0:00:02 > 0:00:04This programme contains some strong language.
0:00:04 > 0:00:08- The council. The organisation we love to complain about. - All they want to do is tell you
0:00:08 > 0:00:09how much of a knob-end you are. Yeah, right.
0:00:09 > 0:00:12Quick as you can. I'll give you five minutes.
0:00:12 > 0:00:14You get quite a bit of abuse now and again -
0:00:14 > 0:00:19people shouting at you as they drive past. As if it's OUR fault.
0:00:19 > 0:00:23Councils across Scotland have endured challenging budget cuts
0:00:23 > 0:00:27while demands for public services have increased.
0:00:27 > 0:00:29The pressure has never been greater.
0:00:29 > 0:00:32I'm not really one normally for doing house clearances,
0:00:32 > 0:00:35but this is, by far, one of the worst ones I've seen.
0:00:35 > 0:00:39The resources out there have just not been there for them.
0:00:39 > 0:00:45There's nobody to help me. Nobody. They don't understand at all.
0:00:45 > 0:00:49Argyll & Bute's council on Scotland's west coast
0:00:49 > 0:00:54delivers those crucial services to some of the UK's most remote areas.
0:00:54 > 0:00:57A wee bit of west coast liquid sunshine.
0:00:58 > 0:01:02- It's not coming.- You're joking me. - Because of the weather.- What?!
0:01:02 > 0:01:05Get the clothes on NOW.
0:01:05 > 0:01:11From island staff working up to six jobs to keep those services going...
0:01:11 > 0:01:13It started off I was just doing the roads,
0:01:13 > 0:01:18then they added the grave digging and the grass cutting at the school.
0:01:18 > 0:01:21..to those dedicated to reaching clients
0:01:21 > 0:01:24hundreds of miles from the nearest cities...
0:01:24 > 0:01:27..these are the staff on the front line.
0:01:42 > 0:01:47Argyll & Bute Council covers a vast tract of Scotland's
0:01:47 > 0:01:50wild countryside and coastal land.
0:01:50 > 0:01:53The majority of the council's residents
0:01:53 > 0:01:57live in settlements of less than 3,000 people, or outside towns
0:01:57 > 0:02:03or villages entirely, and 80% live within just one mile of the sea.
0:02:03 > 0:02:08This unique landscape makes Argyll & Bute one of the most beautiful
0:02:08 > 0:02:11areas of Scotland.
0:02:11 > 0:02:15But it also means that many council workers have to travel long
0:02:15 > 0:02:18distances by road and water to do their jobs.
0:02:18 > 0:02:22In such a sparsely populated territory,
0:02:22 > 0:02:26the council has to work creatively to deliver the essential services
0:02:26 > 0:02:29on which their inhabitants rely.
0:02:29 > 0:02:33Good afternoon, you're through to Argyll & Bute Council.
0:02:33 > 0:02:37But like any local authority, they also have to address
0:02:37 > 0:02:42all the...inventive inquiries of their residents.
0:02:42 > 0:02:44Hi, um, it's a funny one.
0:02:44 > 0:02:47- My bin has disappeared. - Oh, right, OK.
0:02:47 > 0:02:49THEY CHUCKLE
0:02:49 > 0:02:52I've got a whole lot of coat hangers - plastic ones.
0:02:52 > 0:02:56Do I put them in the recycling or the general waste?
0:02:56 > 0:03:00- Hello, can I speak to Gaz, please? - I'm sorry, he's not there.
0:03:00 > 0:03:04- Will he be on his mobile, or is it he's on the bog?- I don't...
0:03:04 > 0:03:07Oh! I don't even know his mobile, I'm sorry!
0:03:07 > 0:03:12I don't know his mobile - or intimate details like that!
0:03:12 > 0:03:16But there is one call to the council no-one likes to make.
0:03:16 > 0:03:21I'm just phoning up, are you able to pay a parking fine on this number?
0:03:25 > 0:03:30Parking wardens regularly make the top ten of the most hated
0:03:30 > 0:03:33professions in Scotland,
0:03:33 > 0:03:37alongside bankers, lawyers and estate agents.
0:03:37 > 0:03:42But parking fines generate over 200,000 annually for the council.
0:03:42 > 0:03:45In a town like Oban, where the population swells
0:03:45 > 0:03:50from 8,500 to 25,000 during the tourist season,
0:03:50 > 0:03:54parking wardens like David keep the town moving.
0:03:56 > 0:03:59It's really quite busy, there's a lot of cars,
0:03:59 > 0:04:01a lot of tourists coming into the town.
0:04:01 > 0:04:04It can get a wee bit harum-scarum, for sure.
0:04:06 > 0:04:09Er, just people constantly circling, trying to get parked.
0:04:10 > 0:04:14See, this is what I mean. Somebody has parked here...
0:04:18 > 0:04:23..on a single yellow line, and bought a ticket. It's just wrong.
0:04:23 > 0:04:25On every level, it's wrong.
0:04:25 > 0:04:28He's a local guy, and he knows the rules.
0:04:30 > 0:04:33That's what's called just taking the Michael.
0:04:40 > 0:04:45Dishing out parking tickets means David is no stranger to conflict.
0:04:45 > 0:04:48All they want to do is complain and moan
0:04:48 > 0:04:52and tell you how unfair it is and how much of a knob-end you are,
0:04:52 > 0:04:57you know? Yeah, right. It's easier just to agree with people.
0:04:57 > 0:05:01- How you doing?- Not bad. Ticket. - Mm-hm.- For what?
0:05:01 > 0:05:03- Parking on a single yellow line. - There was a line of cars there,
0:05:03 > 0:05:06- that's why I parked.- But you shouldn't be parked there.
0:05:06 > 0:05:08You're as well parking somewhere where it's legal.
0:05:10 > 0:05:14- Everywhere in Oban is shite to park. - It's getting that way, pal, aye.
0:05:14 > 0:05:16You take it easy. See you, pal.
0:05:18 > 0:05:21CAR ROARS
0:05:22 > 0:05:25It kind of stops them in their tracks
0:05:25 > 0:05:28because they're maybe waiting for you to go, "Who are you talking to?
0:05:28 > 0:05:31"Who the fuck are you talking to?"
0:05:32 > 0:05:35The bad part of the job obviously is dishing tickets out,
0:05:35 > 0:05:39but if there's no traffic wardens in the town, then it would just
0:05:39 > 0:05:43be mad, it would be absolute madness, absolute madness.
0:05:43 > 0:05:48One of David's main tasks is to keep Oban's busy high street
0:05:48 > 0:05:52clear of the heavy tourist traffic and the constant deliveries
0:05:52 > 0:05:57to local businesses, so the town doesn't grind to a halt.
0:05:57 > 0:06:03It's out of the bay. It's not parked correctly within the bay.
0:06:03 > 0:06:06And he's actually on the double yellows,
0:06:06 > 0:06:08he's that far out of the bay.
0:06:08 > 0:06:12And that's what causes huge congestion - huge.
0:06:15 > 0:06:18It's a delicate balance to make sure the local shops get the stock
0:06:18 > 0:06:22- but the street keeps moving. - Help the community, you know.
0:06:22 > 0:06:25Help the Aged!
0:06:25 > 0:06:27You know, if these guys aren't delivering to businesses,
0:06:27 > 0:06:30the businesses are going to close, so you try to give them a wee
0:06:30 > 0:06:35bit extra, but fair play to them, it has moved as soon as they have
0:06:35 > 0:06:37seen they needed to move,
0:06:37 > 0:06:39whereas others just don't bother their backside.
0:06:45 > 0:06:47- Tell me you're just about to move. - I am.
0:06:47 > 0:06:50Good man, that's the correct question.
0:06:50 > 0:06:52It's double yellows, buddy.
0:06:52 > 0:06:56- Hello, missus, how are you? - OK.- Good stuff.
0:06:56 > 0:07:00- I do have...- That's no problem at all, I seen it. Take it easy.
0:07:00 > 0:07:02I absolutely love the job.
0:07:02 > 0:07:05I surprise myself how much I actually enjoy it.
0:07:05 > 0:07:09How much I enjoy just getting out and speaking to people. It's great.
0:07:15 > 0:07:17COINS RATTLE
0:07:17 > 0:07:20- Bingo.- Jackpot.
0:07:25 > 0:07:28I've been doing this now for just under two years,
0:07:28 > 0:07:29and it was a bit of a test for me.
0:07:29 > 0:07:33A lot of people were taking bets on whether I was going to last.
