Citizen Participation and Public Petitions Committee
Petitioner submission of 7 July 2021
PE1845/Q - Agency to advocate for the healthcare needs of rural Scotland
This response to the Cabinet Secretary is being submitted on behalf of The Dispensing Doctors Association, The Remote Practitioners Association of Scotland, The Scottish Countryside Alliance, Douglas Deans, Professor Philip Wilson (Director, Centre for Rural Health, Aberdeen University), Caithness Hospital Action Team and Galloway Community Hospital Action Group.
The Cabinet Secretary response is welcome, particularly a focus on the “person at the centre of decisions and a focus on return to community.” The reaffirmation “local planning is expected to take account of the particular needs of these populations, and decisions on the provision of services will be based on ensuring fair and equitable access to services wherever this is possible” is particularly welcome. We wholeheartedly share these aspirations.
We consider that an agent such as Rural Health Commissioner would facilitate powerful joint working to solve these issues for modest outlay. This has been a significant success in Australia drawing together best practice, making best use of resources and providing information to inform government and management decisions. In Scotland, we already have an analogous post in the form of a Children and Young Peoples Commissioner post that has driven improvements in care for children.
There has been clear political will, effort and expenditure to improve Rural and Remote Health. Despite this we have still been able to provide the petitions committee with consistent statistical and anecdotal evidence of wide variation in effectiveness and efficiency. There is clearly no ‘one size fits all’ solution for widely differing issues in dissimilar rural areas. Our proposals would, however, be able to draw together and share helpful experience to hasten solutions without having to reinvent from scratch. They would also be well placed to question urban based assumptions. All of this would improve effectiveness and efficiency.
Our proposal for an agency organisation will connect the various educational and planning structures by taking on a function done seamlessly in (non-geographically challenged) urban areas. This fragmented approach to care delivery is characteristic of rural public services and is why we feel in this particular case, a commissioner type role is required.
Encouraging boards to more efficiently and effectively utilise the existing investment in Rural & Remote Health through the structures described in the Cabinet Secretary response will create a consistent, consensual and measured response. An analogy might be that the tools are all present, but prospective customers are unaware of the problems and the presence of tools that have proven effective, both in cost reduction and improved performance. Our proposal will improve care quality across the piece.
Such a resource, independent of Boards but accountable to the Health Secretary through the NHS Chief Executive would drive up standards and reduce wasted effort by sharing experience and asking the right questions. A Commissioner role would provide NHS Scotland with information about trends, weaknesses and potential areas for improvement in Rural Health. Local autonomy of Health Boards and overall NHS leadership is unaffected but would be better informed.