Enhancing Wellbeing in Our Island Communities

Home , Egilsay, Hoy, Rousay, Shapinsay

Delivery Plan September 2019

Papay Community Council

A Community‐Led Partnership

Enhancing Wellbeing in Our Island Communities: Delivery Plan

Authors:

Sarah Foulds

Denize Lace

Magda MacDonald

Alison Meason

Sarah Powers BSN, RN

Project Manager:

Rosalind Aitken

Project Evaluator:

Rosie Alexander

An Aspiring Communities Fund Project

Date: September 2019

Contents 1 Delivery Planning ...... 1 1.1 Introduction ...... 1 1.2 Project Background ...... 1 1.3 Project Outcomes...... 2 2 Current island community care landscapes ...... 4 2.1 Island of Hoy ...... 4 2.2 Rousay, Egilsay and Wyre ...... 11 2.3 Sanday ...... 19 2.4 Shapinsay ...... 25 2.5 Stronsay ...... 32 3 Communication, Engagement and Promotion Plan ...... 38 3.1 Communication Objectives ...... 38 3.2 Internal Project Communications ...... 38 3.3 External Communications ...... 39 3.4 Communication and engagement in an island context ...... 40 4 Island Promotions Plans ...... 51 5 Evaluation Framework ...... 53 5.1 Background to the Project ...... 53 5.2 Rationale for the Evaluation Approach ...... 56 5.3 Theory of change ...... 59 5.4 Logic models ...... 60 5.5 Evaluation questions ...... 63 5.6 Evaluation and Monitoring Plan ...... 65 5.7 Data collection plan ...... 71 5.8 Ethical considerations ...... 75 5.9 Stakeholder Engagement ...... 76 5.10 Timeline ...... 78 6 Acknowledgements ...... 79 7 Bibliography ...... 79

Appendix 1 Project Structure ...... 80 Appendix 2 Memorandum of Understanding ...... 81 Appendix 3 Project Monthly Reporting Form template/ Evaluation Contact Form ...... 82 Appendix 4 Island survey ...... 85 Appendix 5 Participant Information Sheet ...... 92 Appendix 6 Evaluation Consent Form ...... 94

Table of Figures

Figure 1 Common themes in Island Information flows ...... 39 Figure 2 Island Event considerations ...... 51 Figure 3 Enhancement of events ...... 51 Figure 4 Benefits of logic Models: reproduced courtesy of the Strategy Unit (2016) ...... 57

1 Delivery Planning 1.1 Introduction 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 Hoy, Sanday, Shapinsay, Stronsay, Rousay Egilsay and Wyre, and the Community Council of Papa Westray, through a Memorandum of Understanding signed by all parties (HIE 2019, See Appendix 2).

This project was funded through the Aspiring Communities Fund, a Scottish Government fund delivered with European Social Funds, as such the basis for this project was identified through robust Stage 1 ACF preparatory research work (Ref: ACF/R1/S1/HI/0004) and in itself forms a Stage 2 Delivery project (Ref: ACF/R2/D2/Hl/006).

1.2 Project Background The current project is a response to the research undertaken on the Islands of Eday, Hoy, Sanday, Shapinsay, Stronsay, Rousay, Egilsay and Wyre, Papa Westray between May 2017‐ May 2018 (ACF Stage 1 Preparatory work, Alexander 2019). The Aspiring Communities Stage One Report, ‘Implementing Community Led Care in the Non‐linked Isles of Orkney’ was based on comprehensive research carried out within these nine island communities.

During the research work 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 (Alexander, 2018).

In that work it was seen that there was a real need for island‐based representatives to help co‐ ordinate, develop and facilitate non‐regulated community led care initiatives. The report also flagged up the need for the local Health and Care services on Orkney to work closely with the Island communities in order to deliver Community‐led support. In conclusion the report suggested two recommendations:

Recommendation 1: The Isles communities to continue to build and extend existing community services, including identifying the potential for the development of further services. The isles to also consider the potential for bringing services together into one community led care service.

Recommendation 2: Orkney Health and Care to identify potentials for closer partnership working with communities, including co‐production.

The first recommendation addresses the importance of supporting existing community led services in areas such as transportation and lunch clubs, alongside areas for innovation such as community led

befriending and information services. As such this project is a means of taking forward the first recommendation.

The Islands involved in this pilot project include Hoy, Sanday, Stronsay, Rousay, Egilsay and Wyre, funded though the Aspiring Communities Fund, with a fifth island participating through joint funding from those other islands Development Trusts‐ Shapinsay. All of these communities were engaged and involved in shaping and contributing to the research and to this, subsequent project and they continue to be involved through membership of the Steering Group. The project has been developed with and for those communities in response to their identified needs.

1.3 Project Outcomes The project will focus on older people in four of Orkney’s accessed deprived islands with the emphasis being to address the barrier of access to health and social care services through the development of new and enhanced wellbeing services and the creation of employment opportunities. Typically these communities suffer from fuel poverty, distance from services and demographic decline coupled with challenging transport links. These islands also record lower household incomes that the Orkney mainland, Scotland and the UK.

Those who will benefit directly are:  older people in the partnership islands who currently are unable to access the full range of services available to those living on the mainland  the economy of five island communities through creation of five new roles  out of work individuals who will have access to paid employment  island residents seeking employment/training  Care providers who will be able to direct resources to planned interventions so reducing the need for ad hoc and emergency delivery  Improved communication and networking between island communities and with other partners  Other island/remote/rural communities who can learn from this project

Further project outcomes include:

 Older people in island communities will have increased access to activities and services designed to enhance health and wellbeing  Older people in island communities will be better informed of the services that are available to them  Communities’ confidence, capacity and capability to influence and develop services alone or in partnership has been enhanced  Partnerships and networks are enhanced in order to facilitate knowledge sharing, avoid duplication and adopt innovative approaches  The pressure on statutory services is eased

With a view to supporting Aspiring Communities fund outcomes:

 Community based or community led services supported  Deprived or fragile communities supported  People benefitting from new services/support

Community Care Landscape: Island of Hoy

2 Current island community care landscapes Each participating island has recruited a Community Wellbeing Co‐ordinator whose primary role will be to look at existing services, assess if current services meet the needs of the local community, identify gaps, develop and implement a delivery plan to encourage community led groups to fill the gaps, encourage development of new initiatives designed to enhance health and well‐being in the local community.

2.1 Island of Hoy Denize Lace

The Island of Hoy is ranked the largest archipelago after mainland Orkney measuring approximately 57 sq miles. There are three parishes to the island, Hoy, North Walls and South Walls. According to the 2011 census the population of Hoy was 419 since then the population has stayed relatively static although Hoy at present demographically has an aging population (see Table 1).

Table 1 To show the demographically aging population on Hoy (courtesy of Hoy Surgery 2019)

Community Care Landscape: Island of Hoy

Table 2 to show the demographic breakdown of Hoy’s aging population (courtesy of Hoy Surgery April 2019)

Community Care Landscape: Island of Hoy

Travel to and from Hoy is via the Inner Isle RO‐RO ferry service which offers a regular daily service Monday to Sunday (although there is no Sunday service during the winter timetable) from Lyness to Houton on Mainland Orkney, via Flotta on specific sailings during the day. In the north of the Island the foot passenger service between Moaness‐Gramsey‐Stromness, operates a regular service seven days a week. Stage‐coach bus operators do have a timetable to meet the ferry at Houton however it does not meet every sailing.

2.1.1 Existing Assets Since 2013 Hoy has had a Community Bus provided by the Island of Hoy Development Trust. The bus operates six days a week providing a service from Longhope to Lyness ferry terminal five times a day.

The Island of Hoy Development Trust provides support and funding to community led projects. The Blether is an electronic newsletter produced through the Island of Hoy Development Trust with paper versions available.

Hoy and Walls has a school that offers nursery, pre‐school and primary education. There is a youth club and during the summer holidays Hoy and Walls entertainment group (HAWEG) run a children’s drama group.

The Island is fortunate to have a resident GP and practice nurse, the GP is on call 24/7 and is contactable outside of surgery time via the Balfour hospital. There is a fully operational ambulance staffed by two emergency responders, who are paid if/when called out. The island has retained firefighters who will also assist in non‐fire related emergencies if required. Patients can be transported off island via the ferry day and night, whilst medivac is also an option. Homecare (through Orkney Health and Care) employ three contracted homecarers. Crossroads Orkney, a third sector organisation, has one care attendant based on Hoy at present, they are able to offer personal care, social care and domestic cleaning.

There are two weekly lunch clubs available with a minibus collection service if required. A computer club and craft club are held once a week in the YM Community Hall in Longhope (formerly a YMCA hall), the YM has a working cafe (The Shore) and has a programme throughout the year to put on bingo nights, quiz nights, sales and dances. The Haye Hope club also facilitates a monthly shopping trip into Kirkwall on the mini‐bus for people who are not able to take themselves into Kirkwall without assistance.

The Gable End Theatre has an active drama group which is open to everyone; they also have a regular programme of screening films.

The Hoy Community Council play an important role by representing local views, acting as the voice of the local people which can influence decisions in the planning of local services. The Island link officer supports the Orkney Island Council’s Empowering Communities liaison officer to develop and implement new service delivery in Hoy, working with the Community Council. The Community Council and Hoy Development Trust have just begun to work collaboratively on a Community Action Plan to address the outcomes of a survey completed in 2018 by local residents.

Community Care Landscape: Island of Hoy

The Hoy Trust tends to manage land in the north of the Island and lease out parcels of land to farmers and maintain the land they oversee. The Community Association was taken over by the Hoy Development Trust and now oversee the running of the YM Community Hall. The church is able to offer support to its congregation through weekly services, they also hold occasional bingo nights, table top sales and a once monthly soup and sandwiches lunch open to the whole community.

The mobile library visits on a regular basis stopping at specific locations throughout the day ‐ North Walls School, St Colms Quadrant, Custom House, Cemetery, Brims, St John’s Kirk and French Road.

Hoy and Walls is an active and vibrant community there are at least forty established clubs and groups presently running, though there seems to be little communication as to when and how often they run.

2.1.2 Assessment of gaps in provision of wellbeing services and assets Whilst Homecare (through Orkney Health and Care) have three home carers contracted on the island, a known issue is that they do not have the capacity to provide double handed/ double‐up care, and are lone workers. There is no night care support service or community responders available on the island, although call alarms and falls pendants are available to vulnerable people. The respite facility within the health centre is no longer utilised, and there is no access to an intermediate care team within Hoy.

In 2014 the Island of Hoy Development Trust commissioned a feasibility study into the local provision of personal care, domestic assistance and living support to residents on the Island of Hoy and Walls (Sarah Smith, 2014). The aim of the study was to establish the feasibility of providing more support to the island residents and to improve the working terms and conditions for the individuals, providing these services by delivering these services locally. The study concluded that it would not be economically feasible for Homecare services to be provided at a local level.

Since the 2014 report was written, self‐directed support options have become available, potentially allowing people to have more choice in choosing a care provider. Re‐examination of access to services that are not currently provided locally (for example personal care, respite and social care), may indicate the feasibility of bringing services to Hoy and Walls within this new landscape of health and social care.

In the more recent 2018 research Hoy and Walls respondents flagged up their concern that the homecare for service‐users was often (Orkney) mainland dependant because of the lack of carers, and that long‐ term employment for carers was difficult to establish (Alexander 2018).

In March 2018 the Island of Hoy Development Trust undertook a survey ‘How is life on Hoy & Walls?’ to gain insight into the communities’ hopes and expectations.

Questions asked included:  What do you like best about living on Hoy and Walls?

Community Care Landscape: Island of Hoy

 What do you like least about living on Hoy and Walls?  Ideas and solutions for improvements?  To what extent do you feel your community caters for the following groups? (eg parents and toddlers)  In what way?  To what extent do you agree or disagree with the following statements? (eg Hoy and Walls have adequate social housing)  How satisfied are you with the service provided by the community bus?  How satisfied are you with the current broadband provision?  Overall, to what extent do you feel part of the community?  Taking all of the previous into consideration, how satisfied are you with Hoy & walls as a place to live?

The results of the survey will be a valuable source of data for planning and developing new initiatives to enhance wellbeing. For further investigation:

1) Elderly care (Homecare limitations, intermediate Care, Respite Care, End of life Care) 2) Social care Needs for the Elderly (Isolation, Loneliness ) 3) Small living Aids (what’s available, accessibility) 4) Day Care Provision 5) Accessible information (Drop in Centre,) 6) Befriending 7) Patient transport 8) Drug and Alcohol Misuse 9) Accessing specialist services locally (Dentist, Physiotherapy, Opticians ect ) 10) Further wellbeing issues that may become apparent as this project progresses

I feel that a beneficial knowledge and understanding of the healthcare provisions required on Hoy and Walls can be achieved through looking at existing provisions of Healthcare services and what works. Potential options in regards to finding feasible and sustainable solutions to existing gaps in the provision of healthcare will require a continuing dialogue with existing providers (OHAC), Third Sector Care Providers, health care practitioners, and the community through regular drop‐in hubs.

Denize Lace, March 2019

Delivery Plan: Island of Hoy

Outcomes Delivery Actions Island Short term Longer term Co‐ordinator to attend existing lunch clubs. Explore the possibility to offer the lunch club to people who require extra assistance. Look at potential measures for their inclusion to lunch clubs. Existing lunch clubs member levels maintained, with the additional ability to Increased nutrition, reduction in isolation

Hoy Introduce new service users to existing Lunch Clubs support more service users who need levels additional support to attend. Work with potential service users who are reluctant to use the lunch clubs to have a better understanding of any barriers that may prohibit them from attending. Co‐ordinator to liaise with statutory and third sector Enhance signposting, assess gaps Build capacity organisations to determine services available. Co‐ordinator to look at facilitating patient transfers to Service user has access to transport when doctors/hospital appointment for people who are not able Access to services is increased required for appointments to take themselves. Investigate the feasibility of visit specialist running clinics in Hoy and Walls residents will have access Hoy and Walls ‐Opticians, dentist, physiotherapy and Hoy and Walls residents will have access to to services, improvements to resident audiology services 'life curve' Explore the feasibility of piloting a joint venture with Selbro Hoy and Walls residents will be signposted to

Hoy and occupational therapists supplying small aids for Occupational Health, will be provided with Reduce pressure on statutory services, demonstration purposes for the community to see what is information and awareness will be raised of maintain residents’ life curve available. Resource centre displaying small living equipment both Selbro's services and the many small available for kitchens, living rooms, bathroom/toilet and aids available for people. bedroom areas. Provide general information to families, Potential to provide an opportunity for friends carers or service users. people to look at discuss and try some of the Reduce the need to travel to Kirkwall to Approach the health centre in regard to utilising a room equipment available in the use of assistive access this service and thereby remove a within the centre as the resource centre as this is a equipment to help them manage more barrier to accessing services. accessible premises for people with mobility issues. independently for longer.

