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NHS Dumfries and Galloway Health Board Submission of 19 December 2021

PE1845/V - Agency to advocate for the healthcare needs of rural Scotland

NHS D&G would like to offer its support for this petition. It has recognised for some time the concerns expressed by some of our dispersed communities about the potential for inequity of access – and hence a potential imbalance in outcomes - as a result of the challenge to provide fair distribution and deployment of resources across this large geographic area. We also recognise that the perception, (which may or may not have a resonance with reality) can serve to foster resentment of the NHS (and other partners) in communities in areas distant from the centres of provision such as Dumfries and its DGRI.

There are significant challenges to the delivery of services to a relatively small population (approx 3% of Scotland total) dispersed across a land area representing a significantly larger area of Scotland; hence one of the lowest population densities overall.

Efficiency and efficacy of provision steers deployment to centres of excellence meaning some specialty services are provided out with the local area. Specialist services that can be provided in the local district, (supportable in an area of 150,000 population), tend to be delivered from the DGRI. There is clearly an issue about what constitutes specialist vs what is universal in the context of local or district provision.

Our service provision in the west of the Region, centred around Stranraer and the Rhins of Galloway also including the Machars, is focussed on the Galloway Community Hospital – a Rural Hospital. This area has seen significant economic deprivation over recent decades resulting in additional challenges of recruitment and retention of key specialist staff and hence an ongoing risk to the provision of an appropriate range of services. There is evidently a link between an areas economic prosperity (determined by factors out with the control of the NHS) and the ability to support the infrastructure of a broad spectrum of health and social care services.

NHS D&G Board is keen to deploy services as close to the population as possible and to develop digital offers to reduce the need for travel and hence further enhance local delivery. This is a key strategic intent of the Board and its IJB partner and is supported by our community planning partners.

However we recognise that the Boards attempt to maintain high quality services results in difficult decisions as we balance the availability of specialist personnel, the requirement to ensure sufficient activity to maintain excellence in the workforce and the need to balance the financial cost of local vs centrally managed services. The Board has to be cognisant of research supporting ‘centres of excellence’ where patient volumes support ongoing development of expertise vs the outcome of inquiries where low volume patient flows have resulted in poor outcomes as a consequence of reduced clinical experience.

We recognise that the local community campaign groups, such as the Galloway Community Hospital Action Group, and their local councillors have a legitimate desire to ensure that the difficult decisions made by the Board have resulted in the best balance of risk and opportunity re the provision of local vs centrally (and nationally) provided services. We recognise therefore why a ‘petition’ to the Government focusing on a review of Boards delivery of rural healthcare services might be seen as a way to ensure NHS D&G meets the statutory obligations in a way that might improve the experience of people living away from the centres of Dumfries. In this case residents of Stranraer and its environs.

However the complexities of management of such issues as described above are understood by this Board and we feel we do our best to balance the relative risks and opportunities of resource distribution.

That said, should the Government adopt a national approach to the assessment of rural health provision and agree to the model of a ‘Rural Commissioner’ to assess, test and challenge the approach taken by this Board, we would be keen to work with the process; with local stakeholders; and with the ‘commissioner’ to ensure we learn how improvements might be made that would maximise local positive experience of the services we provide and increase the trust in the objectivity and veracity of the Boards decision making processes.