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Hinterland - 15 July 2019

In Hinterland this week - a strong health undertow to our stories, supplemented by some thoughts on the challenges to sustainability in rural places from plastic and the planning system! And Finally a starry story from Cheshire. Read on....

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Amazon Alexa-NHS partnership splits expert opinion

This is fascinating stuff. There are clearly real opportunities to use “off the shelf” technology to make it easier for people in rural areas to receive services. I’m particularly interested in how tools like Alexa might make it easier for vulnerable people to live in their own homes for longer in rural areas. There are however ethical issues and downsides as this article identifies. Read on!!

Worried about a lump? Got a nasty cough that won't budge? Many people Google queries about such symptoms daily - but now they can get NHS advice instantly by asking Amazon's Alexa.

The voice-activated assistant is now automatically searching NHS web pages to find answers to medical questions.

And the government hopes it will reduce the demand on human doctors.

But the move has split opinion among artificial intelligence (AI) experts and data ethicists.

"The sensitive data holdings of a national healthcare provider like the NHS are a form of 'critical social infrastructure'," said Berlin-based tech expert Mathana Stender.

"Yet they've been handed to a foreign company that's both a defence contractor and targeted advertiser,"

NHS GP David Wrigley asked, among other things, whether the questions asked via Alexa would be encrypted and who would store any data relating to patient queries.

Amazon has said all data would be kept confidential.

The NHS has increasingly partnered with private companies to offer access to its services.

Notably, Babylon Health, Push Doctor and Now GP all allow video appointments with GPs to be made remotely.

Babylon Health, for example, says only patients and staff involved in service provision have access to patient medical records.

It adds that all data is encrypted and held in English data centres.

Amazon said multiple layers of authentication would protect the data from UK customers and that all information would be encrypted.

Some commentators felt that the service did not present obvious risks to users' privacy.


Record numbers struggle to see GP - and most can't see the one they want 

Another excellent article from Laura Donnelly following her previous work on increasing distances between GPs and their patients. This article demonstrates how apart from in some of the remotest places the days of the family doctor are numbered….

Most patients who want to see their own GP can no longer get an appointment with them, according to new figures suggesting the days of the family doctor are over. 

The statistics show record numbers of patients struggling to even get through on the telephone, and increasingly long waits for an appointment. 

For the first time, the majority of patients who wanted to see a particular doctor were unable to do so, the survey of more than 770,000 patients shows. 

The research comes amid mounting evidence of a wider NHS crisis, with waiting lists reaching an all-time high.  

Medics said the “worrying” situation was being fuelled by a dispute over pensions, with senior doctors increasingly refusing to work overtime, or opting for early retirement, to avoid high tax rates. 

The figures show that the proportion of patients finding it difficult to get through to make a GP appointment has risen by 65 per cent since 2012.  

In total, 31.7 per cent struggled to make contact, compared with 19.2 per cent seven year ago, the annual GP survey shows. 

More than half of those polled had a preferred GP.  

And of those just 48 per cent said they saw or spoke to them "always or almost always", or "a lot of the time". 

The figure is a fall from 50.2 per cent in 2018. It is also a steep drop from 65 per cent in 2012, although researchers said changes in the way the survey was carried out meant the figures were not directly comparable.

Rising numbers turned to A&E when their GP practices was closed the figures show.


I’m a farmer, and no-deal Brexit would put me out of business

Food for thought from a Cumbrian Farmer!

Everything should be fine, but there is a big, dark cloud lurking on the horizon: the possibility of a no-deal Brexit. This is a threat to everything we do. The uncertainty around Brexit and the prospect of trade tariffs that would cripple our business is a real worry. The future direction of UK-produced food is simply unknown.

Will we be forced to adhere to ever higher standards, while our government allows food to be imported from countries where farmers adhere to welfare or other standards that would, rightly, be illegal on my farm? Will our politicians assure British farmers that they will avoid a disastrous no-deal Brexit?

Politicians visit farms and livestock auction markets and tell farmers: “Don’t worry chaps, it’ll all be fine.” Then we hear them on the radio proclaiming that the great prize of Brexit will be cheaper food.