Delivery Plan: Island of Hoy

Outcomes Delivery Actions Island Short term Longer term Co‐ordinator to look at potential for establishing a community‐led Respite care team, intermediate care team, over flow homecare team, capacity to support OHAC Co‐production of services within a community led‐ context homecare team for double up visits and availability of social care time. To work collaboratively with third sector and statutory organisations to explore the possibilities of community led care teams that would be able to provide cover for respite Co‐production of services within a community led‐ context care, ITC, double up visits with homecare, cover over flow from homecare when they have no capacity and social care visits to service user allocated time. Promote existing Community Bus service. Maintain existing services Discuss with local groups how talks are going with the ferry company regarding time table, winter Sunday services and Co‐production of services within a community led‐ context pricing of ferry services to island residents are progressing. Explore the potential of a setting up a pool of volunteers. Liaise with VAO befriending service on potential ways to overcome barriers to recruiting local befrienders. Reduce loneliness and isolation in the local Explore the options of a community led initiative combining community. two groups e.g. an island‐based volunteer group who would A sustainable, local befriending/ Hoy not only act as befrienders but would be able and willing to volunteer service established undertake tasks such as gardening, minor DIY, light housework.

Explore the potential of third sector organisations offering Third sector organisations recruit befriending befriending through option 2 (of self‐directed support) employees.

Community Care Landscape: Rousay, Egilsay and Wyre

2.2 Rousay, Egilsay and Wyre Sarah Foulds

Rousay, Egilsay and Wyre: three islands, one community.

The population statistics that were shared in the Community –Led Care report (Alexander 2018) were drawn from the 2011 census, the next census being due in March 2021. The statistics have changed quite dramatically since that last census for the islands, in particular for Egilsay and Wyre. The 2011 census states there were 26 residents on Egilsay and 29 residents on Wyre, the population has reduced since then, population numbers are currently 16 on Egilsay (approximately) and 8 on Wyre. The census records for Rousay however, stated that there were 216 residents, that figure is quite similar as to what it is today, although the demographic has changed, the population is becoming increasingly older, with fewer young families moving to the island and less children attending the local junior school.

Table 3 Rousay Total 206 (49% F 51%M) breakdown figures from Rousay surgery 2016

0 - 4 5-14 15-24 25-44 45-64 65-74 75-84 85+

4 18 14 30 66 49 22 3

Table 4 Egilsay Total 13 (46% F 54%M) not all registered with the surgery (2016)

<5 5-14 15-24 25-44 45-64 65-74 75+

0 1 1 0 5 6 0

Table 5 Gairsay‐ (as at present)

<5 5-14 15-24 25-44 45-64 65-74 75+

0 0 0 0 1 2 0

There is no population breakdown available for Wyre.

Some of the islands’ residents are in receipt of assistance from Orkney Health and Care (OHAC) or may have members of the Here2Help team (through Age Scotland Orkney) visiting, or they may have self‐directed care, enabling them to choose for themselves who and what they require assistance with.

Community Care Landscape: Rousay, Egilsay and Wyre

The weekly lunch club is also popular with some of the island’s older residents, giving them the opportunity to engage with others, play card games or Scrabble and have a two course meal at a reasonable price. 2.2.1 Existing Assets

2.2.1.1 Health Care Provision Primary care and emergency care – Rousay has a GP surgery with a visiting GP who is based at Dounby (on Mainland Orkney), the surgery serves the three islands and Gairsay a privately owned island. For the hours that the GP is not on the island there is a nurse practitioner who is on call 24 hours, 7 days a week. If there is an emergency, depending on the severity, the patient can be transported off the islands by way of medivac or the ferry can be utilised out of hours.

First responders have recently been appointed to support the nurse in the event of an emergency, however, they are still in the induction process. In the event of an emergency where the nurse requires assistance there is a volunteer who is able to drive the ambulance and assist.

There are also retained fire fighters on the island who can assist in an emergency.

To ensure residents of Egilsay and Wyre can see a GP, the GP has a surgery on the islands every 2 months. This is a flexible service, for example if residents need to see the nurse practitioner, the surgery on Rousay will be opened at a time to fit in with ferry times to prevent a long wait for the return ferry. For instance, the surgery would be opened at 07:30 for a resident from Egilsay to enable that person to then return on the 09:00 ferry home.

2.2.1.2 Home Care Provision Currently there is one relief carer employed by Orkney Health and Social Care on Rousay, with another relief carer starting once their induction is complete. There are no carers employed by Orkney Health and Social Care on Egilsay and Wyre.

Here2Help – Assistance with household tasks, shopping, meal preparation. The cost of this is subsidised by the Rousay, Egilsay and Wyre Development Trust (REWDT), who pay two thirds of the cost. The Crossroads Orkney service is available but is not currently being utilised.

A chiropodist visits on a 3‐monthly basis. She ties in the visit to the same time as the lunch club so she is able to see the lunch club people at the venue, other folk who are unable to attend at the venue are visited at home.

Frozen meals are available but are not being utilised regularly.

Care is also provided by families, friends and neighbours, some have private arrangements. There is also a lot of help delivered to people purely through goodwill.

Community Care Landscape: Rousay, Egilsay and Wyre

2.2.1.3 Community Resources The over 60’s lunch club provides a two‐course meal and the chance to socialise and engage in some games such as Bridge, Cribbage or Scrabble.

The Church can be a source of support for the islanders, providing religious and spiritual support. There are services held in the church centre. People are notified of when they are held through The Rousay Review and posters around the island and on the boat.

The Crafthub offers a place for people to meet, every Monday there is a coffee morning, Tuesday is a ‘Yap and Yarn’ session

The mobile library visits regularly and has designated stop off points around the island, there are designated stop off points around the island, these are advertised in the local newsletter‐ The Rousay Review.

There is an annual agricultural show that brings people together. There are also other competitions between the neighbouring areas around the islands that bring the residents together, creatively and practically.

The Community Association in Hoy involves itself with events that promote social cohesion such as dances, they can also assist with some funding if it’s for a charity event.

There is also the Community Council, like any other council, issues such as transport, road conditions, general amenities and new initiatives are established and maintained for the good of the island and its residents. They aim to have 6 meetings a year and the meetings are open to the public.

The latest update of the Local Plan has highlighted what the Development Trust have achieved since they started the development of their 5 year plan which was requested by The Big Lottery Fund.

Some of these achievements include affordable heating for those experiencing fuel poverty, community gardens – providing a polytunnel and allotments and money generated from the turbine to be fed back to the islanders in the form of wellbeing grants or education bursaries. REWDT also subsidise the Here2Help service paying two‐thirds of the cost.

Although it is only a small population there is quite a diverse range of people living side by side. People state that they feel safe and there is a good community spirit, people look out for one another.

2.2.2 Assessment of gaps in provision of well‐being services and assets.

Areas that were identified in the 2018 report (Alexander 2018), that could enhance the provision of care on the islands include:

 Night carers – There are no night carers on the islands, although there are a several elderly residents who have alarm pendants that is linked to a central number and in turn that will

Community Care Landscape: Rousay, Egilsay and Wyre

trigger a phone call to a designated person to go and check on the individual in the event of a fall or other event.  Respite – There are no provisions for respite on the island for those receiving care from families or for the carers themselves. The individual would have to go to the mainland.  Physiotherapy – Residents are expected to travel to the mainland Orkney for physiotherapy, the reason for physiotherapy requirement could be a barrier to the individual managing the journey into to Kirkwall.  Mental Health – There are residents who experience issues relating to mental health: the carers would benefit from further training as would some of the families or other residents of the islands. There have been concerns raised regarding the access to mental health provision (Alexander 2018).  Dentist – There is no visiting dentist.  Chiropody – Although the chiropodist visits the island, I have been told that there are still some elderly residents that do not qualify for a home visit or island visit. This will be looked into further.  Nutrition – The nutritional needs of some of the islanders is at risk, some due to lack of knowledge in food preparation, others may be due to other reasons, for instance financial constraints such as fuel poverty. Concerns raised in the 2018 workshop included a perceived room for improvement of the provision of fresh fruit and vegetables on the islands and the potential closure of the local shop.  Heat Smart Orkney – This service diverts unused energy into households to provide affordable heating for those experiencing fuel poverty.

Transport – An intrinsic element to all of the above is the availability of transport within the islands to enable residents to either visit one another, go to coffee mornings or attend GP appointments or get to the mainland for hospital appointments. There are good transport links to the Orkney Mainland by ferry, although during the winter months there is no Sunday sailing, there is a bus service that meets the ferry then goes into Kirkwall. Bus transport is available on a Thursday and booking in advance is required. There is a taxi service which also needs booking in advance, this is not available all year round and is aimed at taking visitors around the island in the summer. Some elderly people have stated that due to the lack of accessibility of transport they sometimes feel isolated. There will be some discussion soon with the transport providers about how improvements can be made to the existing transport system and this will be fed back accordingly.

Community Care Landscape: Rousay, Egilsay and Wyre

My aim will be to connect with these people and the providers and look at how the roles may be enhanced further. I would also be approaching those people that are not in receipt of such assistance, whether this is due to lack of information or understanding or pride, not wanting to ask for help.

I want to promote choice and ownership of services for the individuals, i.e make the service fit around the individual, not the individual fitting around the service.

A way to combat isolation may be through the Adult Befriending Services, who have had success in the isles with group–focused activities. However, befriending on a one‐to‐one basis may not be as successful, as the issue the islands face is that it is generally the same people who deliver the care/home help services who would be the Befrienders.

Sarah Foulds, March 2019

Delivery Plan: Rousay, Egilsay and Wyre

Outcomes Island Delivery Actions Short term Longer term

REWDT have provided the children of REW with a book of 50 boat tickets free of charge. Coordinator will liaise with other agencies to establish what other services are available outwith REW that may be able to assist with hospital appointments or social/sporting events. Discussions will be taking place soon with the local bus provider to establish whether there Continuity of transport services. Improve the will be more availability for the local bus service. The need for a 7‐day ferry service has More people using existing wellbeing of residents both physically and Wyre previously been highlighted ‐ this has been featured in The Orcadian. Coordinator will liaise transport facilities. mentally by enabling ease of access to with Orkney Ferries for further information. REWDT have an electric vehicle that can be hired Appointments to be appointments or social activities, promoting Egilsay,

out at a reasonable cost. accessed more easily. choice therefore reducing feelings of isolation. more people using existing Information swap on what exists/ works on other islands transport links Maintain existing transport services Rousay,

First responders/ambulance drivers currently being appointed. Promote recovery in an Improving recovery rates for residents, feeling of Liaise with other (private) agencies. Recent contact with The Hygge clinic has been made to emergency situation. reassurance that help is close by in an emergency establish the feasibility of therapists coming to the islands.

Lunch club already in place ‐ encouragement for others to join in. For those not wishing to Wyre engage in a social setting, meals are provided from The Triangle club to be eaten at home. Facilitate accessibility to foodbank if a need is recognised. Frozen meals are available ‐ Encourage more people to residents are aware of the service but are not utilising it. attend Maintain existing services Egilsay, Help promote a more diverse range of food

Rousay, shopping to enable a more Better nutrition promoting physical wellbeing, Assisted shopping trips, nutritional education. balanced diet. reduction in isolation. Promote independence

Delivery Plan: Rousay, Egilsay and Wyre

Outcomes Island Delivery Actions Short term Longer term Promotes wellbeing and Look at alternatives to large groups. Some residents regularly attend neighbours houses each reduces isolation for both Continues to promote wellbeing and provide a week for meals. parties. varied diet.

Explore potential for new initiatives to address risk/ barriers for existing community ‐led Facilitate and enhance initiatives ‐ e.g. Game clubs (small groups), befriending. existing initiatives Sustaining the services

Defibrillator network ‐ 3 on Rousay, GP, School, Fire station. Defibrillator map. Community heartbeat trust has contacted the development trust regarding the provision of extra defibrillators, putting them in 'zones' around the island and having volunteers trained in the Lives saved use of them and acting as responders activating the defib until emergency services arrive.

Free sanitary products will be provided‐they will be made available around the island in places Reduce stress and distress utilised by the public caused by 'period poverty' Maintain dignity, wellbeing and confidence Wyre

Postal delivery workers often check the wellbeing and safety of some residents if they notice

Egilsay, something different at the address. Royal Mail has piloted wellbeing checks in England and Able to raise Continued maintenance of the wellbeing of the

are currently looking at formalising them nationwide. help/assistance if required older island residents

Rousay, Request from Age UK for Dementia awareness training to facilitate Rousay to become more dementia friendly. Other agencies will be contacted to deliver mental health awareness Raise awareness of mental Reduce the stigma of mental health ‐ promote training. health issues. mental health wellbeing, improve mental health Immediate reduction in Improved physical wellbeing. Improve self‐ isolation ‐ may bring confidence when going out, reduced risk of falls, Start balance group different people together risk of isolation Be able to look at the Promote confidence throughout the islands that feasibility of introducing people's health and wellbeing will be taken care Liaise with the surgery, Orkney Health and Social care and other agencies for proactive more services such as of. Improved mental and physical wellbeing of support to ensure services can be readily available as the population ages. respite facilities. the island residents.

Delivery Plan: Rousay, Egilsay and Wyre

Community Care Landscape: Sanday

2.3 Sanday

Magda MacDonald

The 2011 Census showed the Island’s population to be 498. This is believed to have fallen slightly over the intervening period up to now. The number of residents registered currently with the GP Surgery is 470, but this is not believed to be representative of the total population on Sanday. The school roll has fluctuated from a modern day peak of c.100 dropping as low as c.50. At the moment it is 63. This suggests an overall reducing presence of young families and a growing number of older inhabitants. Further research is intended to explore the Islands age demographic, in order to establish accurately the population make‐up and in particular, for the purposes of this study, the percentage of elderly.

2.3.1 Update research

2.3.1.1 Health Care Sanday GP Surgery has 4 GP’s in attendance on a rota basis, two nurses and administration staff. The surgery has video conferencing technology which allows specialist consultation to be relayed to the island. Orcadians requiring specialised treatment/surgery not catered for by Kirkwall’s Balfour Hospital are transferred to Aberdeen via established links with Grampian Health Board. There is a limited dispensary service with links to Kirkwall chemists for shipping of prescriptions via ferry and local haulier delivery. GP home visits are available as appropriate.

The NHS Podiatrist visits the Island to offer advice every 6 weeks. A private chiropodist visits the island every 6 weeks offering podiatry, pedicure and foot/lower leg massage. Two private professionals resident on the island also offer full body massage treatments.

A Counselling service, Orkney Alcohol Counselling and Advisory Service (OACAS) covering alcoholism, domestic abuse, and mental health, is available every six weeks with referrals through the GP.

The island has an ambulance with one paid staff and a volunteer. The SAS Air Ambulance from Inverness is available in cases of emergency, backed up (in the event of bad weather) by the Coastguard helicopter from either Shetland or Inverness. The RNLI lifeboat from Kirkwall can evacuate patients by sea. There are 6‐7 Coastguard volunteers on the Island, all trained in First Aid. There are also 10 retained firefighters based on the Island with first‐aid skills. In addition, there is a strong local base from various backgrounds and disciplines with basic first aid training eg Minibus drivers, shop assistants, Development Trust employees. There are five defibrillators on the Island, one each in the Community Hall, Fire Station, Lady Village community shop, GP’s car and Nurse’s car.

