National Islands Plan

Health and Social Care

Islanders tend to display high levels of life satisfaction^[25] and enjoy good health outcomes, with Orkney recording the highest healthy life expectancies in Scotland in 2021-2023^[26].

However, this positive picture does not uniformly apply across all sections of our island communities. Census 2022 data show that one in four island residents live with a long-term illness, around one in ten report a physical disability, and similar numbers suffer from mental health conditions. These figures highlight the scale of need and the importance of building a flexible and adaptable system that is cognisant of the unique circumstances of our islands.

Satisfaction with access to health services is comparatively high on islands. A substantial majority of islanders agree that they can easily access GPs, dentists and pharmacies^[27]. There are however notable differences – for instance, between Mainland and Outer Isles within both Orkney and Shetland. In addition, communities have underlined concerns about levels of on-island support for older people, including home care and care homes.

Persistent and well-documented challenges – including workforce shortages, ageing populations, and infrastructure limitations – continue to affect equitable service delivery. As set out in Scotland’s Population Health Framework (2025), prevention remains fundamental to improving health outcomes and reducing future demand. Achieving better outcomes also depends on addressing the wider determinants of health such as housing, employment, education, and environment – all themes covered in this Plan.

Islanders have consistently voiced the need for services that are locally responsive, digitally enabled, and designed to reduce travel. These priorities have been reflected in policy planning across government, Boards and partnerships, and are now embedded within this National Islands Plan.

Each commitment is framed to deliver tangible improvements while supporting long-term transformation. Collectively, actions featuring in this chapter aim to reduce inequalities, strengthen local delivery models, and ensure that island communities can access high-quality services wherever they live, and whatever their needs.

Access to Services and Operational Improvement

For island communities, access to health care is as much about connection as it is about provision. From targeted improvements in health-related transport to innovative digital tools, we are working to remove the practical barriers that can stand between islanders and timely care.

The Operational Improvement Plan (OIP, 2025) sets out a series of practical, place-based actions to improve access to health and social care. While the OIP applies to all NHS Health Boards, several of its commitments have particular relevance for island communities, where geographic and workforce challenges are more acute. These actions focus on improving local service availability, reducing travel, and supporting digital innovation, with a particular emphasis on enhancing care for older adults and those with complex or long-term conditions.

We are committed to supporting the development of virtual models of care that are designed with and for island communities. This includes expanding the use of Near Me video consultations, point-of-care diagnostics, and remote monitoring technologies to enable safe, effective care at or close to home.

We are not proposing a simple adaptation of mainland services but rather a fundamental redesign of how care is accessed and delivered in island settings. By investing in digital infrastructure, workforce capability, and integrated pathways, we can support a virtual system of care that meets the needs of islanders, regardless of geography.

By early 2026, we will provide funding to HITRANS to develop a Health and Transport Action Plan (HTAP) for the Highlands and Islands, including demand assessments and structured engagement between transport providers and Health Boards.

We will work with NHS Health Boards covering islands to identify a transport lead to coordinate delivery under the new HTAP, ensuring local needs are reflected and coordinated across health and transport systems.

We will support the expansion of Hospital at Home services in island communities through upskilling staff, point-of-care testing, and remote monitoring. This will reduce the need for travel, maintain local economies, support ageing populations, and improve access to urgent and unscheduled care.

We will ensure island communities benefit from digital prescribing solutions. This will improve medication safety, access, and management for older people and those with multiple conditions, supporting continuity of care and reducing reliance on physical travel for repeat prescriptions.

We will ensure that the action plan accompanying the new Long-Term Conditions Framework has a specific focus on improving equality of access to care and support for island communities.

Islands in the Service Renewal Framework

The Service Renewal Framework (SRF, 2025) sets out a national direction for transforming health and social care services, with a focus on improving sustainability, reducing health inequalities, and enabling more person-centred care.

Prevention is particularly vital in island settings, where access to services can be more limited and the impact of avoidable ill health is more acute. We are embedding preventative approaches across all aspects of planning and delivery, including supporting community-led wellbeing initiatives, improving access to screening programmes, and strengthening links between health services and local assets that promote physical, mental, and social wellbeing.

In addition, the SRF provides a framework for tailored engagement and governance, including support for Single Authority Models discussions (see page 67) and the rollout of the Getting It Right for Everyone (GIRFE) approach in island Health and Social Care Partnerships.

The commitments set out in this section reflect opportunities to adapt and apply renewal priorities in ways that respond to island contexts. Together, these actions aim to strengthen local delivery, support innovation, and ensure that island communities are actively shaping the transformation of health and social care services in ways that reflect their needs and aspirations.

We will work with island Health Boards and their partners to define core services and delivery models that ensure equitable access for island populations. This includes care delivered in communities rather than requiring travel off-island.

We will pilot remote diagnostic technologies in at least two island communities by the end of 2026, supporting earlier diagnosis and reducing the need for travel.

As we develop the Primary Care Route Map during 2026, we will consider the feasibility of island-specific workforce incentives.

In early 2026, we will support tailored rollout of the Getting It Right for Everyone (GIRFE) approach in island Health and Social Care Partnerships, assisting staff with training and adaptation.

Addressing Delayed Discharges

Reducing delayed discharges is a priority across Scotland’s health and social care system. Our Home First approach, launched in September 2025 through the No Place Like Home campaign, prioritises patients being discharged to home or a homely setting as soon as clinically possible. Its implementation is supported through a £100 million allocation.

While the underlying causes vary by region, island communities often face additional pressures due to workforce shortages, limited step-down care options, and housing constraints. These factors can make it more difficult to support timely discharge from hospital and maintain effective flow across health and social care services.

