National Islands Plan: annual report 2024

Health and Social Care and Wellbeing

Strategic Objective 7 – Improve and promote health, social care and wellbeing

Commitment 7.1 Work with NHS Boards, Local Authorities and Health and Social Care Partnerships to ensure that there is fair accessible health and social care for those on islands.

Implementation Route Map 2024

• Integration Joint Boards will continue to work closely with Health and Social Care Partnerships to ensure each island is recognised within their unique circumstances.
• Alcohol and Drug Partnerships in island areas will continue to consider how to overcome the challenges of rurality. In some cases, a structured assessment will be employed, covering the extent to which teams have maximised access choice and care through technology, travel and models of care. Progress is noted in the annual Medical Assisted Treatment (MAT) Benchmarking Report, published by Public Health Scotland.

National Drugs Mission

The National Mission was announced in 2021, with an additional £250 million made available over five years to reduce drug deaths and improve lives. The National Mission Annual Report, published in September 2024, sets out the progress made by national government, local government and third sector partners against our outcomes framework.

The Medication Assisted Treatment (MAT) Standards were published in May 2021, and define what is needed for the consistent delivery of safe and accessible drug treatment and support in Scotland. The standards apply to all services and organisations responsible for the delivery of care in a recovery-orientated system. Public Health Scotland publish an annual Benchmarking Report, which provides an evidenced based assessment of progress with the implementation of the ten MAT standards across all Alcohol and Drugs Partnership areas.

There are unique challenges faced by island areas, such as lack of prescribing capacity, the logistics of same day prescribing, a lack of GP shared care and workforce pressures. In order to tackle this, the 2022-23 National Benchmarking Report, detailed assessments of how areas were trying to overcome the challenges of rurality.

Approaches identified included:

• high use of self-referral and telephone; “tele-health” technology such as NEAR ME;
• wide use of bus passes, taxis, and third sector to take people to appointments; and
• offering a choice of venues to be seen at, such as a GP practice, home and community hubs, as well as settings to deliver care when weather disrupted usual access.

In addition, a strength in many areas was the utilisation of informal local networks and relationships to respond to urgent presentations even when no formal arrangements were in place. Although, it was also noted that some areas now had formal arrangements with other Health Boards to utilise guidelines and to share expertise.

The 2023-24 National Benchmarking Report noted progress against the recommendation to strengthen the MAT remote and rural group learning system to share learning and good practice.

The latest Alcohol and Drug Partnership Annual Survey, published in November 2024, highlights that rurality remains a barrier to implementing the Medication Assisted Treatment standards. However, Alcohol and Drugs Partnerships noted that engagement with Public Health Scotland’s MAT Implementation Support Team (MIST) to tackle specific remote and rural challenges was being undertaken.

Commitment 7.2 Identify and promote good practice, especially as regards the improvement of services in islands and other remote areas.

Implementation Route Map 2024

• We will continue to implement the recommendations from the ‘Shaping the Future Together: Remote and Rural General Practice Working Group’ report.
• The National Centre for Remote and Rural Health and Social Care was established in October 2023. The Centre is engaging with stakeholders to better understand the needs and opportunities in our island areas. Work is underway to support health boards and Health and Social Care Partnerships in planning and delivering services.

We recognise that GPs in island areas have a unique role and face distinct challenges. We are committed to ensuring that we engage and consult with a broad range of stakeholders, including those representing rural general practice, as the work progresses.

The Remote and Rural Group was formed by Scottish Government and BMA in June 2018, to support the implementation of the new GP Contract for rural and island populations. Colleagues who work in remote and rural areas encounter additional challenges, requiring distinct roles and contributions. The ‘Shaping the Future Together: Remote and Rural General Practice Working Group’ report was published in 2020. The report contains a series of recommendations to improve Contract implementation and health outcomes for rural and island areas.

We remain committed to Phase 2 of the 2018 GP Contract and ensuring the stability and sustainability of general practice. Discussions with the BMA on Phase 2 are ongoing and we are developing a refreshed plan for this work which will include a revised timeline for delivery.

The Scottish Government recognises that GPs in rural and island areas have a unique role and face distinct challenges. For example, the 2018 GP Contract Offer recognised that rural and island GP practices have, on average, higher expenses per patient than urban ones and these differences will need to be addressed by proposals for Phase 2.

Our Phase 2 discussions will consider these implications for island general practice and ensure that appropriate consultation takes place. Health Board run general practices (“2C practices”) are a small but established part of the primary care system in Scotland. There are a variety of reasons for practices being run by Health Boards, but we know they are particularly important in the provision of general practice for island areas.