2.3.1.2 Home Care OIC currently has four contracted carers, and four relief carers to provide care for approximately 7‐8 elderly service users, two with dementia. Crossroads offer three carers on relief contracts. In

Community Care Landscape: Sanday addition, domestic help services if not provided by family members are available via Crossroads by private arrangement. At present, most service users live with their partners. A Personal Alarm for the elderly quick response system is in use, allowing emergency alerts to be answered by volunteer carers.

2.3.1.3 Transport The island is well served by Orkney Ferries (two sailings a day Mon – Sat and one sailing on Sunday) and Logan Air (two flights a day Mon – Friday and one flight on Sat and Sun). There is a community mini bus (Sanday Bus) belonging to Sanday Development Trust which meets ferries on arrival and offers on‐demand transport from any roadside location to the Ferry Terminal. Transport to the airport is by arrangement. There is also a private taxi service. The Sanday Bus also takes elderly residents on a weekly shopping trip to the island shops and to the Café at Heilsa Fjold. Sanday Lunch Club have their own minibus.

2.3.1.4 Community Assistance Sinclair Stores is the island’s largest and located outwith the two main settlements (Kettletoft and Lady Village). A second Community Shop is situated in Lady Village. A hairdresser offers home visits by appointment.

2.3.2 Existing assets Sanday has an active cross‐generational community scene, most aspects of which directly impact upon the care and well‐being of elderly residents:

 The Community Swimming Pool is available for adult public use on 4 occasions a week.  A well‐equipped Fitness Room is available 6 days a week.  Health Walks offer short safe fun walks supported by trained leaders, aimed at all age levels. These are held weekly during the summer months.  A Community Garden Project offers an outlet for keen gardeners. This is a sociable activity for volunteers, everyone welcome.  An Afternoon Club for over 50’s is held every second week alternating with a craft workshop.  A Ti Chi class meets weekly offering soft exercise for all age groups.  The Sanday Soulka festivals take place over three weekends in the year, May, August and September hosting a variety of social, musical and sporting events.  An annual Agricultural Show takes place each August, very popular with cross‐generational community members.  The community hall regularly hosts Bingo, Whist, Bowls and Badminton.  There are two church facilities on the island which offer religious observance opportunities for locals and visitors alike.

2.3.3 Assessment of gaps in provision of well‐being services and assets. The Stage 1 project research (Alexander 2018) conducted a survey and research exercise across Orkney and found regarding the Isles generally the greatest barrier to delivering care is the human resources to do so, followed by financial constraints. It concluded communities as a whole would

Community Care Landscape: Sanday benefit from strengthening in order to avoid additional strain being placed on the resources and systems in place.

The ‘Care 4 Sanday’ Group have been working towards establishing very sheltered housing and a care home/respite home to include facilities such as a day care centre; ‘step up/step down’ care; and a safe and hygienic space for visiting health specialists. This would not only enable residents who require 24‐hour care to remain on the island that is their home, surrounded by family and friends as opposed to being relocated remotely. This would also offer a wide range of local employment opportunities at a variety of skill levels, enabling existing islanders to obtain extra employment as well as potentially attracting new families to Sanday.

Conversations with the local GP’s revealed a desire for Physiotherapy, Dental, Optician and Audiology services to be available on the island, as opposed to being by appointment in Kirkwall only. It is thought that this would only need to be provided on a visiting, part‐time basis. Slimming/ Weightwatcher’s‐type classes would be a desirable and popular option for residents.

Farmhouse Kitchens provide a home delivery service for daily meals at a set price and proved popular with elderly residents. Unfortunately, this private service is due to end. For those unable to cook regularly for themselves they will more dependent upon the help of others, possibly with economic or dietary implications.

There is no organised ‘befriending’ service on the Island despite past attempts to establish this potentially beneficial facility.

There is no inter‐island fast boat ferry service meaning any inter island travel must pass via Kirkwall, making short journeys impossible for most of the year.

Additional priorities for health care improvements for Sanday were identified by residents at workshops and reported in ‘Implementing Community Led Care In the Non‐Linked Isles of Orkney’ Alexander 2018). These included:

 Earlier intervention  Better discharge process  More help to adapt houses  Respite room  Improved availability of aids  Improved information about support and aids

2.3.4 Going Forward In order to gain a comprehensive understanding of the state and needs of the Island’s elderly population in terms of their care and well‐being, it is my intention to arrange a series of drop‐in sessions, firstly to introduce the project to islanders and then to keep them informed of progress, maintaining effective engagement.

Community Care Landscape: Sanday

In acknowledgement of the likely lack of mobility amongst elderly service users and given the scale of the Island, it should be possible to reach all impacted individuals on a one to one and confidential basis, in order to hear personal experiences and invite ideas for service improvement.

This will be done in consultation with the GP Surgery and local carers by drawing upon local knowledge and word of mouth over the short term. We will then be in a better position to understand how well existing assets are being used and how best to optimise the Island’s overall community led care‐related infrastructure, leading to the preparation of a bespoke plan for future sustainability.

It should also be possible to establish whether there is any correlation between gaps in service provision and geographical location on the Island, in other words to determine the extent to which physical isolation contributes to problems with service provision and, on an Orkney wide basis, whether there are any tangible differences in issues to be found between the islands.

It is envisaged future plans might include improved communication links between service providers and users to meet the gaps identified and the expectations arising out of planned consultation. The precise ideas will come from the aforementioned consultation processes, but the aspiration will be to respond effectively to community opinion.

Delivery Plan: Sanday

Outcomes Island Delivery Actions Short term Longer term

Raise awareness of existing services and their limitations, look at options such as People are better informed of existing services, community buses, incl. electric minibuses, and solutions to overcome barriers to Well‐being coordinator has a good understanding Securing an effective transport access of current situation service New methods of working are Information exchange on what exists/ works on other islands Service providers informed of alternatives implemented Networking between islands first Establish desire for and look at transport structures for community (buses, planes Review and analysis of results presented to the point of contact in developing and community ferry) community and other stakeholders effective relationships

Increased knowledge of assets and

Assess existing Assets (via update of research) Prepare inventory of assets optimised accessibility and usage Explore feasibility of 'time swapping'/'skill sharing' Jobs getting done Self esteem and social benefits

Sanday Help local people living in poverty Reducing poverty Explore feasibility of community self‐help initiatives such as 'Community Fridge' Reducing waste Environmental improvements

Carers and nurses given the opportunity to choose Explore feasibility of diversifying ways to provide care, including Buurzog model an employer or to register as a service provider Improved employment conditions

Service users will be given a choice of care Explore feasibility of diversifying ways to provide care, including Buurzog model provider, more suit for purpose service Improved care

Look at whether the local surgery refers people to the Healthy Living/ fitness centre Maintenance of existing services on isle ‐ and whether the fitness centre caters for older generation (ie the trainers Healthier individuals, living to a longer age whilst available on islands, through regular there?) any need for 'social prescribing' maintaining independence usage.

Learning how the churches might support the Organising meetings with the church representatives, assess their capacity for doing project and how they would like to be assisted in Sanday coffee mornings or run some of the events mentioned at the community hall their own efforts Enhanced social cohesion

Delivery Plan: Sanday

Outcomes Island Delivery Actions Short term Longer term Support the lunch club to establish demand for different activities Enable/encourage more people to attend

Reduce social isolation and improve Attract new organisers where needed Maintain existing service levels general health and well‐being

Ensure sustainability, enhance Introduce new users, use communication and accessibility strategy/ solutions Maintain existing services and increase appeal capacity through bigger attendances

Group events increased, increased nos attending, Work with Linsey etc to bring Adult Befriending Service to the island increase in friend matches etc Residents aware of the potential Reduced isolation within the Establish appetite for befriending service on Sanday New service users in the island community

Facilitating set up of new initiatives (e.g. Men's shed, soft exercise classes, new workshops/classes/talks) Facilitate and enhance existing initiatives New friendships created Tea/coffee mornings Provide alternatives to large group meetings Social cohesion enhanced

Delivery: Shapinsay

2.4 Shapinsay

Alison Meason

Shapinsay comprises one island and is accessed by a Ro‐Ro ferry from Kirkwall. It is a 25‐minute ferry journey and there are six scheduled crossings Monday to Saturday and two return crossings on Sundays and extra sailings in the summer months May to September.

Shapinsay had a population of 307 in the 2011 census, though there has been a decrease in this number since due to youngsters leaving the island for further education and careers and some elderly residents needing to go into care homes on the mainland, and mortality. The population has been balanced slightly by a number of new residents to the island.

There are a small number of vacant properties for sale.

2.4.1 Existing Assets There is an out‐of‐hours (from the M.V Shapinsay timetable) 12‐passenger boat service available twice daily (weather permitting) offering evening sailings. The boat is privately owned. This is a pre‐ booked service and is subsidised by the Shapinsay Development Trust. This service enables islanders to get to Kirkwall to catch flights for Aberdeen hospital appointments, Northlink ferries, attend work or social occasions.

The Shapinsay Development Trust owns an electric car and this can be pre‐booked for use on the island. The trust employs a driver. The car is used for transporting residents to surgery appointments, getting to and from the ferry etc . A donation is asked for by residents towards running costs which in the main is provided by the trust.

The community minibus is available for hiring and can be used both on and off the island. On island it is used to transport residents to the fortnightly lunch club and other times for transporting people on private tours of the island, lifts for residents attending services at church etc. This service is run and subsidised by Shapinsay Development Trust. A small fee is charged for hiring the minibus and the driver, there are also some volunteer drivers whom drive the minibus for the lunch club.

2.4.1.1 Health care provision The Heilindi surgery (located at The Balfour) is linked with Shapinsay and provides two half day G.P.surgeries on the island during the week. Both these surgeries are during the daytime. Residents who work off island can go to the Heilindi surgery in town or take time off work if they prefer to see a G.P in Shapinsay rather than a nurse practitioner. There are no G.P or Nurse Practioner surgeries at weekends only in the case of an emergency.

G.Ps are employed by Heilindi a privately owned practice and the nurse practioners are employed by the N.H.S.

Delivery: Shapinsay

We have two nurse practitioners (one male, one female) usually working a two‐week roster. The nurse practitioner is on duty 24/7 and offer ten surgeries, five days a week, with one of these surgeries an evening one. The nurse practitioner has the back up of an emergency first responder and an island‐based ambulance is available for medivac. There are currently five responders working a 24/7 rota.

The M.V.Shapinsay (ferry) is used for transporting patients in the ambulance to hospital, the ambulance is driven by volunteer drivers. A helicopter is able to land in the local school playing fields in the event of an emergency.

The retained fire fighters can assist with moving and handling of patients and emergencies where necessary.

2.4.1.2 Home care provision There is currently one carer employed by Orkney Health and Care working on the island.

There are a few residents who have private home care arrangements, there are other residents who have been identified by the health professionals as being in need of care. Community care alarms are available and used by those living alone and vulnerable to falls. The responder to these calls is often a neighbour as the resident may not have extended family on the island.

There is a current recruitment campaign to recruit Crossroad carers for the island. To date there has been no‐one appointed.

Podiatry visits are carried out every four to six weeks with appointments available in the resident’s home as well as a clinic in the surgery. Appointments are made by self‐referral or through the surgery.

There are no visits carried out by physiotherapists, dentists etc currently on the island available on the island. Residents travel to Kirkwall for these appointments.

Additional care for residents is provided by the goodwill of family, friends and neighbours. Community members are good at looking out for one another, identifying people potentially at risk.

2.4.1.3 Community resources A successful Lunch Club for the over 50s runs fortnightly, September to June on the island and in the summer months the community minibus is used for trips to the mainland to places of interests such as gardens, out for lunch, and a run around the west/east mainland.

The Lunch Club meets in the local community centre where they have a meal provided by the school meals service (which each resident pays part of and the Lunch Club subsidise), followed by an hour of entertainment in the form of an invited guest speaker or board games and a chat. The Lunch Club has its own committee and they are all volunteers. They hold a raffle each meeting to raise funds.

Delivery: Shapinsay

There is a newly reformed dance group. They meet twice a month or so in an evening in the community centre, during the winter months, where mostly the older (over‐50s) generation participate in Scottish dancing and have supper and a chat.

Some of the residents attend sessions at the Healthy Living Centre where they take part in supervised gym sessions or classes.

There are various social activities such as the heritage centre which residents are involved in.

There are a few social activities such as the heritage centre, badminton, agriculture and horticulture shows etc which residents are involved in. The R.N.L.I active committee hold an annual ceilidh and fête/barbeque.

The Boathouse is used as a venue for various different groups. There is a drawing group, church coffee afternoons and games afternoons.

There is a new games initiative which has recently started. Through successful funding a group were able to form and have purchased and been donated a variety of board games. The group is open to all, and residents are invited to come along to sessions or borrow games to play at groups or at home.

2.4.2 Assessment of gaps in provision of well‐being services and assets. A priority as Wellbeing Co‐ordinator will be to try to promote the role of Crossroad carers to attract recruits so that a good service of care and home help could be offered to residents on the island.

Discussions held with Heilindi surgery to find out about G.P services and the concerns of there being no G.P. resident on the island, will help to reassure residents, with a view to addressing concerns raised at the 2018 workshops on Shapinsay, concerning the lack of access to mental health provision for example. It is hoped that a G.P will attend the community council meeting in the near future to discuss the concerns raised by islanders of the current service provided which some feel is inadequate and not as promised. Shapinsay Development Trust held a community housing consultation in early May where residents were invited to go along to any of the various open sessions to consult and look at maps of various different housing option sites for possible housing on the island. Residents were invited to vote on their preferred housing option. The vote was split and so proposals were unable to go ahead. In August, Shapinsay Development Trust made a second attempt to get a definite decision via a postal vote to every resident in the island, the result of the vote was announced at the S.D.T. AGM in September 2019. This time the result was that the majority wanted to see more housing for the island.

A handyperson scheme would be an advantage on the island to improve quality and safety of life for individuals which in the long term would provide improved living conditions and well‐being.

On Shapinsay there is a lack of social/physical activities available, particularly to older men. Research on the feasibility and potential take‐up for activities, such as a mini men’s shed), re‐

Delivery: Shapinsay establishment of carpet bowls and other social activities, would help with attempts to reduce men’s isolation and loneliness, where once they perhaps lived in a multi‐person household but are now alone. Going to groups would increase their social connectedness and the health and wellbeing benefits that brings.

There is also a need for some physical activity groups to enhance health and wellbeing and to look at if some small changes could enhance and maintain the running of the lunch club so reach is broadened.

Through my role as well‐being coordinator I plan to promote my role by holding workshops, meeting with individual and organisations, create an information hub and write articles for the island newsletter. Promoting and signposting services that are available to the island residents will enhance and support health and well‐being in their everyday lives such as getting the relevant advice/support for them, information, making a telephone call, giving residents an awareness of available services, liaising with health professionals and charities on support with travel to and from hospital and about communication and waiting times.

I would like to look into establishing different social groups and befriending as this is a priority in the ageing population of the island where many are lonely, isolated and without extended family. The challenges I expect to come up against are numbers of available volunteers as more people are already involved in other organisations, reluctance to access available services, fear or pride, bothering others, people having high expectations, people’s fear of confidentiality and trust being broken.

