the Picky Centre, was a Blether by another name, albeit one that people phoned into for support, as opposed to face-to-face contact.

During the first lockdown, over 800 adults and young people were asked to shield as a result of underlying health conditions and Hub staff, redeployed from across Orkney Islands Council, worked alongside local Social Work teams and Allied Health Professionals to support shielding people with weekly welfare calls. Many parishes and islands led their own successful community support efforts. We can learn from these as we move forward, designing collaborative approaches and engaging further with communities to develop this. We are currently developing our CLS Implementation Strategy, and will publish it later this year.

IMAGE: An illustrated Community Led Support diagram shows a person’s life and support network, including “What matters most to me?”, “How do I stay healthy and safe?”, “What is going well?”, “What is not going well?”, “How I want my life to be”, “Outcomes”, “Plans”, “Hopes”, “Dreams”, “Personal Budget”, “Services”, “Personal”, “People / Social Capital”, “Community”, “Statutory and paid support”, and “Resources.”

IMAGE: A text panel headed “WHAT I LOVE ABOUT CLS!” contains a testimonial about meeting people from different professional fields and the Third Sector, finding common goals and aspirations, and the potential for CLS to harness their skills and experiences to support and care in Orkney. The final sentence is cut off in the source image and is not fully legible.

Mental Health and Wellbeing

Why is mental health and wellbeing important?

We think it is important that people who experience mental health problems receive the same level of social and clinical support as those with physical health problems and have made a commitment to improve and develop mental health and wellbeing supports across Orkney so that people can live longer, healthier, and more fulfilling lives.

Mental illness is one of the major public health challenges in Scotland. Around one in three people are estimated to be affected by mental illness in any one year.

What are we doing to support mental health and wellbeing in Orkney?

• Orkney’s Mental Health Strategy (2020 – 2025) sets out a framework for the improvement and development of mental health and wellbeing supports, which was partly informed by the Scottish Government Mental Health Strategy (2017 – 2027), as well as what stakeholders (including staff and people who use services) said.
• We have developed a Distress Brief Intervention (DBI) in Orkney, an ‘ask once get help fast’ approach which offers connected compassionate support to people experiencing distress. This service is being delivered by Orkney Blide Trust and Penumbra in partnership with the Scottish Ambulance Service and Scottish Police Force.
• Mental Health support for children and young people provided by the Child and Adolescent Mental Health Service (CAMHS) is to be greatly expanded from two to fourteen people.

IMAGE: A text panel states: “Mental illness is one of the major public health challenges in Scotland. Around one in three people are estimated to be affected by mental illness in any one year.”

IMAGE: A testimonial panel states: “I NOW HAVE A PLAN AND MORE HOPE FOR THE FUTURE!” and describes being trapped in mental health and relationship difficulties, debt, unsuitable housing and substance misuse, before receiving coordinated support and gaining a plan and more hope for the future.

What future plans do we have to improve mental health and wellbeing?

Some of our future plans to improve mental health and Wellbeing services include:

• A greater focus on prevention and early intervention, including increased support for our children and young people.
• Providing opportunities for statutory health and social care services, third sector organisations, communities, and individuals, to continue to work together in a way that puts people first and makes the best use of local resources.
• Increasing training and capacity of staff across health and social care, including the third sector, so that they have the knowledge, skills, and resources to provide the sort of support that people need.
• Adopting a recovery-based approach that recognises the strengths and resources of individuals, promotes rights, choice, and self-management, and helps people living with mental ill health to live the best life they can.
• Encouraging everyone in our community to work together to reduce stigma and to encourage positive conversations about mental health and wellbeing.
• Providing houses for people with enduring mental health conditions.

How will we know we are making a difference?

• Many people with significant mental health issues currently receive support outwith Orkney. Investment in our services will see an increasing number of these people return home to Orkney.
• Early intervention will see a reduction in the number of people who need to receive support outwith Orkney.
• As we see earlier access to services, we will be seeking to reduce the number of people who take their own lives.