We continue to support General Practice through the following incentives:

• Golden Hellos – which incentivise GPs into taking up rural positions through a payment of up to £10,000 to every GP taking up an eligible post in a rural and island areas. This is administered by Health Boards. The Scottish School of Primary Care is currently evaluating the Golden Hello scheme to assess the role that financial incentives play in supporting GP recruitment and retention.
• GP Rural Fellowship – National Education Scotland (NES) offer a GP Rural Fellowship across six Health Board areas in Scotland. This offers qualified GPs the opportunity to develop the generalist skills required for rural and island areas through working in a range of clinical settings. Eight fellowships were awarded to successful candidates this year.
• Rural and Island Workforce Recruitment Strategy – the Scottish Government, in collaboration with the Centre for Workforce Supply and the National Centre for Remote and Rural Health and Care will develop a sustained model of direct support that will provide employers with the help they need to improve recruitment success.

This long-term, dynamic and connective model of support will enable the whole-system approach which is necessary to provide employers with the help they need to overcome recruitment challenges.

The Scottish Government will publish a short strategy paper which will detail the model of direct support which is currently under development

National Centre for Remote and Rural Health and Care

As set out in the Programme for Government 2023-24, the Scottish Government has committed £3.03 million over 2023-26 to progressing the National Centre for Remote and Rural Health and Care, which launched in October 2023.

The Centre is focussing initially on Primary Care and community services priorities in Phase 1 as an initial proof of concept, with scoping work being carried out during the first two years of the Centre to lay the ground for expansion to include the wider rural healthcare workforce and Social Care in due course.

A detailed programme of monthly online rural specific training sessions are being delivered for multi-disciplinary rural practitioners to ensure access for the widest group of rural practitioners across Scotland.

A new rural supervisory training hub has been developed to specifically support ongoing education and development of Rural Advanced Practitioners and providing resources to support rural supervision for practitioners. Supporting Rural Practitioner Professional Development

The National Centre is funding a second cohort of 11 rural Multi-Disciplinary Team practitioners to qualify as Rural Advanced Practitioners in collaboration with the University of Highlands and Islands and is providing funding awards and support to 16 rural practitioners to enable them to undertake further professional development and research study relevant to their rural Primary Care practice.

The National Centre is providing practical support to the 2024 cohort of eight GPs undertaking the NES Rural GP Fellowship in completing rural projects as part of their fellowship programme and supporting their career development in rural GP practice.

New Improving Recruitment and Retention Programmes

The National Centre has established a set of practical programmes of work with frontline teams and communities to improve and measure a set of different structured methods of improved recruitment and retention in partnership with community and multi-agency rural partners. This is in order to avoid a “one size fits all” approach, building evidence and practical resources.

These programmes will support recruitment and retention within the areas involved, but also produce resources and a toolkit to assist many other rural and island areas in taking up structured evidence-based approaches to improving recruitment and retention.

Commitment 7.3 Support the extension of NHS Near Me, and other digital health initiatives, to reduce unnecessary travel and enable more care to be delivered on Islands.

Implementation Route Map 2024

• NHS Near Me will continue to be utilised across every Health Board in Scotland to provide greater flexibility, whilst supporting remote working, reducing the need to travel and promoting greater access to specialist services.
• Procurement of a “once for Scotland” digital solution for the education and management of Type 2 diabetes is ongoing and is forming part of wider digital transformation work being led by ANIA which will explore a potential value case for Digital Solution to support Type 2 diabetes and prevention agenda.

Near Me video consulting is now an embedded component of the healthcare service. We are seeing important uptake for group sessions with enabled choice driving increased engagement with 81% of people completing Near Me group courses versus just 75% attending in person. Evaluation of Near Me highlighted that while it’s not appropriate for all situations or circumstances, there are important benefits in reducing unnecessary travel for island communities when offered routinely.

Procurement of a “once for Scotland” digital solution for the education and management of Type 2 diabetes is ongoing and is forming part of wider digital transformation work being led by ANIA which will explore a potential value case for Digital Solution to support Type 2 diabetes and prevention agenda.

On 27 January, the First Minister announced the launch of a Health and Social Care App in 2025, initially in Lanarkshire, with national roll-out planned in 2026. To begin with, this will allow people to securely access and manage their hospital appointments online, receive communications, find local services and access and update their personal information with further developments planned as part of a five-year programme development.

Digital developments across Health and Social Care in Scotland are taken forward through the national Strategy for Digital Health and Care and associated Delivery Plan.

Commitment 7.4 Work with stakeholders to develop propositions for a national centre for excellence in remote, rural and island health and social care.

Implementation Route Map 2024

• The National Centre for Remote and Rural Health and Social Care was established in October 2023. Work is underway to support health boards and HSCPS in planning and delivering services, and the Centre is engaging with stakeholders to better understand the needs and opportunities in our rural and island areas.

Please refer to 7.2 above which details the National Centre for Remote and Rural Health and Care.

Commitment 7.5 Work with stakeholders to ensure that we develop a plan to adequately support the ageing population of island communities so that they remain active, connected, engaged and have access to suitable, quality opportunities.

Implementation Route Map 2024

• Integration Authorities have continued to work closely with their communities to develop strategic plans for the delivery of health and social care services most suitable to the specific needs of their communities.