Alison Meason March 2019

Delivery Plan: Shapinsay

Wellbeing Outcomes Concern Delivery Actions Short term Longer term

Provide a point of contact for those Look into possibility of hot meal home delivery service Regular contact with service users isolated/housebound

Number of people accessing support increases Assess if need for summer lunch club on the island Provide alternative Reach is broadened

Nutrition Maintain existing lunch club. Meet with L.C committee to Sustain lunch club where capacity allows, enhance discuss the future of the club Reach is broadened, new service users capacity

Look at financial assistance for those in financial hardship to Service becomes all inclusive, increase numbers attend lunch club New service users attending Awareness & promotion of available services ‐ community bus, electric car, out of hours boat, connection to Northlink Increase usage of existing transport links, increase in Increase capacity for services where capacity ferries number of people using the service allows

Connections to hospital appointments (dial a bus and other Signposting information, increase numbers of people Awareness of available services to make community transport options using the services connections easier, increased capacity?

Support with travel to hospital appointments on mainland Orkney and south Reduce anxiety and stress Full attendance at appointments Services

to Social occasions attended and interaction with Look at an island bus service to local shop/library van Enable more folk access to local services fellow islanders‐ reduction in isolation

Access Promote booking system for transport services Maintain existing service and increase awareness Services used to capacity/ capacity enhanced Awareness & promotion of available services ‐ community bus, electric car, out of hours boat, connection to Northlink Increase capacity for services where capacity ferries Increase usage of existing transport links allows

Connections to hospital appointments (Dial‐a‐Bus and other Awareness of available services to make community transport options Signposting information connections easier

Delivery Plan: Shapinsay

Wellbeing Outcomes Concern Delivery Actions Short term Longer term Social occasion and interaction with fellow Book swap/home library service/museum boxes Enhance library service islanders Consulting V.A.O directory for other service providers Signposting information Increase in users THAW Orkney packs to those in need Support in times of need Signposting of information, improve daily living Awareness and mapping of islands 5 defibrillators increase lives saved Awareness and respect of emergency equipment

Improved living conditions/wellbeing/not Addition of a generic worker handy persons scheme improve quality/safety of life for individuals overwhelmed by what needs done Collaborating with Orkney Health and Care help with adapting homes for older people build capacity increased awareness of wellbeing coordinator and Liaising with medical professionals her role build capacity

Discussing with Heilindi about G.P services, nurse practitioners and reassure community addressing concerns re G.P services on island

enable people to return to their own homes, without Support after discharge from hospital (short term) delayed discharge times improve health and wellbeing

Respite provision ‐ look at provision for residents and their carers signposting other services better support for carers and families

Health find out the services crossroads offers and see if I can Talking to crossroads, talk to community and help promote attract interest for folk to consider applying to be the role of crossroads within the community carers help to build capacity for service Self‐help support groups (mental health, alcohol misuse etc improve health and wellbeing reduction or alleviation in symptoms/problems Re‐establish healthy walking group improve physical health increase physical activity Re‐establish community active indoor games re‐establish indoor carpet bowls etc improve health and wellbeing Exercise classes – e.g. dancing, 60+ gym classes health and wellbeing of individuals improve physical and mental health Re‐establish community active indoor games re‐establish indoor carpet bowls etc improve health and wellbeing

Delivery Plan: Shapinsay

Wellbeing Outcomes Concern Delivery Actions Short term Longer term Exercise classes ‐ eg dancing, 60+ gym classes Improved health and wellbeing of individuals Improved physical and mental health

Home Care ‐ domestic support/housework duties/shopping duties etc Maintain users’ independence Improved health and wellbeing

Establish activities related to mens’ activities, such as looking at research, feasibility/take up (mens’ shed, walking Reduced isolation, enhance skills and increase football etc) To increase mens’ health and wellbeing social connectedness new friendships formed Expanded social networks, develop a sense of Film club‐offer daytime matinees Enable more people to attend belonging

The' Land and Sea' gatherings (chance for farmers, Expand social networks, develop a sense of fishermen etc to get together to be sociable) belonging Provide alternative to large groups (cuppa, chat and table Meet new people, increased confidence games) Isolation Increased social connectedness Reduced loneliness and social isolation

Rural Discuss with Adult Befriending about establishing ball group Improve health and wellbeing Reduced isolation Knit and natter type group Increase companionship Enhanced wellbeing Provide more company and support to other Resident offers in time and skills residents Improved confidence, increased social confidence

Community Care Landscape: Stronsay

2.5 Stronsay

Sarah Powers BSN, RN 2.5.1 Update research As a part of the 2017‐18 research, community led care on the island of Stronsay was reviewed and data collected, regarding population and services offered. In Stronsay, interviews and a group workshop were conducted in January 2018, during which community assets such as the daily transport links, Medical provision, Home Care Teams (from e.g. Orkney Islands Council and Crossroads Carers), and the small caring community were highlighted.

At the time, the population of Stronsay was quoted at 349 (as per 2011 census).

Available transport from Stronsay to Mainland Orkney comprised ferry and flight services, operating daily. Community transport on the island was not available, but a commercial taxi service was present on the island.

Healthcare was provided by two resident GPs and two resident nurses, with the support of ten available carers. This was broken down to show that Orkney Health and Care had eight available carers and Crossroads Carers had two carers available on a relief basis. Domestic help was offered by Crossroads Carers and available through private contract as well. Also available at the time were several emergency response services. On island there was a volunteer first responder team and for medical emergencies that required transfer to Mainland Orkney or Mainland Scotland the Coast Guard, or RNLI lifeboats were available.

At this time there was no lunch club in operation, although other social clubs were up and running. These social clubs are typically inclusive of all age groups but are well attended by many residents in the 50+ age bracket.

2.5.2 Existing assets In April 2019, a meeting was held between several of the resident medical professionals and the Stronsay Community Wellbeing Coordinator. Topics of discussion were the assets and priorities that they see relating to community wellbeing and health.

As of March 2019, the situation on Stronsay is much the same as it was in January 2018. The population is estimated to have grown since the 2011 census to 370 people. This increase is due to new residents, including several young families and an increased birth rate over the last several years.

2.5.2.1 Transport Available transport from the island to Mainland Orkney continues to comprise daily flight and ferry services. However there is a concern about the lack of adequate options for the ferry or plane for

Community Care Landscape: Stronsay those with mobility issues on the island, the hope being that over the next several years, when the Northern Isles ferries are replaced, this issue will be addressed.

Taxi services are available on island for residents and visitors alike. Both operate year around, with one also providing bus service for the school. The taxi service run by Don Peace also provides a delivery service, for items such as medicine and food, as needed. Many older residents choose not to drive at night, but most are able to get rides from family and neighbours.

2.5.2.2 Health Care Health care services on Stronsay remain robust. Our resident doctors and nurses (two each) remain on the island, caring for the majority of health care needs of island residents. Orkney Health and Care and Crossroads both maintain a presence on the island in the form of Home Care and our first responder team is still active. Emergency services from the RNLI and Coast Guard remain available as needed. Residents continue to appreciate that we have such fantastic medical care available on our island. In their own words (from IJB consultation data as cited by Alexander 2018):

“I feel fairly well provided for with health information.”

“We have an excellent medical service on Stronsay with staff always very helpful and taking the time to answer any queries you may have.”

“Small personal service. Out of hours delivered by resident GP.”

“Homecare seems to be very good‐so far as I am aware‐ a very caring team.”

The Exercise Referral Scheme, is a joint effort to improve the physical fitness and overall health of the island by the local Surgery, the Healthy Living Centre and the Stronsay Development Trust, and is a good example of co‐production taking place in Stronsay. The scheme is popular with island residents, and medical professionals have seen the benefits in their patients as expressed by members of the medical team in the April 2019 meeting. It is an ongoing and popular scheme in which the Surgery recommends patients to the programme, the Healthy Living Centre provides the personal training and costs are covered by the Stronsay Development Trust.

2.5.2.3 Befriending Concern for isolation amongst the older generation is high, especially if some of the current activities on offer are allowed to fold. It has been identified that many, if not most, of those individuals at risk are well cared for by their family and friends on island. Others who identify as lonely or isolated have, in many cases, chosen to make Stronsay their home because of the isolated nature of the island.

Social groups and activities are quite popular and often “the highlight of the week” to some older residents. There are a variety of social groups to choose from on Stronsay and more are planned to begin within the next several months. These new endeavours include a cinema club and adults’

Community Care Landscape: Stronsay games club, both supported through the Your Islands Your Choice 2019 fund. Many of the social clubs on Stronsay cater to a more inter‐generational crowd, rather than specifically aimed to support the older generations, with the benefit of increased sustainability as time goes on.

The Companions Group, focused on the over 50 age bracket, was highlighted as an important social group on the island allowing older people to get out and socialize. This group meets weekly, for about an hour, on Monday afternoons, for a chat and coffee. Because it meets mid‐afternoon it enables even those who don’t drive at night to meet year round. Due to lack of funds and able volunteers they have, already, over the last several years altered how they operate their weekly afternoon teas. As of April 2019, they are once again facing major changes, as where they currently meet is changing hands, with an unsure future.

Other social assets that benefit island residents of all ages, are the Peedie Library at Moncur Memorial Church and the mobile library from Mainland Orkney. The Peedie Library is a monthly event that allows residents to stop by the church library, check out some books or DVD’s, as well as enjoy a chat and afternoon tea or coffee. The mobile library comes out bi‐monthly, and residents and health practitioners would like to see this increased to monthly, as it was in previous years, due to it being so popular.

Two of the more popular social groups on Stronsay support the growth and heritage of the local crafting community. The Stitchers and The Spinners both meet monthly, provide a bit of socializing and company, as well as the chance to practice old skills or learn new ones.

Another community‐led success is the Community Greenhouse, where anyone can rent a plot, learn and share gardening tips and recipes, and enjoy each other’s company on a spring or summer evening. There is always a waiting list for plots, as it is a very popular endeavour. 2.5.3 Assessment of gaps in provision of well‐being services and assets. As discussed above, the 2018 workshop shone a light on the perceived assets with regards to community led care. It was identified that an improved IT infrastructure and extended videoconferencing and telemedicine capabilities were top priorities among residents of Stronsay. Other priorities for the Stronsay community, which focused on maintaining and improving existing services, included:

 Retain status quo in terms of medical and social care provision  Improved accessible transport to the mainland and on‐island  Additional visits to the island from clinical services  Development of further social activities and use of bus to allow access  Accessibility of funding to support development

The following are quotes from Stronsay residents addressing several of the identified priorities. Of note are recent changes to services and expanding telemedicine.

“Healthy Living Centre‐limited opening.”

Community Care Landscape: Stronsay

“Counselling for mental and other problems would need regular trips [to] mainland. Could it be provided by phone, chat line or Skype?”

“Surgery not open as much as it used to be. Prescription service now takes an age and is less reliable.”

There is concern regarding the lack of clinical services coming to the island. In the past, services such as audiology, dental and physiotherapy would pay visits to the island but have stopped doing so in recent years. Ideally, having these services on offer, even quarterly, would be a huge benefit to the Stronsay residents.

As a part of the delivery plan for Stronsay a survey was put into the field from April 7th to April 22nd and a workshop is proposed for June to gauge whether these and other priorities have changed over the last year.

The Community Wellbeing Coordinator, based on Stronsay, is well‐placed to expand perceptions of health and wellbeing assets on the island, and through the delivery plan focus on ways to maintain existing health and social care assets.

Delivery Plan: Stronsay

Outcomes Island Delivery Actions Short term Longer term Increased number of users of existing Raise awareness of existing services commercial ventures Establish desire for and look at options to Look at structures for community buses have community bus Non‐drivers are able to access services Look at ride share options Establish need/desire for ride share available on Stronsay Information swap on what exists/ works on Maintain existing transport services, create

other islands More people using existing transport links new services as appropriate and needed Introduce new users, use communication and Ensure sustainability, enhanced capacity accessibility strategy/ solutions Enhance existing services through new people attending Stronsay Apply for funding through Eat Well, Age Well to establish “The Peedie Larder” a

delivery service of locally grown fresh fruits Reduce risk of malnutrition, reduce isolation Develop project to identify, educate and and vegetables over 16 weeks Summer through shared meals, ensure sustainability of prevent malnutrition on Stronsay 2020, also including shared meals. local produce providers Stronsay

Establish new organisers, find venue, advertise, inquire with school to see if it Set up a lunch club could be done with their lunch occasionally Reduce Isolation in community Stronsay reduce isolation, ensure sustainability, enhance capacity through new people attending, Companions Group (Coffee afternoon) Provide alternative to large group meetings increase communication regarding group

Delivery Plan: Stronsay

Outcomes Island Delivery Actions Short term Longer term Work with Linsey etc to bring Adult Befriending group events increased, increased nos Service to Stronsay attending, increase in friend matches etc reduced isolation in communities Explore idea of befriending phone calls as well new service users involved, friend matches as visits established reduced isolation in communities Work with VAO to create inter‐generational group events increased, increased nos befriending group attending, increase in friend matches etc Reduced isolation in communities Set up independent group befriending (e.g. ball group) New service users Reduced isolation in communities

Explore potential for new initiatives to address Enhance capacity, reduce isolation in risk/ barriers for existing community‐led community, involve new people into services Facilitate and enhance existing services established programs

Determine interest, form planning Have an operational Men's Shed, with suitable committee, explore possibilities of venue, funding and support from community to reduce Explore options for Men's Shed set‐up requirements isolation for older men in the community

Communication and Engagement: Island of Hoy

3 Communication, Engagement and Promotion Plan

Our communication and engagement plan sets out how the Enhancing Wellbeing in Our Island Communities project intends to work with its various stakeholders, including the island communities, families and individual residents, service–users, member GP practices, partner organisations, community organisations.

3.1 Communication Objectives Our challenge is to access and engage with people in order to break down some of the barriers and stigmas that exist, to raise awareness and connect people to wellbeing services available.

This plan aims to ensure we:

1. proactively engage with stakeholders and ensure they are informed and involved 2. develop a culture that promotes open communication and engagement with Island Community residents and service suppliers (including third sector organisations and regulated providers of community led care).; 3. facilitate and enable people in the Islands of Sanday, Stronsay, Shapinsay, Hoy, Rousay, Egilsay and Wyre, to contribute to shaping health and wellbeing services available on the isles; 4. embrace digital and other technology‐enabled support for enhancing advances in community‐led wellbeing; 5. create a community that is well informed about the work of the Community Wellbeing Co‐ ordinators and who choose to utilise the services we offer.

3.2 Internal Project Communications Effective internal communication is essential in ensuring the project team have the information they require to do their job. Whilst balancing the requirement for community‐led initiatives to keep bureaucracy to a minimum (Orkney CLS 2019), several key communication conduits provide a framework for the project as a whole. These structures include (but are not limited to):

 Project Structure indicating internal lines of communication, (Appendix 1, Figure A2‐1)  The quarterly meeting frequency of the Steering Group (Appendix 1)  The agreement and updating of a Memorandum of Understanding between partners (Appendix 2)  Reporting frequency between Co‐ordinators and Project Manager: Report form Template (Appendix 3)  Quarterly (minimum) networking meetings established as a mechanism for Co‐ ordinators to meet (i.e)  Template/ resource sharing (networking meetings established/ programmes such as ‘Slack’)

Communication and Engagement: Island of Hoy

3.3 External Communications  Stakeholder analysis was undertaken through Partnership members, Project Manager and Project Evaluator (who had also written the original research project and was able to continue networks built up during that time). Given the scope of the project and limiting factors such as time and resources it is felt that these organisations should be the primary focus for engagement on the project; this is not to the detriment of groups who are not mentioned here, views, information and ideas from all the project stakeholders are welcome and part of the project aims is to explore who these might be, and to fill potential gaps in existing services.

