Seventeen percent of Scotland’s population live in rural locations – six percent in remote rural and 11 percent in accessible rural. 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 particularly true for the age range of 65 and over in remote rural areas.
There are some health and social care issues that can impact on rural areas more markedly. These include:
- access to services
- recruitment and retention of staff
- training for staff
- health outcomes.
Health and social care is a large employment sector in rural Scotland, and demographic changes can have an impact on the resilience of rural health and social care services. The University of the Highlands and Islands operates a Scottish Rural Health Partnership. This is a membership organisation which aims to influence and shape rural and remote healthcare policy.
This blog outlines when rural health and social care has been discussed in the Scottish Parliament and discusses some recent and forthcoming developments aimed to improve rural healthcare.
There are a number of petitions related to rural healthcare and services currently being considered by the Citizen Participation and Public Petitions Committee.
- PE1845: Agency to advocate for the healthcare needs of rural Scotland
- PE1890: Find solutions to recruitment and training challenges for rural healthcare in Scotland
- PE1915: Reinstate Caithness County Council and Caithness NHS Board
- PE1924: Complete an emergency in-depth review of Women’s Health services in Caithness & Sutherland
Organisation and structure of health and social care in rural Scotland
In Scotland there are 14 regional NHS Boards that are responsible for the protection and the improvement of their population’s health and for the delivery of frontline healthcare services. Seven special NHS Boards and one public health body support the regional NHS Boards by providing a range of specialist and national services.
The integration of health and social care thorough the Public Bodies (Joint Working) (Scotland) Act 2014 created 31 integration authorities (IAs), which are partnerships between the 14 territorial health boards and 32 local authorities. The IAs are responsible for planning adult social care, primary and community health care, and unscheduled hospital care, delivered by Health and Social Care Partnerships (HSCPs). The HSCPs play a key role in supporting national health service boards to work with communities and stakeholders on designing services according to the needs of local populations.
In 2020, the Remote and Rural General Practice Working Group published its report Shaping the Future Together, which aimed to enhance primary care across remote, rural and island communities. The Scottish Government accepted all the recommendations of this report. This included a commitment to the development of a National Centre for Remote and Rural Healthcare for Scotland. This is due to be operational by spring 2023. It is intended that the centre will support recruitment, retention, ideal practice, evaluation, training, education and research.
The report also recommended that the Scottish Government should 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 has recently introduced the National Care Service (Scotland) Bill in the Scottish Parliament. The accompanying island communities impact assessments highlights concerns raised in the consultation which included:
- the general need for flexibility to account for specific island and rural communities when developing a national approach to social care
- barriers to accessing social care for island communities such as transport limitations and small and dispersed populations
- barriers to portability of care packages between urban and rural/island areas
- barriers to social worker and social care recruitment due to working age population decline and the need to attract workers to the islands
- potential disruption to existing mature integration arrangements that have developed to account for island settings
- economic and demographic constraints on establishing new public bodies due to small size of island communities
- impact of any disruption on local authority provision of social care due to local authorities delivering a far greater share of social care on islands compared to mainland Scotland
- ensuring funding models for social care accurately reflect additional costs associated with delivery on islands.
Further detail on the consideration of the National Care Service (Scotland) Bill can be found in the National Care Service – hub for SPICe material.
Recruitment and retention of staff
A commonly discussed issue in rural areas relates to the recruitment and retention of staff, including the availability of continuing training. The Scottish Government published its Health and Social Care National Workforce Strategy in March 2022. This committed to developing a Remote and Rural workforce recruitment strategy by the end of 2024. This is intended to provide a framework which will support employers to ensure that the Health and Social Care needs of people who live in remote and rural communities are met.
The Scottish Government also funds 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 GP training route for rural GP has existed in Scotland with posts 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 across remote, rural and island general practice.
Training has also been identified as an issue 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 healthcare education to remote, rural and island areas for multi-disciplinary rural teams.
The Scottish Government is also undertaking a review of Allied Health Professions (AHPs) education. The review, which is expected to be published in Winter 2022, is intended 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 the remote, rural and island areas of Scotland. This includes provision of:
- ongoing access to all RRHEAL educational resources
- learning resources for multidisciplinary staff
- accessible education sessions via video conferencing and other technologies.
Use of digital technology
Since the COVID-19 pandemic there has been an increased use of digital technology by both by staff and patients. The report Shaping the Future Together recommended renewed efforts to make maximum use of information technology and digital connectivity in the provision of remote and rural primary care.
The NHS recovery plan outlined how primary and community care services used digital technology during the pandemic:
“Primary care teams moved swiftly to utilise digital and telehealth services to deliver care through the pandemic, and these will continue to play a part in the delivery of care as part of the mix of service provision. This form of care will not be suitable in all circumstances or for all patients, but it is a welcomed option by many as it allows them to get care without disrupting personal and work commitments, and reducing unnecessary travel”.
In relation to innovation and redesign it noted:
“The increase in digital – planned for before the pandemic, and significantly accelerated as part of our response to the pandemic – means the time is now right to ensure that Digital is always available as a choice for people accessing services and staff delivering them. This will allow more people to manage their condition at home, to be able to carry out pre and post-operative assessments remotely, and to continue to manage their recovery from home”.
In October 2021 the Scottish Government published its refreshed digital health and care strategy. This makes a number of commitments to improve digital access, digital services, digital foundations, skills and leadership and around innovation.
The National Rural Mental Health Forum is a network of third, private and public sector organisations which hopes to drive change to:
- enable rural people to be open about their mental health
- create solid evidence base for what works to improve people’s lives
- develop a programme to influence policy-makers to channel resources in ways that bring positive change through a network of rural organisations across Scotland.
Mental health issues and rural isolation was discussed in the Scottish Government’s Mental Health Transition and Recovery Plan:
“Although there are many positives about rural life, we also recognise that there can be challenges relating to rural isolation. These may be increasingly felt by those in remote communities as a result of the pandemic. In partnership with the National Rural Mental Health Forum, we will develop an approach to ensure that these communities have equal and timely access to mental health support and services, including consideration of whether dedicated pathways are needed”.
It goes on to say that it will “support efforts by NHS Boards to promote the use of digital services, in particular to maximise the benefits for rural communities”.
Grants of up to £2,500 are available to groups/organisations in rural communities to support and promote mental health recovery following the COVID-19 pandemic.
The accessibility of health and social care services in rural Scotland has and will continue to be an issue of importance in the Scottish Parliament.
Lizzy Burgess, Senior Researcher, Health and Social Care.
Featured image from the Institute of Health Research and Innovation at the University of Highlands and Islands.