Remote and Rural Health Care

Part of the debate – in the Scottish Parliament at 10:15 am on 5 June 2008.

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Photo of Helen Eadie Helen Eadie Labour 10:15, 5 June 2008

I will focus on two aspects of remote and rural health care. The first is policy and resources, and I will give an extremely distressing example of the impact that the failure to deliver quality care has, not just on the patient but on their immediate family. The second aspect is the emergency response service and the Scotland-wide problem with the co-ordination of transport, which is crucial not just for those in remote and rural areas but for everyone in Scotland.

As we prepare for debates, politicians strive week in, week out to inform ourselves of the contents of various reports. We recognise with humility that we can never do justice to the incredible efforts of the authors of those reports, and that is particularly true of "Delivering for Remote and Rural Healthcare". I read with interest the summary report on the Nuffield scholarships to Australia and the comparative analysis that it provides, which describes truly remote living. I readily acknowledge that, although the Dunfermline East constituency undoubtedly has rural characteristics, I have no expert knowledge or experience of the more crucial challenges of remoteness, which are vital to the debate. However, during my service on the Health Committee in session 2, I had the privilege of travelling throughout the Western Isles, from Barra to Uist, over a number of days, and I learned directly from clinicians, patients and health board members of the challenges that confront them daily.

Our opinions as politicians are shaped in many ways. Primarily, we seek to ensure that our constituents' experiences are embraced by the reports that we read and addressed in as realistic and practical a way as possible. Above all, we know that policy documents gather dust on shelves throughout the country. A policy only truly becomes policy when it is matched with adequate financial resources. If policy change is to happen, the allocation of funding is required.

The amount of service change that is required to implement the commitments in "Delivering for Remote and Rural Healthcare" should not be underestimated. I recognise—and I am sure that others recognise—that it is vital that the Scottish Government allocates funding, as called for in the report, for the appointment of a national programme manager. They must have the appropriate administrative assistance to enable them to support NHS boards and other groups in the implementation of the policy changes.

Labour has always recognised that remote and rural communities require a different and tailored approach to health care provision. We showed that with our implementation of the Arbuthnott formula for the funding of health boards, which recognised the additional costs of delivery in those areas. Although there is some recognition of that in the new NRAC formula, it is less transparent, and the cuts in funding to many of the rural health boards are worrying.

The revised NRAC formula will be phased in over a number of years, starting in 2009-10. Although no board will receive less in cash terms, boards' shares will change dramatically. The gap between current spending and the NRAC formula shows big gains for Lothian and Lanarkshire and big losses for Ayrshire and Arran, Highland and Glasgow. The implementation of the NRAC formula will reduce the share that Glasgow and those other boards receive and will increase inequality. NRAC replaces Arbuthnott as the target, not the allocation. If the Arbuthnott index had been retained with the new unmet need weighting, Glasgow's target would have increased.