 Social media/ website content‐ Facebook and twitter feeds‐ the Development Trusts, as partners are allowing the Co‐ordinators to use their accounts for spreading information about events;

 Newsletters – already well‐established in most of the project islands, will be a valuable resource for reaching the community;

 Information leaflets for various stakeholder groups (tbc);

 Attendance and involvement with community events such as the more formal Community Engagement meetings/ sessions and the less formal county shows;

There are several themes common throughout the Islands concerning how information is disseminated on a regular basis. They often include consideration of the elements in Fig 1 below.

 Figure 1 Common themes in Island Information flows

Communication and Engagement: Island of Hoy

The mechanism for collection of feedback from relevant stakeholder groups regarding the effectiveness of engagement is explained in detail in the Evaluation Framework section 5.

3.4 Communication and engagement in an island context

3.4.1 Hoy and Walls Communication

Denize Lace

Communication is a key component in island life, and is essential for the growth of individuals and society. Enabling people at all levels to communicate, empowers them to recognise important issues and find common grounds for action.

Generally, information on Hoy and Walls is circulated using several formats: via social media on the Hoy and Walls Facebook page which can be used to advertise community events, the Orkney Facebook marketplace for selling items, and for people asking for local recommendations for example, broadband providers, Ferry information (if there are going to be any disruptions to sailings), public notices (road works) etc.

There are numerous community notice boards around Hoy and Walls that are used to advertise local events, community bus time tables and ferry time tables. The local shop also displays advertisements for the local community.

The Island of Hoy Development Trust produces a digital newsletter, “The Blether” giving subscribers information regarding local projects and events. This is produced every couple of months and is available in paper format if requested. Some members of the community are not able to access The Blether due to lack of internet access so I shall be correlating a list of names of people who might like a copy of the printed version of The Blether and arrange distribution if wanted.

The above methods of communication are generally sufficient in delivering information regarding local news and events). Issues regarding communication in the local community tend to be around accessing health and social care information, help and support when needed.

To enable residents to have the opportunity to have a face‐to‐face meeting with someone who can address some of their concerns, answer questions, or signpost them to the right organisation, I intend to run a regular drop‐in centre, where people can just pop in for a cuppa and a chat. As part of these sessions I will also look at the potential for inviting public sector, third sector and voluntary organisations to come along and offer advice and support in their related area.

Communication and Engagement: Island of Hoy

Outcomes Island: Hoy Delivery action Short term Outcome Long term Outcome Co‐ordinator to have a good To give the local community a underpinning knowledge of voice regarding issues relating existing services on the isles. Organise, promote to well‐being. Initiate an informative drop in and advertise regular centre To promote Health dates for the drop‐in Health and well‐being on Hoy and well‐being on Hoy centre. is promoted Hoy To liaise with other co‐ Communications ordinators, share knowledge, experience and ideas. Explore ways that resident Local information being can access local news, if they available to everyone. are not able to or do not have Increased awareness of access to social media, Improving access to services and an increase in internet. local information. numbers utilising the services.

Communication and Engagement: Rousay, Egilsay and Wyre

3.4.2 Rousay, Egilsay, Wyre Communication

Sarah Foulds

Information around the island can be communicated by word of mouth or passed on at coffee mornings and the lunch club, but to ensure every household has access to updates about activities around the islands, there is the Rousay Review. It is delivered to every household, either a paper copy through the door or via email. I have recently been in contact with the editor asking what other formats are available, for instance large print for those of poor vision.

The issues that have been highlighted above are not exhaustive, as my role develops I am aware that there will be more issues coming to the fore. My aim is to develop a dialogue with service providers, finding out what services are on offer and whether they are appropriate for what the service user is requiring.

For the service user, I aim to be developing a relationship based on trust and openness and be able to promote the choice of the individual. This could be through contacting an advocacy service, or depending on the issue, I could assist the individual in making their choice, or signpost to the appropriate agency on his or her behalf.

I am also looking at developing an outreach programme. This would involve me visiting those who are reluctant to engage in the lunch club or coffee mornings but give me the opportunity gauge awareness of the wellbeing of the person.

Overall, I view my post as being able to communicate effectively between the individuals involved and the agencies who can provide assistance. I will be focusing on the many positives that REW has to offer and build upon them further through networking, research and community meetings and listening to the feedback.

Communication and Engagement: Rousay, Egilsay and Wyre

Islands: Outcomes Delivery action REW Short term Outcome Long term Outcome Utilise Rousay Review to communicate Clear communication events ‐ drop in sessions etc. Different between agencies formats are available to ensure accessibility and coordinator to all. The majority of the islanders have it enabling a seamless emailed to them allowing them to increase service the viewing size accordingly Introduction will be put onto the REWDT Bridge issues of website and will be going into The Review. accessibility to Notices put up around the island eg waiting Promote the role of services room, Crafthub, Triangle Club (lunch club) wellbeing coordinator ‐ Rouusay, Co‐ordinators Assess/ gain familiarity with enable networking, Egilsay services available on isles. Develop a point Communities and Wyre of contact ‐ by way of using the social clubs understand role of Co‐ ie Crafthub, Triangle Club, Allotment ordinator, Reach is Association,GP surgery Set up a 'Meet and broadened Greet' type workshop or have 'Drop in' Confidence in co‐ sessions at a designated place. Outreach ‐ ordinator role visiting individuals in their own homes. established Technology ‐ some elderly residents are able to utilise tablets to aid communication ‐ there is a support group for over 50's to aid with understanding new technology‐ however poor internet quality may be a barrier to this

Communication and Engagement: Sanday

3.4.3 Sanday Communication

Magda Macdonald

The ‘Sanday Sound’ is a free community newsletter provided to each household on the Island. It contains all community news of interest to residents and provides a daily calendar of events and activities for the month ahead.

Notice boards located in the shops, on the ferries, in the Community Hall, in Heilsa Fjold Centre and the GP Surgery, provide useful local information and updates.

Various groups communicate via Facebook, and pages such as Sanday Residents, Sanday Development Trust, Sanday Soulka, Sanday Gruelly Belkies are very popular and help islanders to be kept informed as well as providing an outlet for the sharing of their personal news/comments/ideas.

Outcomes Island: Sanday Delivery action Long term Short term Outcome Outcome Look at communication: about the project (workshops); within the project (networking meetings); enhanced by the project (signposting to other services); Sanday promotion Bridge issues over plan created Broaden our reach accessibility to Create a formal structure and involve services other groups Provide regular updates Create welcome packs Sanday Understanding the Communications issues affecting staff Improved care Reaching out to patients and support for and service users vulnerable Gathering information residents, their Establishing contact with and meeting on the issues and families and individuals (e.g. doctors, nurses, barriers affecting carers carers) and established groups (e.g. residents Care for Sanday) Building long term relationship Broadening our reach through regular public engagement

Communication and Engagement: Sanday

Outcomes Island: Sanday Delivery action Long term Short term Outcome Outcome Gathering information on various issues and Surveys/questionnaires building our data bases

Drop ‐ in sessions Community understands the nature Confidence in Advertising and promotion in Sanday of the project, role of project and co‐ Sound, public notice boards, social Co‐ordinator. Gathering ordinator role media, school information on established community needs Constantly seek to improve communication Initiating discussions Helping secure Flyer for carers to distribute amongst about difficult issues support for service users that impact upon people who face people difficult problems Communities Confidence in co‐ Organising the event at the same time understand role of Co‐ ordinator role as other events scheduled ordinator established Inviting various professionals to coffee Community gets mornings for informal chat about informed on new The community is potential problems (e.g. Dementia, initiatives/ various better supported domestic abuse) and activities (e.g. opportunities/ new Cooking, basic IT skills) legislation etc. Community understands the role of Confidence in co‐ Set up workshops Co‐ordinator gathering ordinator role information about established community needs Community gets informed on new Community is Regular updates in social media initiatives/ various better supported opportunities/ new legislation etc. Community understands the role of Confidence in co‐ Maintain awareness of news from Co‐ordinator gathering ordinator role within the sector in Orkney information about established community needs Confidence in co‐ Signposting role Regular updates in Sanday Sound ordinator role enhanced established Co‐ordinators Assess/ gain familiarity Increase with services available on Sanday availability and

Communication and Engagement: Sanday

Outcomes Island: Sanday Delivery action Long term Short term Outcome Outcome Look at role of technology to help with Coordinator familiarised sharing of communication‐ GIS, Orkney info hub, with channels of relevant ALISS support information

Communication and Engagement: Shapinsay

3.4.4 Shapinsay Communication

Alison Meason

The Shapinsay Sound, a monthly island newsletter is posted out to every household and contains information, interesting articles, calendar of events.

Shapinsay has its own Facebook page accessible to all and a Shapinsay web page is currently being created by Shapinsay Development Trust

Notice boards are available for all residents to use in the local shop, on the ferry and at the community centre. Local news is also exchanged at island events, in the shop and on the ferry. Shapinsay community school is very good at engaging and encouraging participation club for events such as Burns Night and Christmas.

As Community Well‐being Coordinator, three different residents have approached me with three different well‐being concerns of islanders, upon which I was able to signpost them information or refer them onto the health professionals. Some residents have approached me with offers of help.

Outcomes Island Delivery action

Short term Outcome Long term Outcome

Look at communication about the Capacity of service An informed community project(workshops), within the reached project (networking meetings) enhanced by the project (signposting Improved awareness within community of to other services) entitlement for support

Improvement in hospital discharge Residents get support Smooth transitions back process needed home from hospital Shapinsay Community understands Confidence in co‐ Promote wellbeing coordinators role role of coordinator ordinator role established Gather information Capacity of service Create an information hub/resource leaflets, resources which increased. Additional area/contact point may be of benefit to support residents Understanding about Find out about Shapinsay Information finding project and its benefits to Development Trust housing project the island known

Communication and Engagement: Shapinsay

Outcomes Island Delivery action

Short term Outcome Long term Outcome

Find out about Shapinsay care home Reassure community they are being listened too needs

Liaise with community and Ensure sustainability of Reach is broadened community groups in wellbeing role service Liaise with community and Peoples' wellbeing in community responders re care alarm Co‐ordination of support times of emergency system, power/water supply cuts to in times of need power cuts are dealt with form a group to assist quickly and efficiently Capacity of services Hold workshops Inform community increased Look at holding health prevention Help maintain Improve knowledge and workshops‐ eg. Falls clinic/healthy independence health living etc Telecare good day calls to Reassurance for folk to Help maintain housebound/elderly. Alarms/ sensors enable them to stay in independence and other equipment to help their own home Health and wellbeing articles in island Increase Educate and inform newsletter (large print/different reach/information on about services available formats) services Look at possibility of video Improved healthcare Improved healthcare conferencing for health appointment attendance, appointment attendance, appointments mainland less time away from less time away from Orkney/Aberdeen home home, less costs Utilise social media/local Capacity of service Reach is broadened noticeboards to promote information increased Improvement in Create a useful information sheet of Increase in quality of discharge processes, contact numbers for patients to use signposting information communications and when discharged from hospital. waiting times

Communication and Engagement: Stronsay

3.4.5 Stronsay Communication

Sarah Powers

Members of the community can access a wide variety of information in several ways. The Limpet is a monthly newsletter that has a wealth of information, from frequently used phone numbers to recent bird sightings to job vacancies. It is available both online and in printed format. In the previous research (Alexander 2018: Integrated Joint Board Consultation data) residents were quoted as saying,

“Good information…spread using The Limpet.”

The Stronsay Facebook page is another font of information. This is frequently updated with notices and reminders for everything you could think of, events, sicknesses, closings, sheep loose on the road, etc. Also, both shops have notice boards that contain printed versions of many announcements and advertisements.

Residents on Stronsay also have positive views on the availability of healthcare information. “I feel fairly well provided for with health information,” states one resident. The surgery staff always have time to talk through any questions a patient might have, and there is a good number of pamphlets kept in stock at the surgery as well.

As a part of my role I have created the Stronsay Community‐Led Wellbeing Facebook page. My aim in doing so is to help keep the island residents informed about how the project is running, information about available services, as well as a place to inspire all island residents with what is possible when the community comes together for the wellbeing of its older generations. I also plan on providing regular updates to The Limpet and the Stronsay Facebook page, hopefully reaching the vast majority of residents on the island.

Several years ago, in an effort to improve communication and investigate if some of the services provided by Orkney Islands Council (OIC) could be facilitated or administered by the local Community Council, the Island Link Officer role was trialled on Stronsay. The trial was successful, and the Island Link Officer remains in place here, allowing island residents to resolve OIC issues closer to home.

During the previous research it was identified that an improved IT infrastructure and extended videoconferencing and telemedicine capabilities were top priorities among residents of Stronsay. As a part of the delivery plan for Stronsay a survey was put into the field from April 7th to April 22nd and a workshop is proposed for June to gauge whether these and other priorities have changed over the last year.

Communication and Engagement: Stronsay

Outcomes Island Delivery action

Short term Outcome Long term Outcome Bridge issues of Look at communication: about the project Reach is broadened accessibility to services, (workshops); within the project (networking and signposting role confidence in meetings); enhanced by the project is established Coordinator role (signposting to other services) established Communities Confidence in co‐ Create welcome packets understand role of ordinator role Co‐ordinator established Look at role of technology to help with Confidence in co‐ Signposting role communication‐ GIS, Orkney info hub, ALISS, ordinator role enhanced Stronsay Facebook Page, website established Set up workshop with GPs, Nurse Practitioners etc Co‐ordinators Assess/ gain familiarity with services available on isles Promotion of a collaborative approach to all Research, establish good working areas of development. relationships with statutory and third sector organisations and local community ensuring that all discussions are open and inclusive.

Island Promotions Plan 4 Island Promotions Plans

Having a clear understanding of the various promotion avenues can enhance information flow both within and across the islands communities, help the co‐ordinators with signposting services, and foster good relationships between Co‐ordinators and their communities.

A series of considerations need to be given to holding events on Island, given restricted transport, venue opportunities, and extremes of weather.

Weather/ On island or Winter/Summer mainland? timetables

How much does it cost?

Can the venue accommodate your Audience?

Figure 2 Island Event considerations

Presentations?

Discussion?

Games? Teas/ coffee?

Cake?!

One to One chat?

Figure 3 Enhancement of events

Island Promotions Plan In addition, given access to internet can be limited in the isles and the benefits of social media effectiveness can be limited. Each Island has a combination of different resources they can use to promote wellbeing initiatives. These avenues have added value where access to communities can be difficult, particularly where individuals are reluctant to engage, and social isolation is major concern.