0:07:33 > 0:07:34BEEPING
0:07:34 > 0:07:36However, I proved them all wrong.
0:07:36 > 0:07:39BEEPING, HE CHUCKLES
0:07:39 > 0:07:43I've got all their number plates, don't you worry, I'll get them!
0:07:51 > 0:07:53HE CHUCKLES
0:07:57 > 0:08:0118 miles south of Oban lies Dunoon, on the Cowal peninsula.
0:08:01 > 0:08:04Here, like the rest of Argyll & Bute,
0:08:04 > 0:08:08the council work in partnership with NHS Highland,
0:08:08 > 0:08:12pooling much-needed resources and funds.
0:08:12 > 0:08:16Health visitors work with families to give pre-school-age children
0:08:16 > 0:08:19the best possible start in life.
0:08:19 > 0:08:20But across Scotland,
0:08:20 > 0:08:24a shortage in staff is leaving health visitors stretched.
0:08:26 > 0:08:30Sue and Jen work within the Cowal hospital in Dunoon.
0:08:30 > 0:08:34- DOORBELL JINGLE - Liam Gallagher. So, that's to remind me at ten o'clock,
0:08:34 > 0:08:37concert tickets go on sale today at ten o'clock.
0:08:37 > 0:08:41- No-one sells out when I go to a concert!- I'm trying to think who you'd like.
0:08:41 > 0:08:46- Sue is a qualified salsa teacher. I'm a tap dancer. - All right, OK, give me your hands.
0:08:46 > 0:08:50When I step forward on this foot, you step back. Back. And replace.
0:08:50 > 0:08:55Out here. OK, you walk forward, and I'll go under.
0:08:55 > 0:08:59- What do I do now?- You let go. You would finish up that way.
0:08:59 > 0:09:02- OK. Done.- Oh, my goodness!
0:09:02 > 0:09:06So... We'll have a team-building day and I'll do you a salsa class.
0:09:06 > 0:09:07I would love that!
0:09:13 > 0:09:17Sue is en route to the first client of the day.
0:09:17 > 0:09:23I qualified in 1990. So I'm going for my long-service award!
0:09:26 > 0:09:29We're heading off to see a wee lad who's recently had
0:09:29 > 0:09:34a diagnosis of autism. As far as I understand it, his behaviour
0:09:34 > 0:09:39tends to be quite boisterous so he could be all over the place.
0:09:39 > 0:09:43Mum is quite a talker, so she'll not be shy in coming forward,
0:09:43 > 0:09:46and that's great. The parents may well have been worried about it,
0:09:46 > 0:09:51but when they hear the words "this is what your child has",
0:09:51 > 0:09:54then it can be quite traumatic for them.
0:09:54 > 0:09:57Park here, I think, but there is a rather large puddle.
0:10:02 > 0:10:04Autism is on the rise,
0:10:04 > 0:10:09and now affects more than one child in every 100 across Scotland.
0:10:12 > 0:10:18Hi, how you doing? Hello! Wow, look at you! Hiya!
0:10:18 > 0:10:22- I like this.- Yeah, his letters. What letter is that?- Dub.
0:10:22 > 0:10:26W, that's right. What else is there?
0:10:26 > 0:10:29Em...
0:10:29 > 0:10:30What one's that?
0:10:30 > 0:10:33I knew that there wasn't something quite right,
0:10:33 > 0:10:36development has just not been that fast.
0:10:36 > 0:10:40He's taking a bit longer with everything, with his walking
0:10:40 > 0:10:44and everything, his speech, and finally we got the agreement
0:10:44 > 0:10:48six months ago that he is autistic, so that we can get everybody to
0:10:48 > 0:10:52kind of help us and know that it is not just his speech that is
0:10:52 > 0:10:55slow, his developments are all catching up on him as well.
0:10:57 > 0:10:58It has been stressful,
0:10:58 > 0:11:01but the smiles and everything make up for it.
0:11:01 > 0:11:05Autism affects a child's social development and learning,
0:11:05 > 0:11:08meaning Jamie will have difficulties interacting
0:11:08 > 0:11:11and communicating with those around him.
0:11:11 > 0:11:15With the diagnosis a recent one, Sue is keen to look today at where
0:11:15 > 0:11:18mum Charlene might need some additional help.
0:11:18 > 0:11:20Right, so, learning and developing, I think
0:11:20 > 0:11:24there's a few things in there that were causing a little bit
0:11:24 > 0:11:27- of a blockage.- Yes, his speech.- OK.
0:11:27 > 0:11:32So, developmentally, language is a bit of a wee block just know. OK.
0:11:32 > 0:11:35Righty-ho, I think he's a pretty confident, outgoing wee boy!
0:11:35 > 0:11:37Yes, he's too confident at times!
0:11:37 > 0:11:41So, if I get my diary we can do that in a wee tick.
0:11:41 > 0:11:44- He does prefer being by himself quite often.- That's grand.
0:11:44 > 0:11:47Is there anything...? You want to sort him? Sure, that's fine.
0:11:48 > 0:11:51- HE SCREAMS - Come on.
0:11:53 > 0:11:54"Oh, Mummy, I'm back." Hello.
0:11:54 > 0:11:56Is there anything in that thing
0:11:56 > 0:11:59you think is specifically important?
0:11:59 > 0:12:01The thing that worries me the most is his temperament
0:12:01 > 0:12:04and he's still head-butting quite a lot of things.
0:12:04 > 0:12:05He's doing it at nursery as well.
0:12:05 > 0:12:08- JAMIE YELLS - If he gets frustrated and doesn't understand... Just leave him.
0:12:08 > 0:12:12Sometimes if he's going to have one, you can try and tickle him
0:12:12 > 0:12:14or try and do something, depending on the frame of mind that he's in,
0:12:14 > 0:12:17and sway him away from what he was actually getting
0:12:17 > 0:12:21frustrated at, but other times, if he's too far gone then that's him.
0:12:21 > 0:12:22- Plan B.- Yes.
0:12:22 > 0:12:25JAMIE CHUCKLES
0:12:25 > 0:12:29- What are you doing?- Jamie, what ARE you doing? Right, I think that's us.
0:12:34 > 0:12:36It was a bit distracting.
0:12:36 > 0:12:41Mum was a bit distracted by the wee lad, but she did well.
0:12:41 > 0:12:44Diagnosis was obviously a bit of a bombshell.
0:12:44 > 0:12:47We need to start building their confidence and giving them
0:12:47 > 0:12:50the support that they need, so we're looking, then, at maybe getting
0:12:50 > 0:12:55one-to-one support for them. It ends up being a multi-agency jigsaw.
0:12:55 > 0:12:58As part of my role as health visitor, it's up to me
0:12:58 > 0:13:00to co-ordinate that jigsaw
0:13:00 > 0:13:04and make sure that things get done to help him.
0:13:04 > 0:13:08An autism diagnosis can be a very daunting
0:13:08 > 0:13:10and emotional time for parents,
0:13:10 > 0:13:15something Sue's colleague Jen understands more than most.
0:13:15 > 0:13:18I remember when my son got diagnosed, and it was actually
0:13:18 > 0:13:21the nursery teacher that picked it up. It's enormous,
0:13:21 > 0:13:24it affects everything. It's not just communication,
0:13:24 > 0:13:26it's their dexterity, their coordination.
0:13:26 > 0:13:29It's a long, long road for parents.
0:13:29 > 0:13:34And I remember being in tears that this woman had had the audacity
0:13:34 > 0:13:38to say that my son could possibly be on the autistic spectrum.
0:13:38 > 0:13:40And I remember phoning some of my friends
0:13:40 > 0:13:43and being absolutely devastated, absolutely devastated.
0:13:43 > 0:13:47I think you've got another level of awareness or knowledge
0:13:47 > 0:13:51that a lot of parents may not have. And you get this piece of news and then you're left.
0:13:51 > 0:13:55You are. And I don't feel, when I look back now to 2009,
0:13:55 > 0:13:59that we were properly supported with that diagnosis.
0:13:59 > 0:14:03There's obviously much more aftercare now.
0:14:03 > 0:14:06The next stage is to pull in some of that support
0:14:06 > 0:14:09from across the council and social care partnership
0:14:09 > 0:14:13to help Jamie communicate better with those around him.
0:14:13 > 0:14:16I mean, it's all about making things better, there's no point
0:14:16 > 0:14:17in us slogging away on our own,
0:14:17 > 0:14:20because we're not going to make the difference on our own.