Throughout 2024, Integration Authorities have continued to work closely with their communities to develop strategic plans for the delivery of health and social care services most suitable to the specific needs of their communities.

Islands Programme – Thomson Court Care Home Project

The Scottish Government offered Argyll and Bute Council a grant of up to £157,265 through the 2024-25 Islands Programme to expand Thomson Court. The latter is currently the only care home on the island of Bute, and this project will help address the increasing demand for spaces as well as the importance of individuals remaining on the island with their families.

Commitment 7.6 Support relevant local authorities to plan and develop sports facilities on the islands that respond to the needs of communities.

Implementation Route Map 2024

• sportscotland will continue to engage strategically with local authorities (through their capital planning processes) and island communities with regards to opportunities to deliver improved local facility provision for sport and physical activity.
• sportscotland and the Scottish Government Islands Team are continuing to have discussions with Orkney Islands Council regarding improved local facility provision in preparation for the 2025 Orkney Island Games and beyond.

Sportscotland, our national agency for sport, continues to engage strategically with local authorities and island communities to identify opportunities to deliver improved local facility provision for sport and physical activity.

In February 2024, sportscotland invested £200,000 in Shetland Islands Council for a new floodlit 3G synthetic pitch compliant for football and rugby in Lerwick. The facility will increase the playing capacity and match fulfilment in a location where a large amount of sport activity is subject to the weather. The key beneficiaries of the facility will be the football clubs and rugby clubs during evenings and weekends, and during the weekday the local high school will be able to gain access. As the weather in Shetland can be a significant barrier to participation in sport, this facility will improve the offer to clubs and those wanting to take part in sport and physical activity. The facility will be used by clubs and individuals from right across Shetland.

Facilities improvements formed a key element of the £1 million package of support provided by sportscotland to support the 2025 Orkney Island Games.

Commitment 7.7 Promote participation in sport and physical activity by ensuring national programmes such as Active Schools and Community Sports Hubs are serving island communities, and continuing the Islands Athlete Travel Award Scheme.

Commitment Fulfilled.

This commitment was fulfilled in 2020. Please see the National Islands Plan Annual Report 2020 for further details.

Commitment 7.8 Work with Orkney Islands Council and other partners to use the hosting of the 2023 Islands Games by Orkney to strengthen sports development on the island.

Implementation Route Map 2024

• sportscotland will continue to support Orkney Islands Council, Orkney Islands Organising Committee and local sports associations to add value to Orkney hosting the (rescheduled) 2025 International Island Games through the development of the local infrastructure of people, places and pathway opportunities.
• sportscotland will continue work with the Community Sport Hub Officer and with the Orkney Islands Games Organising Committee to deliver a needs-based programme of education and development for coaches and volunteers.

sportscotland continue to provide resource and additional capacity through ongoing technical expertise and other staff support. sportscotland are represented on the Orkney 2025 Committee and will continue to sit on this committee until the delivery of the games in July 2025. This representation is critical both in terms of continuing to add value and for oversight on the approved investment that will support the delivery and legacy of hosting the Island Games.

Following extensive work and consultation with the Orkney 2025 Committee, Orkney Islands Council, the Pickaquoy Trust and Scottish Governing Bodies colleagues and Clubs, sportscotland approved a package of investment and resource across four thematic areas in March 2024 totalling £1,003,638. Investment is not predicated solely on the requirements of hosting the games on Orkney in 2025, but also focused on the long-term benefits and demand to enhance sport and physical activity in the area for the future.

The four key areas are:

1. Partnerships – governance, political and strategic input.

2. People – training and development of volunteers, coaches and officials.

3. Places – facilities upgrades, equipment and technical support.

4. Performance – athlete and coach support.

Key Highlights of This Investment

Sportscotland will invest in strengthening partnerships and provide funding for Scottish Governing Bodies of Sport to support on-island visits to aid planning and preparation with respective organising sports clubs and event volunteers.

Additional staffing capacity and well-trained people are essential to all aspects of Orkney 2025 functioning effectively. Sportscotland will enable increased capacity and provide additional staff time by delivering a coaching subsidy scheme worth £30,000. Over three years this will support current and potential coaches from local areas with travel and accommodation costs to access education, training and development opportunities.

A £241,335 investment in the athletics track at the Pickaquoy Centre in Kirkwall will also secure the long-term future of the only track in Orkney and the home of Orkney Athletic and Running Club. The funding will enable the venue to receive certified track mark status, providing a competition venue for Orkney 2025, and the potential to host further licenced events.

Investment of £189,032 will enable the purchase of 24 ILCA sailing boats to be used during the games. With the support of Royal Yachting Associate Scotland, these boats will be re-distributed for the wider benefit of the Scottish sailing community after the event. Many of them will remain in Orkney to be used by local sailing clubs, while others will be moved to benefit other rural and island communities.