Evaluation Framework

5 Evaluation Framework

Rosie Alexander 5.1 Background to the Project The “Enhancing Well‐Being in our Island Communities” project was developed out of an earlier piece of research work exploring possibilities for community led care in the non‐linked Orkney Isles. 5.1.1 The first research project The initial research was conducted as a collaboration between Voluntary Action Orkney, Highlands and Islands Enterprise and Robert Gordon University, with the support of the Island development trusts on each island. The project involved a literature review as well as primary data collection from 7 islands within Orkney, and the findings are reported by Alexander (2018). The research report considered the priorities and assets in each island community using data gathered from workshops held in each island community (which followed a nominative group technique methodology). The assets and priorities identified showed a high degree of commonality across the islands, although the specific ‘mix’ in each island was different. Key common assets included a caring community, social events (including lunch clubs), primary healthcare and emergency healthcare and community transport. Key priorities included increased availability of home care, availability of extra‐care housing, infrastructure improvements (including broadband and transportation around and off the islands), availability of home‐help, and additional activities around social inclusion. An asset / priority summary was produced for each island location.

In addition to the consideration of assets and priorities, workshop data was supplemented by interviews with care providers and care recipients in each of the island groups. The data from the workshops and interviews was analysed thematically, and two key themes, each with four sub‐ themes were identified:

Community:

 Informal provision: the strength of local communities providing help on a neighbourly basis  Isolation and deprivation: not all older adults are equally integrated into the community and may experience significant isolation and / or deprivation  Reluctance to access services: older islanders may find it difficult to ask for help, with issues of pride, confidentiality and understanding what services are available.  Personalised care: recognising that professional care relationships are highly personalised with care and medical staff being members of the community, friends and neighbours.  Doing things differently:

 Understanding true costs: being able to calculate the costs of different models of care delivery in order to understand what innovations may be cost effective.

Evaluation Framework

 Understanding wider community costs and benefits: recognising that there may be additional costs / benefits to communities of different models of care – e.g. additional employment, infrastructure  Context‐sensitive developments: recognising that each island is different, and developments need to be context sensitive.  Rules regulations and risk: recognising that rules and regulations may be a barrier to service delivery (e.g. requiring people with certain levels of training to undertake different tasks), but that to operate ‘outside’ of rules and regulations puts people at risk.

The report identified a number of innovations in community led care on a national and international basis. However, the report identified that it would be highly challenging for communities to engage in delivery of regulated care without the support of a partnership with a regulated care provider (statutory or voluntary). The delivery of non‐regulated aspects of care and support is potentially less challenging for communities to deliver and could potentially offer ways of improving the quality of life, health and wellbeing of older island residents. Support services can also assist with improving access to health and social care services – either through, for example, physical access (such as transport) or through the provision of information and signposting. Providing care for individuals at a lower level of need can also help older people stay well for longer, and can ensure that a care infrastructure develops as the older person ages, rather than needing to be put in place rapidly at a time of crisis. In other communities, the development of community support initiatives has also provided the groundwork for these communities to later engage in further partnerships or delivery of regulated care services.

The report made two recommendations:

 Recommendation 1: The Isles communities to continue to build and extend existing community services.  Recommendation 2: Orkney Health and Care to identify potentials for closer partnership working with communities, including co‐production.

5.1.2 The Enhancing Well‐Being in our Island Communities project The Enhancing Well‐Being in our Island Communities project was developed to address Recommendation 1 in the previous research, but also to help to establish the conditions (from a community perspective) for further collaborations, and potentially co‐production, with statutory and voluntary care providers (Recommendation 2).

Five island communities are taking part in the project: Hoy, Rousay, Shapinsay, Stronsay and Sanday. A sixth island (Papa Westray) is represented on the steering group for the project. The original project proposal identified scope for four communities to be involved, and grant funding was secured on this basis. However, with five communities expressing an interest, the island communities agreed to contribute additional funding to support the inclusion of five communities within the project. The five communities represent a mix of inner and outer isles and a mix of islands in terms of population size.

Evaluation Framework

The aim of the project is ‘to support existing community led services such as transportation and lunch clubs but also to develop new initiatives such as community led befriending and information services led on an island basis’. The target group for the project is ‘older people living in…. the islands and typically from low income households, but workless households will also be targeted’.1 The project aligns to the health and social care and community development priorities nationally and within Orkney, and these are mapped within the project documentation.2

The project duration is 15 months. The project is overseen by a steering group which comprises the Island development trusts in each of the islands, Voluntary Action Orkney, Highlands and Islands Enterprise, Orkney Health and Care and Robert Gordon University. The project involves providing funding to the island development trusts to recruit one community well‐being co‐ordinator in each island. This post will report to the development trust, as well as to a project manager who has been recruited centrally, by Voluntary Action Orkney, and who is responsible for overseeing the delivery of the whole project. Ongoing support for the co‐ordinators will be provided by the project manager and by a nominated individual at the Island Development Trust. This will enable on‐island support as well as wider project support. Although recruited by the island development trusts, the co‐ ordinators are understood to have an island‐wide responsibility and this will involve working closely with other island groups and internal island stakeholders (e.g. Community Associations, Community Councils, other island‐based groups and services, island‐based medical practitioners, social care workers, and others).

A Project Evaluator has also been employed by Voluntary Action Orkney to monitor and evaluate delivery of the project, with the intention that ongoing monitoring and evaluation should be used to help inform the ongoing development of the project.

The project documentation identifies a range of key outputs / milestones for the project and five key outcomes:

1. Older people3 in island communities will have increased access to activities and services designed to enhance health and wellbeing 2. Older people in island communities will be better informed of the services that are available to them

1 This wording is provided in the ACF project documentation, funding application Ref No: ACF/R2/D2/HI/006. 2 The project documentation (VAO 2018) identifies the project as delivering against objectives in the Fairer Scotland Action Plan, Scotland’s Economic Strategy, and the Revised National Outcomes. On a local level the project delivers against objectives in Orkney’s Local Outcomes Improvement plan, the Orkney Partnership Locality Plan, and the Strategic Commissioning Plan of the Integrated Joint board. 3 The definition of ‘older people’ being used in this project is over 65 as this is the age at which people have historically had a right for free personal care if they are assessed as needing this support. In June 2018 the Community Care and Health (Scotland) Act 2002 was updated to extend free personal care to people under the age of 65. However, the existing data about health and social care is necessarily retrospective, and frequently utilises an ‘over 65’ category or designation.

Evaluation Framework

3. Communities’ confidence, capacity and capability to influence and develop services4 alone or in partnership has been enhanced 4. Partnerships and networks are enhanced in order to facilitate knowledge sharing, avoid duplication and adopt innovative approaches 5. The pressure on statutory services is eased.

These outcomes are central to the evaluation framework outlined below, and consideration will follow of how these outcomes can be monitored and evaluated. However, the scope of the evaluation is considerably broader than these outcomes, the rationale for the approach to evaluation is given below, and further details of the specific evaluation questions, framework for data collection and data collection tools are given in the subsequent sections. 5.2 Rationale for the Evaluation Approach The project will be evaluated using a theory‐based approach to evaluation. This is an approach that is widely used in health and social care. These approaches have also been used to evaluate similar community led care projects in the past – this includes the Opportunities for Older People Project (see Farmer and Bradley 2012), and the Community Led Support evaluation conducted by NDTI (Brown, Carrier, Hayden & Jennings, 2017).

Theory based approaches to evaluation seek to understand the theory of change behind a project or an intervention. The theory of change outlines how an intervention is expected to produce results and is normally complemented with a project logic model which articulates the relationship between inputs, outputs and outcomes. Importantly a logic model considers the environmental and contextual conditions as well as the underlying assumptions in a project. Using such an approach to evaluation helps to make explicit how a project is expected to ‘work’, and evaluation can be targeted to not only to the outputs and outcomes of a project, but also to understanding the context for a project, and to test the underlying assumptions.

As well as providing a useful conceptual underpinning to structure the process of evaluation, theories of change and logic models can be used by project implementation teams, with a recognition that the development and ongoing refinement of these frameworks can help to guide project implementation.

4 ‘Services’ is the language of the project documentation. However, this should be understood broadly to include a range of potential initiatives or activities.

Evaluation Framework

Figure 4 Benefits of logic Models: reproduced courtesy of the Strategy Unit (2016)

Theory‐based approaches to evaluation are particularly appropriate for new initiatives or programmes, especially where the context is complex. The approach to evaluation draws specifically on Pawson and Tilley’s (1997) realistic evaluation. Summarising this approach Pawson and Tilley (2004) state:

“Realist evaluations asks not, ‘What works?’ or, ‘Does this program work?’ but asks instead, ‘What works for whom in what circumstances and in what respects, and how?’”

Evaluation proceeds through a series of stages, whereby the theory of change is tested and further refined. This approach recognises the value of formative as well as summative evaluation ‐ that is evaluation which can be used to refine and develop programmes, not just evaluate impact. The importance of formative assessment in community care initiatives is also highlighted by Bardsley et al (2013) who identify that summative evaluation of community care interventions can sometimes be limited because there can be a lack of a ‘theory of change’ articulating how outcomes are expected to be achieved through a project, and because of the length of time that can be taken by some projects to implement. Engaging in processes of evaluation that are designed to understand how and why programmes work and for whom therefore can help to articulate this theory of change, and assist with ongoing implementation of projects. 5.2.1 2.1 Outline of the evaluation plan Having outlined the approach to evaluation, the rest of the document will proceed through the following structure:

Evaluation Framework

‐ Identification of the Theory of Change for the project ‐ Identification of the Logic Model for the project (as a whole) ‐ Identification of the Logic Models for each island project ‐ Identification of the evaluation questions ‐ Monitoring & evaluation plans: with details of the data that will be gathered to address the questions ‐ Data collection plan: outlining the main methods of data collection and the timelines attached to them. ‐ Stakeholder engagement plan. ‐ Timeline

Details of each of these areas are given in the sections below.

Evaluation Framework

5.3 Theory of change This section outlines a basic theory of change model for the project, as developed by the project evaluator based on the stage one research project and literature consulted within this research project (see bibliography of Alexander (2018) for details). The aim of the theory of change is to outline how the project is expected to deliver its long‐term aims. That is, how is change going to happen? The theory of change outlined below has been constructed at the start of the project (March 2019) and is subject to change as the project develops.

Increased employment Pilot community led Reduced initiatives Sustained depopulation Community led / sustainable Older people care and communities Community access more Increased knowledge support Increased led support wellbeing and and capacity of availability and support services communities for of health Improved wellbeing health and social care and care health and project Partnerships support wellbeing of between Improved access island Increased engagement communities & to statutory residents with statutory, voluntary or services voluntary and informal statutory support services for support & health and social care providers.

Evaluation Framework

5.4 Logic models This section presents a basic logic model for the Enhancing well‐being project as a whole, as well as a draft template for the island‐based projects, each of which will in time have their own logic models based on the approach they take to addressing the project objectives.

5.5 Evaluation questions Considering the theory of change and logic models for the project, it is possible to establish a range of evaluation questions. These are designed to address the outcomes and outputs of the project as well as the underpinning assumptions and contextual factors.

The approach to formulating evaluation questions draws on the domains for organizing evaluation questions as outlined by Markiewicz and Patrick (2016). These domains draw on the OECD DAC criteria,5 which have been widely adopted in an international development context. The domains are:

 Appropriateness: the extent to which a program’s design and approach was suitable in terms of achieving its desired effect and working in its given context  Effectiveness: the extent to which the program and stakeholder objectives were achieved, taking into account their relative importance  Efficiency: a measure of the outputs delivered and how economically the resources /inputs have been converted to outputs.  Impact: positive and negative, medium and longer term changes produced by a program, directly or indirectly, intended or unintended.  Sustainability: the continuation of benefits associated with a program. Including consideration of economic, environmental and social aspects of sustainability.

(summarised from Markiewicz and Patrick, 2016:101‐2)

These areas can also be mapped against other evaluation domains for example those of Rossi et al (2004), which include: needs assessment, program theory, program process, impact assessment and efficiency assessment.

The draft evaluation questions identified are:

Appropriateness

1. To what extent was the project design (ie different communities developing their own approaches) suitable for assisting the development of community led services? a. To what extent were the management and reporting arrangements suitable? b. To what extent were co‐ordinators able to access appropriate support and information to help deliver the project? c. To what extent were the design(s) of the island‐based program(s) able to meet the needs of older people (65+) in each of the island communities? d. To what extent were coordinators able to engage with the whole island community? e. To what extent was inter‐island collaboration in programme delivery achieved?

Effectiveness

2. To what extent have older people in the communities benefitted from the project? a. To what extent has the target group: older people (65+) individuals been reached by the project?

5 Development and Assistance Committee (DAC) of the Organisation of Economic Co‐operation and Development (OECD)

b. To what extent have low income and workless households also been reached by the project? c. To what degree are older people better informed of the services that are available to them as a result of the project? d. To what degree do older people in island communities have increased access to activities and services designed to enhance health and wellbeing? e. To what extent do voluntary and statutory agencies have improved access to communities and individuals?

Efficiency

3. To what extent was the implementation of the project effective and efficient? a. To what extent has implementation been as intended? b. What were the barriers and enablers of the effectiveness of the project? c. How did the approaches taken in the different islands different and why? d. How far was a collaborative inter‐island approach taken? e. What are the characteristics of successful community led projects?

Impact

4. To what degree has the project facilitated the long‐term health and social care sustainability of the islands? a. To what degree have partnerships and networks been enhanced in order to facilitate knowledge sharing, avoid duplication and adopt innovative approaches? b. To what extent has the pressure on statutory services eased? c. To what extent does the community show improved health and wellbeing outcomes? d. To what extent do the projects show the potential for further employment / voluntary activities? e. To what extent have those involved in delivering the projects experienced additional benefits e.g. health and wellbeing f. What other impacts (expected or unexpected) are evident from the project?

Sustainability

5. To what degree is community confidence, capacity and capability to influence and develop services alone or in partnership been enhanced? a. To what degree did the program develop capacity? b. What factors contributed to or prevented the achievement of ongoing benefits? c. To what extent can and should the program model be replicated in other settings? d. To what extent should or could the small islands of Orkney collaborate to address health and social care needs in the future and in what way?

5.6 Evaluation and Monitoring Plan 5.6.1 Approaches to evaluation and monitoring

Monitoring and evaluation are both important components in programme evaluation. Monitoring provides ongoing data about project implementation, whereas evaluation offers more in‐depth consideration of a programme. Approaches to monitoring and evaluation are governed by the same set of evaluation questions to ensure that data gathered is purposeful and appropriate.

The approach to evaluation will be mixed methods – combining both quantitative data and qualitative data. Utilising a range of different kinds and sources of data is appropriate for theory‐ based evaluation (Pawson & Tilley, 2004). The exact data collection mechanisms will utilise documentary evidence, a survey, interviews, focus groups and workshops. The monitoring and evaluation plan is outlined below, showing what data will be collected and how, in order to answer each of the evaluation questions. In the following section (section 7) a data collection plan is outlined which summarises the methods used and how and when they are to be implemented.

When constructing the evaluation plan consideration has particularly been made of the implications of small community sizes on data collection. Judgements have been made to include a number of ‘workshop’ style activities in the recognition that workshops and focus groups can produce beneficial data as individuals can respond to each other and think through challenges and opportunities together. However, it is also acknowledged that particularly in small communities individuals may not feel equally able to take part in group activities, or feel freely able to articulate their thoughts and feelings because of community sensitivities, and personal relationships. Previous research into communities has shown that there is a risk of treating a ‘community’ as a singular entity without recognising that every community will contain a range of different people with different view‐points. There is a risk therefore that just using group‐based methods would limit the data collected, but equally just using individual methods (e.g. interviews and surveys) would also limit the data. The proposed evaluation plan therefore proposes a mix of group and individual methods.