0:14:20 > 0:14:23We need to do it with everybody in the other agencies,
0:14:23 > 0:14:27and they need to be aware of the situation the same as we do,
0:14:27 > 0:14:30- because we're all part of the solution.- Yeah.
0:14:39 > 0:14:42Bringing services to the islands is challenging.
0:14:42 > 0:14:47But with 17% of the Argyll & Bute population living on islands,
0:14:47 > 0:14:50the council must attempt to deliver the same services
0:14:50 > 0:14:53as those on the mainland.
0:14:53 > 0:14:5740% of Argyll & Bute's road networks are on the islands,
0:14:57 > 0:15:01and today, the roads department are on Jura, where the
0:15:01 > 0:15:07200-strong population are served by one single-track, bumpy road.
0:15:07 > 0:15:10It may be the only road in Jura, but it's the main road!
0:15:10 > 0:15:14It's also a principal lifeline route, between the ferry
0:15:14 > 0:15:16and the main areas of population.
0:15:16 > 0:15:20Callum and David, from the council's roads department,
0:15:20 > 0:15:24are carrying out an inspection of Jura's eight-mile-long road.
0:15:26 > 0:15:28Aye, well. This has held up for a while,
0:15:28 > 0:15:30but once the surface has broken again...
0:15:31 > 0:15:35Across the island, it is a losing battle.
0:15:35 > 0:15:37But this is one of the major concerns about here,
0:15:37 > 0:15:40the amount of rainfall that we do get.
0:15:40 > 0:15:42It's a bit kind of chewy, isn't it, Davy?
0:15:42 > 0:15:45- I mean, it's certainly flexible, but...- Aye.
0:15:45 > 0:15:49- ..once the water penetrates it, it's going to break away again.- Yeah.
0:15:51 > 0:15:54Hardest to get to, hardest to fix, and...
0:15:54 > 0:15:58..seems to be the most susceptible to damage again.
0:15:58 > 0:16:01- About 200,000 to 300,000 to actually fix this?- Yes.
0:16:01 > 0:16:03That would just blow the budget, if we did that.
0:16:03 > 0:16:06This is a single-track road. You know, there's no solid base.
0:16:06 > 0:16:10The whole of this section is basically moving all the time.
0:16:10 > 0:16:12It is quite literally a flexible road.
0:16:12 > 0:16:14It's basically floating on peat.
0:16:14 > 0:16:18Digging out the peat would literally cost millions. It's just not a practical option.
0:16:19 > 0:16:24It's millions the council does not have.
0:16:24 > 0:16:30The annual repair budget across the entire region is £5.5 million.
0:16:30 > 0:16:32We're in a position just now
0:16:32 > 0:16:34where we are
0:16:34 > 0:16:38struggling to hold the fort with the resources we have.
0:16:38 > 0:16:42The islands exacerbate that - you know, we have vast distances
0:16:42 > 0:16:48between our depots, so it's not easy to sort of move resources around.
0:16:48 > 0:16:52A six-strong team have had to be brought over to Jura,
0:16:52 > 0:16:55to patch up the worst section of road.
0:16:55 > 0:16:57A job that would take half a day on the mainland
0:16:57 > 0:16:59will take three days on the island,
0:16:59 > 0:17:03because of the logistics to get the tarmac delivered.
0:17:03 > 0:17:05It has to be hot when laid,
0:17:05 > 0:17:07so must travel the same day -
0:17:07 > 0:17:10a four-hour journey, via two ferries.
0:17:11 > 0:17:15The ferry we get now to Islay is CalMac,
0:17:15 > 0:17:18and the one from Islay to Jura
0:17:18 > 0:17:21is a council one. It's council-owned.
0:17:21 > 0:17:24So we're going to get to Jura, with the tar, some time this afternoon.
0:17:24 > 0:17:27Heat it up, make it quite warm,
0:17:27 > 0:17:29so it lasts the journey.
0:17:29 > 0:17:31Any delay to the journey
0:17:31 > 0:17:33will risk the tarmac setting,
0:17:33 > 0:17:37slowing down the job and pushing up the budget.
0:17:37 > 0:17:41Sometimes we do about six or seven loads.
0:17:41 > 0:17:47But when it's the islands it's basically one load, and it's a long day for one load.
0:17:47 > 0:17:51- What's that, 12 o'clock...?- Yeah.
0:17:51 > 0:17:54The boats'll just be about arriving, it'll be another hour and a half.
0:18:02 > 0:18:08While they wait for the tarmac, David and Callum inspect the work so far.
0:18:10 > 0:18:13This has a budget of £45,000.
0:18:13 > 0:18:18For that, on this single-track road, we'll probably be able to surface three quarters of a kilometre.
0:18:22 > 0:18:26- HE LAUGHS - It's pretty bumpy.
0:18:26 > 0:18:30It's a hell of a lot of waiting around for...
0:18:30 > 0:18:33You know, what you're taking three days to do is...
0:18:33 > 0:18:37- ..you know, a good morning's work... - Aye, that's right.
0:18:37 > 0:18:39- ..in the real world, eh?- Yes.
0:18:39 > 0:18:42That's what you get for living on the edge of the known universe!
0:18:48 > 0:18:50With the tarmac finally here,
0:18:50 > 0:18:52the crew can get to work.
0:18:56 > 0:18:58That's perfect, aye. Bang on.
0:18:58 > 0:19:00I couldn't have done a better job myself!
0:19:02 > 0:19:04They want 40 laid on the middle,
0:19:04 > 0:19:07so we measure that with a bit of tape.
0:19:07 > 0:19:09Technical branch!
0:19:11 > 0:19:14All island traffic comes to a halt
0:19:14 > 0:19:16until that work is done.
0:19:16 > 0:19:18We'll get a traffic jam now.
0:19:18 > 0:19:20Cars on both sides waiting.
0:19:22 > 0:19:26This is the only road in and out of Jura, there's only one single road.
0:19:26 > 0:19:29You get a bit of abuse now and then -
0:19:29 > 0:19:32people shouting at you as they drive past. As if it's OUR fault.
0:19:34 > 0:19:37- Go on...!- CYCLIST: Spoil it for you.
0:19:37 > 0:19:41That might make it better, you might roll it out better for us!
0:19:41 > 0:19:42It's a constant battle -
0:19:42 > 0:19:45we try and do our best with the budget we have available,
0:19:45 > 0:19:47but it's never enough.
0:19:54 > 0:19:59The increasing costs of Scotland's growing, ageing population
0:19:59 > 0:20:04has led to a rise in the number of community nurses nationwide.
0:20:04 > 0:20:07The service, funded by the council
0:20:07 > 0:20:09and the NHS's Health And Social Care Partnership,
0:20:09 > 0:20:14now helps treat more patients at home, instead of in hospital,
0:20:14 > 0:20:17which is both better for the patients' wellbeing
0:20:17 > 0:20:19and reduces costs.
0:20:21 > 0:20:23OK, are we ready to go?
0:20:25 > 0:20:27- OFF-CAMERA: Packhorse.- Packhorse!
0:20:27 > 0:20:29Packhorse on a Friday morning.
0:20:33 > 0:20:35Community nurse Gillian
0:20:35 > 0:20:40has worked on the Isle of Bute and Rothesay for the last 20 years,
0:20:40 > 0:20:44and deals with a huge range of care needs for her patients.
0:20:44 > 0:20:50Our first patient's called Annie, and she is 74 years old...?
0:20:50 > 0:20:52A lady with a great character.
0:20:52 > 0:20:55Sort of a smallholder as well, she has, erm...
0:20:55 > 0:20:58goats, chickens, ducks,
0:20:58 > 0:21:00the odd peacock, I think,
0:21:00 > 0:21:02and a collie dog, who you'll meet.
0:21:06 > 0:21:10Temptation is to go and try and touch them - they probably would run away, wouldn't they?
0:21:10 > 0:21:11Hello!
0:21:11 > 0:21:13You speaking?
0:21:13 > 0:21:14Hello...
0:21:14 > 0:21:16Hello.
0:21:16 > 0:21:19- Hello! - SHE LAUGHS
0:21:20 > 0:21:23Hello...! Hello, Meggy-Meggy-Meggy!
0:21:23 > 0:21:25Hi...
0:21:25 > 0:21:26Come to join the party.
0:21:26 > 0:21:28I'm all right, thanks.
0:21:28 > 0:21:31- Ah... - I've got flies in my hair.
0:21:31 > 0:21:33Causing chaos, eh?
