Rural Health Plan Improving – integrated service delivery across Wales

Llywodraeth Cymru - Welsh Government


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  • Rurality can be difficult to define but it is clear this should be a nationwide concern and a key element within each LHBs planning and service delivery processes.
  • Rural health will be an important issue for all 7 Local Health Boards but a particular challenge for those areas with a high degree of rurality.
  • Rural health cannot be considered in isolation from social, economic, transport, housing and social care matters, reinforcing the need for rural proofing and integrated planning and service delivery. This document is not an alternative health strategy but is a template for translating the delivery of all-Wales strategies into meaningful service delivery mechanisms, tailored more specifically to the needs of rural communities.
  • The ageing population factor is increasing faster in rural authorities than in urban authorities, compounded by outward migration of young people and inward migration of older people. This will have a significant impact on local service needs and support systems across health and social care. Immediate action is needed to address this.
  • The crucial issues identified within this work revolve around access, integration and community cohesion and engagement, which are not exclusive to rurality, but are deeply affected by the prevailing conditions in rural life.
  • Rural health is generally good in comparison to urban, however distance from services and more general support can impact greatly upon this and is a cause for concern. Accessing services is the foundation of effective rural health and a basic human right.
  • Access in terms of getting timely services to people and people to services across primary, community, secondary/ specialist and social care needs to be improved across the spectrum, from emergency survival to the convenient delivery of routine services. More creative and flexible solutions will be necessary to ensure that the needs of those people living in rural areas are met in the most appropriate way, as well as strengthening existing developments such as telehealth and telecare.
  • Central to improving services is the crucial factor of integration. So much waste can be prevented and better care and support provided by eliminating duplication. Integrated service models, workforce planning and systems are necessary to improve future provision and ensure the effective use of all resources and skills within communities. This will necessitate a vastly improved
    cohesion across organisational/ professional and business boundaries and between NHS, local government and third sector services.
  • Transport plays an essential part in rural health. Regional Transport Consortium are preparing Regional Transport Plans that will set out transport priorities and planned interventions. It is important that plans for rural health services are shared at the earliest opportunity with the Consortium so that transport issues can be identified and resolved at the earliest opportunity.
  • The sustainability of smaller community hospitals is not specifically a rural issue, nevertheless, the crucial role that they play in the life of the countryside gives them greater significance and importance than would be the case in urban areas. It is essential that services are based on local needs, requiring more holistic and multifaceted solutions, some of which are beginning to evolve across Wales.
  • Cost is a relevant factor for all services and a balance is needed between quality, critical mass, access and costs to ensure that the needs of local people are met safely and effectively. However, in the context of rurality critical mass should not be the ultimate determinant. The balance and allocation of financial provision requires further analysis and consideration.
  • The improvements we would like to see brought about may involve re- thinking of existing plans or policies or better links between them. In other cases quick and simple improvements such as improved appointment systems can be made immediately. The challenges of distance and resources will always prove difficult, but by working together and pooling our knowledge, resources and skills more effectively; we should be able to ensure the delivery of efficient and appropriate services to the most rural of communities.
  • Community cohesion is an important resource and a factor of immense potential to both rural and urban settings, but the remoteness of rural communities places even greater emphasis on this. Community cohesion, engagement and ownership needs to be actively supported  and nourished within mainstream service planning and in supporting services delivered locally. The third sector has an important part to play in this.
  • Ensuring the trust and support of local communities will be essential, as will the part they have to play in enabling this to happen. Doing nothing is not an option and we have an ideal opportunity through NHS reconfiguration to make a real success of this.