Episode 2 The Country Council

This programme contains some strong language.

-The council. The organisation we love to complain about.

-All they want to do is tell you

how much of a knob-end you are. Yeah, right.

Quick as you can. I'll give you five minutes.

You get quite a bit of abuse now and again -

people shouting at you as they drive past. As if it's OUR fault.

Councils across Scotland have endured challenging budget cuts

while demands for public services have increased.

The pressure has never been greater.

I'm not really one normally for doing house clearances,

but this is, by far, one of the worst ones I've seen.

The resources out there have just not been there for them.

There's nobody to help me. Nobody. They don't understand at all.

Argyll & Bute's council on Scotland's west coast

delivers those crucial services to some of the UK's most remote areas.

A wee bit of west coast liquid sunshine.

-It's not coming.

-You're joking me.

-Because of the weather.

-What?!

Get the clothes on NOW.

From island staff working up to six jobs to keep those services going...

It started off I was just doing the roads,

then they added the grave digging and the grass cutting at the school.

..to those dedicated to reaching clients

hundreds of miles from the nearest cities...

..these are the staff on the front line.

Argyll & Bute Council covers a vast tract of Scotland's

wild countryside and coastal land.

The majority of the council's residents

live in settlements of less than 3,000 people, or outside towns

or villages entirely, and 80% live within just one mile of the sea.

This unique landscape makes Argyll & Bute one of the most beautiful

areas of Scotland.

But it also means that many council workers have to travel long

distances by road and water to do their jobs.

In such a sparsely populated territory,

the council has to work creatively to deliver the essential services

on which their inhabitants rely.

Good afternoon, you're through to Argyll & Bute Council.

But like any local authority, they also have to address

all the...inventive inquiries of their residents.

Hi, um, it's a funny one.

-My bin has disappeared.

-Oh, right, OK.

THEY CHUCKLE

I've got a whole lot of coat hangers - plastic ones.

Do I put them in the recycling or the general waste?

-Hello, can I speak to Gaz, please?

-I'm sorry, he's not there.

-Will he be on his mobile, or is it he's on the bog?

-I don't...

Oh! I don't even know his mobile, I'm sorry!

I don't know his mobile - or intimate details like that!

But there is one call to the council no-one likes to make.

I'm just phoning up, are you able to pay a parking fine on this number?

Parking wardens regularly make the top ten of the most hated

professions in Scotland,

alongside bankers, lawyers and estate agents.

But parking fines generate over 200,000 annually for the council.

In a town like Oban, where the population swells

from 8,500 to 25,000 during the tourist season,

parking wardens like David keep the town moving.

It's really quite busy, there's a lot of cars,

a lot of tourists coming into the town.

It can get a wee bit harum-scarum, for sure.

Er, just people constantly circling, trying to get parked.

See, this is what I mean. Somebody has parked here...

..on a single yellow line, and bought a ticket. It's just wrong.

On every level, it's wrong.

He's a local guy, and he knows the rules.

That's what's called just taking the Michael.

Dishing out parking tickets means David is no stranger to conflict.

All they want to do is complain and moan

and tell you how unfair it is and how much of a knob-end you are,

you know? Yeah, right. It's easier just to agree with people.

-How you doing?

-Not bad. Ticket.

-Mm-hm.

-For what?

-Parking on a single yellow line.

-There was a line of cars there,

-that's why I parked.

-But you shouldn't be parked there.

You're as well parking somewhere where it's legal.

-Everywhere in Oban is shite to park.

-It's getting that way, pal, aye.

You take it easy. See you, pal.

CAR ROARS

It kind of stops them in their tracks

because they're maybe waiting for you to go, "Who are you talking to?

"Who the fuck are you talking to?"

The bad part of the job obviously is dishing tickets out,

but if there's no traffic wardens in the town, then it would just

be mad, it would be absolute madness, absolute madness.

One of David's main tasks is to keep Oban's busy high street

clear of the heavy tourist traffic and the constant deliveries

to local businesses, so the town doesn't grind to a halt.

It's out of the bay. It's not parked correctly within the bay.

And he's actually on the double yellows,

he's that far out of the bay.

And that's what causes huge congestion - huge.

It's a delicate balance to make sure the local shops get the stock

-but the street keeps moving.

-Help the community, you know.

Help the Aged!

You know, if these guys aren't delivering to businesses,

the businesses are going to close, so you try to give them a wee

bit extra, but fair play to them, it has moved as soon as they have

seen they needed to move,

whereas others just don't bother their backside.

-Tell me you're just about to move.

-I am.

Good man, that's the correct question.

It's double yellows, buddy.

-Hello, missus, how are you?

-OK.

-Good stuff.

-I do have...

-That's no problem at all, I seen it. Take it easy.

I absolutely love the job.

