Posted by: ayrshirehealth | August 7, 2013

Small is beautiful … but also vulnerable, challenging and rewarding by @JohnRossScott

Standards, targets and regulations

NHS Orkney is the smallest health board serving the smallest population in Scotland with the smallest budget, yet it faces the same challenges and must adhere to the same targets, standards and regulations as all other territorial Boards.  Are we complaining? Absolutely not! This unique place provides a fabulous backdrop to learn and be exposed to a variety of clinical, managerial and leadership situations that test even the very best.

orkney_mapSo what challenges does ‘small’ present for us in our 70-island archipelago? Firstly our people wear many hats and for us flexibility and adaptability equals sustainability.  Secondly we are often single-person dependent leading to a vulnerability which can, at times, leave us exposed, and, thirdly, we often need more than what we require, for example – to ensure that our on-call is adequately covered across the unique geography – with the costs alone of providing 24/7 primary and community care to our 13 inhabited islands amounting to about £2million per year.

Complex and risky

By understanding these challenges you soon come to realise why small is more complex and risky, and that the impact and consequence of our decision-making affect the whole of Orkney as an economy. We do, however, have a great deal to offer on different fronts and our entrepreneurial ‘can-do’ spirit and willingness to embrace innovation and change allows us to punch well above our weight on the national stage.

Innovation, improvement and integration are our friends and our enablers and these pathways will provide us with real opportunities to do things right and do the right thing in line with our 20/20 vision.

But enough of vulnerability challenges and opportunity – we in Orkney do a lot more than just survive. The county is now Scotland’s Cruise Liner capital and second to Edinburgh as a major tourist destination, as well as being voted the most peaceful place in Scotland, the happiest place in Scotland (along with Western Isles and Shetland), and – according to visitor satisfaction figures from Trip Advisor – the UK’s top island destination, and Europe’s fifth.

Renewable energy leaders

As a leader in Scotland’s renewable energy industry – with a thriving tourism and food industry – Orkney has also bucked the trend when it comes to isles depopulation.


While the population of Shetland and Western Isles have dropped over the past decade, Orkney’s has, according to the early information from the 2011 Census, risen from just under 20,000 to 21,400.  This rise – however – comes from in migration and we continue to have an increasing aging population in the county, which brings challenges of a different kind.

You would think that such an idyllic place as Orkney – with its Big Sky, palm trees, Northern Lights, standing stones, war time history and sunsets – would be a huge attraction for NHS staff, and for some it is. But it seems that, while our long bright summers are a magnet, the appeal that engenders wavers somewhat when it’s blowing a Hooley and all the hatches are battened down in November.

At the Centre of Everything

Nevertheless, those in the health community who pledge their souls to Orkney generally find the living easy and the lifestyle appealing and we want more to do so. I, for one, could not think of a better place to stay in Scotland when it comes to quality of life and rural facilities.

As Margaret Gardiner – creator of the award winning Pier Arts Centre in Stromness – once said when asked why she lived in such an out-of-the way place: “Orkney is not remote it is at the centre of everything!”

We at NHS Orkney try to live within that philosophy.

This week’s blog was by @JohnRossScott Chair of NHS Orkney

Next week’s blog is by @GarryCoutts Chair of NHS Highland


  1. I love that line “Innovation, improvement and integration are our friends and our enablers”, very inspiring stuff. Great to hear how you’re taking this forward.

    We’ve just run a shared learning seminar on energy management. It’d be great to hear from you about any work you’ve undertaken on renewable energy – we’re always keen to hear from public services around the UK about what they’re doing.

    Great blog – thank you!


  2. […] Small is beautiful … but also vulnerable, challenging and rewarding by John Ross Scott for Ayrshire Health […]

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