Orkney Athletes will continue to benefit from a share of £40,000 over the next four years as part of the Athlete Travel Awards Scheme. In addition, 11 athletes will also be supported through the Orkney Performance Development Programme, which will receive £36,000 over three years. Athletes will receive access to performance support from sportscotland institute of sport experts including physical preparation sessions, physio, advice from a performance lifestyle advisor and a programme of education opportunities.

The “Support to Orkney” investment is in addition to sportscotland’s annual investment of just under £170,000 to sport in Orkney, which includes a commitment and investment in Active Schools, Orkney Community Sports Hub, young people and cycling.

Commitment 7.9 Work with our partners to eliminate unlawful discrimination, harassment and victimisation and take steps to assist with promoting equality and meeting people’s different needs.

Implementation Route Map 2024

• The introduction of the Bairns’ Hoose model provides Scotland with an opportunity to adopt a genuinely child-centred approach to delivering justice, care and recovery for children who have experienced abuse or harm. National Bairns’ Hoose Standards were published in May 2023, with Standard 3.4 stating that: “Children in rural and island communities can access Bairns’ Hoose in a way that is right for them.” From October 2023, these Standards are being tested by Pathfinder partnerships (made up of local authorities, police, health and third sector partners) including in island settings. By Autum 2026, we will have enough knowledge about how the Standards work in different contexts to develop a national Bairns’ Hoose blueprint that can be adapted to local requirements whilst guaranteeing the same quality of care. The Pathfinder phase, which will be completed by March 2027, will be followed by an incremental roll-out phase.
• The Scottish Child Interview Model for Joint Investigative Interviews (JII) is being introduced nationally and is a cornerstone of Bairns’ Hoose. The Model is now live in every local authority except Orkney and Shetland who, with support from the National JII team, continue to reflect on the best strategy to ensure this new approach is available to children and young people in their communities. It is expected that the Model will be available in every area by the end of 2024.
• The Caledonian System is an internationally recognised behavioural change programme for perpetrators of domestic abuse which involves working with woman and children to reduce the risk of harm that domestic abuse can have. Consideration is being given to the lessons learned during COVID and the needs of island communities. We remain committed to investing in interventions which provide evidence of being able to change the attitudes of offenders. We will continue to explore with Community Justice Scotland the safest, most effective way in which we can increase the availability of the Caledonian System across Scotland.

Child Protection

We are committed to ensuring that robust child protection measures are in place across Scotland and continue to be followed at all times.

As a result, in 2024 we established a new joint Child and Adult Protection Learning Review Group to consider national and local improvements from child and adult protection review findings. Child sexual abuse and exploitation (CSAE), including online abuse, are significant harms that have a devastating impact on victims, their families and carers and wider Scottish society.

Cross-directorate government-supported workstreams collectively have taken action to prevent and protect children in Scotland and to provide appropriate support to victims and survivors of such abuse.

To help with this a new National Child Sexual Abuse and Exploitation Strategic Group has been established bringing together operational partners and other expert stakeholders to review current actions and agree where additional focus is needed to better protect children from abuse and exploitation, including harm online.

CPJ Bairns’ House

The Bairns’ Hoose Pathfinder phase was launched in October 2023, with the announcement of six Pathfinders, including the Outer Hebrides partnership, and four Affiliate partnerships. The primary aim of the Pathfinder phase is to trial and test the Bairns’ Hoose Standards within various operational and geographical contexts. This includes Standard 3.4, which states: “Children in rural and island communities can access Bairns’ Hoose in a way that is right for them.”

The Pathfinder phase seeks to identify effective practices, address challenges, and produce valuable knowledge about the methods, practices, and resources required for successful implementation. To achieve this, a phased approach to implementation is being followed to develop a system that meets the needs of all children across Scotland.

Insights and evidence gathered during the initial Pathfinder phase will inform the development of a national Bairns’ Hoose Blueprint, which will underpin the incremental roll-out phase starting in 2027.

The Pathfinder and Affiliate areas encompass a diverse range of geographical contexts, including island settings, and operational contexts, such as cross-boundary and multi-local authority, sheriffdom, police division, and health board partnerships. This variety will enable the capture of valuable learning and insights as lessons will be drawn from island partnerships through ongoing work in the Outer Hebrides, Skye (as part of the Highland Affiliate considerations), and Arran (as part of the Ayrshire Affiliate considerations).

Additionally, seven further partnerships are being supported through the Bairns’ Hoose Development Fund, including the Argyll and Bute partnership, to assist with their early progress towards Bairns’ Hoose development and build momentum in these areas to pave the way for incremental rollout of Bairns’ Hoose.

The Scottish Government has committed £7.2 million in funding for 2024-25, including nearly £500,000 allocated to the Outer Hebrides Pathfinder partnership and £160,000 to the Argyll and Bute Development partnership.