I surprise myself how much I actually enjoy it.

How much I enjoy just getting out and speaking to people. It's great.

COINS RATTLE

-Bingo.

-Jackpot.

I've been doing this now for just under two years,

and it was a bit of a test for me.

A lot of people were taking bets on whether I was going to last.

BEEPING

However, I proved them all wrong.

BEEPING, HE CHUCKLES

I've got all their number plates, don't you worry, I'll get them!

HE CHUCKLES

18 miles south of Oban lies Dunoon, on the Cowal peninsula.

Here, like the rest of Argyll & Bute,

the council work in partnership with NHS Highland,

pooling much-needed resources and funds.

Health visitors work with families to give pre-school-age children

the best possible start in life.

But across Scotland,

a shortage in staff is leaving health visitors stretched.

Sue and Jen work within the Cowal hospital in Dunoon.

-DOORBELL JINGLE

-Liam Gallagher. So, that's to remind me at ten o'clock,

concert tickets go on sale today at ten o'clock.

-No-one sells out when I go to a concert!

-I'm trying to think who you'd like.

-Sue is a qualified salsa teacher. I'm a tap dancer.

-All right, OK, give me your hands.

When I step forward on this foot, you step back. Back. And replace.

Out here. OK, you walk forward, and I'll go under.

-What do I do now?

-You let go. You would finish up that way.

-OK. Done.

-Oh, my goodness!

So... We'll have a team-building day and I'll do you a salsa class.

I would love that!

Sue is en route to the first client of the day.

I qualified in 1990. So I'm going for my long-service award!

We're heading off to see a wee lad who's recently had

a diagnosis of autism. As far as I understand it, his behaviour

tends to be quite boisterous so he could be all over the place.

Mum is quite a talker, so she'll not be shy in coming forward,

and that's great. The parents may well have been worried about it,

but when they hear the words "this is what your child has",

then it can be quite traumatic for them.

Park here, I think, but there is a rather large puddle.

Autism is on the rise,

and now affects more than one child in every 100 across Scotland.

Hi, how you doing? Hello! Wow, look at you! Hiya!

-I like this.

-Yeah, his letters. What letter is that?

-Dub.

W, that's right. What else is there?

Em...

What one's that?

I knew that there wasn't something quite right,

development has just not been that fast.

He's taking a bit longer with everything, with his walking

and everything, his speech, and finally we got the agreement

six months ago that he is autistic, so that we can get everybody to

kind of help us and know that it is not just his speech that is

slow, his developments are all catching up on him as well.

It has been stressful,

but the smiles and everything make up for it.

Autism affects a child's social development and learning,

meaning Jamie will have difficulties interacting

and communicating with those around him.

With the diagnosis a recent one, Sue is keen to look today at where

mum Charlene might need some additional help.

Right, so, learning and developing, I think

there's a few things in there that were causing a little bit

-of a blockage.

-Yes, his speech.

-OK.

So, developmentally, language is a bit of a wee block just know. OK.

Righty-ho, I think he's a pretty confident, outgoing wee boy!

Yes, he's too confident at times!

So, if I get my diary we can do that in a wee tick.

-He does prefer being by himself quite often.

-That's grand.

Is there anything...? You want to sort him? Sure, that's fine.

-HE SCREAMS

-Come on.

"Oh, Mummy, I'm back." Hello.

Is there anything in that thing

you think is specifically important?

The thing that worries me the most is his temperament

and he's still head-butting quite a lot of things.

He's doing it at nursery as well.

-JAMIE YELLS

-If he gets frustrated and doesn't understand... Just leave him.

Sometimes if he's going to have one, you can try and tickle him

or try and do something, depending on the frame of mind that he's in,

and sway him away from what he was actually getting

frustrated at, but other times, if he's too far gone then that's him.

-Plan B.

-Yes.

JAMIE CHUCKLES

-What are you doing?

-Jamie, what ARE you doing? Right, I think that's us.

It was a bit distracting.

Mum was a bit distracted by the wee lad, but she did well.

Diagnosis was obviously a bit of a bombshell.

We need to start building their confidence and giving them

the support that they need, so we're looking, then, at maybe getting

one-to-one support for them. It ends up being a multi-agency jigsaw.

As part of my role as health visitor, it's up to me

to co-ordinate that jigsaw

and make sure that things get done to help him.

An autism diagnosis can be a very daunting

and emotional time for parents,

something Sue's colleague Jen understands more than most.

I remember when my son got diagnosed, and it was actually

the nursery teacher that picked it up. It's enormous,

it affects everything. It's not just communication,

it's their dexterity, their coordination.

It's a long, long road for parents.

And I remember being in tears that this woman had had the audacity

to say that my son could possibly be on the autistic spectrum.

And I remember phoning some of my friends

and being absolutely devastated, absolutely devastated.

