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Implementing Community Led Care in the Non-Linked Isles of Orkney

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Implementing Community Led Care in the Non-Linked Isles of Orkney Implementing Community Led Care In the Non-Linked Isles of Orkney 1 This project is a result of a partnership between Voluntary Action Orkney, Highlands and Islands Enterprise, Robert Gordon University, and the island development trusts of Eday, Hoy, Sanday, Shapinsay, Stronsay, Rousay Egilsay and Wyre and the Community Council of Papa Westray. This project was funded through the Aspiring Communities Fund, a Scottish Government fund delivered with European Social Funds. Report prepared by Rosie Alexander, Research Officer With the support of Dr Sue Barnard, Academic Supervisor Report Published: 14th May 2018 Enquiries about this report should be directed to: [email protected] The researchers would like to express their grateful thanks to all who supported with this project, taking the time to meet with the research team, discuss existing health and care services, and share ideas for future developments. 2 Contents 1. Executive Summary ............................................................................................................ 4 2. Context and methodology .................................................................................................. 9 3. The landscape of Health and Care ................................................................................... 10 3.1 Key Policy Drivers in Health and Care ......................................................................... 10 3.2 Home Care .................................................................................................................. 12 4. Health and Care in Orkney ............................................................................................... 14 4.1 Orkney context ........................................................................................................... 14 4.2 Health and Care Priorities in Orkney .......................................................................... 14 4.3 Health and care provision for older people ............................................................... 15 4.4 Locality planning ......................................................................................................... 18 5. Communities and Health and Social Care Delivery .......................................................... 22 5.1 Community co-production ......................................................................................... 22 5.2 Community co-production in Orkney ......................................................................... 24 6. Specific Examples of innovations ..................................................................................... 26 6.1 Health and Care services ............................................................................................ 26 6.2 Community Partnerships in Care Delivery ................................................................. 29 6.3 Community Led services ............................................................................................. 32 6.4 Innovative Community Connections .......................................................................... 34 7. Non-Linked Isles: research findings .................................................................................. 37 7.1 Background ................................................................................................................. 37 7.2 Project methodology .................................................................................................. 40 7.3 Findings: Island Assets and Priorities ......................................................................... 41 7.4 Thematic Analysis ....................................................................................................... 51 8. Discussion ......................................................................................................................... 62 8.1 Home Care Services .................................................................................................... 63 8.2 Community Led Innovations ....................................................................................... 66 8.2 Wider partnerships with Statutory Providers ............................................................ 68 9. Conclusion and recommendations................................................................................... 72 10. References ...................................................................................................................... 73 3 1. Executive Summary • The Community Led Care Research project was set up as a partnership between Voluntary Action Orkney, Highlands and Islands Enterprise, Robert Gordon University and the island development trusts of Eday, Hoy, Sanday, Shapinsay, Stronsay, Rousay Egilsay and Wyre and the Community Council of Papa Westray. • The research aimed to answer the question: How can community led care solutions be implemented in the small island communities of Orkney? • The research aimed to produce the following: o A literature review o A case study of health and social care for older adults in Orkney o Individual case studies of each of the island groups involved in the research, focusing on the island assets and priority areas as identified by the communities. o Innovation case studies of health and social care in communities elsewhere in the UK and internationally. o Recommendations for development of services in the Orkney islands • The following methods were utilised: a desk based literature review, meetings with key service providers and stakeholders in Orkney, and research visits to each of the isles. A workshop (based on nominative group technique) was held in each island group, alongside interviews with individuals who had experience of care as service users or providers, and informal meetings with other members of the community. Background • Following the Christie report (2011) there is a strong policy impetus for communities and statutory providers to collaborate in the design and delivery of health and social care services. The term ‘co-production’ is often used to describe this process. • Personalisation and choice are key drivers in the current health and social care landscape, and the introduction of the Social Care (Self-Directed Support) (Scotland) Act 2013 has allowed individuals greater choice and flexibility in how their care needs are met. • Home Care services nationally are experiencing challenges in terms of recruitment and retention of staff. Issues of low pay and low status also affect the sector. Regulations are coming into effect that require individuals employed by a care service delivering personal care to be qualified at SVQ2. Health and Care in Orkney • Orkney’s Integration Joint Board (Orkney Health and Care) is responsible for health and care services within Orkney. • Orkney like other communities, is facing a critical issue in terms of budget pressures on statutory services and an ageing population. 4 • Alongside home care, wider health and social care provision can impact on individuals’ ability to remain in their own home. In Orkney, services available on the isles differ from services available on the mainland – for example there are no care homes, and extra care housing (a form of housing which includes provision of personal and domestic care) is limited to Westray. In addition, the intermediate care team, the mobile responders, and formal night support services offered through home care are all unavailable on the non-linked isles. • Home-care in Orkney is a service that has received a great deal of scrutiny. With the vast majority of home care services still provided by the council, diversifying the range of service providers has been a key objective. In addition, capacity of home care services is a particular issue in smaller outlying communities. • Under the Public Bodies (Joint Working) (Scotland) Act 2014 Orkney Health and Care is required to identify localities to assist with strategic planning. One of the localities identified is the Isles. Despite a recent consultation taken forward jointly with Community Planning, locality working is still to be properly established in Orkney. Communities and Health and Social Care delivery • Co-production is an approach whereby communities and individuals are jointly involved in the design and delivery of health and social care services. • Co-production is challenging, but has a number of benefits in terms of developing service efficiencies and increasing the ownership of, and engagement with, services. • Recent work in Orkney has frequently identified the need for closer working with communities, and particularly the diversification of health and social care services to include community run and voluntary sector services. Innovation examples • With Joint Integration Boards across the country facing significant financial pressure alongside agendas around personalisation of care and co-production, there are a wide range of examples of innovation in health and social care provision for older people in Scotland. • Innovations may be specific to health and social care services, may include community-agency partnerships, or be entirely community led. In addition, some innovations have sought to more effectively link community and statutory services. • Innovations specific to health and social care include examples of: o Wholescale service redesign following models such as Nuka1 and Buurtzorg2 o Innovations in roles – such as the development of a generic worker o Innovations in services – such as GP beds
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