0:21:37 > 0:21:41She wants somebody to play with her, with that ball. I get that from morn to night.
0:21:41 > 0:21:45I was chatting to your cattle. But they weren't chatting back.
0:21:50 > 0:21:53- This is no' part of the NHS, Meg. - No!
0:21:53 > 0:21:56This isn't part of the process. Go on...
0:21:56 > 0:21:59Get!
0:21:59 > 0:22:00Right...
0:22:02 > 0:22:04- MEG YAPS - Ah!
0:22:06 > 0:22:07GILLIAN LAUGHS
0:22:09 > 0:22:11- Meg!- Right, down.
0:22:11 > 0:22:13Down. Good girl.
0:22:13 > 0:22:15- Right, see you Monday.- Monday.
0:22:15 > 0:22:18- MEG BARKS - I'll keep her in...
0:22:22 > 0:22:26Gillian travels over 140 miles a week,
0:22:26 > 0:22:28seeing up to six patients a day.
0:22:30 > 0:22:35Right. Next visit is to a gentleman called John.
0:22:35 > 0:22:40John has got lung carcinoma, so he's got a lung cancer.
0:22:40 > 0:22:42And that was diagnosed four months ago.
0:22:44 > 0:22:47He consented to referral to our team, the ECCT,
0:22:47 > 0:22:51which is the extended community care team,
0:22:51 > 0:22:53and he starts his journey with us.
0:22:59 > 0:23:02I always think that's part of the reason why I got this job,
0:23:02 > 0:23:05my ability to carry equipment and bags!
0:23:06 > 0:23:08It's a good ability.
0:23:09 > 0:23:13Treating patients at home, rather than in hospital -
0:23:13 > 0:23:16even those with a more complex illness like cancer -
0:23:16 > 0:23:18is more cost-effective.
0:23:18 > 0:23:20It's going to be a gorgeous day today, John.
0:23:21 > 0:23:23Yeah.
0:23:26 > 0:23:28All that vitamin D!
0:23:28 > 0:23:30OK...
0:23:30 > 0:23:33I'll just get organised and do your legs, if that's OK.
0:23:33 > 0:23:34Yeah?
0:23:34 > 0:23:37So how long have you lived here now, John?
0:23:39 > 0:23:41About nine years.
0:23:41 > 0:23:42Right...
0:23:47 > 0:23:48Right.
0:23:53 > 0:23:56It's a lifestyle, isn't it, being at sea? That career.
0:24:00 > 0:24:04Can you?
0:24:06 > 0:24:08SHE LAUGHS
0:24:11 > 0:24:15It's just a matter of getting the medication
0:24:15 > 0:24:18properly set out for his regime, and
0:24:18 > 0:24:22a staff that can oversee his, er...
0:24:22 > 0:24:26..administration of his medication, so that he's taking it regularly.
0:24:26 > 0:24:28- OFF-CAMERA: Do you think presently he CAN still live at home?- Yeah.
0:24:28 > 0:24:30He will have good days and bad days.
0:24:31 > 0:24:34- See those two little white ones? - Aye...
0:24:34 > 0:24:36Those are important. That's your steroids.
0:24:36 > 0:24:38Right.
0:24:40 > 0:24:42Yeah, you do.
0:24:42 > 0:24:45If you feel like you ARE going to nod off watching the television,
0:24:45 > 0:24:48try and elevate your legs, it'll do them good.
0:24:48 > 0:24:51While you're taking those, I'll just finish getting organised...
0:24:54 > 0:24:56Have you got your Telecare bangle on...?
0:24:57 > 0:24:59That's good.
0:24:59 > 0:25:02SHE CHUCKLES
0:25:02 > 0:25:04OK...
0:25:04 > 0:25:08- We'll catch up with you tomorrow, John.- OK.- Right? Bye.
0:25:10 > 0:25:14John lives on his own, his family live miles away.
0:25:14 > 0:25:18He is only 64 years old.
0:25:18 > 0:25:21He should really have a good chunk of life still ahead of him.
0:25:22 > 0:25:24He should be retired now and enjoying life.
0:25:27 > 0:25:29It's a poor prognosis.
0:25:29 > 0:25:32There isn't any active treatment for John,
0:25:32 > 0:25:35so we'll support him as well as we can at home in the meantime.
0:25:36 > 0:25:40There are over 750 patients annually
0:25:40 > 0:25:43in end of life care across Argyll & Bute.
0:25:43 > 0:25:46OFF-CAMERA: Is it hard in your profession to deal with death?
0:25:46 > 0:25:50It's good, it's positive, to be able to support that person.
0:25:50 > 0:25:54Make sure that they're symptom-free, and that you listen to their wishes.
0:25:55 > 0:25:58The wishes of the patient, the wishes of John.
0:25:58 > 0:26:01But, yes, it can be really sad.
0:26:18 > 0:26:22On an early-morning ferry to the island of Islay
0:26:22 > 0:26:26are two members of the adult learning disability service -
0:26:26 > 0:26:31speech therapist Carole-Anne and learning disability nurse Angela.
0:26:31 > 0:26:34We see people with Down's syndrome, autism...
0:26:37 > 0:26:41Lots of people with learning disabilities have other health conditions,
0:26:41 > 0:26:46so you might have a learning disability but also have elements of dyspraxia, or cerebral palsy.
0:26:46 > 0:26:48We pretty much always take the seven o'clock ferry,
0:26:48 > 0:26:53cos otherwise we wouldn't be over in Islay till lunchtime, and then
0:26:53 > 0:26:55wouldn't get much of a working day in, so, yeah,
0:26:55 > 0:26:59we usually take the seven o'clock ferry, which means getting up...
0:26:59 > 0:27:01- Five.- Five!
0:27:02 > 0:27:06Argyll & Bute spend almost £7 million annually
0:27:06 > 0:27:10on supported living for adults with learning disabilities.
0:27:10 > 0:27:15Carole-Anne and Angela look after around ten clients on Islay -
0:27:15 > 0:27:18a two-hour ferry journey from the mainland.
0:27:18 > 0:27:20The distances involved
0:27:20 > 0:27:23make supporting their clients a real challenge.
0:27:23 > 0:27:26I think being based in Lochgilphead, it means that we
0:27:26 > 0:27:29can access most of Argyll within about an hour and a half,
0:27:29 > 0:27:33but Islay's one of the longer distances that we do.
0:27:33 > 0:27:36I mean, people on Islay are...
0:27:36 > 0:27:39They're not getting the same service as people on the mainland would,
0:27:39 > 0:27:43because...physically we can't provide it.
0:27:43 > 0:27:47So when we get over here we tend to allocate
0:27:47 > 0:27:51a longer session with the individual.
0:27:51 > 0:27:53With the distances involved
0:27:53 > 0:27:55limiting the time Carole-Anne and Angela
0:27:55 > 0:27:58can devote to individual clients,
0:27:58 > 0:28:02they need to find a way of using resources already ON the island
0:28:02 > 0:28:06to create a more sustainable support network locally.
0:28:06 > 0:28:10A life skills course at the island's college might be the answer.
0:28:11 > 0:28:15One of the clients they are trying to help is Rhona,
0:28:15 > 0:28:19who lives in the north of the island with her mum Irene and dad Neil.
0:28:19 > 0:28:22She's very sociable and... You know?
0:28:22 > 0:28:24I mean, if Rhona met you next week,
0:28:24 > 0:28:28the first thing she'd do is cuddle you.
0:28:29 > 0:28:32We're not always going to be here.
0:28:32 > 0:28:34It's very much in our mind to
0:28:34 > 0:28:36try and get something set up for Rhona,
0:28:36 > 0:28:40to be independent and live on her own,
0:28:40 > 0:28:42before we get too old.
0:28:44 > 0:28:46A life skills course on the island
0:28:46 > 0:28:50would help give Rhona some more independence,
0:28:50 > 0:28:54and create a support network amongst those who attend.
0:28:54 > 0:28:55Carole-Anne and Angela
0:28:55 > 0:28:59need to assess what that life skills course should include.
0:28:59 > 0:29:04To do that, they're meeting Rhona and her support worker, Emma,
0:29:04 > 0:29:06as well as another local client, Alison.
0:29:06 > 0:29:08Are you up for doing a talking mat?
0:29:08 > 0:29:10Aye.
0:29:10 > 0:29:12And YOU'RE up for doing a talking mat?
0:29:12 > 0:29:14- Maybe...?- Yeah.
0:29:14 > 0:29:15OK. So...