I think you've got another level of awareness or knowledge

that a lot of parents may not have. And you get this piece of news and then you're left.

You are. And I don't feel, when I look back now to 2009,

that we were properly supported with that diagnosis.

There's obviously much more aftercare now.

The next stage is to pull in some of that support

from across the council and social care partnership

to help Jamie communicate better with those around him.

I mean, it's all about making things better, there's no point

in us slogging away on our own,

because we're not going to make the difference on our own.

We need to do it with everybody in the other agencies,

and they need to be aware of the situation the same as we do,

-because we're all part of the solution.

-Yeah.

Bringing services to the islands is challenging.

But with 17% of the Argyll & Bute population living on islands,

the council must attempt to deliver the same services

as those on the mainland.

40% of Argyll & Bute's road networks are on the islands,

and today, the roads department are on Jura, where the

200-strong population are served by one single-track, bumpy road.

It may be the only road in Jura, but it's the main road!

It's also a principal lifeline route, between the ferry

and the main areas of population.

Callum and David, from the council's roads department,

are carrying out an inspection of Jura's eight-mile-long road.

Aye, well. This has held up for a while,

but once the surface has broken again...

Across the island, it is a losing battle.

But this is one of the major concerns about here,

the amount of rainfall that we do get.

It's a bit kind of chewy, isn't it, Davy?

-I mean, it's certainly flexible, but...

-Aye.

-..once the water penetrates it, it's going to break away again.

-Yeah.

Hardest to get to, hardest to fix, and...

..seems to be the most susceptible to damage again.

-About 200,000 to 300,000 to actually fix this?

-Yes.

That would just blow the budget, if we did that.

This is a single-track road. You know, there's no solid base.

The whole of this section is basically moving all the time.

It is quite literally a flexible road.

It's basically floating on peat.

Digging out the peat would literally cost millions. It's just not a practical option.

It's millions the council does not have.

The annual repair budget across the entire region is £5.5 million.

We're in a position just now

where we are

struggling to hold the fort with the resources we have.

The islands exacerbate that - you know, we have vast distances

between our depots, so it's not easy to sort of move resources around.

A six-strong team have had to be brought over to Jura,

to patch up the worst section of road.

A job that would take half a day on the mainland

will take three days on the island,

because of the logistics to get the tarmac delivered.

It has to be hot when laid,

so must travel the same day -

a four-hour journey, via two ferries.

The ferry we get now to Islay is CalMac,

and the one from Islay to Jura

is a council one. It's council-owned.

So we're going to get to Jura, with the tar, some time this afternoon.

Heat it up, make it quite warm,

so it lasts the journey.

Any delay to the journey

will risk the tarmac setting,

slowing down the job and pushing up the budget.

Sometimes we do about six or seven loads.

But when it's the islands it's basically one load, and it's a long day for one load.

-What's that, 12 o'clock...?

-Yeah.

The boats'll just be about arriving, it'll be another hour and a half.

While they wait for the tarmac, David and Callum inspect the work so far.

This has a budget of £45,000.

For that, on this single-track road, we'll probably be able to surface three quarters of a kilometre.

-HE LAUGHS

-It's pretty bumpy.

It's a hell of a lot of waiting around for...

You know, what you're taking three days to do is...

-..you know, a good morning's work...

-Aye, that's right.

-..in the real world, eh?

-Yes.

That's what you get for living on the edge of the known universe!

With the tarmac finally here,

the crew can get to work.

That's perfect, aye. Bang on.

I couldn't have done a better job myself!

They want 40 laid on the middle,

so we measure that with a bit of tape.

Technical branch!

All island traffic comes to a halt

until that work is done.

We'll get a traffic jam now.

Cars on both sides waiting.

This is the only road in and out of Jura, there's only one single road.

You get a bit of abuse now and then -

people shouting at you as they drive past. As if it's OUR fault.

-Go on...!

-CYCLIST: Spoil it for you.

That might make it better, you might roll it out better for us!

It's a constant battle -

we try and do our best with the budget we have available,

but it's never enough.

The increasing costs of Scotland's growing, ageing population

has led to a rise in the number of community nurses nationwide.

The service, funded by the council

and the NHS's Health And Social Care Partnership,

now helps treat more patients at home, instead of in hospital,

which is both better for the patients' wellbeing

and reduces costs.

OK, are we ready to go?

-OFF-CAMERA: Packhorse.

-Packhorse!

Packhorse on a Friday morning.

Community nurse Gillian

has worked on the Isle of Bute and Rothesay for the last 20 years,

and deals with a huge range of care needs for her patients.

Our first patient's called Annie, and she is 74 years old...?

A lady with a great character.

Sort of a smallholder as well, she has, erm...

goats, chickens, ducks,

the odd peacock, I think,

and a collie dog, who you'll meet.

