Another year of continuous improvement and achievement – there’s much to celebrate

Dear Orkney Community,

2024/25 has been a year of significant transition, change and further progress for NHS Orkney.

With just a few days of 2024/25 to go, it’s important for us that we pause and take some time to look at how far we’ve come and recognise the further progress we’ve made that is making a positive difference to you, our patients, our community, and our colleagues.

We have reached many more important milestones and achievements and we want to celebrate these.

Our ambition and promise at NHS Orkney is to look after our community and provide excellent care on a consistent basis, and be an organisation where being open and honest and treating each other with respect and kindness is at the very heart of everything that we do. We are certainly moving in the right direction – as evidenced by the highlights we share in this update.

The foundations are now in place which will support sustainable improvement and these include:

• Improving our organisational culture - a strong focus on visible and compassionate leadership, staff wellbeing and value and recognition, responding to feedback and creating a strong safety and speak up culture
• Stability of leadership – close to a fully substantive Executive Team and acting on the recommendations in an external review report into cultural development, governance and senior leadership (which concluded in December 2024; with the Action Plan now being overseen by our Health Board)
• Operational and financial grip and control – clear ways in which we are held to account for delivery of performance improvements, including our Improvement Board, Senior Leadership Team, Planned Care Programme Board and Performance Review Meetings underpinned by improved data and benchmarking, including our Integrated Performance Report
• Strengthened approach to governance and risk management in the organisation

Here is a selection of our achievements by our Strategic Objectives – People, Patient Safety, Performance, Potential and Place.

People

Our iMatter (staff survey) scores are an important measure of how our staff feel working at NHS Orkney. Our scores improved in many areas in 2024 compared to 2023 and benchmarking against other Boards showed much positive news for NHS Orkney.

The headlines:

• Overall national response rate: 58% (NHS Orkney was 69%, marking a 10% increase for NHS Orkney versus 2023 and the largest increase in response rate compared to any other Board)
• Action plans agreed within 8-week window: national score 56% (NHS Orkney was 69%)
• Employee Engagement Index national score: 76 (NHS Orkney’s was 75, however, this shows an improvement versus last year and continued improvement)
• In the section ‘My Organisation’ – NHS Orkney achieved the greatest improvement of all of the ‘My Organisation’ components across all Boards with an increase of 8 points for ‘I feel that Board members who are responsible for my organisation are sufficiently visible’ (from 53 in 2023 to 61 in 2024)
• NHS Orkney was the only Territorial Health Board to improve (by +2 in 2024 versus 2023 from 72 to 74) for the question ‘I would be happy for a friend or relative to access services within my organisation’
• Five top ‘People’ priorities were agreed by our Senior Leadership Team and Area Partnership Forum:

1. Improving Job Evaluation process and timings
2. Improving sickness absence, including absence related to stress and anxiety
3. Improving appraisal rates
4. Budgets
5. Improving training compliance (including that related to health and safety)

While still not where we want to be, we have addressed the backlog of Job Evaluation requests, and our appraisal rates increased from less than 20 to 40% last year. These areas will remain priorities in the year ahead.

• 80 members of staff completed an introduction to change management training and we have agreed our approach to Quality Improvement methodology at NHS Orkney, with this programme launching in October 2025
• Linked to this – our staff ideas scheme has gone from strength to strength with over 80 Bright Ideas received to date, which has resulted in improvements to patient and staff experience
• There have been 36 Board walkarounds between May 2023 - February 2025, spanning The Balfour, our community and our ferry linked isles. Board walkarounds involve a blend of Executive Directors and Non-Executives visiting different teams and departments across NHS Orkney and listening to how it feels working at NHS Orkney. They are an opportunity to listen, for Board members to get to know staff and build relationships and hear firsthand what staff are proud of and any challenges they face, leading to how Board members can support to resolve and help to support and in some cases unblock issues
• NHS Orkney was delighted to have three finalists nominated for the Nurse of the Year Award and Midwife of the Year Award in the 2024 Scotland Health Awards. Two of these colleagues went on to win their categories which very much put Team Orkney on the map. Anne Gregg was also awarded an MBE for her commitment to the NHS and to improving care and services in her role asMacmillan Specialist Nurse
• We launched a Board and Executive Team Development programme – recognising leadership and culture starts with the Board
• We’ve received national recognition and confirmation that medical students on placement here get an excellent experience
• We were awarded the Gold Award for the Defence Employee Recognition Scheme in recognition of our commitment to the Armed Forces earlier this year. Representing the highest badge of honour, the Gold Award identifies organisations that employ, advocate for and support those who serve, veterans and their families