Between 2012/13 and 2018/19 the number of people diagnosed with depression in Orkney increased by 102%. It is anticipated that this number will have increased significantly as a result of the COVID-19 pandemic.

Facts and Figures

Population and Projections

Orkney’s population has risen from 19,220 in 2001 to an estimated 22,400 in 2020.

IMAGE: Population and projections infographic showing the proportions and population figures for age groups 0 to 15, 16 to 64, 65 to 74, and over 75 in 1982, 2002, 2022, and 2042, with projected changes between 2022 and 2042. It shows the under-65 population declining while the over-75 population is projected to increase by 58%, from 2,714 to 4,293 people.

Older People

• There has been an increase from 500 to 896 telecare and/or community alarm clients between 2015/16 & 2019/20.
• There were 187 clients receiving home care services on 31 March 2021.
• 60% of patients with multiple hospital admissions during the year were aged 65+.
• 70% of emergency admissions in 2019/20 were for people with Long Term Conditions.
• In 2019/20 80% of people who passed away spent their last six months of life either at home or in the community.
• The number of people suffering from dementia is once again on the increase following a dip during the pandemic, with a most recent figure of 160. A further significant increase is estimated up to 2041.
• Occupancy rates across Orkney’s care homes averaged 90% between 2009 and 2019.

Life Expectancy

Source: NRS Life Expectancy

COVID-19

• As of 1 March 2022 there has been a total of 13 Covid-19 deaths in Orkney.
• As of 1 March 2022 there has been a total of 3,457 Covid-19 cases in Orkney.
• As of 2 March 2022 78.9% of over 12’s in Orkney have been vaccinated with 3 doses.

IMAGE: Older People and COVID-19 infographic presenting statistics on telecare, home care, hospital admissions, long-term conditions, dementia, care-home occupancy, life expectancy, COVID-19 deaths, COVID-19 cases, and vaccination coverage.

General Statistics

• It is estimated that there could be up to 3,684 carers in Orkney, up from 1,970 in 2011.
• Acute and medical specialties, which account for the largest group of beds, were 97% and 94% occupied respectively.
• In the 2011 Census 6.5% of Orkney’s population reported having a disability (Scotland 6.7%).
• Between 2010/11 and 2019/20 hospital occupancy was around 80% across all specialties.

Mental Health

• During 2019/20 there were 100 hospital admissions with a psychiatric diagnosis. Broadly in line with previous years.
• There was a 56% increase in mental health referrals from 562 in 2016 to 890 in 2019. Referrals have risen further in 2020.
• In 2018/19 there were 738 people suffering from Depression registered at GP’s in Orkney. This is a 102% increase on 2012/13.
• In 2018 84 young people under the age of 18 were referred to the Child and Adolescent Mental Health Service.

IMAGE: General Statistics and Mental Health infographic showing figures for carers, hospital-bed occupancy, disability, hospital occupancy, psychiatric admissions, mental-health referrals, depression registrations, and referrals of young people to CAMHS.

How Housing Services Will Help

One of our priorities is to support people to stay at home. The Scottish Government, too, wants services to try and support people in their home and community, rather than in a hospital or care facility, so it is important that our colleagues from the Council’s Housing Service plan for how they will support health and social care services to do this.

This is called the Housing Contribution Statement, and is a really important link between this plan and the Council’s Local Housing Strategy. It highlights, amongst other things, the need to help people who have physical and other support needs, and identifies a number of areas for action. In fact, one of the of the strategy’s key objectives is to support people to stay at home, something that is called Independent Living.

People who need specialist housing or support to live independently can be found across Orkney's population. Some people need these services for a short time whilst, for others, specialist housing or support will be needed for the long-term.

A link to the Housing Contribution Statement here will be provided once it has been updated.

Financial Implications

The Orkney Health and Social Care Partnership’s budget is funded through delegated budgets from NHS Orkney and OIC – the budget for 2022/23 is almost £58.9 million for 2022/23, which includes an amount of £8 million related to set aside for the delivery of unscheduled acute hospital care.