Note that the precise methods, particularly in terms of monitoring data, and the final evaluation are subject to change depending on the nature of the projects developed in the isles.

Alongside data collected through these tools, the evaluator will also attend project meetings, and other relevant forums (e.g. Voluntary Action Orkney’s Health and Social Care sub group). A diary recording notes and observations from these activities will be maintained. In addition, records and observations from informal conversations, isles visits and other activities will be taken. These notes will be used to inform data analysis, and used as part of an ongoing reflective, and reflexive process for the evaluator.

5.6.2 The Monitoring Plan Evaluation Questions Focus of Monitoring Indicators Monitoring Data Sources

To what extent was the project design (ie different Steering group activities Identification of agreed island‐ Project documentation communities developing their own action plans) and engagement based actions Project leaflets / documents from suitable for assisting the development of community Island plans Attendance at steering group each island led services? Co‐ordinator engagement with Meeting documentation networking and support Isles delivery plans

To what extent have older people in the communities Participant No of island‐based activities Contact form (part of monthly benefitted from the project? characteristics & impacts monitoring form – see No’s of older adults reached by appendices) island‐ based activities Feedback forms from island No’s of workless / low income activities households engaged

Data from partner agencies where appropriate about their (facilitated) island activities To what extent was the implementation of the project Project reporting, Performance against timelines EU reporting effective and efficient? including budget and budget

performance

Updated island plans Isles project reporting Performance of islands against agreed plans

Evaluation Questions Focus of Monitoring Indicators Monitoring Data Sources

To what degree has the project facilitated the long‐ Partnerships facilitated, No of partnership activities Monthly monitoring form (see term health and social care sustainability of the including partner undertaken appendices) islands? characteristics Partners engaged (by type) Feedback forms from on‐island volunteer engagement: activities No. of volunteers engaged. characteristics and Volunteer records from VAO impacts Characteristics including workless and low income

Impacts on volunteers

To what degree is community confidence, capacity Confidence, capacity and Nos of networking & learning Monthly monitoring form (see and capability to influence and develop services alone capability of and development activities appendices) or in partnership been enhanced? coordinators undertaken by coordinators Steering group documentation Feedback forms from

networking / training events

No’s of partnerships engaged in / nature of partnerships

5.6.3 The Evaluation Plan Evaluation Questions Summary of Monitoring Focus of Evaluation Evaluation Method When

To what extent was the project design (ie Project documentation Stakeholder expectations Isles workshops (with Start and different communities developing their island stakeholders) end Meeting documentation own action plans) suitable for assisting the point development of community led services? Isles delivery plans Meetings with Start and stakeholders end point

Process of developing island‐based Interviews with Start, delivery plans community mid and coordinators & project end manager point

Community Apr 2019 coordinator monthly – Mar reporting (qualitative 2020 information)

Perceptions of older people in the Island based survey End communities about their needs &

wishes

To what extent have older people in the No of island‐based activities Identification of impacts on adults Island based survey End communities benefitted from the project? requiring support and their carers No’s of older adults reached by Interviews with older End in terms of: island‐ based activities people ‐ Information Feedback forms from island ‐ Access to support activities to collect:

Evaluation Questions Summary of Monitoring Focus of Evaluation Evaluation Method When

‐ Participant characteristics & the relationship of this to their ‐ Immediate impacts on wider health and well being participants experience

Data from partner agencies where appropriate about their (facilitated) island activities

To what extent was the implementation of Project reporting, including Project implementation Interviews with Start, the project effective and efficient? budget performance coordinators and mid and Barriers and enablers project manager end Isles project reporting Characteristics of successful point projects Co‐ordinator Apr 2019 monitoring forms – Mar (qualitative content) 2020

Island workshops Start & end

Stakeholder interviews Start & end

To what degree has the project facilitated No of partnership activities Partnership working – knowledge Partner workshop End the long‐term health and social care undertaken sharing, innovation, avoidance of Isles workshop Start & sustainability of the islands? duplication Partner characteristics end

Monitoring arrangements Meetings with Start & where appropriate for: stakeholders end

Evaluation Questions Summary of Monitoring Focus of Evaluation Evaluation Method When

‐ Impact on volunteers Pressure on statutory services Island survey End ‐ Impact on statutory Island focus group Start & services end

Meetings with Start & stakeholders end

Community benefits – community Island survey End wellbeing, impacts on volunteers Island workshop Start & end

To what degree is community confidence, Nos of networking & learning Capacity, confidence and capability Interviews with Mid & capacity and capability to influence and and development activities of individuals community end develop services alone or in partnership undertaken by coordinators coordinators been enhanced? Feedback forms from networking / training events Capacity, confidence and capability Island workshop Start & Monitoring arrangements of communities end where volunteers are engaged Capacity, confidence and capability Stakeholder Meetings Start & in projects. of partners and statutory end organisations to engage island Partner workshop End communities

5.7 Data collection plan This section outlines the key data collection tools. These are summarised below

5.7.1 Researcher diary Purpose: to keep a record of the progress of the project.

Timing: ongoing

Focus: To record observations and reflections as well as details of key events and activities. These include:

. Steering group meetings . Third sector forum health and social care meetings . Other meetings as appropriate

Use of data: data will be reviewed regularly. Data from the diary will be used to gain insight, and to triangulate against other forms of data. Although it is possible that extracts from the diary may be used in the final report, data which identifies organisations or individuals will not be used. 5.7.2 Stakeholder meetings Purpose: to identify expectations of stakeholders

Timing: May‐July 2019

Focus: informal conversations held one to one or in small groups. These meetings will explore:

The stakeholder’s view of the project, what they think its primary aims are, where they see the strengths and weaknesses of the project.

How the project might align to the wider aims and objectives for their organisation.

Sampling: to include members of the steering group including: OHAC (NHS Primary care & social care), VAO, Development Trusts, HIE.

Use of data: These meetings will not be recorded for the sake of confidentiality, but records kept in the researcher’s diary. 5.7.3 Documentary evidence Purpose: to explore the context of the project in the wider health and social care landscape in Orkney and elsewhere.

Timing: ongoing, although formally reviewed at mid‐ and end‐ points of evaluation, i.e. August‐September 2019 and January‐March 2020.

Focus: documentary evidence including strategic and policy documents from Orkney Health and Care and Community Planning. Nationally produced research and evaluations into community led wellbeing and health and care projects. Island‐based community plans. Other documentary evidence as appropriate.

Use of data: reviewed at the mid‐point evaluation and final evaluation as part of the contextual information for the project. 5.7.4 Project monitoring diaries Purpose: track ongoing development of project from the island coordinators’ perspective.

Timing: ongoing from May 2019 completed on a monthly basis

Focus: coordinators to keep records of their activities, including some reflective content to capture how their ideas, insights, knowledge and skills are developing, as well as how the project itself is developing. A template is given in Appendix 3.

Sampling: all coordinators

Use of data: the records will be used to inform interviews with the coordinators, as well as being a record in their own right. They will be analysed at mid and end points of the evaluation to identify common themes. 5.7.5 Interviews with project team members Purpose: To explore programme implementation, and coordinator experiences (including challenges, opportunities and learning).

Timing: Held at three points in the evaluation:

. Beginning of the project (May) . Mid point of the project (August / September) . End of the project (January / February)

Focus: These interviews will be informal, semi structured interviews. The focus of the interview will be having an open exploratory conversation about the experience of the project. Key topics to be covered will include:

. How the project has been progressing . What the key achievements have been . What the key barriers have been . What the staff member feels they have learnt . How they plan to take the project forward

Sampling: all coordinators and project manager

Use of data: interviews will be recorded and transcribed. Data will be analysed to identify key themes. No data will be included in the project reports without the co‐ordinator’s approval. Consent forms signed before interviews undertaken. 5.7.6 Island workshops Purpose: to explore community engagement in the project and relevant insights on an island basis. A secondary purpose is to build interest and engagement in each island.

Timing: Two workshops. First held at the beginning of the project: May‐ July 2019 (in line with the needs of each coordinator / island project). Second to be held towards the end of the project in Jan / Feb 2020.

Focus: The first workshop will explore general awareness of the project, as well as anticipated activities, barriers and enablers. At the end of the first workshop a logic model will be drawn up for how the project may work in the island community. In the second workshop, the relative success of the project will be reviewed, using the logic model as a reference point. Ideas for future developments will also be considered

Sampling: Island based stakeholders for the project, identified by each island coordinator themselves. Likely to include:

. GP or nurse practitioner . Paid or unpaid carers on the island . First responders . Lunch club co‐ordinator or other social group co‐ordinators . Representative(s) from the community council / community association . Representative(s) from the Development Trust

Use of data: the primary data produced from these workshops will be an island based logic model, and a review of the logic model. The workshops will also be recorded and transcribed and analysed alongside the rest of the project data for key themes. All participants will be given a participant information sheet and consent form. 5.7.7 Island Survey Purpose: Gather data on an island‐wide basis about the impact of the project.

Timing: end of the project, Dec 2019‐Jan 2020

Focus: The aim of this survey will be to: . Identify awareness and perceived impact of the project . Gather data on capacity of the island and islanders for further engagement in care . Gather data on general health and well‐being of islanders and how the project may have impacted . Gather ideas for the future of the project. A draft survey is given in the appendices.

Sampling: All islanders will be invited to take part, and the survey will be publicised online and through island newsletters. The survey will be provided in hard copy and online for accessibility purposes.

Use of data: data analysed to produce descriptive statistics, qualitative data analysed to identify key themes. 5.7.8 Interviews with older island residents Purpose: gain insight into older people’s experience of health and care and perceived impacts of the project

Timing: end of the project: Jan / Feb 2020

Focus: Interviews will cover the following topics:

. Experience of health and social care . Awareness of, and engagement with the project . Perceived impacts of the project . Ideas for project development

Sampling: sample will be identified from respondents to the survey who volunteer to take part. Sample will be selected on the basis of those who meet the inclusion criteria (must be aged sixty five or over). Aim for 3 interviews to be conducted on each island, if more than 5 individuals over the age of 65 volunteer to be interviewed on an island, potential interviewees will be purposively sampled.

Use of data: interviews will be recorded and transcribed. They will be analysed to identify key themes.

5.8 Ethical considerations This evaluation does not require ethical clearance from the NHS, university or other organisation. However, it remains important that the evaluation is conducted ethically. A key consideration of the evaluation surrounds confidentiality. The island communities involved in this project are small, and the organisations involved are also relatively small. There is therefore a significant risk that participants in the evaluation will be identifiable. There is also a reputational risk to some of the participants in the research – especially the co‐ordinators who are members of their communities as well as employees for the project. Living and working in small communities can offer some challenges in terms of managing professional and personal relationships. It is vital that participants in the evaluation feel safe enough to share their honest views of the project, and are able to have control over information which may be personally identifiable.

These risks will be mitigated in the following ways:

‐ Central to the evaluation will be data which is not personally identifiable – specifically a case study of the projects in each island community. This will be based on the activities undertaken in each island and the island delivery plan. Data collected through the island‐based survey is also important. This data is anonymised and will be used for primarily statistical purposes. ‐ Data gathered from the island coordinators and project manager via interviews and diaries will be used to contextualise the project achievements (or challenges) in each island. This is central data for drawing out the learning from the project, however this is also data which risks identifying individuals (e.g. coordinators) and potentially individuals within the island communities. Data from these interviews will be used to inform the island case studies – but quotes will be used cautiously. The island‐based cases will be shared with and okayed by the relevant coordinator before publication. Data will also be analysed across the five island case studies to draw out themes. These themes will be presented in reports, but again quotations will be used cautiously and island coordinators given the opportunity to see and okay the inclusion of these quotations prior to publication. ‐ Data gathered from older people within the islands will be anonymised. Older people will also be given the opportunity to see and comment on how any quotations used in reporting is used. ‐ For stakeholder engagement through workshops ‐ confidentiality will be discussed at the start of the sessions, as well as respect and other ground rules. Where data is used in the reports which may potentially identify a participant, again this participant will be contacted to gain consent (or otherwise).

Interviews and workshops will be voice recorded and transcribed. This data will be held by the evaluator only and not shared with anyone else in the project. All data will be held securely.

Consent will be gained from all participants taking part in interviews and workshops. An opportunity will also be provided to discuss the evaluation process and answer any questions or concerns individuals may have.

5.9 Stakeholder Engagement Effective delivery of this evaluation plan requires stakeholder engagement. Stakeholders include local and national organisations. Stakeholder engagement is important for:

. Consultation on the evaluation framework . As a source of documents and data . As participants in the evaluation processes . Involved in data gathering and data collection . As audiences for evaluation outputs.

Stakeholders and their various roles are outlined in the table below.

data

documents for

Stakeholder (organisation)

framework

interviewed/

data

Directly surveyed Involved collection Audience Consult Framework Endorse Source / report(s) Partner agencies, Voluntary Action Orkney x X X x x X senior managers Highlands and Islands Enterprise x X x X and policy makers Orkney Health and Care x X X x X

RGU x x Isles Development Trusts x x x x x

Project managers Project manager x X x x X X and implementers Community Coordinators x x X x x X

Key partners Primary Care Manager x X X  Isles GPS & NPs

OIC Home Care x x x

Third sector agencies, and the X Health and Social Care committee

Beneficiaries I‐Hub X X Other social care researchers

Service users and their x x representatives

Community Associations & X Community Councils

Strong Communities delivery x group

5.10 Timeline

Phase 1: evaluation framework

‐ Complete Draft evaluation framework 30th March ‐ Consult with: . Development trusts . Coordinators . HIE . OHAC & OIC

Identify additional input on measures / questions. 15th April

Phase 2: data collection

Round 1 data collection: . Isles survey . Interviews (project team) . Interviews stakeholders . Isles workshop

30th May ‐ Round 2 data collection o Interviews (project team) 30th Sept ‐ Mid point report (drawing on monitoring data too) for 15th Oct

Phase 3: data collection

Round 3 data collection . Isles survey . Interviews (project team) . Interviews stakeholders . Isles workshop

30th Jan Phase 4: report writing

‐ Draft report 30th Feb ‐ Final draft 30th Mar

6 Acknowledgements

Thank you to: Jean Comber (SDT), Moira Cussor (IOHDT), Anna Bliss‐Davies (Stronsay DT), Imogen Sawyer, Sandra Towrie and Mavis Knowles (Sanday DT) Gill Wigley and Helen Castle (Rousay DT) Chessa Couperwhite (HIE), Gail Anderson (VAO), Naomi Bremmer (OIC), Maureen Swannie (NHS Orkney) for advice, comment and support. Additional thanks to the doctors and nurse practitioners on the islands for all their help in producing this report.