Patient Safety

• We are beginning to see learning from incidents, complaints and Significant Adverse Events shared more widely across the organisation, with lessons learned summaries now discussed at our Senior Leadership Team meetings and Joint Clinical and Care Governance Committee
• We introduced Care Opinion, starting with Maternity, as a new way of listening to and responding to patient feedback
• We have further strengthened our Corporate Risk Register and how we manage risk in the organisation. We are now focused on further strengthening our approach to risk management, governance, and clinical engagement, with the introduction of an Integrated Risk Management process and staff training underway
• Our Board agreed our new Board Assurance Framework in December 2024, which provides the Board with a way of monitoring risks associated with the achievement of strategic objectives which are set out in our Corporate Strategy
• We’ve retained our UNICEF Gold Accreditation (part of the baby friendly accreditation), which is testament to our Health Visiting and Maternity Services – evidencing a strong commitment from staff towards this evidence-based, patient-centred approach to care for babies and their families

Performance

• While being formally escalated for our deteriorating financial performance by the Scottish Government has understandably dominated much of our focus since November 2023, recognising we are in Level 3 of the NHS Scotland Support and Intervention Framework, it has been an enabler that has supported the acceleration of much-needed wider changes at NHS Orkney, including an entreated approach to improvement. Our Improving Together Programme (organisation-wide efficiency programme) is going from strength to strength
• At the time of writing this update we are awaiting confirmation of our year end results. However, it looks very likely that we have achieved our 2024/25 Financial Plan and Savings Plan of £4m (of which more than 70% savings are recurrent) which is an incredible achievement and something NHS Orkney has not achieved before. A separate piece of communications will follow on our year-end financial position in the weeks to come
• To reduce our waiting times for planned care patients, which includes outpatient appointments, operations, tests, scans, and cancer care, we set up a new Planned Care Programme Board. We completed a deep dive on planned care waiting times at our Finance and Performance Committee and have developed plans to improve access to key services and those where we have the longest waits, including: Pain, Ophthalmology, Ear, Nose and Throat and Orthopaedics
• In response to feedback from our community, in 2024 we started to publish a simple summary each month of our waiting times by specialty on our website, so it is easy to understand and digest, so we are being transparent
• We are consistently a top three Board in Scotland for our 4-hour emergency access performance, which means our patients consistently receive timely emergency care
• A multi-disciplinary discharge planning group has been established to improve the discharge experience for our patients, particularly those living on the ferry linked isles, recognising this is an area where our patients consistently let us know we have more work to do
• New Performance Review Meetings were introduced in 2024/25 so that teams can be supported and held to account for delivery and improving across the full range of performance metrics. These meetings are for clinical and non-clinical teams and are held quarterly

Potential

• To accelerate the digitisation of NHS Orkney, we agreed three top digital priorities, which are the roll-out of Electronic Patients Records (EPR) for community-based staff, upgrading our electronic document management system (cCube) and re-provision of our GP IT systems. The first team to go live this year with MORSE is our Community Mental Health Team. The roll-out of the community EPR will continue into 2025/26. cCube was upgraded as planned and a national delay to GP IT means this project is behind plan currently, which is outside of NHS Orkney’s control
• We now have a digital champions network meeting in place, with 20 people from across the organisation volunteering to be part of the digital transformation workstream of our Improving Together programme
• In December 2024, our Digital Services underwent an external audit by Scottish Government on our compliance against the Public Sector Cyber Resilience Framework which helps public sector organisations assess their cyber resilience. As a result of an increased focus on compliance, feedback from auditors was excellent, and we have increased our compliance to 50% which is what we set out to achieve in 2024/25
• Our student and trainee experience at NHS Orkney is excellent and we received external endorsement of this in 2024, which is an achievement we are very proud of and want to build on
• Our Senior Leadership Team has agreed in principle to proceed to a full options appraisal and costed Business Case for a new and inclusive Education and Improvement Centre at The Balfour, which is another exciting development which evidences we are prioritising investing in our staff. This project will be a priority for concluding in 2025/26

Place

• We have introduced a new chapter in our Integrated Performance Report which shows how we are performing on key performance indicators related to Population Health recognising its criticality in us achieving our Promise to our community
• We have made good progress moving forward with our plans for the Old Balfour site and King Street to ensure we maximise the use of these assets to support the delivery of our Corporate and Clinical Strategies. An options appraisal is being completed for King Street and we have completed a valuation of the Old Balfour Site
• All work to decarbonise our estate has now finished – which is an incredible achievement after being awarded £4million by Scottish Government back in 2023 to further reduce reliance on the use of fossil fuels and ensure alternative renewable energy systems are installed
• As the Board with the highest uptake in Scotland for Flu vaccinations (adults) and Covid vaccinations, we are playing a fundamental role in keeping our community safe

We are incredibly proud of Team Orkney and how we have responded to the many pressures and challenges we have and will continue to face.

Looking to 2025/26, following three months of engagement and listening to our patients, community, partners and staff, and after Board approval in March 2025, we will launch our Year 2 Corporate Strategy priorities on Monday 31 March 2025.

Thank you to our partners and external stakeholders whom we work closely with throughout the year for their support and collaborative working and important contributions to our continuous improvement journey. We look forward to building on this in the year to come.
We go into 2025/26 with much hope and optimism for our future knowing we are very much moving in the right direction, are evidencing continuous improvement and because we know that by working together, we can achieve amazing things for our patients, community, and staff.

Laura & Meghan