Temptation is to go and try and touch them - they probably would run away, wouldn't they?

Hello!

You speaking?

Hello...

Hello.

-Hello!

-SHE LAUGHS

Hello...! Hello, Meggy-Meggy-Meggy!

Hi...

Come to join the party.

I'm all right, thanks.

-Ah...

-I've got flies in my hair.

Causing chaos, eh?

She wants somebody to play with her, with that ball. I get that from morn to night.

I was chatting to your cattle. But they weren't chatting back.

-This is no' part of the NHS, Meg.

-No!

This isn't part of the process. Go on...

Get!

Right...

-MEG YAPS

-Ah!

GILLIAN LAUGHS

-Meg!

-Right, down.

Down. Good girl.

-Right, see you Monday.

-Monday.

-MEG BARKS

-I'll keep her in...

Gillian travels over 140 miles a week,

seeing up to six patients a day.

Right. Next visit is to a gentleman called John.

John has got lung carcinoma, so he's got a lung cancer.

And that was diagnosed four months ago.

He consented to referral to our team, the ECCT,

which is the extended community care team,

and he starts his journey with us.

I always think that's part of the reason why I got this job,

my ability to carry equipment and bags!

It's a good ability.

Treating patients at home, rather than in hospital -

even those with a more complex illness like cancer -

is more cost-effective.

It's going to be a gorgeous day today, John.

Yeah.

All that vitamin D!

OK...

I'll just get organised and do your legs, if that's OK.

Yeah?

So how long have you lived here now, John?

About nine years.

Right...

Right.

It's a lifestyle, isn't it, being at sea? That career.

Can you?

SHE LAUGHS

It's just a matter of getting the medication

properly set out for his regime, and

a staff that can oversee his, er...

..administration of his medication, so that he's taking it regularly.

-OFF-CAMERA: Do you think presently he CAN still live at home?

-Yeah.

He will have good days and bad days.

-See those two little white ones?

-Aye...

Those are important. That's your steroids.

Right.

Yeah, you do.

If you feel like you ARE going to nod off watching the television,

try and elevate your legs, it'll do them good.

While you're taking those, I'll just finish getting organised...

Have you got your Telecare bangle on...?

That's good.

SHE CHUCKLES

OK...

-We'll catch up with you tomorrow, John.

-OK.

-Right? Bye.

John lives on his own, his family live miles away.

He is only 64 years old.

He should really have a good chunk of life still ahead of him.

He should be retired now and enjoying life.

It's a poor prognosis.

There isn't any active treatment for John,

so we'll support him as well as we can at home in the meantime.

There are over 750 patients annually

in end of life care across Argyll & Bute.

OFF-CAMERA: Is it hard in your profession to deal with death?

It's good, it's positive, to be able to support that person.

Make sure that they're symptom-free, and that you listen to their wishes.

The wishes of the patient, the wishes of John.

But, yes, it can be really sad.

On an early-morning ferry to the island of Islay

are two members of the adult learning disability service -

speech therapist Carole-Anne and learning disability nurse Angela.

We see people with Down's syndrome, autism...

Lots of people with learning disabilities have other health conditions,

so you might have a learning disability but also have elements of dyspraxia, or cerebral palsy.

We pretty much always take the seven o'clock ferry,

cos otherwise we wouldn't be over in Islay till lunchtime, and then

wouldn't get much of a working day in, so, yeah,

we usually take the seven o'clock ferry, which means getting up...

-Five.

-Five!

Argyll & Bute spend almost £7 million annually

on supported living for adults with learning disabilities.

Carole-Anne and Angela look after around ten clients on Islay -

a two-hour ferry journey from the mainland.

The distances involved

make supporting their clients a real challenge.

I think being based in Lochgilphead, it means that we

can access most of Argyll within about an hour and a half,

but Islay's one of the longer distances that we do.

I mean, people on Islay are...

They're not getting the same service as people on the mainland would,

because...physically we can't provide it.

So when we get over here we tend to allocate

a longer session with the individual.

With the distances involved

limiting the time Carole-Anne and Angela

can devote to individual clients,

they need to find a way of using resources already ON the island

to create a more sustainable support network locally.

A life skills course at the island's college might be the answer.

One of the clients they are trying to help is Rhona,

who lives in the north of the island with her mum Irene and dad Neil.

She's very sociable and... You know?

I mean, if Rhona met you next week,

the first thing she'd do is cuddle you.

We're not always going to be here.

It's very much in our mind to

try and get something set up for Rhona,

to be independent and live on her own,

before we get too old.

A life skills course on the island

would help give Rhona some more independence,

and create a support network amongst those who attend.

Carole-Anne and Angela

need to assess what that life skills course should include.

To do that, they're meeting Rhona and her support worker, Emma,

as well as another local client, Alison.