All this plays to my very real fear that we will be sold out as the British government desperately seeks trade deals with anyone who will have us. I believe they would happily open up our highly regulated food sector to all-comers if they’ll buy our financial services.

Selling out British farming could end up being the legacy of Brexit. My fear is that free-trading ministers, who are frustrated by what they dismiss as the “red tape” of the EU, could sacrifice rural Britain in a heartbeat if it meant a trade deal with the US.


Battle with time: Italian towns face demise by depopulation

This story reminds us that many rural places across Europe become vulnerable when their diversity and connections seize up. England is more densely populated but many an unimaginative town planner might learn something from pondering on this story. There are places in far flung corners of our country where a blanket presumption against growth and development is a deep threat to the future.

The birth of a baby in the small town of Acquaviva Platani, in inland Sicily, is such a rare event that the village bells toll to celebrate the arrival.

With just 800 inhabitants Acquaviva is among thousands of Italian towns risking extinction in the coming decades, as the country faces an unprecedented crisis of population decline.

For the first time in 90 years the Italian population has fallen to about 55 million, according to the national statistics agency (ISTAT). From 2014 to 2018, the population decreased by 677,000 people.

Two factors are behind the decline according to experts: a decrease in births, which is at an all-time low since the unification of Italy, and an increase in the emigration of young people to other European countries in search of job opportunities. According to ISTAT nearly 157,000 people left the country in 2018.

UN reports that Italy is the only major European economy with a population set to decline further in the next five years. It ranks second – behind only Japan – in terms of having the greatest share of older people, with an estimated 168.7 people over 65 for every 100 young people.

Most people living in Acquaviva are more than 60 years old, and the number of deaths fluctuates between 20 and 30 each year. As for the bells announcing the birth of a child, they only ring once or, at the most, three times a year.


Small shops still hand out 2 million plastic bags every day

This is a really interesting article, not just for its environmental implications, but in terms of the way it looks at how behaviour can be influenced by policy. It tells us:

Up to 2 million plastic bags a day could be kept out of landfills, recycling plants, and rivers if the government doubled the 5p levy on carrier bags and extended it to small shops, figures suggest.

Businesses with fewer than 250 employees are currently exempt from the charge which was introduced in England in 2015, and has helped remove 15 billion bags from circulation.

The Department for the Environment, Food, and Rural Affairs (Defra) has said it plans to increase the charge to 10p and include all retailers, from as early as January 2020.

Lord Gardiner of Kimble, a government environment minister, said 3.6 billion plastic bags were handed out by small businesses in 2017, compared to 1.7 billion sold in major retailers in 2017-18.

“We estimate that the policy to increase the charge to 10p would cause a decline in consumption of SUCBs (single use carrier bags) in MSMEs (micro and small businesses),” he said in response to a written question by Lord Hayward of Cumnor.


And Finally

Jodrell Bank Observatory given world heritage status by Unesco

Ive been in Chester this week at the ACRE Board meeting. So this story seemed particularly relevant. Interestingly this rural location was chosen because the area was free from radio interference. Such interference in the form good broadband connectivity is now highly desirable, not just here but across Rural England more widely!

Observatory, which has played a leading role in astronomical research since 1945, has been added to the Unesco World Heritage List.

The site in Cheshire has contributed to the study of meteors and the moon, the discovery of quasars, quantum optics, and the tracking of spacecraft.

It is probably best known for the landmark Lovell Telescope, a steerable 250ft radio dish which was the largest in the world when it was built in 1957.

Weighing 3,200 tonnes, it can be seen for miles around, it is still the third-largest of its kind and has appeared in Doctor Who and Douglas Adams’ Hitchhiker’s Guide to the Galaxy.

Jodrell Bank, which is part of the University of Manchester, joins historic international sites such as Machu Picchu, the Great Wall of China and the Taj Mahal on the Unesco world heritage list.

Announcing the decision, Unesco said: “Located in a rural area of northwest England, free from radio interference, Jodrell Bank is one of the world’s leading radio astronomy observatories. This exceptional technological ensemble illustrates the transition from traditional optical astronomy to radio astronomy (1940s to 1960s), which led to radical changes in the understanding of the universe.”


About the author:
Hinterland is written for the Rural Services Network by Ivan Annibal, of rural economic practitioners Rose Regeneration.


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