It is the purpose of this paper to review how the advent of the Scottish parliament and changes in local government departments have affected the way in which social work services are organised and delivered in the Outer Hebrides in Scotland. This article describes and assesses in terms of three currently accepted theoretical principles of rural practice, namely generalist interventions, local culture and the nature of rural communities and social relationships, how the current system of organisation is being perceived primarily by providers. The data were collected through field study methods (interviews and focus groups) and are viewed against the background of a similar study in 1986 that focused on services in one ‘patch’ of the islands. The authors conclude that broad-based services responsive to the local milieu still appear to make sense in the remote island and in other rural and small-town settings. The authors observed that, given the many structural changes that have taken place in the past twenty years, there is a form of ‘reorganisation fatigue’ among service providers. Decision makers should bear in mind that this fatigue is likely to affect social services settings beyond the Outer Hebrides.