Are you up for doing a talking mat?

Aye.

And YOU'RE up for doing a talking mat?

-Maybe...?

-Yeah.

OK. So...

We're talking about activities, and we're talking about things that we like, on this side...

The talking mat is a tool to aid communication.

Carole-Anne and Angela can use it to help assess

what Rhona and Alison

would like to do on the life skills course.

Money...

Going to learn more about money.

What do you think about that?

Do you like just having money?

-No.

-No?

-You do!

She likes change - lots of change!

Money management, domestic tasks

and even outdoor activities

are all part and parcel of what the life skills course can help teach.

With an idea of what the course could look like,

the team head to Argyll College on Islay

to meet with learning centre manager Mhairi.

We could look at doing small, short courses,

where, over the course of the year,

they could actually do one, two or three units.

I think what would be a good idea is to get the students

and see what they want, and what days suit them,

and then they're leading us

and we're developing a course that suits them.

That was really good, wasn't it?

That's the best outcome we could have hoped for, I think.

Couldn't have asked for better.

She's so enthusiastic and something is definitely going to happen.

-Absolutely, she won't stop.

-Good, good, good.

With the course going ahead,

there will now be more support on the island for Rhona.

Yeah, it's a big day for us, really.

Yes. We think it will be very positive.

Lots of practical skills,

anything at all that will help her to live a more independent life.

In Dunoon, mum Charlene is concerned about three-and-a-half-year-old Jamie,

who has recently been diagnosed with autism.

Autism affects a child's social interactions and language development,

making communication difficult

and leaving Jamie frustrated that he cannot be understood.

What's that?

No, no!

All right.

To try and help with Jamie's communication,

health visitor Sue has arranged a meeting with speech therapist Elaine.

I didn't even do my roots, I meant to do my roots.

-I'm putting you on the spot here.

-That's fine!

So that's my analysis from what I've seen

and what Mum was saying, that's mostly her comments

-and other things that have been going on.

-OK.

I mean, he is vocal and he has got a single-word vocabulary

that is developing.

He has got a couple of two-word phrases

but I'm not sure how many of them are learned as two words.

But he is sociable with familiar people as well,

so he's got a lot of strengths going on communication-wise

even though the verbal language is not particularly where it should be.

My aims for him for the next wee while is just to continue

with the PECS at home and just to get it established in nursery.

OK.

Where's your book?

Where's your cookies in it? You find them.

Clever boy. What's that?

Cookie.

Right, you give Mummy a card.

Card.

-Cookie.

-Cookie. Clever boy.

That's his PECS book.

That's what we use for communicating with him.

It's a great wee invention.

Drink or food or if he wants to go

outside, the toilet, toothbrush.

It's good to be able to have that card

so he learns and for communication.

KNOCKING

-Who is it?

-Hello.

-Oh, hello. It's Elaine, are you saying hiya?

Speech therapist Elaine is here to check on Jamie's progress.

-How are you?

-I'm all right, you?

-I'm good. We've got a new addition.

-Oh, Jamie, who's this?

-Is that Bella?

How is he coming on?

Yeah. He has been doing really, really well with it.

He's interested in it, that's what I like to see anyway.

Yeah, yeah. That's Play-Doh. You had that at nursery today, didn't you?

Does he take it to nursery with him?

He's back again on Tuesday so I can certainly say to Alexis,

right, here's his book, yous can have a go with him

because obviously everything in nursery is asking for and things.

See how he gets on with it.

And I mean, you'll get off of him now, "I want. I want."

So he'll say that and then whatever it is,

and he will a lot of the time, if you say something he will try

and say it, and obviously the cards help with that

because we've got the picture.

-That's him now...

-Going to be four come New Year's Eve.

More likely to be his pre-school year or we don't know?

I don't know whether he's as well staying at nursery.

I would rather that than he went in and then had to get kept back.

We'll see how he gets on.

We have his Child's Plan meeting on Tuesday and then take it from there

and see how we get on.

Thank you for coming again.

-Thank you!

-Take care.

-See you later. Bye!

So, as far as I'm concerned,

I think he's doing well compared to when we'd seen him before.

Charlene is great. She's great with Jamie.

She will have to get used to different things with him

and what it means for him to have autism.

And things will change for him throughout his life.

Are you all right?

One of the biggest decisions for Charlene

is whether Jamie will be ready to go to school.

I'm worried because kids are innocent

and I don't want him necessarily getting, not picked on,

but people leaving him out and things like that

because he does have a speech problem,

in the sense of he's a little bit slower with it and things.

Jamie's way of getting his frustration out

is he'll head-butt things, and he'll go to an outside wall

and full-pelt head-butt it.

If Jamie is kept out of school for an additional year,

he may fall further behind.