0:29:15 > 0:29:19We're talking about activities, and we're talking about things that we like, on this side...
0:29:19 > 0:29:23The talking mat is a tool to aid communication.
0:29:23 > 0:29:26Carole-Anne and Angela can use it to help assess
0:29:26 > 0:29:28what Rhona and Alison
0:29:28 > 0:29:31would like to do on the life skills course.
0:29:31 > 0:29:33Money...
0:29:33 > 0:29:35Going to learn more about money.
0:29:38 > 0:29:40What do you think about that?
0:29:43 > 0:29:45Do you like just having money?
0:29:45 > 0:29:47- No.- No?- You do!
0:29:48 > 0:29:50She likes change - lots of change!
0:29:50 > 0:29:53Money management, domestic tasks
0:29:53 > 0:29:55and even outdoor activities
0:29:55 > 0:30:00are all part and parcel of what the life skills course can help teach.
0:30:06 > 0:30:09With an idea of what the course could look like,
0:30:09 > 0:30:12the team head to Argyll College on Islay
0:30:12 > 0:30:15to meet with learning centre manager Mhairi.
0:30:19 > 0:30:22We could look at doing small, short courses,
0:30:22 > 0:30:25where, over the course of the year,
0:30:25 > 0:30:28they could actually do one, two or three units.
0:30:28 > 0:30:32I think what would be a good idea is to get the students
0:30:32 > 0:30:35and see what they want, and what days suit them,
0:30:35 > 0:30:37and then they're leading us
0:30:37 > 0:30:39and we're developing a course that suits them.
0:30:39 > 0:30:41That was really good, wasn't it?
0:30:41 > 0:30:44That's the best outcome we could have hoped for, I think.
0:30:44 > 0:30:45Couldn't have asked for better.
0:30:45 > 0:30:49She's so enthusiastic and something is definitely going to happen.
0:30:49 > 0:30:51- Absolutely, she won't stop. - Good, good, good.
0:30:51 > 0:30:54With the course going ahead,
0:30:54 > 0:30:59there will now be more support on the island for Rhona.
0:30:59 > 0:31:02Yeah, it's a big day for us, really.
0:31:02 > 0:31:05Yes. We think it will be very positive.
0:31:05 > 0:31:07Lots of practical skills,
0:31:07 > 0:31:11anything at all that will help her to live a more independent life.
0:31:25 > 0:31:30In Dunoon, mum Charlene is concerned about three-and-a-half-year-old Jamie,
0:31:30 > 0:31:33who has recently been diagnosed with autism.
0:31:33 > 0:31:37Autism affects a child's social interactions and language development,
0:31:37 > 0:31:39making communication difficult
0:31:39 > 0:31:43and leaving Jamie frustrated that he cannot be understood.
0:31:43 > 0:31:44What's that?
0:31:44 > 0:31:46No, no!
0:31:46 > 0:31:47All right.
0:31:50 > 0:31:53To try and help with Jamie's communication,
0:31:53 > 0:31:58health visitor Sue has arranged a meeting with speech therapist Elaine.
0:31:58 > 0:32:02I didn't even do my roots, I meant to do my roots.
0:32:02 > 0:32:05- I'm putting you on the spot here. - That's fine!
0:32:05 > 0:32:09So that's my analysis from what I've seen
0:32:09 > 0:32:12and what Mum was saying, that's mostly her comments
0:32:12 > 0:32:14- and other things that have been going on.- OK.
0:32:14 > 0:32:18I mean, he is vocal and he has got a single-word vocabulary
0:32:18 > 0:32:20that is developing.
0:32:20 > 0:32:21He has got a couple of two-word phrases
0:32:21 > 0:32:24but I'm not sure how many of them are learned as two words.
0:32:24 > 0:32:28But he is sociable with familiar people as well,
0:32:28 > 0:32:32so he's got a lot of strengths going on communication-wise
0:32:32 > 0:32:36even though the verbal language is not particularly where it should be.
0:32:36 > 0:32:40My aims for him for the next wee while is just to continue
0:32:40 > 0:32:46with the PECS at home and just to get it established in nursery.
0:32:46 > 0:32:47OK.
0:32:49 > 0:32:51Where's your book?
0:32:51 > 0:32:55Where's your cookies in it? You find them.
0:32:56 > 0:32:59Clever boy. What's that?
0:32:59 > 0:33:00Cookie.
0:33:00 > 0:33:03Right, you give Mummy a card.
0:33:03 > 0:33:04Card.
0:33:04 > 0:33:07- Cookie.- Cookie. Clever boy.
0:33:07 > 0:33:10That's his PECS book.
0:33:10 > 0:33:13That's what we use for communicating with him.
0:33:13 > 0:33:14It's a great wee invention.
0:33:14 > 0:33:17Drink or food or if he wants to go
0:33:17 > 0:33:19outside, the toilet, toothbrush.
0:33:19 > 0:33:21It's good to be able to have that card
0:33:21 > 0:33:24so he learns and for communication.
0:33:24 > 0:33:25KNOCKING
0:33:25 > 0:33:30- Who is it?- Hello.- Oh, hello. It's Elaine, are you saying hiya?
0:33:30 > 0:33:34Speech therapist Elaine is here to check on Jamie's progress.
0:33:34 > 0:33:38- How are you?- I'm all right, you? - I'm good. We've got a new addition.
0:33:38 > 0:33:42- Oh, Jamie, who's this? - Is that Bella?
0:33:42 > 0:33:45How is he coming on?
0:33:45 > 0:33:48Yeah. He has been doing really, really well with it.
0:33:48 > 0:33:51He's interested in it, that's what I like to see anyway.
0:33:51 > 0:33:54Yeah, yeah. That's Play-Doh. You had that at nursery today, didn't you?
0:33:54 > 0:33:56Does he take it to nursery with him?
0:33:56 > 0:33:59He's back again on Tuesday so I can certainly say to Alexis,
0:33:59 > 0:34:03right, here's his book, yous can have a go with him
0:34:03 > 0:34:07because obviously everything in nursery is asking for and things.
0:34:07 > 0:34:08See how he gets on with it.
0:34:08 > 0:34:11And I mean, you'll get off of him now, "I want. I want."
0:34:11 > 0:34:15So he'll say that and then whatever it is,
0:34:15 > 0:34:19and he will a lot of the time, if you say something he will try
0:34:19 > 0:34:22and say it, and obviously the cards help with that
0:34:22 > 0:34:24because we've got the picture.
0:34:24 > 0:34:27- That's him now...- Going to be four come New Year's Eve.
0:34:27 > 0:34:31More likely to be his pre-school year or we don't know?
0:34:31 > 0:34:35I don't know whether he's as well staying at nursery.
0:34:35 > 0:34:39I would rather that than he went in and then had to get kept back.
0:34:39 > 0:34:40We'll see how he gets on.
0:34:40 > 0:34:44We have his Child's Plan meeting on Tuesday and then take it from there
0:34:44 > 0:34:46and see how we get on.
0:34:46 > 0:34:47Thank you for coming again.
0:34:47 > 0:34:49- Thank you!- Take care.- See you later. Bye!
0:34:53 > 0:34:56So, as far as I'm concerned,
0:34:56 > 0:35:01I think he's doing well compared to when we'd seen him before.
0:35:01 > 0:35:06Charlene is great. She's great with Jamie.
0:35:06 > 0:35:10She will have to get used to different things with him
0:35:10 > 0:35:12and what it means for him to have autism.
0:35:12 > 0:35:16And things will change for him throughout his life.
0:35:16 > 0:35:17Are you all right?
0:35:17 > 0:35:20One of the biggest decisions for Charlene
0:35:20 > 0:35:23is whether Jamie will be ready to go to school.
0:35:23 > 0:35:25I'm worried because kids are innocent
0:35:25 > 0:35:28and I don't want him necessarily getting, not picked on,
0:35:28 > 0:35:32but people leaving him out and things like that
0:35:32 > 0:35:35because he does have a speech problem,
0:35:35 > 0:35:39in the sense of he's a little bit slower with it and things.
0:35:39 > 0:35:42Jamie's way of getting his frustration out
0:35:42 > 0:35:45is he'll head-butt things, and he'll go to an outside wall
0:35:45 > 0:35:47and full-pelt head-butt it.
0:35:47 > 0:35:51If Jamie is kept out of school for an additional year,
0:35:51 > 0:35:54he may fall further behind.
0:35:54 > 0:35:56To help Charlene make the decision,
0:35:56 > 0:36:00a child planning meeting has been called
0:36:00 > 0:36:03with all the services supporting Jamie.
