SG Call for Evidence healthcare in Remote and Rural areas
Argyll and Bute Council · 29 November 2023
Back to Argyll and Bute HSCP Integration Joint Board (IJB) — 29 November 2023 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Response ID ANON-R78T-CZH7-H Submitted to Healthcare in Remote and Rural Areas Submitted on 2023-10-13 10:30:32 About You Please read the privacy notice below and tick the box below to show that you understand how the data you provide will be used as set out in the policy. I have read and understood how the personal data I provide will be used. How your response will be published I would like my response to be published in its entirety What is your name? Name: Charlotte Craig What is your email address? Email: charlotte.craig@argyll-bute.gov.uk Are you responding as an individual or on behalf of an organisation? Organisation Organisation details Name of organisation Name of organisation: Argyll & Bute Integration Joint Board Information about your organisation Please add information about your organisation in the box below: Argyll and Bute IJB is responsible for the strategic planning and delivery of all community based health and social care services for adults and children in Argyll and Bute. This includes services which are purchased from external providers including NHS Greater Glasgow and Clyde. The Partnership has been established as a separate legal entity from both the Council and the Health Board, with a board of governance the (Integration Joint Board (IJB)) which has responsibility for the planning, resourcing and overseeing the operational delivery of integrated services, as identified in its Strategic Plan. This includes the services, staff, and resources. IJB membership comprises elected councillors, NHS Highland non- executive Board members and a number of other members from a range of sectors and stakeholder groups including the Third Sector, Independent Sector, patients/service users, trade unions, staff and carers. Your Views Are there any immediate issues unique to remote and rural communities which the National Centre will need to focus on to improve primary and community care in these areas? Please use this textbox to provide your answer: Argyll & Bute currently has a unique geography including remote mainland, 23 inhabited islands and urban centres. Island and remote present similar logistical and clinical/care risks and issues in the delivery of care and can further create inequalities of access to care in comparison with access to urban areas. Robust equality impact assessments would be advantageous to support and inform any strategy delivery. The cost of care is disproportionately high and the staffing skills mix is becoming increasingly hard to meet within the resident population. In June 2023 Argyll & Bute Council; declared a housing crisis. This impacts on ability to recruit and retain workforce. The whole system of public services and infrastructure contributes to the decision to locate to a remote area. The ability to provide the education, employment, transport and life opportunities required to support a balanced population who can deliver services as well as receive them is key to maintaining safe services and ensuring small communities remain vibrant and viable. Urban areas and the scale of their infrastructure allows for the balance of shortfalls of skilled resource. The NRAC share in respect of health funding mitigates some of the cost implications associated with small scale service delivery. With a declining population, we have a declining share and increasing cost of delivery as such any benefit is in effect removed. Demographics and population decline is a key risk to the future of health and social care delivery
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in remote communities. Primary Care modernisation has some rural flexibility but as with the application of most national policy it does not take into consideration the unique need in Argyll & Bute where community hospitals are led by General Practitioners and the rural practitioner skills required by all professions supporting a generalist approach. This exists outside the increasing specialist model favoured by national policy and professional bodies. We reference specific issues in recruiting and retaining essential community workforce in social care in question response 4 and 5. Reference to social care and social work seems light in the overall strategy approach, yet these staffing groups and services are integral to the delivery of primary care. maintaining care at home and preventing acute admission. Are there any issues which the National Centre will be unable to address, which may require further policy action from the Government? Please use this textbox to provide your answer: As referenced in question 1 Remote and Rural requires a whole system approach to planning and delivery of public services and a place based rather than professional or workforce grouping based approach. Transport is key to any strategy and it’s unlikely that this can be addressed specifically in the proposed strategy. While a focus is welcomed for remote and rural, even with increased investment in Technology Enabled Care in Argyll & Bute we are unable to substitute the interventions of skilled care practitioners and disproportionally deliver unscheduled care locally which precludes adequate resource being channelled towards prevention and early intervention. Remote and Rural health and social care delivery is different. There are parallel requirements in respect of policy; rural policy flexibility is required as standard acknowledging the difference in need and resource, whole system funding and to combat population decline and maintain service delivery/service need balance and acknowledgment of the benefit and breadth of the generalist rural practitioner roles required. In addition a longer term planning perspective on the increased impacts of failing to address the social determinants of health is required. Argyll & Bute is committed to delivering a prevention programme with a long term strategy of this underpinning better health for local people and would seek to achieve critical mass in this area that impacts on service need in future. This approach is transformative and requires a strategic approach. What would you like to see included in the Scottish Government’s forthcoming Remote and Rural Workforce Strategy? Please use this textbox to provide your answer: Recognition of the need to review professional roles for a modern service, focus on prevention, rural career pathways, provision of appropriate training and learning opportunities, recruitment, sustainability of services e.g. specialisms are often one role area wide and equitable access to development opportunities. National Strategies should have a robust island and remote mainland impact assessment with resource to meet the mitigating actions. Cognisance of how health and care act as one system and are interdependent. National action on recruitment to professions and care roles with a positive focus on remote and rural practice and facilitating practitioners to live and work locally to ensure commitment and local ownership of services. Provide confidence to young people that they can live in remote and rural areas and will be able to access housing and all of the services they require (in a rural context) and will be able to reliably travel to larger population centres if required. Key worker housing is essential for a wide range of public sector staff including support for relocating families. What specific workforce related issues should the strategy look to resolve? Please use this textbox to provide your answer: For remote and rural Health and Social Care to be sustainable, there needs to be a drive towards more professional collaboration, across disciplines, services etc. Utilising resources available in the best way. Ensuring, Health boards, Councils, SAS etc all work together to provide standardised levels of care / support to remote areas. Argyll and Bute performs well on integrated service provision and any strategy should aim to support development in this direction collaboratively. For example on Island staff may require to undertake several roles/interventions and this is not supported by growing specialism in professions. We need the strategy to support setting a strategic direction that supports robust health and care roles tailored to the delivery need. Nationally agreed Job roles require review to look at what multifunctional roles could look like supporting remote and rural care provision and we would seek engagement with professional and regulatory bodies to support the rural approach. We are also working with partners to prioritise the opportunities that are available to the families of key workers Dedicated housing / accommodation must be available to professionals in these remote areas. We are actively working with partners to support local housing strategies Are there any workforce-related issues which the creation of a Remote and Rural Workforce Strategy alone will not address. If so, what are these issues and what additional action may be required to address them? Yes If you answered Yes, please use this textbox to provide further detail: Overall lack of staff to recruit into the Care professions, low wages which can't compete with the other local employers. Lack of workforce supply inevitably results in increased pay rates, again more flexible approaches to terms and conditions of employment are required. This makes provision of remote and rural care even harder as the job market competition in these areas makes health and social care less attractive to alternative posts etc. We have a local joint workforce strategy which is exploring through a range of work streams how we can recruit, retain and develop our staff. Modern health and social care services with a prevention agenda require a partnership wider than health and social care and support for an environment that supports third and independent sectors to grow which will allow the development of commissioned service provision.