To help Charlene make the decision,

a child planning meeting has been called

with all the services supporting Jamie.

The idea with it is it's just really everyone who is involved

in a child's life gets the opportunity to come together

round one table and discuss where the child is

at that particular point in time in their development.

And really what are the next steps that we're identifying,

where we need to go next to help this child progress further?

Aww. You give her a kiss.

Back in Rothesay, on the Isle of Bute,

community nurse Gillian has had a call

about her terminally ill patient, John.

John is unable to get out of his chair.

One of the health-care support workers was attending him today.

She couldn't get into the property.

The problem obviously being to get in to John to help him,

so I phoned the housing association,

who his property belongs to, and they're helping me.

They've arranged for a joiner to meet me at the property

to open the door, so that's good.

My only other option would have been to have the police

break the door down.

Let's go.

Hi, John. It's Gillian here.

I'm just phoning to let you know what's happening.

With John unable to answer the door,

the only way in for the joiner is via an upstairs window.

So hopefully we'll get in to see John soon and can assess him.

Probably get the GP involved today,

he's obviously not as well as he was.

And take it from there.

Right. Oh, that's great.

Oh, John.

Oh! You've slipped right off your chair.

How long have you been like that, John?

We could maybe get him up and sit on that, couldn't we?

Are you ready?

One, two, three.

When you're up, reach out for your frame.

Is that possible?

And push yourself back. Is that possible?

That's it.

So you think you've been on the floor for about an hour?

More than that?

Looks like you've just slipped out of that chair, haven't you?

-Thank you very much.

-No worries.

I'm going to get the on-call doctor to come and see John,

see what she thinks, and she potentially might admit John

just to control some symptoms, perhaps.

There you are, that's better. That's a wee something.

You slept in your chair last night, John?

So you were on the floor most of the night? Yeah?

Hey, hi, Dr Calvo-Til. Dr Calvo-Til's here to see you.

So how are you feeling now?

All right?

Can I take you back one step, can you remember,

what were you doing?

Oh, right. So have you any idea, when was that?

How long ago?

So it's a few hours.

Do you think you might have passed out?

You think you might. OK.

I'm going to ask you to try and push against my hands.

OK, that's a little weak, isn't it? Can you push up?

OK.

You getting any pain anywhere?

I think, given what's happened to you, and because we don't know

if you've been on the floor for, who knows, seven or eight hours,

I think I might bring you into the hospital to perform an assessment.

And if needs be,

we could keep you in the hospital for a couple of days, you know?

Until you've picked up a little bit.

I'm not sure how you're going to manage.

With the best care in the world,

I think being at home might be complicated for you.

We'll arrange an ambulance to pick you up and I'll meet you up in A&E

when you get there.

Great. I'll pack a bag and get his medication.

He's been on the floor for an unknown amount of time.

Why did he fall?

We don't know for sure.

First of all, I think it will be appropriate to keep him

under observation for 24 hours,

do some more tests.

It could be just general sort of weakness

or it could be that there is something else.

Or it could be just general deterioration.

John is transferred to the Victoria Hospital in Rothesay.

You're looking a bit better now.

Yes, you did.

Do you recall getting the ambulance crew,

collecting you and bring you up here? Do you remember any of that?

No, you weren't well that day.

Did you?

Thailand.

No!

But you know where you are now, don't you?

John's nephew William has come to visit his uncle.

Uncle John was at sea for quite a lot of my youth,

when I was very young.

I remember you coming home, you always had stuff with you,

little presents for your sisters and my mother.

I remember that, that you used to bring things back

from all over the place.

You used to tell me where you'd been,

the Panama Canal and lots of places.

Australia, Asia.

Yeah, big inspiration, absolutely.

One of the concerns will be for us to send him home with the care package

that he had, which was four times a day, I believe.

I think the carers would struggle,

four times a day would not be enough.

I think we would have to be looking at probably every two hours.

Marie Curie could've been the support

but we have limited availability just now.

I think, again, the nights, he would certainly need

to have somebody there overnight with him.

The staffing levels and resources needed to keep John at home

and safe now outweigh the care that can be given to him in hospital.

We discussed about where he would like to be.

He's more than happy to stay here,

die in hospital here.

Being with us, he's built a rapport with the staff as well.

He's comfortable with the staff, he knows the staff,

he knows the staff by their first names.

I think also you were saying he wanted people around him.

He does, yeah. He's expressed that he wants that.

We don't obviously have hospice facilities on the island,

so we can provide that.

Hi, John.

Hi, John. It's Gillian. How are you today?

I found it hard but positive as well,

because John wanted to be in hospital

for the end stages of his life.

He wants to die in hospital, so we've upheld his wishes.

You've got to know the staff here quite well, I understand.