The ongoing work to establish Bairns’ Hoose in island settings has been praised by Bragi Guðbrandsson, founder of the Barnahus model and vice-chair of the United Nations Committee on the Rights of the Child. During his visit to the Outer Hebrides Pathfinder partnership, he commended its work developing innovative solutions tailored to unique population needs. He also remarked that Scotland is ahead of many countries in its efforts to ensure nationwide access to Bairns’ Hoose services, describing the Outer Hebrides partnership as a pathfinder not only for Scotland but for all of Europe.

The Scottish Child Interview Model

The Scottish Government is continuing to support the implementation of the Scottish Child Interview Model (SCIM) across the country. This new model of practice for joint investigative interviewing (JII) began to be tested in practice in 2020, and a strategy to introduce this to all areas of Scotland commenced in 2021, with recognition that full implementation of this new approach would take several years.

Now forming a cornerstone of the Bairns’ Hoose Pathfinder Phase, the ongoing implementation of SCIM continues to be supported by the Scottish Government with funding for the National JII Team confirmed until March 2025.

The Scottish Child Interview Model is a five-component trauma-informed model of practice which aims to minimise the risk of further traumatisation, while seeking to achieve best evidence through improved planning and interviewing techniques.

The National JII Team continue to engage with island localities, in a variety of ways, supporting them to develop and implement strategies to ensure children living in remote and island communities have access to the Scottish Child Interview Model.

Engagement has been undertaken both collectively – bringing together local authorities and policing divisions who serve remote, rural and island communities to discuss mutual challenges and potential solutions – and individually, recognising the diversity inherent across such communities.

The Scottish Child Interview Model is now live in all policing divisions and in 31 local authorities including in the Western Isles, Argyll and Bute and Highland and Orkney, with the majority of the child population now able to access this trauma-informed approach to joint investigative interviewing.

The National JII Team, having listened to practitioners and managers in island communities, has responded to an ask by introducing a bespoke regular online discussion forum from January 2025 for all relevant staff in these areas for the purposes of peer support and shared learning.

This is in addition to the wide range of existing supports already provided by the National JII Team, including a national discussion forum for interviewers and managers across the whole country.

The National JII Team continues to work collaboratively with Shetland who are expected to be live later in 2025, as they prepare to introduce the model, to support them to make progress towards creating optimal conditions locally that will offer them the best approach which takes account of their needs as an island authority.

Due to long standing challenges with the local social work workforce in Shetland, their implementation strategy is still to be determined. The National JII project partners have also offered to visit Shetland if this would be of value to help progress matters.

The Scottish Government has provided grant funding to the Children and Young People’s Centre for Justice (CYCJ) to evaluate the impact of the SCIM on the experiences and outcomes for children and young people as well as the use of the interviews in court processes. The evaluation is expected to be concluded in early 2025.

Work is ongoing to review the national ‘Guidance on Joint Investigative Interviewing of Child Witnesses in Scotland, 2011’ to reflect current best practice in the field of forensic interviewing of children. This statutory guidance will affirm that the Scottish Child Interview Model is the model of practice to be utilised.

All local partnerships, including those serving remote, rural and island communities, have regular opportunities to contribute to the emerging content of the revised guidance.

Community Justice

The Caledonian System is an internationally recognised behavioural change programme for perpetrators of domestic abuse which involves working with women and children to reduce the risk of harm that domestic abuse can have.

We remain committed to investing in interventions which provide evidence of being able to change the attitudes of offenders. We continue to explore with Community Justice Scotland the safest, most effective way in which we can increase the availability of the Caledonian System across Scotland.

Over the last year three new delivery areas have adopted the Caledonian System, with Shetland being one of those areas preparing to deliver the system by the end of 2025.

Commitment 7.10 Address any equality, health and wellbeing-related data gaps that exist in respect of, for example, women and girls, pregnancy and maternity, gender reassignment and sexual orientation.

Implementation Route Map 2024

• The Equally Safe strategy published in December 2023 recognises that women living in island communities may experience distinct challenges, such as lacking places to seek refuge or assistance in times of danger.
• The Delivering Equally Safe fund supports third sector organisations and public bodies to contribute to the objectives, priorities and outcomes of the Equally Safe strategy. It funds a range of organisations working in island communities including Orkney Women’s Aid and Western Isles Rape Crisis Centre.
• The Scottish Government have established a Sustainable Funding Project Board to take forward our commitment to develop a stable and flexible funding model for Violence Against Women and Girls services. The Project Board is co-chaired with COSLA and brings together a range of public sector and specialist third sector organisations, including representation from the islands.

Through the Women’s Health Plan 2021- 2024, work has been ongoing to map the data on women’s health in Scotland. We have published a ‘Review of the Data Landscape’ that sets out some of the routinely published data on women’s health currently available in Scotland and highlights key gaps. The Care and Wellbeing Dashboard, which provides access to the latest data on population health outcomes and the wider determinants of health in Scotland, will also include breakdowns by sex where this data is available.

The Women’s Health Plan 2021 - 2024 Final Report sets out the progress that has been made in the first three years of the Women’s Health Plan.

