Hansard

I am happy to open yet another health debate. I suspect that there are members here this morning who have not been home since last night's member's business debate. That said, this debate is extremely important.

At the outset, I want to re-emphasise this Government's belief that everyone in Scotland should enjoy equal access to the national health service no matter where they live, and that that access should be provided as locally as possible. As we all know, many things need to be done to turn that principle into reality. This debate gives us an opportunity to reflect on what those things are, and on the changing nature and increasing complexity of health care in Scotland; to consider the challenges that are inherent in delivering health care in our more remote areas; and to suggest how best to enhance the accessibility of services in order to deliver further improvements to the health and wellbeing of people who live and work in remote and rural areas.

We all recognise that although the health care needs of rural and urban communities are very similar, there are substantial differences in the way care needs to be delivered. The Government recognises—as, indeed, did the previous Administration—that a one-size-fits-all approach cannot and will not meet the challenges of providing health care in remote and rural areas now or in the future.

That is why I was so pleased to endorse the recommendations of the remote and rural steering group, which was charged with identifying a strategy for sustainable health care in remote and rural Scotland. It delivered its final report to me late last year. I record my thanks to the group for its excellent work and the comprehensive report that it has submitted. The report undoubtedly provides us, perhaps for the first time, with a clear blueprint for the future—a blueprint that will enable more care to be delivered locally to more people and which will, if implemented, secure the future of all our rural general hospitals. After so many years of uncertainty, I know that that will be particularly welcome news for the people who live in our rural communities.

As the group now gets to work on implementing its recommendations over the coming months and years—which, of course, is always the hard, but most important, part of the process—I expect to see developments that will maximise the contribution of each and every member of the health and social care team and encourage further integration through models of care in which the majority of services are provided locally with only a small number of cases requiring onward referral.

I also expect to see e-health solutions—which are already making a big difference to the way in which health care is delivered in rural communities—become an ever more central part of the delivery model. All that means that we will be able to reduce the need for individuals in such communities to travel to access services that their urban neighbours are likely to have on their doorsteps.

As I said, there should be no one-size-fits-all approach. We must all accept that services that are offered locally will vary. That said, those services will include, as a minimum, a range of out-patient clinics, day-case treatment, midwifery services, palliative care and support for people with long-term conditions and mental health problems. Emergencies and minor injuries will also be treated locally, wherever possible.

Our six rural general hospitals will also deliver, as a minimum, a core range of services. Standard protocols for procedures and transfers should be established and formal links with other centres will be established. Rural general hospitals will act as health care hubs and will be staffed by doctors, nurses and other professionals who have the general and specialist skills that are appropriate to the needs of the communities that they serve. They will be equipped to resuscitate, stabilise and prepare patients for emergency surgery where appropriate. They will also provide access to diagnostics and offer a range of in-patient, out-patient and rehabilitation services, which means that more people will be able to access the services that they need much closer to their homes. In addition, by working closely with hospital staff and other specialist centres, the extended community care teams will help to manage locally patients who have more complicated conditions and who cannot be cared for at home.

Of course, all our efforts are aimed at providing better quality care that is patient centred, safe, effective, efficient, equitable and timely. All that must, of course, be underpinned by procedures that ensure patient safety. That is why we have taken the decision to extend, from this month, the innovative emergency medical retrieval service pilot to cover the whole of the west coast of Scotland. The pilot aims to upskill rural practitioners and to provide rapid access to emergency medical advice, including—crucially—the ability to transfer a consultant with critical care skills to the patient, whatever their location. For patients with life-threatening injuries and illnesses in remote and rural hospitals, the service also provides consultant-based, on-site resuscitation and safer transfer.

As well as attending to patients in person, the consultants who work for the service will provide 24-hour online and telephone advice to any health care professional in the rural area. The service not only provides increased support for rural practitioners; it has already been shown to improve survival rates and outcomes for seriously ill or injured patients whom the service has attended. I am delighted that the extended pilot, which covers five health boards, has commenced. I am also delighted to note that the service anticipates attending 160 to 200 patients and providing advice for another 120 to 150 during the 18-month trial.

I am also delighted that NHS Education for Scotland has established the remote and rural health care educational alliance—RRHEAL—to meet the specific educational needs of the staff who provide health care services in remote and rural areas throughout the country. RRHEAL is an integral part of the remote and rural implementation plan. It will develop and co-ordinate new educational solutions to ensure that the staff who work in those areas can access appropriate education and training opportunities.

Since implementation began in January, RRHEAL has started work in co-operation with NHS boards, education providers, communications and technology services, health care staff and other stakeholders to provide a practical remote and rural focus around learner access, content and support. Initial work has focused on mental health, long-term conditions, health improvement, dentistry and front-line leadership. I hope that, in time, the list will expand as needs arise.

Within the implementation plan, RRHEAL has been tasked specifically with taking forward or supporting key actions around the development of pre-hospital psychiatric emergency care courses, locally delivered educational and training packages for paediatric teams, accessible training programmes to fill skills gaps in the nursing workforce within rural general hospitals, and education programmes to support emerging roles in respect of allied health care professionals with special interests. I refer to flexible radiography teams, multi-skilled generalist biomedical scientists and generic support workers.

In all that, RRHEAL will work closely with NHS boards, regional planning groups and education providers. It will do so to ensure that educational responses genuinely meet the speed of change in remote and rural services, to ensure that identified learning needs are used collectively to establish a critical mass of learners to give educational providers a sound basis on which to make viable investment decisions, and to ensure—crucially—that learning is properly accredited, wherever possible.

As specific programmes are developed, RRHEAL will have a fundamental role in remote and rural proofing of education and training provision, and in evaluating its impact on remote and rural health services. No member—certainly not those who represent remote or rural constituencies—will underestimate the size of the task that RRHEAL has been given. However, the task is crucial and vital. I am confident that the team will, in working alongside partner organisations—which is an important element in all this—respond well to the challenges that it has been set.

I would like to say a word about the amendments that have been lodged to today's motion, and also to say a word about the NHS Scotland national resource allocation committee, which many members will refer to in their speeches.

I am happy to accept the Conservative amendment. As I said in my statement yesterday, I recognise the importance of the ambulance service in rural communities, which is why I will by the end of this month receive from the service an action plan detailing how it intends to eliminate rostered single manning of ambulances that should be double crewed.

Although aspects of the Labour amendment have merit, I am afraid that I cannot accept it, although I know that that will come as no huge surprise to Margaret Curran and her colleagues. The amendment attacks the recommendations of NRAC—which is something that Labour MSPs from Grampian, Forth Valley, Fife, Lothian and Lanarkshire might find very difficult to explain to their constituents. The Labour amendment makes criticisms, as it has every right to do, but its key weakness is that it does not offer an alternative. It fails to recognise that NRAC—an independent group that was set up by the previous Administration—is about securing, as far as is possible, fair funding allocations that take into account the real costs of delivering health care. It also fails to recognise that I have made it clear repeatedly that NRAC's recommendations will be implemented on a phased basis, and that no health board in Scotland will lose any funding. It is irresponsible for any member of this Parliament to suggest otherwise.