In person: Island life

Recently back from Shetland and Orkney, CSP chief executive Karen Middleton reflects on the reality of providing physiotherapy in isolated places.

I have just returned from an island visit to members in Shetland and Orkney. I visited the Western Isles in 2016 and, once again, this trip was very instructive. However, this time I went with a more open mind, having admitted to some preconceptions when I visited Lewis and Harris two years ago.
First, I learned that although the travel guides lump Shetland and Orkney together, they are very different in terms of landscape, culture and healthcare. The islanders don’t consider themselves any more similar to each other than they do to the rest of the UK. Many people I met in Shetland have a greater affinity to Norway than the UK.
How often do we inadvertently lump people together like this and then lose sight of the value of difference? How often might we disengage people by not being aware of sensitivities? I am certainly grateful for the briefing I was given by my staff before I left because I could easily have disengaged members through my own ignorance of differences.
Once again I saw great practice and, in particular, autonomy in practice. The island life, geography, demographics and workforce issues necessitate this, and the issue of ‘integration’ was hardly mentioned as it happens as a matter of course. You do what needs to be done; and there appears to be much less concern about what is and isn’t one’s job.
Self-management was a feature of what I saw and is essential where accessing healthcare on the islands may require long drives and several ferries. Once again I saw how the shift in focus towards prevention and self-management required across the UK is the modus operandi on these islands.
There are challenges, though, and these can be instructive. Confidentiality is tested almost every day in a place where everyone knows everyone else. Retaining the patient-clinician boundary can be tricky when a simple supermarket shop can turn into a consultation.
Workforce is also a challenge, as the islands are remote and life there is not for everyone. Succession-planning is a problem and every job vacancy brings a debate about how to recruit differently, how to use the vacancy to innovate and make changes, and how to market the whole package of island life. I wonder how many of us on the mainland, in a rush to fill a post, take time to look at a vacant role differently 
and creatively.
Another thing I noticed was how much partnership working there was between the NHS and the private and charitable sectors to create and deliver services. I sensed a real spirit of ‘this is our island health and we’ll all pitch in to make it better’, which seemed to engage everyone to pool their efforts, talents and money. This reminded me of the CSP message about organising, and what can be achieved if you get organised and what 57,000 members can achieve by pulling in the same direction.
Continuing professional development has been a challenge in the past when access was traditionally through attendance at courses and in-person training. Much use is made of webinars, supervision via Skype calls and Twitter – another lesson for the rest of us, perhaps.
The challenge of travel was interesting, particularly for me as a Londoner. Travel within the isles of Shetland and Orkney is as tricky as travel between the two groups of islands and relies on the weather. The mist came down one day, disrupting my journey, but I saw how relaxed and adaptable the physiotherapists were about juggling their plans for the day.
The overwhelming feeling I had when I left the islands was how flexible staff were and had to be because of the weather, the workforce challenges or the digital technology, which wasn’t always as good as it could be. This flexibility is an attribute we all need as the pace of change increases. We talk about workforce planning and training the workforce for the future but I believe the best we can do is to train a more flexible workforce with an agile mindset, ready to respond and adapt.
While I take no commission from any tourist board, the islands were stunning and well worth a visit. And maybe, just maybe, you might consider a job there.  

Contact Karen

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