0:36:03 > 0:36:06The idea with it is it's just really everyone who is involved
0:36:06 > 0:36:11in a child's life gets the opportunity to come together
0:36:11 > 0:36:14round one table and discuss where the child is
0:36:14 > 0:36:18at that particular point in time in their development.
0:36:20 > 0:36:23And really what are the next steps that we're identifying,
0:36:23 > 0:36:27where we need to go next to help this child progress further?
0:36:29 > 0:36:31Aww. You give her a kiss.
0:36:36 > 0:36:39Back in Rothesay, on the Isle of Bute,
0:36:39 > 0:36:42community nurse Gillian has had a call
0:36:42 > 0:36:45about her terminally ill patient, John.
0:36:45 > 0:36:49John is unable to get out of his chair.
0:36:49 > 0:36:54One of the health-care support workers was attending him today.
0:36:54 > 0:36:56She couldn't get into the property.
0:36:56 > 0:37:01The problem obviously being to get in to John to help him,
0:37:01 > 0:37:06so I phoned the housing association,
0:37:06 > 0:37:09who his property belongs to, and they're helping me.
0:37:09 > 0:37:13They've arranged for a joiner to meet me at the property
0:37:13 > 0:37:16to open the door, so that's good.
0:37:16 > 0:37:19My only other option would have been to have the police
0:37:19 > 0:37:20break the door down.
0:37:20 > 0:37:22Let's go.
0:37:24 > 0:37:27Hi, John. It's Gillian here.
0:37:27 > 0:37:29I'm just phoning to let you know what's happening.
0:37:29 > 0:37:32With John unable to answer the door,
0:37:32 > 0:37:37the only way in for the joiner is via an upstairs window.
0:37:37 > 0:37:41So hopefully we'll get in to see John soon and can assess him.
0:37:41 > 0:37:44Probably get the GP involved today,
0:37:44 > 0:37:48he's obviously not as well as he was.
0:37:48 > 0:37:50And take it from there.
0:37:53 > 0:37:55Right. Oh, that's great.
0:37:57 > 0:37:58Oh, John.
0:38:02 > 0:38:04Oh! You've slipped right off your chair.
0:38:04 > 0:38:06How long have you been like that, John?
0:38:06 > 0:38:09We could maybe get him up and sit on that, couldn't we?
0:38:09 > 0:38:11Are you ready?
0:38:11 > 0:38:13One, two, three.
0:38:13 > 0:38:16When you're up, reach out for your frame.
0:38:16 > 0:38:18Is that possible?
0:38:18 > 0:38:21And push yourself back. Is that possible?
0:38:25 > 0:38:26That's it.
0:38:26 > 0:38:28So you think you've been on the floor for about an hour?
0:38:31 > 0:38:32More than that?
0:38:32 > 0:38:35Looks like you've just slipped out of that chair, haven't you?
0:38:37 > 0:38:39- Thank you very much.- No worries.
0:38:39 > 0:38:44I'm going to get the on-call doctor to come and see John,
0:38:44 > 0:38:47see what she thinks, and she potentially might admit John
0:38:47 > 0:38:50just to control some symptoms, perhaps.
0:38:52 > 0:38:55There you are, that's better. That's a wee something.
0:38:55 > 0:39:00You slept in your chair last night, John?
0:39:00 > 0:39:04So you were on the floor most of the night? Yeah?
0:39:04 > 0:39:10Hey, hi, Dr Calvo-Til. Dr Calvo-Til's here to see you.
0:39:10 > 0:39:13So how are you feeling now?
0:39:16 > 0:39:18All right?
0:39:18 > 0:39:20Can I take you back one step, can you remember,
0:39:20 > 0:39:23what were you doing?
0:39:25 > 0:39:28Oh, right. So have you any idea, when was that?
0:39:28 > 0:39:31How long ago?
0:39:34 > 0:39:37So it's a few hours.
0:39:37 > 0:39:40Do you think you might have passed out?
0:39:40 > 0:39:43You think you might. OK.
0:39:43 > 0:39:47I'm going to ask you to try and push against my hands.
0:39:47 > 0:39:51OK, that's a little weak, isn't it? Can you push up?
0:39:51 > 0:39:53OK.
0:39:53 > 0:39:55You getting any pain anywhere?
0:39:58 > 0:40:03I think, given what's happened to you, and because we don't know
0:40:03 > 0:40:08if you've been on the floor for, who knows, seven or eight hours,
0:40:08 > 0:40:14I think I might bring you into the hospital to perform an assessment.
0:40:17 > 0:40:19And if needs be,
0:40:19 > 0:40:23we could keep you in the hospital for a couple of days, you know?
0:40:23 > 0:40:26Until you've picked up a little bit.
0:40:26 > 0:40:29I'm not sure how you're going to manage.
0:40:29 > 0:40:32With the best care in the world,
0:40:32 > 0:40:36I think being at home might be complicated for you.
0:40:38 > 0:40:42We'll arrange an ambulance to pick you up and I'll meet you up in A&E
0:40:42 > 0:40:45when you get there.
0:40:45 > 0:40:48Great. I'll pack a bag and get his medication.
0:40:48 > 0:40:52He's been on the floor for an unknown amount of time.
0:40:52 > 0:40:55Why did he fall?
0:40:55 > 0:40:57We don't know for sure.
0:40:57 > 0:41:01First of all, I think it will be appropriate to keep him
0:41:01 > 0:41:02under observation for 24 hours,
0:41:02 > 0:41:05do some more tests.
0:41:05 > 0:41:08It could be just general sort of weakness
0:41:08 > 0:41:10or it could be that there is something else.
0:41:10 > 0:41:14Or it could be just general deterioration.
0:41:16 > 0:41:20John is transferred to the Victoria Hospital in Rothesay.
0:41:21 > 0:41:24You're looking a bit better now.
0:41:28 > 0:41:29Yes, you did.
0:41:32 > 0:41:34Do you recall getting the ambulance crew,
0:41:34 > 0:41:38collecting you and bring you up here? Do you remember any of that?
0:41:38 > 0:41:41No, you weren't well that day.
0:41:42 > 0:41:45Did you?
0:41:48 > 0:41:51Thailand.
0:41:51 > 0:41:53No!
0:41:56 > 0:41:59But you know where you are now, don't you?
0:42:03 > 0:42:08John's nephew William has come to visit his uncle.
0:42:08 > 0:42:12Uncle John was at sea for quite a lot of my youth,
0:42:12 > 0:42:14when I was very young.
0:42:14 > 0:42:17I remember you coming home, you always had stuff with you,
0:42:17 > 0:42:20little presents for your sisters and my mother.
0:42:20 > 0:42:22I remember that, that you used to bring things back
0:42:22 > 0:42:23from all over the place.
0:42:25 > 0:42:27You used to tell me where you'd been,
0:42:27 > 0:42:30the Panama Canal and lots of places.
0:42:30 > 0:42:33Australia, Asia.
0:42:34 > 0:42:37Yeah, big inspiration, absolutely.
0:42:39 > 0:42:42One of the concerns will be for us to send him home with the care package
0:42:42 > 0:42:44that he had, which was four times a day, I believe.
0:42:44 > 0:42:47I think the carers would struggle,
0:42:47 > 0:42:49four times a day would not be enough.
0:42:49 > 0:42:52I think we would have to be looking at probably every two hours.
0:42:52 > 0:42:55Marie Curie could've been the support
0:42:55 > 0:42:58but we have limited availability just now.
0:42:58 > 0:43:02I think, again, the nights, he would certainly need
0:43:02 > 0:43:04to have somebody there overnight with him.
0:43:04 > 0:43:09The staffing levels and resources needed to keep John at home
0:43:09 > 0:43:13and safe now outweigh the care that can be given to him in hospital.
0:43:13 > 0:43:16We discussed about where he would like to be.
0:43:16 > 0:43:18He's more than happy to stay here,
0:43:18 > 0:43:20die in hospital here.
0:43:20 > 0:43:23Being with us, he's built a rapport with the staff as well.
0:43:23 > 0:43:25He's comfortable with the staff, he knows the staff,
0:43:25 > 0:43:28he knows the staff by their first names.
0:43:28 > 0:43:30I think also you were saying he wanted people around him.
0:43:30 > 0:43:32He does, yeah. He's expressed that he wants that.
0:43:32 > 0:43:35We don't obviously have hospice facilities on the island,
0:43:35 > 0:43:37so we can provide that.
