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Health / Work ongoing with outer island communities over nursing provision after resignations

Fair IsleFair Isle from the sky.

WORK is ongoing to review how healthcare is provided on Shetland’s outer islands following the resignation of nurses in Skerries, Fair Isle and Fetlar – with technology seen as a key part of future provision.

All three nurses left their posts by the end of October, with temporary cover arrangements currently in place.

A meeting of Shetland’s integration joint board (IJB) heard on Thursday that the resident nurse remains in Foula.

Members of the board, which oversees health and social care in Shetland, were updated on the “direction of travel” for change in how care is provided on the four “non-doctor islands”.

Chief nurse Edna Mary Watson told IJB members that there was a hope that nursing and healthcare model could be agreed for Skerries, Fair Isle and Fetlar by the end of March.

A report to members said that while the “island conversations are ongoing, it is apparent that all of the islands would wish to retain a residential nurse model”.

It said that the resignations in quick succession, as well as the “increasing challenges posed in providing a resident nurse service on a 24/7 basis”, has led to the need to review the model of care.

In the mix is finding a solution that complies with working time regulations.

In the non-doctor islands of Fair Isle, Foula, Fetlar and Skerries a resident nurse has traditionally been the first point of contact for all healthcare needs on a round-the-clock basis.

Before the Covid pandemic the islands also had visiting services from GPs and professionals in areas like podiatry and dentistry.

The report to members said that recruitment and retention of nursing staff remains a challenge.

It also highlighted that there is the potential for “health inequalities” when people live on remote islands.

However, the expanded use of technology resulting from Covid-19 and the rise in video appointments is seen as an opportunity for the islands – providing that suitable connectivity is in place.

A small working group has put together to explore the development of service models on each of the four islands, and their membership also includes agencies such as the fire and ambulance service as well as local development officers.

So far four models have been identified for consideration.

One is a resident nurse with no on call commitment, with out of hours provision delivered by NHS24.

Another is a rotational model with a working pattern of two weeks on, two weeks off.

There is a second rotational model mooted, while the final option is a hybrid model created in development with the Fair Isle community.

It includes a resident nurse, a variable split between clinic scheduled hours and on call time, and access to general advice by NHS Inform and NHS24.

This model also encourages fire service volunteers to increase their skills and participate in an on-call service, while there is also the possibility of a pilot involving the fire and ambulance services using technology to access support during emergencies.

Watson said “each of the communities have some different priorities and different things that are perceived to be important to them”.

For instance the Fair Isle community is keen to have a resident nurse rather than one who visits the island.

Watson said the population of Skerries is greater at the weekends, so there might be an emphasis there for weekend working.

The project gained praise from IJB members, although chair councillor Emma Macdonald said the team should not overstretch themselves when they have also got the Covid vaccination programme to contend with.

Speaking about the progress on the islands project, she added: “It does show that working with people is definitely the best option and gives the best solutions.”