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Petitioner submission of 19 December 2021

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

I submit this statement to the petition on behalf of Calloway Community Hospital Action Group (GCHAG) Caithness Hospital Action team (CHAT). We are concerned about the disconnect between boards with a lack of awareness of the negatively synergistic combination of rurality and socio-economic deprivation in reducing quality of care outcomes, and advocates for rural and remote communities.

At the last hearing of Petition 1845, an MSP stated “let’s look at the elephant in the room, the role of the NHS Health Boards who are meant to be the democratic voice for the Stakeholders in their regions and are clearly not performing that role effectively if this is an issue arising from the organic groups underneath’’ … ‘’there needs to be consideration of how effective these Health Boards are at representing the interests of their areas’’.

Our local attempts at advocacy deliver limited success. Boards have a conflict, a dual role, balancing the needs (and capabilities) of the organisation, against access to care for rural and remote patients. The nature of this conflict is articulated in the Sturrock report for Highland Health board, which states "Geographic element has its impact in rural areas. …. communities themselves have felt bullied because of promises made and not kept, giving a feeling of being lied to and deceived.” Section 2.32 states "For a number of reasons, including inadequate provision of information to the Board which was not conducive to effective and informed decision-making and a culture which tended to discourage challenge, it appears that the Board has not functioned optimally in its governance and oversight role leading to a situation where allegations apparently could not be raised and responded to, adequately, locally.”

GCHAG met with a senior member of the non-executive board, to discuss a mediation process to help deliver better care for a rural community. There was a suggestion, (previously expressed at several levels of the board), that being rural and remote is a positive life choice and thus rural and remote patients should expect to travel. This correlates with the Highlands report of inadequate provision of information to the board. West Galloway is a very deprived area which affects life choices, and inability to choose relocation. This conflict between the board perception of a “rural idyll” with life choices being the solution while overlooking cumulative effects of remoteness and deprivation continues to be nationally widespread. It prevents boards from throughout Scotland appreciating the unfair disadvantages imposed on remote communities, for whom the poverty trap is wider and deeper. We support the concept of a national rural and remote advocacy framework to assist boards in the provision of fair and reasonable care pathways.

An essential pre-cursor to that is for all parties to recognise that for those in poverty, frail, ill, disadvantaged patients (and families) rurality can mean not having appropriate care. This is unacceptable. Boards and Scottish Executive should recognise the need to account for challenges facing rural and remote communities, either providing local services, accessing remotely, or providing better support for necessary travel. A national advocacy service as proposed would inform boards and politicians in a balanced, informed, and equitable process.