0:44:15 > 0:44:16Hi, John.
0:44:16 > 0:44:20Hi, John. It's Gillian. How are you today?
0:44:20 > 0:44:23I found it hard but positive as well,
0:44:23 > 0:44:27because John wanted to be in hospital
0:44:27 > 0:44:30for the end stages of his life.
0:44:30 > 0:44:33He wants to die in hospital, so we've upheld his wishes.
0:44:33 > 0:44:38You've got to know the staff here quite well, I understand.
0:44:38 > 0:44:41He is comfortable and he is well looked after
0:44:41 > 0:44:43and he has got the 24-hour care
0:44:43 > 0:44:48so it's been a good end result to his pathway. Good pathway.
0:44:52 > 0:44:55You're tired today. You quite comfortable, though?
0:44:55 > 0:44:57Quite comfortable? That's good.
0:44:57 > 0:45:02I find it sad from the point of view of he is just a young gentleman
0:45:02 > 0:45:06of 64, which I regard as a young age.
0:45:06 > 0:45:09He would normally have a good few decades ahead of him
0:45:09 > 0:45:11to enjoy his retirement.
0:45:16 > 0:45:18You're tired today, aren't you?
0:45:22 > 0:45:26John passed away in hospital, two weeks later.
0:45:29 > 0:45:35I didn't really know John when he was healthy and well,
0:45:35 > 0:45:40and he was a working man, a family man.
0:45:40 > 0:45:44I only got to know John in the last few months of his life.
0:45:44 > 0:45:48He died peacefully and with dignity.
0:45:48 > 0:45:53You can get very emotionally involved with people...
0:45:53 > 0:45:55..and their families.
0:45:58 > 0:46:00But it has got... As I've...as I've got more mature and had more
0:46:00 > 0:46:05experience, it has got a little bit easier.
0:46:05 > 0:46:08Cos you just take different positives from it,
0:46:08 > 0:46:10as opposed to it being a negative.
0:46:19 > 0:46:22On the west shore of the Firth of Clyde, in Dunoon,
0:46:22 > 0:46:26mum Charlene has been working with council health-care services
0:46:26 > 0:46:29to develop a programme of support for Jamie,
0:46:29 > 0:46:32diagnosed six months ago with autism.
0:46:32 > 0:46:35What jacket are you wearing? Are you wearing your green jacket?
0:46:35 > 0:46:37- Ah, yeah.- Yeah, yeah.
0:46:37 > 0:46:40- You don't have a yellow jacket. - I wear yellow.
0:46:40 > 0:46:43I don't have a yellow jacket!
0:46:43 > 0:46:48For health visitor Sue, helping Jamie to be understood and understand
0:46:48 > 0:46:52others around him has been vitally important to supporting the family.
0:46:54 > 0:46:57For Jamie, the autism that he does have, it can affect
0:46:57 > 0:46:59the way you understand and communicate with the world...
0:46:59 > 0:47:01- Here.- I want...
0:47:01 > 0:47:04..and it makes it very difficult to make their way
0:47:04 > 0:47:07and make relationships and get things that they need,
0:47:07 > 0:47:10so one of the ways that we're doing that just now is to help
0:47:10 > 0:47:13Jamie to have more vocabulary,
0:47:13 > 0:47:16so he's going to...concentrating on giving him more words.
0:47:16 > 0:47:19Oh! You need your Minion bag and your lunch bag.
0:47:19 > 0:47:22Don't you? And your PECS cards for nursery.
0:47:22 > 0:47:26Jamie will have more skills to communicate with people, which
0:47:26 > 0:47:29should reduce frustration, which he is displaying at the minute.
0:47:29 > 0:47:31Right, are you climbing in?
0:47:31 > 0:47:33- Yah.- Yah.
0:47:33 > 0:47:36So his head-butting in response to somewhere where
0:47:36 > 0:47:39he's not feeling understood should go down.
0:47:41 > 0:47:44- Right, are we sorted?- Yah.- Yah.
0:47:44 > 0:47:48Today is a crucial day, with a big decision for Charlene ahead.
0:47:48 > 0:47:53She must decide if Jamie is ready to start school next year.
0:47:53 > 0:47:57All the services that have been working with Jamie will come together
0:47:57 > 0:48:03to assess his progress, but the final call will lie with Charlene.
0:48:03 > 0:48:06This is all still a bit new for us.
0:48:06 > 0:48:09Everything that I come to is a new obstacle.
0:48:09 > 0:48:12No two children are the same, never mind no two
0:48:12 > 0:48:15children with autism are the same, so you can't really gauge
0:48:15 > 0:48:18it on anybody else's experience, or even your own,
0:48:18 > 0:48:20if you had another child with anything. It is really
0:48:20 > 0:48:25basically what's Jamie, down to Jamie, and what's best for Jamie,
0:48:25 > 0:48:27and we'll take it a day as we come.
0:48:27 > 0:48:30Go the way that we have been going, and it seems to be working
0:48:30 > 0:48:33- so far, so...we must be doing something right. - SHE CHUCKLES
0:48:33 > 0:48:36Hello, hello, hello. Hiya. Come on in. Get you a seat.
0:48:36 > 0:48:40Hi, both of you. How are you doing?
0:48:40 > 0:48:43Joining Charlene and Jamie's father Andrew at
0:48:43 > 0:48:48the meeting are council and social care staff from across the team -
0:48:48 > 0:48:53speech therapist Elaine, Jamie's nursery teacher, alongside Sue.
0:48:53 > 0:48:55Anyway, nice to see you both.
0:48:55 > 0:48:58Thank you for sparing the time to come.
0:48:58 > 0:49:01It can feel a bit intimidating for parents.
0:49:01 > 0:49:04We try and make it as friendly,
0:49:04 > 0:49:08if you like, as we can, and as supportive as we can.
0:49:08 > 0:49:11- Have you heard of this Getting It Right process?- Eh...- Vaguely.
0:49:11 > 0:49:14- A wee bit.- A wee bit, OK. So it just means that,
0:49:14 > 0:49:17now we're in the position of trying to coordinate the support
0:49:17 > 0:49:20that Jamie might need, it means we're round the table together
0:49:20 > 0:49:23and we're all going to be hopefully heading in the same direction.
0:49:23 > 0:49:26You had some other comments, because you sent me some comments
0:49:26 > 0:49:29earlier on about how things were within the nursery setting
0:49:29 > 0:49:33- for Jamie.- We see a really big difference in him since the holidays.- Oh, he has.
0:49:33 > 0:49:36He's interacting with the kids a lot more.
0:49:36 > 0:49:40- What kind of things is he doing? - We always try and do a group time,
0:49:40 > 0:49:43singing songs. I'll let them all stand up individually,
0:49:43 > 0:49:46- and Jamie would never, ever do that. - Mm-hmm.
0:49:46 > 0:49:48But the other week, I said, "Do you want to sing a song?"
0:49:48 > 0:49:50- He was like, "Yeah." And he stood up...- Great.
0:49:50 > 0:49:53- ..and he sang his alphabet. - That is nice. OK.
0:49:53 > 0:49:56And the other thing I know that you'd been thinking about earlier on
0:49:56 > 0:49:59was about school entry and whether you need to adjust that or not.
0:49:59 > 0:50:01- Yeah. I'm still humming and hawing, but...- OK.
0:50:01 > 0:50:06..I'm probably swaying more towards keeping him back for another year.
0:50:06 > 0:50:08- Right.- He might come on miraculously in the next few months,
0:50:08 > 0:50:11- and it might be a completely different kettle of fish...- Uh-huh.
0:50:11 > 0:50:14- ..but at the moment...- It's an option.- Yeah.- It's an option.
0:50:22 > 0:50:24It's whatever's going to suit him best, because I don't want him
0:50:24 > 0:50:28to start and then end up struggling with the rest of his school years.
0:50:28 > 0:50:32So I would rather that he was more prepared than not prepared enough.
0:50:32 > 0:50:34But we shall see.
0:50:34 > 0:50:37It is too soon to decide on school.
0:50:37 > 0:50:42But for mum Charlene and dad Andrew, the support from the team over the
0:50:42 > 0:50:45last few months has made a world of difference.
0:50:45 > 0:50:49It's been a long time coming, getting all of these meetings
0:50:49 > 0:50:50and everything organised,
0:50:50 > 0:50:55from when we discussed that there was possibly something...
0:50:55 > 0:50:57- ..that was wrong. - LAUGHTER
0:50:57 > 0:51:00And now that we're actually getting somewhere,
0:51:00 > 0:51:03it feels a lot better, that everybody's kind of helping.