He is comfortable and he is well looked after

and he has got the 24-hour care

so it's been a good end result to his pathway. Good pathway.

You're tired today. You quite comfortable, though?

Quite comfortable? That's good.

I find it sad from the point of view of he is just a young gentleman

of 64, which I regard as a young age.

He would normally have a good few decades ahead of him

to enjoy his retirement.

You're tired today, aren't you?

John passed away in hospital, two weeks later.

I didn't really know John when he was healthy and well,

and he was a working man, a family man.

I only got to know John in the last few months of his life.

He died peacefully and with dignity.

You can get very emotionally involved with people...

..and their families.

But it has got... As I've...as I've got more mature and had more

experience, it has got a little bit easier.

Cos you just take different positives from it,

as opposed to it being a negative.

On the west shore of the Firth of Clyde, in Dunoon,

mum Charlene has been working with council health-care services

to develop a programme of support for Jamie,

diagnosed six months ago with autism.

What jacket are you wearing? Are you wearing your green jacket?

-Ah, yeah.

-Yeah, yeah.

-You don't have a yellow jacket.

-I wear yellow.

I don't have a yellow jacket!

For health visitor Sue, helping Jamie to be understood and understand

others around him has been vitally important to supporting the family.

For Jamie, the autism that he does have, it can affect

the way you understand and communicate with the world...

-Here.

-I want...

..and it makes it very difficult to make their way

and make relationships and get things that they need,

so one of the ways that we're doing that just now is to help

Jamie to have more vocabulary,

so he's going to...concentrating on giving him more words.

Oh! You need your Minion bag and your lunch bag.

Don't you? And your PECS cards for nursery.

Jamie will have more skills to communicate with people, which

should reduce frustration, which he is displaying at the minute.

Right, are you climbing in?

-Yah.

-Yah.

So his head-butting in response to somewhere where

he's not feeling understood should go down.

-Right, are we sorted?

-Yah.

-Yah.

Today is a crucial day, with a big decision for Charlene ahead.

She must decide if Jamie is ready to start school next year.

All the services that have been working with Jamie will come together

to assess his progress, but the final call will lie with Charlene.

This is all still a bit new for us.

Everything that I come to is a new obstacle.

No two children are the same, never mind no two

children with autism are the same, so you can't really gauge

it on anybody else's experience, or even your own,

if you had another child with anything. It is really

basically what's Jamie, down to Jamie, and what's best for Jamie,

and we'll take it a day as we come.

Go the way that we have been going, and it seems to be working

-so far, so...we must be doing something right.

-SHE CHUCKLES

Hello, hello, hello. Hiya. Come on in. Get you a seat.

Hi, both of you. How are you doing?

Joining Charlene and Jamie's father Andrew at

the meeting are council and social care staff from across the team -

speech therapist Elaine, Jamie's nursery teacher, alongside Sue.

Anyway, nice to see you both.

Thank you for sparing the time to come.

It can feel a bit intimidating for parents.

We try and make it as friendly,

if you like, as we can, and as supportive as we can.

-Have you heard of this Getting It Right process?

-Eh...

-Vaguely.

-A wee bit.

-A wee bit, OK. So it just means that,

now we're in the position of trying to coordinate the support

that Jamie might need, it means we're round the table together

and we're all going to be hopefully heading in the same direction.

You had some other comments, because you sent me some comments

earlier on about how things were within the nursery setting

-for Jamie.

-We see a really big difference in him since the holidays.

-Oh, he has.

He's interacting with the kids a lot more.

-What kind of things is he doing?

-We always try and do a group time,

singing songs. I'll let them all stand up individually,

-and Jamie would never, ever do that.

-Mm-hmm.

But the other week, I said, "Do you want to sing a song?"

-He was like, "Yeah." And he stood up...

-Great.

-..and he sang his alphabet.

-That is nice. OK.

And the other thing I know that you'd been thinking about earlier on

was about school entry and whether you need to adjust that or not.

-Yeah. I'm still humming and hawing, but...

-OK.

..I'm probably swaying more towards keeping him back for another year.

-Right.

-He might come on miraculously in the next few months,

-and it might be a completely different kettle of fish...

-Uh-huh.

-..but at the moment...

-It's an option.

-Yeah.

-It's an option.

It's whatever's going to suit him best, because I don't want him

to start and then end up struggling with the rest of his school years.

So I would rather that he was more prepared than not prepared enough.

But we shall see.

It is too soon to decide on school.

But for mum Charlene and dad Andrew, the support from the team over the

last few months has made a world of difference.

It's been a long time coming, getting all of these meetings

and everything organised,

from when we discussed that there was possibly something...

-..that was wrong.

-LAUGHTER

And now that we're actually getting somewhere,

it feels a lot better, that everybody's kind of helping.

When Jamie's interacting with other people, they'll understand him.

