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Seventeen percent of Scotland’s population live in rural areas – six percent in remote rural areas and 11 percent in accessible rural areas. Rural areas tend to have a lower proportion of people aged 16 to 44, but a higher proportion of people aged 45 and over. This is especially true for the 65+ age group in remote rural areas.
Certain health and social protection problems may have a greater impact on rural areas. These include:
- access to services
- staff recruitment and retention
- training for staff
- health outcomes.
Health and social care is an important sector of employment in rural Scotland, and changing demographics can impact the resilience of rural health and social care services. The University of the Highlands and Islands runs a Scottish Rural Health Partnership. It is a membership organization that aims to influence and shape rural and remote health care policy.
This blog describes when rural health and social care was discussed in the Scottish Parliament and discusses some recent and upcoming developments aimed at improving rural health care.
A number of petitions related to rural health care and services are currently being reviewed by the Citizen Participation and Public Petitions Committee.
- PE1845: Agency to Advocate for the Healthcare Needs of Rural Scotland
- PE1890: Finding solutions to recruitment and training challenges for rural healthcare in Scotland
- PE1915: Re-establish Caithness County Council and Caithness NHS Council
- PE1924: Carry out an emergency comprehensive review of women’s health services at Caithness & Sutherland
Organization and structure of health and social care in rural Scotland
In Scotland, there are 14 regional NHS boards which are responsible for protecting and improving the health of their people and delivering frontline healthcare services. Seven special NHS councils and one public health body support the regional NHS councils by providing a range of specialist and national services.
The Integration of Health and Social Care under the Public Bodies (Joint Working) (Scotland) Act 2014 has created 31 Integration Authorities (IAs), which are partnerships between the 14 councils of territorial health and 32 local authorities. RNs are responsible for planning adult social care, primary and community health care and unscheduled hospital care, delivered by Health and Social Care Partnerships (HSCPs). HSCPs play a key role in supporting national health service boards to work with communities and stakeholders to design services based on the needs of local populations.
In 2020, the General Practice in Remote and Rural Task Force released its Shaping the Future Together report, which aimed to improve primary care in remote, rural and island communities. The Scottish Government has accepted all of the recommendations in this report. This included a commitment to the development of a National Center for Remote and Rural Healthcare for Scotland. This is expected to be operational in the spring of 2023. The center is expected to support recruitment, retention, ideal practice, assessment, training, education and research.
The report also recommended that the Scottish Government work closely with HSCPs, territorial and national (special) health boards and bodies to establish change management support and capacity for remote, rural and island communities.
The Scottish Government recently introduced the National Care Service (Scotland) Bill in the Scottish Parliament. The accompanying Island Community Impact Assessments highlight concerns raised during the consultation, including:
- the general need for flexibility to consider specific island and rural communities when developing a national approach to social assistance
- barriers to accessing social care for island communities, such as transportation limitations and small, dispersed populations
- barriers to portability of care packages between urban and rural/island areas
- barriers to recruiting social and social service workers due to the declining working-age population and the need to attract workers to the islands
- potential disruption of existing mature integration agreements that have grown to accommodate island contexts
- economic and demographic constraints to the creation of new public bodies due to the small size of island communities
- impact of any disruption on local authority social care provision due to local authorities providing a much larger share of social care on the islands compared to mainland Scotland
- ensure that social care funding models accurately reflect the additional costs associated with providing on islands.
Further details of the National Care Service (Scotland) Bill review can be found in the National Care Service – hub for SPICe material.
Staff recruitment and retention
A frequently debated issue in rural areas concerns the recruitment and retention of staff, including the availability of continuing education. The Scottish Government released its National Health and Social Care Workforce Strategy in March 2022. This committed to developing a remote and rural workforce recruitment strategy by the end of 2024. This aims to provide a framework that will help employers ensure that the health and social care needs of people who live in remote and rural communities are met.
The Scottish Government is also funding the Scottish Rural Medicine Collaborative (SRMC) to develop ways to improve the recruitment and retention of primary care staff in remote, rural and island areas. Since 2012, a specific training route for rural GPs has existed in Scotland with positions available in Fort William, Wick, Stornoway, Kirkwall, Lerwick and Oban.
To support the recruitment of GPs to remote and rural practices, the Sottish Government has allocated £200,000 to support rural relocation expenses and £400,000 to fund Golden Hellos. These initiatives are intended to help address workforce challenges in remote, rural and island general practices.
Training was also identified as a problem in rural areas. NHS Education for Scotland has a particular focus on rural healthcare through its Remote and Rural Healthcare Educational Alliance, which designs and delivers remote, rural and island healthcare training for multi-disciplinary rural teams .
The Scottish Government is also undertaking a review of Allied Health Professions (AHP) education. The review, which is due to be published in winter 2022, aims to include potential solutions to key issues facing Scotland’s remote and rural services.
The Remote and Rural Healthcare Educational Alliance (RRHEAL) coordinates healthcare education, development and training for all remote, rural and island areas of Scotland. This includes the provision of:
- continuous access to all RRHEAL educational resources
- learning resources for multidisciplinary staff
- training sessions accessible by videoconference and other technologies.
Use of digital technology
Since the COVID-19 pandemic, there has been an increased use of digital technology, by both staff and patients. The report Shaping the Future Together recommended redoubled efforts to make the most of information technology and digital connectivity in the delivery of primary care in remote and rural areas.
The NHS recovery plan described how primary and community care services have used digital technology during the pandemic:
“Primary care teams have quickly used digital and telehealth services to deliver care during the pandemic, and these will continue to play a role in delivering care across the spectrum of services. This form of care will not suit all circumstances or all patients, but it is an option appreciated by many as it allows them to seek care without disrupting their personal and professional commitments, and reducing unnecessary travel.”
Regarding innovation and redesign, he noted:
“The rise of digital – predicted before the pandemic and significantly accelerated as part of our pandemic response – means that now is the time to ensure that digital is always available as a choice for people accessing services and staff who provides them. This will allow more people to manage their condition at home, to be able to perform pre- and post-operative assessments remotely and to continue to manage their recovery from home.”
In October 2021, the Scottish Government published its updated digital health and care strategy. This involves a number of commitments to improve digital access, digital services, digital foundations, skills and leadership and around innovation.
The National Forum on Rural Mental Health is a network of third sector, private and public sector organizations that hopes to drive change to:
- enable rural populations to be open about their mental health
- create a solid foundation of what works to improve people’s lives
- develop a program to inspire policy makers to channel resources to bring about positive change through a network of rural organizations across Scotland.
Mental health issues and rural isolation have been addressed in the Scottish Government’s Mental Health Transition and Recovery Plan:
“While there are many positive aspects of rural life, we also recognize that there can be challenges associated with rural isolation. These may be increasingly felt by residents of remote communities due to the pandemic. In partnership with the National Forum on Rural Mental Health, we will develop an approach to ensure these communities have equal and timely access to mental health support and services, including the need for dedicated pathways.”
It goes on to say that it will “support the efforts of NHS boards to promote the use of digital services, in particular to maximize the benefits for rural communities”.
Grants of up to £2,500 are available for rural community groups/organisations to support and promote mental health recovery from the COVID-19 pandemic.
Accessibility to health and social services in rural Scotland has been and will continue to be an issue of importance in the Scottish Parliament.
Lizzy Burgess, Senior Researcher, Health and Social Assistance.
Featured image courtesy of the University of the Highlands and Islands Institute for Health Research and Innovation.