Rural health and social care in Scotland – SPICe Spotlight

Time to read: 6 minutes

Seventeen per cent of Scotland’s population live in rural areas: six per cent in remote rural areas and 11 per cent in accessible rural areas. 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 65 and older age range in remote rural areas.

There are some health and social care problems that may have a more marked impact in rural areas. These include:

  • access to services
  • staff recruitment and retention
  • staff training
  • health outcomes.

Health and social care it is a large sector of employment in rural Scotland, and demographic changes may have an impact on the resilience of rural health and social services. The University of the Highlands and Islands operates a Scottish Rural Health Society. This is a membership organization that 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 looks at some recent and future developments aimed at improving rural health care.

parliamentary consideration

There are a number of petitions related to rural health and services. currently under consideration by the Committee on Citizen Participation and Public Petitions.

  • 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: Re-establish Caithness County Council and Caithness NHS Board
  • PE1924: Complete an emergency comprehensive review of women’s health services in Caithness and Sutherland

Organization and structure of health and social care in rural Scotland

In Scotland there is 14 regional NHS boards who are responsible for protecting and improving the health of their population and for the provision of front-line health 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 through Public Bodies (Joint Working) (Scotland) Act 2014 created 31 integration authorities (IA), which are alliances between the 14 territorial health boards and 32 local authorities. IAs are responsible for planning adult social care, primary and community health care, and unscheduled hospital care, provided by Health and Social Care Associations (HSCPs). HSCPs play a key role in supporting national health services boards to work with communities and stakeholders to design services according to the needs of local populations.

In 2020, the Remote and Rural General Practice Task Force published its report Shaping the future together, which aimed to improve primary care in remote, rural and island communities. The Scottish Government accepted all the recommendations in this report. This included a commitment to developing a National Rural and Remote Healthcare Center for Scotland. It is scheduled to be operational in the spring of 2023.. The center is intended to support recruitment, retention, best practice, assessment, training, education, and research.

The report also recommended that the Scottish Government should work closely with HSCPs, boards and territorial and national (special) health agencies to establish support and change management capacity for remote, rural and island communities.

The Scottish Government has recently introduced the National Care Service Bill (Scotland) in the Scottish parliament. The attached island community impact assessments highlight the 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 transportation limitations and small, dispersed populations.
  • Barriers to portability of care packages between urban and rural/island areas
  • Barriers to hiring social workers and social care due to the declining working-age population and the need to attract workers to the islands.
  • potential disruption of existing mature integration arrangements that have been developed to account for island environments
  • economic and demographic limitations to establish new public bodies due to the small size of the island communities
  • impact of any interruption in the provision of social care by local authorities due to local authorities providing a much higher proportion of social care on the islands compared to mainland Scotland
  • ensure that social care financing models accurately reflect the additional costs associated with delivery on the islands.

Further details on the consideration of the National Care Service (Scotland) Bill can be found in the National Customer Service: SPICe material center.

Staff Recruitment and Retention

A commonly discussed topic in rural areas relates to staff recruitment and retention, including the availability of ongoing training. The Scottish Government published its National Health and Social Care Workforce Strategy in March 2022. It has committed to developing a remote and rural workforce recruitment strategy by the end of 2024. This is intended to provide a framework that will help employers ensure that the health and social care needs of people live in remote and rural communities are met.

The Scottish Government also funds the Scottish Rural Medicine Collaboration (SRMC) to develop ways to improve the recruitment and retention of primary care staff in remote, rural and insular areas. Since 2012, In Scotland there has been a specific GP training route for rural GPs. with positions available in Fort William, Wick, Stornoway, Kirkwall, Lerwick and Oban.

to support the recruiting GPs for remote and rural practices, the Sottish Government has allocated £200,000 to support rural relocation costs and £400,000 to fund Golden Hellos. These initiatives are intended to help address workforce challenges in remote, rural, and insular general practice.

Training has also been identified as a problem in rural areas. NHS Education for Scotland has a particular focus on rural health care through its Remote and Rural Healthcare Educational Alliancethat designs and delivers health education in remote, rural and island areas for multidisciplinary rural teams.

The Scottish Government is also undertaking a review of education in the allied health professions (AHP). 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 remote, rural and insular areas of Scotland. This includes the provision of:

  • ongoing access to all RRHEAL educational resources
  • learning resources for multidisciplinary staff
  • educational sessions accessible through 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 staff and patients. The report Shaping the future together recommended renewed efforts to take full advantage of information technology and digital connectivity in remote and rural primary care delivery.

the nhs recovery plan described how primary and community care services used digital technology during the pandemic:

“Primary care teams have moved quickly to use digital and telehealth services to deliver care during the pandemic, and these will continue to play a role in delivering care as part of the service delivery mix. This form of care will not be suitable in all circumstances or for all patients, but it is a welcome option for many, allowing them to receive care without interrupting personal and work commitments, and reducing unnecessary travel.”

In relation to innovation and redesign, he pointed out:

“The rise of digital, planned before the pandemic and significantly accelerated as part of our response to the pandemic, means now is the right time to ensure Digital is always available as an option for people accessing services and the staff who provide them. This will allow more people to manage their condition at home, be able to perform pre- and post-operative assessments remotely, and continue to manage their recovery from home.”

In October 2021, the Scottish Government published its updated digital health and care strategy. This sets out a series of commitments to improve digital access, digital services, digital foundations, skills and leadership and around innovation.

Mental health

the National Rural Mental Health Forum is a network of third sector, private and public organizations that hopes to drive change to:

  • allow rural people to be open about their mental health
  • create a strong evidence base of what works to improve people’s lives
  • Develop a program to influence policymakers to channel resources in ways that create positive change through a network of rural organizations across Scotland.

Mental health problems and rural isolation were discussed in the Scottish Government Mental Health Recovery and Transition Plan:

“Although there are many positives about rural life, we also recognize that there can be challenges related to rural isolation. These may be increasingly felt by those in remote communities as a result of the pandemic. In partnership with the National Forum on Rural Mental Health, we will develop an approach to ensure these communities have equitable and timely access to mental health services and supports, including consideration of whether dedicated pathways are needed.”

It goes on to say that it will “support NHS boards’ efforts to promote the use of digital services, in particular to maximize the benefits to rural communities.”

Grants of up to £2,500 are available for groups/organizations in rural communities to support and promote mental health recovery after the COVID-19 pandemic.

The accessibility of health and social care services in rural Scotland has been and will continue to be a major issue in the Scottish Parliament.

Lizzy Burgess, Senior Researcher, Health and Social Care.

Featured image from the Institute for Health Research and Innovation at the University of the Highlands and Islands.

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