Equally Safe Delivery Plan

The Equally Safe delivery Plan was published in August 2024 and contains key deliverables and actions that will enable us to prevent and eradicate violence against women and girls and the underlying attitudes and systems that perpetuate it.

This delivery plan sits below the refreshed Equally Safe strategy and outlines the tangible actions we will take to realise our ambitions. It sets out that the Scottish Government, COSLA and all partners intend to continue to drive progress by implementing action individually and collectively in a truly cross-cutting and inclusive way.

Commitment 7.11 Consider our consultation on out-of-school care through which we have gathered views from parents on the challenges of accessing childcare and range of activities for school age children in island communities. Responses to our consultation will, together with continued engagement, inform development of a future strategic framework which will be published before the end of this parliamentary term.

Implementation Route Map 2024

• The School Age Childcare Delivery Framework, published in October 2023, sets out our commitment to develop and test solutions that support the sustainability of essential school age childcare services within rural and island communities.
• We have established an Early Adopter Community in Shetland where we will work with the local authority and partners to understand what it takes to support childcare systems that are locally appropriate, within island communities.

School Age Children

We know that high-quality, accessible and affordable early learning and childcare is vital in island communities to support children’s outcomes and to enable parents or carers to train, work or study.

The Scottish Government is supporting projects to improve childcare provision in island communities through our Early Adopter Communities (EACs) work, including in communities in Shetland. We are continuing to invest in EACs which are working to expand access to affordable childcare for low-income families with children from the early years through to the end of primary school. A key focus of this approach is to test change locally and to consider how we apply this learning nationally.

Four Early Adopters Communities were established in October 2022 in local areas within Clackmannanshire, Dundee, Glasgow and Inverclyde, to expand access to school age childcare that meets the needs of priority families. In October 2024, we published two early evaluations of the EACs, a Process Evaluation and Evaluability Assessment, which include findings on early implementation and recommendations for future evaluations of these projects. The EACs have since expanded into new communities in Fife and Shetland, and also in scope to include younger children. Continued funding has been agreed over 2024-25 and 2025-26.

Our investment in the EAC projects is enabling us to work with local authorities and communities to understand what it takes to deliver local childcare systems that support families with children from the early years to the end of primary school, and the difference this can make in ending child poverty. The EACs will be a leading source of evidence, data and insights relating to the approach and outcomes associated with place-based, people-centred systems of childcare.

Early Adopters Community – Shetland

Our Early Adopter Community work in Shetland is helping us to gather learning and insights about what it takes to deliver childcare that meets the needs of families living in island communities in particular. Following a period of community engagement and scoping, the Early Adopter Community moved into a delivery phase in 2024. The Shetland project is testing new breakfast club and after school club provision, exploring options for expanding access to funded childcare for families with younger children, and considering the best staffing models for childcare services – including childminders – that can support sustainable provision in island communities.

Commitment 7.12 Ensure that health, social care and wellbeing services are available through the medium of Gaelic to support Gaelic speaking island communities.

Implementation Route Map 2024

• Both NHS Highland and NHS Western Isles have published revised Gaelic Language Plans for 2023-28.
• Bòrd na Gàidhlig has commissioned a study looking at Gaelic and wellbeing. It will be delivered later in 2024.

The Short Life Working Group on Economic and Social Opportunities for Gaelic has made several recommendations relating to health and social care within Gaelic-speaking communities. In its response to the group, the Scottish Government has committed to developing opportunities for the provision of Gaelic medium training and service delivery in the health and social care sector.

This will build on efforts already underway within the Gaelic Language Plans of NHS Western Isles and NHS Highland to utilise the benefits of Gaelic across their workforces and services. It will also draw on the efforts of other organisations, such as the West Highland branch of Alzheimer Scotland, to use Gaelic within their work.

Commitment 7.13 Align our ambition to eradicate child poverty with the Plan by continuing to work with island local authorities and health boards to build on their understanding of child poverty in their areas – helping to focus efforts on lifting families out of poverty and mitigating against its damaging impact.

Implementation Route Map 2024

• The second Tackling Child Poverty Delivery Plan, published in March 2022, outlines the transformational actions we will take alongside our delivery partners – including island local authorities and health boards – to deliver on our national mission to tackle child poverty.
• Island local authorities and health boards will continue to be required to produce Local Child Poverty Action Reports under the terms of the Child Poverty (Scotland) Act 2017.
• We launched the second round of the Child Poverty Practice Accelerator Fund (CPAF) in May 2024. It is open to local authorities and health boards as lead applicants. The fund supports small-scale projects to generate evidence on a known problem, adapt a promising approach from elsewhere, or re-design a service or services to deliver greater impact on child poverty.
• The 2024-25 round of the Islands Cost Crisis Emergency Fund, worth £1 million, will have a strengthened focus on tackling child poverty on islands.

