Health services for rural communities
Last Friday the East Sussex Health Overview and Scrutiny Committee started its investigation into NHS delivery to rural communities with a conference at the Uckfield Civic Centre. It was well organised and sparked some very interesting discussion.
AirS had been asked to contribute an initial presentation to prompt discussion and ‘get the juices flowing’. My powerpoint presentation can be found here.
We take the view that resources and initiatives tend increasingly to be focused on the small number of, mainly urban, places where there are a high proportion of disadvantaged people; despite there being many similarly disadvantaged people spread across our more dispersed rural areas. The perception within the Health Service is clearly different: they see the better off and vocal middle classes who live in rural areas tending to demand more from a service that must try to be universal.
Resolving this tension would seem to be about focusing on the needs of individuals and families wherever they live and responding accordingly irrespective of their location. So what might intrude on this excellent solution? There are probably three key barriers to be overcome: 1. Government set targets are easier to achieve in urban areas because the target population comes in big clumps 2. There may not be a ‘travelling premium’ attached to the budget for outreach services for rural areas and 3. Away from urban centres people often look across administrative boundaries for services and this often results in a poor focus on the individual or family.
Overcoming these barriers means taking account of the particular situation of rural people and treating them with the same respect, engagement and lack of discrimination as any other minority group. The NHS in East Sussex is clearly listening, so roll on HOSC’s investigation, it was a good start.
Jeremy Leggett, 30th November 2009
December 1st, 2009 at 9:49 am
But how do you plan to fund all of this - with a massive budget deficit and huge tax increases due how can we possibly afford to play the game in your presentation?
December 1st, 2009 at 1:52 pm
It’s quite simple - you use the existing budget differently, for example:
You live in Hastings and have 14 grandchildren. 7 of them live in Hastings, 2 live in Battle and the remaining 5 live all over East Sussex
You can only afford a cake big enough to feed 10. You decide to give the cake to the youngest children, of whom 4 live in Hastings.
You make a cake big enough for 9 children, walk to the houses of the 4 local children to deliver it and then use the money saved from not making the 10th portion to pay the costs of posting the other slices to the remaining 5 younger children.
Result - equity of provision for those you determine to be in greatest need.
Alternative model as currently practised by NHS:
You make a cake for 9 children.
You deliver cake to the 7 children in Hastings because after all, it isn’t a very nice place to live, you can get there easily and half of your grandchildren live there.
You use the money saved from the 10th portion to get the train to Battle and give cake to the 2 children there, because you don’t drive and train travel is much more sustainable anyway.
You decide that the other children will be OK because it’s lovely living in the countryside and their mothers are much more likely to make homemade cake.You don’t tell these grandchildren that there was any cake, but if Aunty Joan lets it slip, you explain that there wasn’t enough money or cake to go around; it was important to make sure that as many grandchildren as possible got cake; it wouldn’t keep so it wasn’t practical to get it to them; living in the countryside is lovely so it wouldn’t matter too much to them; and it wouldn’t have been a good idea for them to collect it because using the car is unsustainable.
Result - unfair distribution of cake, according to geography rather than need
December 1st, 2009 at 3:51 pm
alternatively you encourage people not to have so many children that they cannot afford and instead expect handouts of “cake” from the state (aka tax payers).
December 2nd, 2009 at 1:44 pm
You have spectacularly missed the point! As a grandparent or indeed as the NHS, you are not in control of the number of children. The point is that as a publicly funded body, you can distribute your limited resources equitably, according to the definition of greatest need, or you can discriminate against some of the people in greatest need on the basis of where they live.
If you want to dispute the wisdom of a publicly funded health service, that is a different argument!
December 2nd, 2009 at 2:10 pm
Your point was very badly made - and offensive to anyone who lives in Hastings too.
As a publicly funded body (and this applies to Action in Rural Sussex too) we are living beyond our means. We can’t share the same cake - we need to eat less. Charities and Government have become obese and should start to eat sensibly,
December 8th, 2009 at 4:16 pm
Oe last try! Jeremy’s blog does not argue for increased resources, or even for the same level - it puts the case for equity of provision for people with similar needs living in rural or urban areas, not for a particular quantity of provision.
I think it had better be finally! - my earlier point is a parody of what actually happens, not an attempt to offend the good folks of Hastings!
December 10th, 2009 at 6:13 pm
You really do miss the point Kathy. We need to live in the real world not one imagined by Jeremy. We need to live within our considerably reduced means as a country. Where have you been?
December 15th, 2009 at 1:26 pm
Why does Antony C reply to these blogs? He doesn’t seem to read them!
December 16th, 2009 at 11:17 am
Who is Antony C ?????