They'll understand what he's feeling, and he'll also

benefit from being able to explain his emotions a little bit better.

-Uh-oh.

-Uh-oh. Uh-oh!

-Uh-o-o-o-oh!

LAUGHTER

It is just good to have the support of everybody. I think that's

one of the main things but, is to have everybody

-round about you helping.

-LAUGHTER

-All in a day's work.

-More than a day's work.

-SHE LAUGHS

With an annual spend of nearly £71 million,

education is the council department with the largest overall budget.

But even with that investment, delivering education to every

child across rural communities can be challenging

and sometimes means kids from remote areas must

travel for school to larger towns.

On the small island of Colonsay, the council's primary headteacher,

Miss Mackenzie, is ending the school year on a high,

with a sports day and a sendoff for the Primary Seven leavers.

It's quite emotional, actually,

cos we've all built up a relationship with these children,

so much more than you would have in a bigger school.

There are only six pupils at the primary school on Colonsay,

and today two of them graduate to high school.

Jamie...

..and Geri.

Go!

They're with you the whole time, throughout their primary life,

so it is a bit...

..it's...it...it can be a bit emotional.

Kids from Colonsay have to travel to the mainland to attend

secondary school.

For the next six years,

they will only return to the island at weekends.

You know, 11 and 12 years old, it can be quite hard,

but the hostel that they are going to is superb, very well managed, and

they've got great communication with the parents.

Young people leaving in search of education is a major

cause of depopulation in Argyll & Bute.

The area's populace is predicted to decline by up to 8% over

the next two decades,

threatening vital services, like Colonsay's primary school.

As it stands, it is a very small school already.

-Losing two pupils just makes it, I suppose, a micro-school.

-SHE LAUGHS

So we just... we hope to get some more.

There's a lady on the island who is expecting as well, so...

-..fingers crossed she'll want to stay.

-SHE LAUGHS

That's quite good. Good news for everybody.

Geri has only lived on Colonsay for a short time,

but Jamie has been here his whole life,

and at the moment,

Jamie's adamant that he will come back to Colonsay after high school.

He loves to run wild around the island,

and he loves to become involved in what's going on,

with the ferries and what's going on with the farming.

In actual fact, the two boys that are going off are very excited,

and they're very ready for it, I think.

Uh-uh, Eve, stand back, please.

But I suppose it's part of that process, it's

part of growing up, it's part of... you know, becoming independent,

and they just have to do it a bit earlier than...

..than a lot of other children have to do.

Jamie's sister Emma,

mum Pauline and dad George are all here to see him graduate.

Faced challenge after challenge after challenge, and the improvement

and the progress that has been made this year is phenomenal,

-and that is Jamie. Up you come. Well done.

-APPLAUSE

Well done, you. Excellent.

CHEERING AND APPLAUSE

-He did very well, though, didn't he?

-Yes, he did.

-George, your eyes were sweating. I could see it.

-LAUGHTER

-That's hay fever.

-LAUGHTER

Jamie and his friend Geri have the summer holidays to

spend on Colonsay with family.

But soon enough it's time to pack for the move to the mainland

and the big school.

What pictures is that you're taking, Jamie?

A bit from my family.

That's you. Ready to go?

-Is that you? Definitely?

-Mm-hmm.

-That's him. He's offski.

-LAUGHTER

I'll be lonely. I'll be lonely.

The house will be quiet.

-There'll be less mess.

-LAUGHTER

But will Jamie return to live in Colonsay after high school?

At the moment, Jamie's adamant that he's doing as many years as

he has to and then he's coming home to work on one of the farms.

But in saying that, he's 12.

Things might change.

It's time for Jamie

and his classmate Geri to take the ferry to the mainland.

and the Colonsay community have turned out to wave them off,

including their primary headteacher, Miss Mackenzie.

It just is quite a big step for them,

and I think...I think it's nice for them to see

their old teachers and just sort of wave them off and give them

a wee...a wee nod of encouragement.

They've a whole different world to go to now.

Personally, I wouldn't want Emma or Jamie coming back to the island

at 18, because then I would think, "Well, that's them kind of stuck."

I would want them to go out, see a bit more,

make some money and come back and build their own house.

-Maybe I'll be lucky and they'll maybe do that.

-SHE LAUGHS

You have to wave to the chickens.

-Wave to the chickens.

-The chickens!

-LAUGHTER

-But I don't sing.

-You don't sing?

-I just...

-HE HUMS A MELODY

LAUGHTER

I wasn't expecting that. That's unauthorised.

You're not going in the water.

-You're not going in the water.

-Look...

-LAUGHTER

-Do you know this chap?

-Whay-oh!

-I think he's best taken away.

-I hope you're not making me look wobbly from behind.

-LAUGHTER

I don't know if you want to come in here, but it's something else.