Ensuring equitable access to Ensuring equitable access to health and social care for health and social care for

rural and remote rural and remote communities communities

Dr I J MungallDr I J Mungall

Access to HealthcareAccess to Healthcare

• Under increasing strain

• Ever increasing centralisation

• Ever increasing specialisation

The ReportThe Report

• Rural Health Forum

• Royal College of GPs

• Academy of Medical Royal Colleges

• Available at:-

• www.ruralhealth.co.uk

• And from the Institute of Rural Health

Why ever more centralisation?Why ever more centralisation?

• Cost of infrastructure & gear• Training• High volume of work• The specialist team• Efficient use of scarce budget• (though transferring some costs to the

patients)• Status?

Local services lostLocal services lost

• Why?

• “Inadequate Consultant cover”

• “Insufficient work to maintain the necessary skills”

• “Insufficient experience for Junior doctors’ training needs”

• European Working Time Directive

Access v. QualityAccess v. Quality

• Access x Quality = a constant

(assuming finite resources)

• Whenever Quality improvements are proposed, ask, “ how will this affect Access to care”

Access mattersAccess matters

• Heart attacks and urgent stenting

• Strokes and CAT scans

• Distance decay

• Outcomes for cancer / distance from GP

• Asthma deaths

• RTAs

• Diabetic eye disease

• The process of cancer care:

• Stranraer study

What can be done?What can be done?

• Defining best practice

• Innovative thinking about Skills

• Enhancing teamwork

• A rural career path

• Better use of IT

• Improving Rural transport

• Equitable funding

• Outreach clinics

• A different relationship between a region’s hospitals

• Realistic expectations

Specific RecommendationsSpecific Recommendations

• Including:-• Colleges to increase support to rural

members• Standards for Access to care• Standards for communication• Transport – improvements crucial• Rural proofing• Equitable funding

• Enhance use of IT

• Consider the Kerr report ( similar review undertaken in Scotland )

Progress on the recommendationsProgress on the recommendations

• Remarkably little!

• Why is it so difficult to advance the rural agenda?

• Thank you for coming and listening

• I would love to hear your opinions,

• and will try to answer your questions