We will work with education and workforce partners to pilot “Earn as You Learn” (EAYL) digital training for Allied Health Professionals (AHP) in island communities. This will support the development of a sustainable pipeline of qualified AHPs and reduce reliance on agency staffing.

Dentistry

Island residents remain generally satisfied with their access to dental services. However, concerns remain in areas such as Argyll islands, Orkney’s Outer Isles and Shetland’s Outer Isles^[28]. In these communities, a routine dental appointment can involve a ferry crossing, a long road journey, or even an overnight stay – adding cost, time, and stress for patients.

Scotland’s national shortage of NHS dentists is felt most acutely in rural and island areas, where recruitment and retention remain challenging. Our 2025-26 Programme for Government commits to targeted action to strengthen the NHS dental workforce, backed by a £3 million investment. This includes increasing student dental places by 7% to secure a future pipeline of dentists, and working with NHS Health Boards to develop refined financial incentives that reflect the realities of island life – from travel and housing costs to professional isolation.

Over the course of 2026, we will monitor the impact of revised incentives on NHS dental service uptake in island communities, with a specific focus on improving access to general dental services (high street dentistry). In addition, we will explore alternative models of care and workforce incentives to further support the role of the Public Dental Service (PDS) in island areas, especially for patients with complex needs.

In early 2026, we will convene an advisory group – including community representatives – to explore alternative models of dental service provision in island areas. The group will consider options beyond traditional high street and Public Dental Service models, including alternative ownership structures to support financial sustainability.

Mental Health

Scotland’s islands benefit from strong community spirit and close networks. However, these same tight-knit communities can also experience challenges such as isolation, stigma and limited access to specialist services. Data from the 2022 Census show that almost one in ten people across our islands live with a mental health condition, with Orkney and Shetland recording rates that are above the national average. Mental wellbeing scores are slightly lower on islands than in Scotland as a whole, especially among younger residents^[29].

We are committed to improving mental health across island communities, with a stronger focus on prevention and early intervention before individuals reach a point of crisis. This approach is emphasised within our Mental Health and Wellbeing Strategy and Delivery Plan (2023), which recognises that a highly effective mental health system must address all levels of need, from improving mental wellbeing and strengthening support in communities, to tackling mental health stigma and ensuring specialist services are available whenever needed.

Since 2020, a £160 million investment has provided community-based support for children, young people and adults across Scotland, including over 970 adult-focused projects in rural and island areas. Looking ahead, £15 million will be allocated every year to local authorities to support services for children and young people, with an additional £15 million available in 2026-27 for adult-focused projects. Island authorities will be given flexibility to design and deliver support that is specifically tailored to the unique needs of their communities.

Since 2021, we have also provided £500,000 to Samaritans Scotland to deliver intensive suicide prevention work in the West Highlands and Skye – areas with higher suicide rates – including community training and lone worker support. We also continue to collaborate closely with the National Rural and Islands Mental Health Forum, which brings together lived experience and local expertise to identify barriers and share innovative practice.

Through the Scottish Government’s Mental Health Unscheduled Care Network, we have completed a National Review of Psychiatric Emergency Plans (PEPs) which considered issues impacting the delivery of emergency psychiatric care and treatment in rural and island communities. National PEP guidance is being developed to improve consistency while taking into account the need for local flexibility. This work will build on the progress already made with implementing the award-winning Enhanced Mental Health Pathway, which allows Police Scotland and Scottish Ambulance Service call centres to direct mental health-related calls to the 111 Mental Health Hub and the Distress Brief Intervention Programme. This provides timely, compassionate support to people in distress who come into contact with frontline services in all areas of Scotland.

We will create new mental wellbeing resources tailored for island communities and make them available on the Mind-to-Mind website. This will include culturally relevant materials, such as additional resources in Gaelic, to support inclusive access and engagement.

We will deliver mental health training in partnership with young people in island communities, with the aim of creating a network of mental health champions. This initiative will help reduce stigma, increase peer support, and build community resilience.

Cross-Government Action

Delivering sustainable health and social care in island communities requires coordinated action across government portfolios. The commitments in this section reflect an ambition to align infrastructure investment, workforce development, and economic planning with health and care needs in ways that deliver added value for island populations.

Earlier in this chapter, we commit to developing a Health and Transport Action Plan (HTAP) to improve coordination and integration of transport and health services. Future investment and planning decisions – whether in housing, renewables, or workforce – will need to consider transport as a key enabler of equitable access to care, particularly in multi-island settings.

This includes repurposing disused assets, such as care homes, for service delivery or staff accommodation. It also includes improving access to funded learning pathways for working-age adults. These actions are intended to support long-term resilience, strengthen local capacity, and enable more integrated service models.

Housing and childcare are also frequently cited as barriers to recruitment and retention in island areas. Health and social care staff may be unable to take up job offers due to a lack of affordable housing or access to reliable childcare.

Further development and delivery of these commitments will require close collaboration across government, and ongoing engagement with island Health Boards, local authorities and community stakeholders to ensure alignment with local priorities and ensure the solutions identified are deliverable and effective.

Over the course of this Plan, we will identify opportunities where new infrastructure investment – for instance, in renewables and housing – can deliver added value for health and social care. This includes exploring the repurposing of disused assets to support workforce accommodation or future service provision.

We will work across government portfolios to improve access to funded learning pathways for working-age adults in island communities, particularly those entering support worker roles. This includes addressing barriers related to cohort size, funding eligibility, and remote learning infrastructure.