0:51:03 > 0:51:07When Jamie's interacting with other people, they'll understand him.
0:51:07 > 0:51:10They'll understand what he's feeling, and he'll also
0:51:10 > 0:51:14benefit from being able to explain his emotions a little bit better.
0:51:14 > 0:51:18- Uh-oh.- Uh-oh. Uh-oh!- Uh-o-o-o-oh!
0:51:18 > 0:51:20LAUGHTER
0:51:20 > 0:51:23It is just good to have the support of everybody. I think that's
0:51:23 > 0:51:25one of the main things but, is to have everybody
0:51:25 > 0:51:28- round about you helping. - LAUGHTER
0:51:30 > 0:51:34- All in a day's work. - More than a day's work. - SHE LAUGHS
0:51:46 > 0:51:49With an annual spend of nearly £71 million,
0:51:49 > 0:51:55education is the council department with the largest overall budget.
0:51:55 > 0:51:59But even with that investment, delivering education to every
0:51:59 > 0:52:03child across rural communities can be challenging
0:52:03 > 0:52:06and sometimes means kids from remote areas must
0:52:06 > 0:52:09travel for school to larger towns.
0:52:13 > 0:52:17On the small island of Colonsay, the council's primary headteacher,
0:52:17 > 0:52:20Miss Mackenzie, is ending the school year on a high,
0:52:20 > 0:52:25with a sports day and a sendoff for the Primary Seven leavers.
0:52:25 > 0:52:27It's quite emotional, actually,
0:52:27 > 0:52:30cos we've all built up a relationship with these children,
0:52:30 > 0:52:33so much more than you would have in a bigger school.
0:52:33 > 0:52:38There are only six pupils at the primary school on Colonsay,
0:52:38 > 0:52:41and today two of them graduate to high school.
0:52:41 > 0:52:43Jamie...
0:52:43 > 0:52:45..and Geri.
0:52:45 > 0:52:47Go!
0:52:47 > 0:52:51They're with you the whole time, throughout their primary life,
0:52:51 > 0:52:53so it is a bit...
0:52:53 > 0:52:55..it's...it...it can be a bit emotional.
0:52:57 > 0:53:00Kids from Colonsay have to travel to the mainland to attend
0:53:00 > 0:53:03secondary school.
0:53:03 > 0:53:04For the next six years,
0:53:04 > 0:53:08they will only return to the island at weekends.
0:53:08 > 0:53:12You know, 11 and 12 years old, it can be quite hard,
0:53:12 > 0:53:17but the hostel that they are going to is superb, very well managed, and
0:53:17 > 0:53:20they've got great communication with the parents.
0:53:20 > 0:53:24Young people leaving in search of education is a major
0:53:24 > 0:53:28cause of depopulation in Argyll & Bute.
0:53:28 > 0:53:32The area's populace is predicted to decline by up to 8% over
0:53:32 > 0:53:34the next two decades,
0:53:34 > 0:53:39threatening vital services, like Colonsay's primary school.
0:53:39 > 0:53:42As it stands, it is a very small school already.
0:53:42 > 0:53:46- Losing two pupils just makes it, I suppose, a micro-school. - SHE LAUGHS
0:53:46 > 0:53:49So we just... we hope to get some more.
0:53:49 > 0:53:53There's a lady on the island who is expecting as well, so...
0:53:53 > 0:53:56- ..fingers crossed she'll want to stay. - SHE LAUGHS
0:53:56 > 0:53:59That's quite good. Good news for everybody.
0:54:01 > 0:54:05Geri has only lived on Colonsay for a short time,
0:54:05 > 0:54:08but Jamie has been here his whole life,
0:54:08 > 0:54:10and at the moment,
0:54:10 > 0:54:16Jamie's adamant that he will come back to Colonsay after high school.
0:54:16 > 0:54:18He loves to run wild around the island,
0:54:18 > 0:54:22and he loves to become involved in what's going on,
0:54:22 > 0:54:25with the ferries and what's going on with the farming.
0:54:25 > 0:54:30In actual fact, the two boys that are going off are very excited,
0:54:30 > 0:54:34and they're very ready for it, I think.
0:54:34 > 0:54:35Uh-uh, Eve, stand back, please.
0:54:35 > 0:54:38But I suppose it's part of that process, it's
0:54:38 > 0:54:41part of growing up, it's part of... you know, becoming independent,
0:54:41 > 0:54:44and they just have to do it a bit earlier than...
0:54:44 > 0:54:48..than a lot of other children have to do.
0:54:48 > 0:54:50Jamie's sister Emma,
0:54:50 > 0:54:54mum Pauline and dad George are all here to see him graduate.
0:54:54 > 0:54:57Faced challenge after challenge after challenge, and the improvement
0:54:57 > 0:55:00and the progress that has been made this year is phenomenal,
0:55:00 > 0:55:03- and that is Jamie. Up you come. Well done. - APPLAUSE
0:55:04 > 0:55:06Well done, you. Excellent.
0:55:07 > 0:55:10CHEERING AND APPLAUSE
0:55:12 > 0:55:15- He did very well, though, didn't he? - Yes, he did.
0:55:15 > 0:55:18- George, your eyes were sweating. I could see it. - LAUGHTER
0:55:18 > 0:55:21- That's hay fever. - LAUGHTER
0:55:23 > 0:55:27Jamie and his friend Geri have the summer holidays to
0:55:27 > 0:55:29spend on Colonsay with family.
0:55:44 > 0:55:49But soon enough it's time to pack for the move to the mainland
0:55:49 > 0:55:51and the big school.
0:55:54 > 0:55:57What pictures is that you're taking, Jamie?
0:55:57 > 0:56:00A bit from my family.
0:56:00 > 0:56:02That's you. Ready to go?
0:56:02 > 0:56:05- Is that you? Definitely?- Mm-hmm.
0:56:07 > 0:56:10- That's him. He's offski. - LAUGHTER
0:56:10 > 0:56:13I'll be lonely. I'll be lonely.
0:56:13 > 0:56:15The house will be quiet.
0:56:15 > 0:56:18- There'll be less mess. - LAUGHTER
0:56:22 > 0:56:27But will Jamie return to live in Colonsay after high school?
0:56:27 > 0:56:31At the moment, Jamie's adamant that he's doing as many years as
0:56:31 > 0:56:35he has to and then he's coming home to work on one of the farms.
0:56:35 > 0:56:37But in saying that, he's 12.
0:56:37 > 0:56:40Things might change.
0:56:40 > 0:56:42It's time for Jamie
0:56:42 > 0:56:45and his classmate Geri to take the ferry to the mainland.
0:56:45 > 0:56:49and the Colonsay community have turned out to wave them off,
0:56:49 > 0:56:53including their primary headteacher, Miss Mackenzie.
0:56:53 > 0:56:55It just is quite a big step for them,
0:56:55 > 0:56:57and I think...I think it's nice for them to see
0:56:57 > 0:57:00their old teachers and just sort of wave them off and give them
0:57:00 > 0:57:02a wee...a wee nod of encouragement.
0:57:02 > 0:57:06They've a whole different world to go to now.
0:57:06 > 0:57:09Personally, I wouldn't want Emma or Jamie coming back to the island
0:57:09 > 0:57:13at 18, because then I would think, "Well, that's them kind of stuck."
0:57:13 > 0:57:16I would want them to go out, see a bit more,
0:57:16 > 0:57:20make some money and come back and build their own house.
0:57:20 > 0:57:23- Maybe I'll be lucky and they'll maybe do that. - SHE LAUGHS
0:57:23 > 0:57:25You have to wave to the chickens.
0:57:25 > 0:57:28- Wave to the chickens.- The chickens! - LAUGHTER
0:57:36 > 0:57:39- But I don't sing.- You don't sing?
0:57:39 > 0:57:41- I just... - HE HUMS A MELODY
0:57:41 > 0:57:42LAUGHTER
0:57:42 > 0:57:45I wasn't expecting that. That's unauthorised.
0:57:45 > 0:57:47You're not going in the water.
0:57:47 > 0:57:50- You're not going in the water.- Look... - LAUGHTER
0:57:50 > 0:57:53- Do you know this chap?- Whay-oh! - I think he's best taken away.
0:57:55 > 0:57:59- I hope you're not making me look wobbly from behind. - LAUGHTER
0:57:59 > 0:58:01I don't know if you want to come in here, but it's something else.