7 Bibliography

Alexander R, 2018 Implementing Community Led Care in the Non‐linked Isles of Orkney, VAO, Orkney

Bardsley, M.; Steventon, A; Smith, J. & Dixon, J. (2013) Evaluating Integrated and community‐based care: how do we know what works? Nuffield Trust. Available from: https://www.nuffieldtrust.org.uk/files/2017‐01/evaluating‐integrated‐community‐care‐web‐ final.pdf

Brown, H.; Carrier, J.; Hayden, C. & Jennings, Y. (2017) What works in Community Led Support? Findings and lessons from local approaches and solutions for transforming adult social care (and health) services in England, Wales and Scotland. First evaluation report. NDTI

Farmer J. & Bradley (2012) in Farmer, Hill & Munoz (eds) Community Co‐Production: Social Enterprise in Remote and Rural Communities, Edward Elgar: Cheltenham.

HIE, 2019 Enhancing well‐being in Our Island Communities: Memorandum of Understanding, HIE, Orkney

Markiewicz, A. & Patrick, I. (2016) Developing Monitoring and Evaluation Frameworks Sage: London.

Pawson and Tilley (2004) Realist Evaluation. Available from: http://www.communitymatters.com.au/RE_chapter.pdf

Pawson and Tilley (1997) Realistic Evaluation Sage: London

The Strategy Unit (2016) Using Logic Models in Evaluation: Briefing. NHS England.

Voluntary Action Orkney (VAO) 2018, Round 2 Application: Enhancing Wellbeing in our Island Communities REF: ACF/R2/D2/HI/006 (unpublished application).

Appendix 1 Project Structure

Dates of Steering Group Meetings

Quarter Date Time Location Q1 January 2019 Tuesday 29th January 1:30pm ‐ 2:30pm St. Magnus Centre, Kirkwall Q2 April Tuesday 23rd April 1:00 pm ‐ 2:30pm VAO Boardroom, Kirkwall Q3 July Tuesday 23rd July 1pm ‐ 2:30 pm VAO Boardroom, Kirkwall Q4 October Tuesday 22nd October 1pm ‐ 2:30pm VAO Boardroom, Kirkwall Q5 January 20201 Tuesday 21st January 2020 1pm ‐ 2:30 pm VAO Boardroom, Kirkwall

Appendix 2 Memorandum of Understanding

Appendix 3 Project Monthly Reporting Form template/ Evaluation Contact Form

Island: Co-Ordinator Name: Reporting period (Date):

1 Progress with Planned Tasks Xx This can be a bullet point list if you prefer- Did you get done what you wanted to get done? How far along with things are you?

3 Successes? Xx What went well? Don’t hold back! xx

4 What went less well? Xx Were there any issues this month? How did these get resolved if at all? Are there any solutions to these that you think will help? xx

5 Meetings attended

Xx Can separate into meetings with people in your community, those from eg third Sector organisations, or publ engagement meetings attended, project meetings e.g. other Co-ordinators, Evaluator xx

6 Training attended/ learning gained

Xx This can be formal, or informal, e.g. on the-job training, mentoring - please also record key learning you may gained (through any of your activities) xx

7 Plans for next month Xx Can be a bullet point list if preferred xx

8 Training/Support Requested or further learning required Xx What do you need to know/ do to fulfil your role? What could you do to address this need? xx

9 Any Other Matters to Note

Statistics Xx i.e. events held and no’s of people attending/ nos attending regular drop-in sessions No of enquiries (can divide this into relevant project areas if you like, (such as transport, befriending, lunch club) N.B. It might be useful for comment on whether it is the same people attending events, or if there is new reach. x

Event Description (and date) In partnership with Nos attending Promotion

Vintage Tea to raise project profile an VAO Befriending 12 Orcadian 23/05/2019 promote group befriending 26th May 2 (photocopy/scan attached) Video of event (link) Island Newsletter (attached)

Garden Help training event 30th May The Blide Trust 4 Island Newsletter (attached) BBC Radio Orkney (30/5/2019) Drop-in Sessions 12th May 2019, 19th Weekly Development Trust 2019 N/A 7 Facebook Page, twitter (links)

Contact Form

Please use this form to record basic details of the contacts you have had with people over the last month. This information

Date How was contact who enquired Nature of enquiry Actions Who did you made? signpost to?

General General information Signposting Drop in in Drop Telephone At an event other Direct: O65 U 65 Direct: of O65 On behalf of U65 On behalf enquiry General 13/06/19 X X Wanted information about the project X 15/06/19 x x Seeking help with house work x Crossroads

Appendix 4 Island survey

Introduction

This survey is part of the community health and well‐being project taking place in [insert island name]. The project is supported by Voluntary Action Orkney, Orkney Health and Care, Highlands and Islands Enterprise and the Development Trusts in the five islands taking part in the project. The survey aims to gather some feedback about your experience of the project and gather some ideas for how the project could be built upon in the future.

Background to the project

The aim of the project was to pilot a community led approach to providing support for health and social care for older adults (aged 65+). It is not intended to replace statutory services, but to explore the potential for community led initiatives which may support access to statutory services, or provide additional support for quality of life of older people. A secondary focus of the project was to identify if increasing community led activities has the capacity to increase the sustainability of the islands.

In this survey the definition of older adults is those aged over 65. This age boundary is important because of health and social care legislation. However in this project we recognise that people of all ages have a wide range of capabilities and capacities.

What is the survey and who should take part?

This survey is designed to gather some basic information about the care and support of older people in the community. We are interested to hear from all islanders over the age of 18. For those over 65 we would like to hear about what support you are currently accessing, feel you need or feel you could provide. For those under 65 we are interested in your general health and well being, and what support you are currently providing or could provide to older people. This will help inform the way the project develops in the future. We are also interested in your feedback on the project itself.

Will my information be kept confidential?

Yes, all information you provide in this survey will only be seen by the evaluator for the project (Rosie Alexander). Data you provide will be used to inform a short report which will be shared with the project coordinator on your island, and other members of the project team. A longer final evaluation report will also be written. No identifying information will be included in any of the reports.

Where can I get more information?

If you have any questions or concerns about this questionnaire or the evaluation of the project please contact: Rosie alexander [insert email]

If you would like to discuss the project being developed on your island, including sharing any thoughts or ideas then please contact: [island coordinator] [insert email] or Ros Aitken, project manager [insert email]

Is this survey available in different formats? if you prefer you can complete the survey online: XXXXXXXXXXXXXXXXXXXXX

All adults over the age of 18 are encouraged to complete this survey.

How long will the survey take?

The survey should only take 10 minutes to complete. Your help is greatly appreciated.

Background

This section collects some background information.

1. How old are you? ‐ 18‐24 ‐ 25‐34 ‐ 35‐44 ‐ 45‐54 ‐ 55‐64 ‐ 65‐74 ‐ 75‐84 ‐ 85+

2. What is your gender identification: a. Male b. Female c. Do not wish to disclose

3. What is your current employment status: ‐ In full time education ‐ Employed full time ‐ Employed part time ‐ Self‐employed ‐ Unemployed ‐ Retired

4. How much time do you spend in [insert island name]?:

‐ I am here all year ‐ I spend less than 6 weeks away a year ‐ I am here most of the time ‐ I spend more than 6 weeks away a year, but less than six months ‐ I am away more often than I am here – I spend six months or less on the island each year

Supporting older people

This section collects some information about your current engagement with older people (over 65) in your community on a paid or unpaid basis. Please complete this section whatever age you are.

5. In the last month how often have you: a. visited an older person never /once / 2‐4 times /4 times+/ daily b. helped out with shopping c. helped out with lifts d. done some cleaning / odd jobs e. done some food preparation f. provided personal care e.g. washing, dressing g. helped provide information and advice / write cards or letters h. Other ______

6. In what capacity do you provide this help (tick all that apply)?

I am unpaid

a. As a friend or neighbour b. As a family member i. I do / do not receive carers allowance c. I volunteer for an organisation Please provide name of organisation:______d. Other______

I am paid

e. I am paid to do this (employed by a care agency) f. I am paid to do this (by the older person themselves)

7. Thinking about your current activities, which of the following may you be willing to do more of?

On an unpaid basis on a paid basis

a. visiting an older person b. helping out with shopping c. helping out with lifts

d. helping with cleaning / odd jobs e. helping with food preparation f. helping with personal care g. I help provide information and advice / write cards or letters h. Other: ______i. None of the above

8. What are the main barriers to providing unpaid support to older people in your community: a. I am not interested in helping out b. I don’t have time c. I don’t have the skills d. I don’t know who needs support e. I would be cautious about offering support and would rather wait to be asked f. I would prefer to work for an organisation (volunteer or employer) g. I think support should be provided by others (family or paid workers) h. Other:______

9. What are the main barriers to providing paid support to older people in your community: a. I am not interested in the work b. I don’t have time c. I don’t have the skills d. There aren’t any jobs available e. The jobs don’t pay enough f. The hours aren’t enough g. The hours are too irregular h. Other:______

Your general health and wellbeing

This section asks you about your health and wellbeing. It uses two measures of health and wellbeing which are widely recognised. The first explores your wellbeing, and the second your health. Answering these questions will enable the researcher to create a picture of health and wellbeing on your island.

5 (excellent) 3 (neither good or bad) 1 (terrible)

10. How would you rate your health? 11. How would you rate your wellbeing? 12. How would you rate your access to health and wellbeing services? a. GP b. Pharmacy c. Chiropody / Podiatry

d. Physiotherapy e. Mental health services f. Home care (e.g. help with personal care) g. Home help (e.g. help with domestic tasks)

13. Does limited access to services impact on your health and wellbeing? Yes/ no/ maybe a. Can you say why?

14. How far does the accessibility of health and social care services on your island as you age concern you? a. A significant concern b. Somewhat of a concern c. Not a concern

15. Do you expect the availability of health and social care services as you age to impact on whether or not you stay in your island? a. Yes – I plan to move when I am older b. Maybe – I am not sure if I will move c. No – I plan to stay here whatever happens

16. Do you have any further comments on the availability of health and social care on your island?

Your experience of the project

Considering the community led project (information enclosed)

1. How aware were you of the project: a. I knew something was happening but I wasn’t aware of the details b. I was well aware of what was happening c. I didn’t know about this project until now.

2. What has been your engagement with the project? a. None b. I have read information about it c. I have accessed a service d. I have met and discussed the project with the coordinator e. I have attended an event f. I have helped with the delivery of an activity or an event (on an unpaid basis) g. I have helped with the delivery of an activity or an event (on a paid basis)

3. If you have only engaged with the project a little bit, what barriers were there in accessing the service? a. It didn’t provide a service or help I needed b. I don’t think it’s for people like me c. I wasn’t aware it was available d. I didn’t like to ask e. I was worried what people would think f. I didn’t want to speak to the people involved in the project 4. Has the project made any difference to your health or wellbeing? 5 – a significant benefit 4 – a good benefit 3‐ some benefit 2‐ slight benefit 1‐ no benefit a. Can you give details?

Future developments

1. Would you like to see the [insert name of island] community continue to develop community led supports for older adults. a. Yes definitely, b. yes possibly, c. unsure, d. probably not, e. definitely not Can you say why you think this?

1. In initial research a range of ideas were gathered for the kinds of support older people might benefit from in their communities. Considering these kinds of services please rank how useful you would find the following:6 a. A companions for hospital appointments service b. A lift sharing or community transport scheme c. A befriending / visits service d. Help with hoovering and cleaning e. Help with shopping f. Help with DIY and small jobs around the house g. Additional help with food / meals e.g. a hot meals service, frozen meals h. Help with gardening i. Help to look after my pet / animals j. Additional information about health and social care services

2. Is there anything else you think would be useful?

6 Please note that this ranking is for information only. We will be gathering this data and presenting in reports to various organisations who may (or may not) be able to provide these services.

3. Would you be willing to pay for these services?

a. Yes – full cost b. yes – contribution c. no 4. would you be willing to take part in an interview….?

Follow up

Thank you for completing this survey. In addition to this survey a small amount of interviews will be conducted on your island with people over the age of 65. If you are interested in taking part in these interviews please leave your name and contact details here. Please note this is entirely voluntary.

Name:______

Contact details: ______

Your feedback and ideas will help to inform the project reports. If you would like to receive a copy of the project report(s) please leave your email address or postal address here:

______

[insert information on GDPR here]

Appendix 5 Participant Information Sheet

What is the Enhancing Wellbeing project?

The enhancing wellbeing project is a short 12 month project taking place in Stronsay, Sanday, Shapinsay, Rousay Egilsay and Wyre, and Hoy. The aim of the project is to support the development of community led initiatives to support older people in these island communities. The project is supported by Voluntary Action Orkney, Orkney Health and Care, Highlands and Islands Enterprise and the Development Trusts in the five islands.

What is the purpose of the evaluation?

The evaluation is designed to understand the impacts of the project, as well as how and why the project develops, and what we can learn for successful implementation of community led initiatives in the future.

Why am I being invited to take part?

During the evaluation perspectives on the project will be gathered from multiple different sources including: statutory and voluntary health and care providers, island‐based health and care providers and other stakeholders, older people themselves in the island communities, and people involved in delivering the project. There will also be an island‐based survey to collect some data from the island populations as a whole.

Do I have to take part?

No, participation is entirely voluntary.

What are the potential advantages and risks of taking part?

The advantages of taking part are that you will be contributing your knowledge to helping understand how the project can be built upon for the future.

Possible risks may include reputational risks if you share information or opinions that others consider controversial. These risks will be managed through careful management of confidentiality (see below). Additionally, participants taking part in group forums will be pre‐briefed about the topics for discussion as far as is possible to allow preparation of answers. They will also not be required to share opinions in these group settings, and will have the possibility of discussing privately matters of interest with the researcher.

Will information be kept confidential?

Yes, all information supplied will be confidential. Interviews and focus groups will be recorded but these recordings will be securely stored and available only to the project evaluator. Survey data will also only be held by the evaluator. In reports for the project quotations from interviews, focus groups, and the survey may be used. Anything that may potentially identify the participant will be

removed from these quotations before they are used. In addition, where possible the information in the report will be shared (in extract form) with participants before the report is published to ensure that participants are happy with this. The full report will be circulated to key stakeholders (coordinators, project managers, isles focus groups, health and social care providers) before it is published to gain feedback and additional input.

Where can I go for further information?

Further information about the project is available from your island‐based coordinator [insert name] or from the project manager: Ros Aitken: [email protected]

Information about the evaluation of the project is available from the project evaluator: Rosie Alexander: [email protected]

The project is being managed by Voluntary Action Orkney and if you have concerns that you do not wish to raise with any of the above members of staff, you may also contact: Gail Anderson Voluntary Action Orkney, Chief Executive: [email protected]

Appendix 6 Evaluation Consent Form

Consent form

Title of Project: Enhancing Well‐being in our Island Communities ‐ Project Evaluation

Investigator(s): Rosie Alexander Email: insert

Please read the following statements and, if you agree, initial the corresponding box to confirm agreement:

I confirm that I have read and understand the information sheet for the above study. I have had the opportunity to consider the information, ask questions and have had these answered satisfactorily.

Initials

I understand that my participation is voluntary and that I am free to withdraw at any time without giving any reason.

Initials

I understand that my data will be treated confidentially and any publication resulting from this work will report only data that does not identify me.

Initials

I agree to having my voice/likeness digitally recorded.

Initials

I freely agree to participate in this study.

Initials Signatures:

Name of participant (block capitals) Name of evaluator (block capitals)

Date Date

Signature Signature