Tackling Child Poverty – Rural and Island Activity

During 2024, the Scottish Government continued to work with the Improvement Service and other National Partners to support island local authorities and health boards in the development and implementation of their Local Child Poverty Action Reports.

The Remote, Rural and Island Child Poverty Network continued to meet in 2024 to discuss areas of mutual interest and share learning and good practices. A small number of local authorities have also continued to work with the Scalable Approach to Vulnerability through Interoperability initiative to explore how rural and island authorities can approach data sharing to better identify and support families at risk of child poverty.

Through the Child Poverty Practice Accelerator Fund, the Scottish Government is supporting areas to test innovate approaches to tackling child poverty. This includes support for North Ayrshire Council to develop its single shared assessment approach to improve understanding and use of existing data to better target local support for families at risk of poverty.

The Islands Cost Crisis Emergency Fund (ICCEF)

Scotland’s islands experience a high-cost economy. High fuel costs, colder climates and lack of consumer choice intensify the impacts of the cost crisis among our island communities. Access to fresh food can be challenging in some island areas, with increasing concerns around food insecurity and resilience highlighted by the Scottish Human Rights Commission in their report published in November 2024.

The ICCEF was established in December 2022 to help the six island local authorities support those households worst affected by cost-of-living pressures. It involves the distribution of monies to each of the island authorities using a 100% Population Formula which is now based on the newly available 2022 Census data.

The ICCEF was worth £1.4 million in 2022-23, and a further £1 million in 2023-24. In 2024-25, funding increased to £5 million, with £1 million allocated to maintain the delivery of the “original” fund. The additional £4 million was provided in lieu of a review of the Special Islands Needs Allowance (SINA), in partnership with COSLA.

Commitment 7.14 Work alongside national partners, continuing to share good practice identified across Scotland which could be applicable to child poverty in our island communities.

Implementation Route Map 2024

• We will continue to work with national partners to ensure knowledge and good practice is shared and to support and improve local responses to tackling child poverty, including in our island communities.

We have continued to work with National Partners to support local areas to share knowledge and good practice, including through the Child Poverty Peer Support Network, which includes leads from local authorities and health boards across islands.

The Network is an opportunity to share information and highlight local approaches to eradicating child poverty. Good practice from local areas and from our Child Poverty Practice Accelerator Fund is also being shared via the Tackling Poverty Locally Directory, which profiles a wide range of anti-poverty work being undertaken across Scotland, including in island communities.

Commitment 7.15 Work with islanders to contribute, where we can, to the creation of a fairer, healthier, happier nation for all of Scotland by supporting the work of the group of Wellbeing Economy Governments (WEGo).

Implementation Route Map 2024

• We will continue to learn from and collaborate with other countries and organisations through WEGo, and more broadly, to transition to build a fair, green and growing, wellbeing economy that puts people first, serving current and future generations. That means empowering our island communities to take a greater stake in the economy, tackling inequalities, and aiming to ensure that they can seize the opportunities from the just transition to net zero to deliver greater prosperity and increased wellbeing.

The Scottish Government’s goal is to help people in all parts of Scotland live happier and healthier lives with higher living standards, to help businesses boost profitability, and build a more resilient Scottish economy that promotes the wellbeing of all of our people. The four priorities set out by the First Minister are all underpinned by a fair, green, growing economy and only by progressing all four of the interconnected priorities will we ensure that we are positively impacting on the lives of people all across Scotland.

The long-term transition to a net zero, nature-positive, wellbeing economy requires system-wide change, cross-sector partnership, engagement with communities, and the involvement of all of society. The Wellbeing Economy Toolkit is a resource available to areas across Scotland, including islands, to support a place-based approach to economic development, based on local circumstances and developed through a participative process.

In 2024, we have worked with the New Deal for Business Group to produce a description of the Wellbeing Economy aimed at a business audience. Building on the work of the Business Purpose Commission, the description sets out practical examples of actions private enterprises can take to contribute, as appropriate to their size, location, sector and business model. It recognises the importance of promoting the interests of employees, suppliers, communities, society and the environment, as well as customers and investors.

We are also informed by our Wellbeing Economy Expert Advisory Group and through engaging with international partners such as the OECD, World Health Organization, and the Wellbeing Economy Governments (WEGo) network. WEGo member countries collaborate and learn, utilising the advice of practitioners and experts to deepen our understanding of how to use wellbeing frameworks and evidence to improve policymaking. Recent WEGo Policy Lab topics have included: circular economy, child wellbeing, trade and wellbeing, and just transitions. More information can be found in our Annual Engagement Report.

Commitment 7.16 Work with our partners to consider a range of options to ensure that adequate mental health care is available, whilst taking into consideration the uniqueness of our island communities

Implementation Route Map 2024

• The Mental Health and Wellbeing Delivery Plan 2023-2025 includes an undertaking to address the unique challenges faced by those living in rural and island communities. We will work with the National Rural Mental Health Forum to gather and share evidence around the barriers faced by rural and island communities, with a view to building their resilience further and supporting wellbeing.

