Holyrood Committee calls for urgent action to improve access to and delivery of healthcare services in remote and rural areas

The Committee’s inquiry has found that recruitment and retention of staff is one of the key challenges to effective delivery of services in remote and rural areas. The report highlights the availability and affordability of housing, and access to education and training as significant barriers to recruiting and retaining staff.

The Committee is calling on decision-makers to recognise the extent to which a lack of available and affordable housing is acting as an indirect barrier to healthcare provision in remote and rural areas of Scotland, by making it very challenging for healthcare workers to locate themselves within the communities they wish to serve. It calls on relevant NHS Boards, local authorities, professional bodies, trade unions and other key stakeholders to work together to find practical solutions to these problems.

Another barrier highlighted in the report is the lack of locally available training and development opportunities for staff. The Committee is calling on the Scottish Government and the new National Centre for Remote and Rural Health and Care to set out how they will improve the availability and suitability of local training and development opportunities.

Difficulties with accessing healthcare services in remote and rural areas were repeatedly raised during the Committee’s evidence gathering. These include practical challenges for patients attending in-person appointments and the often substantial additional travel and accommodation costs, which the Committee say must be addressed.

The Committee highlights significant variations in policy on reimbursement of patient travel costs, depending where an individual lives and whether or not they are in receipt of benefits. It calls for a fairer and more consistent policy for reimbursement of travel and accommodation costs to be developed.

The importance of technology and digital infrastructure in facilitating access to healthcare in remote and rural areas was also raised repeatedly during the Committee’s evidence gathering. While recognising that some will continue to prefer face-to-face appointments, the Committee is calling on the Scottish Government to set out the specific actions it is taking, or that may be required at UK Government level, to improve digital access to healthcare services in remote and rural areas.

The Committee commends existing good practice in the provision of remote and rural healthcare services, including that demonstrated by third sector organisations. However, it concludes that more action is needed to ensure this good practice is more consistently and widely shared across different organisations and areas.

Clare Haughey MSP, Convener of the Health, Social Care and Sport Committee, said:

“Our inquiry has shone a light on the unique challenges facing remote and rural healthcare services, both for those accessing and those delivering those services.

“The evidence suggests that often healthcare policy is developed as ‘one size fits all’, which fails to address the particular needs of remote and rural communities.

“We want to see a whole system approach which designs services in a way that is more flexible and responsive to local needs – while systematically learning from the good practice that is out there.

“We believe that developing a tailored approach to healthcare service delivery that reflects local challenges and circumstances should be an overarching priority of the new National Centre for Remote and Rural Health and Care.

“We also look forward to the forthcoming publication of the Scottish Government's Remote and Rural Workforce Recruitment Strategy and how this strategy will address some of the workforce-related issues our report highlights.

“The voices of people who live in remote and rural areas and work or receive care in these settings have been at the centre of our inquiry and we thank them for their vital contribution to this report.”

Other findings in the report include:

• The evidence gathered by the Committee suggests that the current NRAC funding formula fails to meet the specific needs of remote and rural areas. The Committee reiterates previous calls for this formula to be reformed to take better account of the specific challenges and associated higher costs of healthcare delivery in those areas, which include an ageing population, depopulation, and the greater requirement for small scale service delivery.
• The Committee says it has heard extensive evidence of the specific challenges associated with implementing the 2018 General Medical Services (GMS) contract in remote and rural GP practices, in particular the practical challenges associated with trying to develop multi-disciplinary teams. The Committee is calling on the Scottish Government to explore the extent to which a revised, more flexible approach to implementation of the contract, specifically in remote and rural settings, might help to improve the sustainability of these services.
• The Committee highlights evidence of acute pressures on the provision of social, palliative and end of life care services in remote and rural areas and warns that the tendency of an ageing population increasingly living in more remote and rural areas of the country will mean demand for these services will increase significantly in the years ahead.