A Medium Term Financial Plan is being developed to highlight factors affecting the financial sustainability of the partnership over the medium term. This Plan establishes the estimated level of resources required by the Partnership to operate its services, over the next three financial years, given the demand pressures and funding constraints that we are likely to experience.

There are a number of key opportunities and challenges for the Orkney IJB at a national and local level. The most significant opportunity is the Review of Adult Social Care, alongside the proposed development of a National Care Service, on an equal footing to the National Health Service; expansion of support for lower-level needs and preventative community support, and increasing support to unpaid carers.

The onset of the COVID-19 pandemic represented the most challenging and complex financial period in the history of the public sector. The impact of COVID-19 on services commissioned by the Orkney IJB has been unprecedented and required a significant degree of service change within a short period of time, resulting in substantial financial impact. These costs have been refunded in full, but it must be recognised that this is financial pressure is expected to continue in the medium term, as services recover and potential longer-term impacts emerge, which are yet to be fully assessed.

IJB BUDGET 2022-2023

IMAGE: Pie chart titled “IJB BUDGET 2022-2023” showing Orkney Islands Council Contribution of £27,661,000, NHS Orkney Contribution of £23,180,000, and Set Aside Budget of £8,032,000.

Local Context

Due to medical advances and improved quality of care, individuals who require or are in receipt of complex care have substantial and ongoing health and social care needs. These can be the result of chronic illness, disabilities, or following hospital treatment. Social care services were previously more general in nature but there is an increasing requirement for specialist input, as more and more people receive care in their own homes.

Although this challenge is not unique to Orkney, our older population is increasing faster than the national average. In addition, significant numbers of our working age population are leaving the islands, leaving fewer people available to provide the care and support required. Alongside the challenges, the contribution that older people make to our society also needs to be recognised. For example, people over 65 years of age deliver more care than they receive – acting as unpaid carers, child minders and volunteers.

Additional Funding

The Scottish Government is investing over £300 million in hospital and community care, across Scotland, as well as £120 million in mental health. We await full details of how much we will receive, here in Orkney; however, we have already been able to allocate extra money to Care at Home services, as well as our Child and Adolescent Mental Health Service.

While this additional funding is welcome, there will be financial challenges to the Orkney IJB to deliver a balanced budget, over the next three-year period. Future pay settlements, inflation, and contractual commitments, and rising prescribing costs, are expected to continue to add to the challenge facing the Orkney IJB in the medium term. In addition, there is an expectation of savings targets to be met from existing resources which will require substantial transformation in service delivery.

Key Areas Identified to Close the Financial Gap

Transform and Redesign Services

• Introduce a programme of Transformation and service redesign, focussing on identifying opportunities to redesign services and use alternative care models that match the ambitions of the Orkney Health and Social Care Partnership’s Strategic Plan.

Improve Efficiency

• Introduce initiatives to deliver services more efficiently.

Strategic Commissioning

• Ensure services that we commission from external providers deliver the best quality support and focus on the needs of the local population, deliver good quality support, and are aligned to the strategic priorities of the Orkney IJB.

Shift the Balance of Care

• Address a shift in the balance of care away from hospital-based to community-based services.

Prevention and Early Intervention

• Promote good health and wellbeing, help people to manage their long-term conditions, and intervene earlier, reducing the need for people to receive care outwith their own home.

IMAGE: Table listing five areas for closing the financial gap: Transform and Redesign Services, Improve Efficiency, Strategic Commissioning, Shift the Balance of Care, and Prevention and Early Intervention, each with its associated action.

Get Involved

We would really welcome your feedback. Here’s how you can have your say:

• Just drop us an email with your comments and we’ll get back to you: OHACFeedback@orkney.gov.uk.
• We also have a dedicated area within Engage Orkney where you can contribute your views: www.engageorkney.com/.
• You can call us for a chat, and we’ll direct you to the right person! 01856 873535 extension 2601.
• You can still write to us! Our address is: The Orkney Health and Social Care Partnership, School Place, Kirkwall, Orkney, KW15 1NY.
• We are always looking for input from folk and have spaces on some of our strategic groups. Please call us on the number above, for a chat.