Wellbeing and Prevention

We are aware that people in island communities can experience a number of challenges in relation to their mental health and wellbeing, due to challenges around social isolation, infrastructure and transport. The Scottish Government is helping people in island communities maintain good mental health and wellbeing and encouraging connections within communities through our Rural Mental Health Forum, Communities Mental Health Fund for adults, Community Mental Health Support for Children and Young People and Suicide Prevention work.

National Rural Mental Health Forum

We have provided £50,000 of annual funding for the National Rural Mental Health Forum chaired by Change Mental Health. The Forum focuses on exchanging knowledge, experience and learning about mental health and wellbeing in rural, remote and island areas, enabling it to better understand and support communities. The Forum openly shares ideas and good practice, building an evidence base which feeds into policy.

The Forum has organised and hosted 10 online Seminars over the last year engaging nearly 300 organisations across the public sector, third sector, community, private sector and academia. The Forum has discussed a wide range of issues impacting rural, island and remote communities including financial support, rural-focused support organisations, and access to services and mental health, including suicide, distress brief interventions and social isolation and loneliness.

We are supporting innovative practice through the National Rural Mental Health Forum, such as the Rural Community Engagement Project which promotes mental health recovery for people who face additional inequalities, including refugees and asylum seekers, young carers and the LGBTI+ community, through community engagement and support approaches in Dumfries and Galloway, Perthshire, and the Highlands.

Communities Mental Health and Wellbeing Fund for Adults

Since 2021, we have invested £66 million in our Communities Mental Health and Wellbeing Fund for adults, with approximately 4,800 grants made to local projects across Scotland over three years to help tackle the impact of social isolation, loneliness and mental health inequalities made worse by the pandemic and the cost-of living crisis.

The Fund has a strong focus on prevention and early intervention, prioritising a range of “at risk” groups including those people disadvantaged by geographical location (particularly islands and rural areas). It has a focus on those facing socio-economic disadvantage made worse by the cost-of-living crisis.

The Fund supports grassroots community groups in building resilience and aims to reduce the need for clinical interventions by supporting community-led initiatives and local support services.

The Year 3 Monitoring Report shows that 234 projects had people disadvantaged by geographical location as their sole focus and social isolation and loneliness was a strong theme, with 1,311 projects including a focus on this.

More than £6.5 million has been allocated to supporting projects in areas covered by the National Islands Plan, since the Fund was set up in 2021.

Over 900 awards have been made to community projects supporting people disadvantaged by geographical location (including island areas). For example, the Assist Project, based in Bernera in the Western Isles, which focuses on reducing social isolation and loneliness.

Community Mental Health Support for Children and Young People

The Scottish Government provided local authorities with a further £15 million in 2024-25 to continue delivering community-based mental health and wellbeing supports and services for children, young people and their families. Support and services are focused on prevention and early intervention, promoting positive mental health and wellbeing, and tackling emotional distress.

In line with our supporting Framework, local authorities decide which supports and services to implement on the basis of locally-identified need, which means that island authorities can use their funding to put in place supports and services that are specifically tailored to the needs of island communities. The Framework also advises local authorities to consider factors such as rurality when determining the balance between the provision of face-to-face and digital supports and services.

Suicide Prevention and Distress Interventions

In November 2023, the Scottish Government published a dedicated Self-Harm Strategy and Action Plan jointly with COSLA. The strategy is about making sure that anyone affected by self-harm gets the compassionate, recovery-focused support they need, without fear of stigma or discrimination. Over the last three years, SG has invested £1.5 million in the development of bespoke self-harm support services through Self-Harm Network Scotland, run by Penumbra. The support is available to anyone over the age of 12 anywhere across Scotland. We have committed a further £1.5 million for delivery of the action plan, including the continuation of these vital services for 2024-26.

Through our wider suicide prevention work, we are providing Samaritans Scotland with funding of over £500,000 to establish a new service in West Highlands and Skye (an area which has a relatively high suicide rate). The service has a particular focus on reaching and supporting lone and isolated workers, many of which are in agriculture, and who we know may be at a higher risk of suicide. As well as exploratory work to trial new ways of reaching lone workers, the service also offers a programme of workplace and community training.

We have introduced the Distress Brief Intervention (DBI), a non-clinical support programme which provides compassionate support to people aged 16 and over, in emotional distress who do not require urgent clinical intervention. The DBI model allows trained local front-line staff (such as Police Scotland, the Scottish Ambulance Service and in Primary Care) to ensure initial support is provided within 24 hours. This is followed by up to two weeks of third sector-based support which connects people to support that can help them over a longer time period.

In late 2024, we completed the rollout of DBI to all Health and Social Care Partnership areas in Scotland, including island areas. In addition to local coverage, we have created three national pathways to DBI through NHS24 and call handling centres operated by the Scottish Ambulance Service and Police Scotland.