Date: 26th May 2021

Subject: Rural Health & Care

Chair: Kerry Booth Assistant Chief Executive, Rural Services Network

- To download the Agenda for this seminar click here

- To download the Learning Outcomes from this seminar click here

Speakers:

• Kerry Booth, Assistant Chief Executive, Rural Services Network

  "Welcome to RSN Seminar Rural Health and Care 26th May 2021"

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• Patricia Miller, Chief Executive, Dorset NHS Trust

  "Key challenges facing rural communities in the context of rural health & social care?"

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• Jonathan Corne, Postgraduate Dean East Midlands, Health Education England
  
  "The Generalism Project. A cure for rural ills?"

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• Nik Harwood, Chief Executive, Young Somerset
  
  "Locked-up in Lockdown: young people - rural isolation, mental health and Covid-19"

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Learning Outcomes:

Examples of Good Practice

• 65 High Street – a High Street Digital Health Hub based in Nailsea, North Somerset
• Knowledge for Healthcare and responding to Covid-19 (CILIP and HEE)
• Campus for Future Living – Landmark Project in the Mablethorpe Town Deal

Key Learning Points

Key challenges facing rural communities in the context of rural health & social care:

• Dorset NHS Trust has many access challenges for its communities to overcome due to its large rural geographical area. This is compounded by the coastal area of Portland which is on the national radar as having one of the highest levels of social deprivation.
• Key challenges include: an ageing population which is predicted to grow by 34% in the next 5-8 years, hard to reach, isolated communities, weak transport links, digital exclusion, lack of working age people so difficult to fill vacancies, financial pressures as working on smaller scale but costs are higher and working across multiple sites and locations.
• Key Partner in Dorset ICS working with Local authority organisations to improve local people’s ability to live well, improve their overall health and ensure services are more responsive to their need and more accessible.
• Being an Anchor Institution in the local community is a vital role to enable the Trust to move forward on its social value commitments. These include procuring goods locally, supporting local businesses, employing locally, and investing in flexible, family friendly working. Supporting HE institutions to provide relevant courses, locally, and ensure education is based closer to home and long-term careers in NHS.
• Promoting Civic Partnerships i.e., moving away from traditional approaches to delivering services. The needs of the community and citizen comes first and removing the barriers to living longer, healthier lives.
• Recognising move towards digital platforms and that not everyone has good access to broadband or the hardware. Partnered with local authority and successfully bid to improve broadband accessibility in Dorset.  Also, in co-ordination with a local education supplier provided hardware support to local communities by recycling hospital laptops etc.
• Developed interim health inequality strategy to support the citizen first model until March 2022. This will inform longer-term health initiatives with Local Government.  Think through democratic links Local Government already has and overlay a lens of “system thinking”.
• Biggest challenge is not how we engage, as health partners have been paternalistic in approach since 1948, but now we need a different relationship with the community and provide a wrap-around service. We need to listen and behave differently to improve health and look at what support/training and development do we need to do this.

The Generalism Project. A cure for rural ills?

• A National project to change the way junior doctors are trained. Health Education England is responsible for changing the secondary care training to “learning on the job”.
• Why change – with the increasing numbers of older people, the traditional method of training doctors does not work. Although it is advantageous to have specialist registrars and consultants, as people’s care needs become more complex the method of delivery becomes inefficient.  Multiple clinic visits to see different specialist combined with the cost of appointments, non-attendance, time consuming leads to being ineffective.  Doctors need some specialist knowledge but alongside broader knowledge. The doctor of the future is a generalist (21.07.20 – HEE).
• Traditionally, training given in a hospital setting. These trainees are not seeing any other types of service delivery models or learning how to adapt them.  On a broader note, they have a lack of role models. Doctors are good at diagnosis and treatment but fail to look at the social/economic factors that create the disease/illness.  There will always be specialist centres, but it is envisaged that more will be developed nearer to people’s homes.
• Need to focus on health inequalities and how they can influence that. Some of the most deprived areas are in rural/remote areas. 
• How to bring in change – provide a broader knowledge of disease, broader knowledge of delivery models and change the place where junior doctors train i.e., outreach clinics and community hospitals jointly run by GPs and secondary care.
• Vital to learn about socio/economic challenges and skills required to help address these.
• Immersive Experience – working with Connected Coast, Rural Action Derbyshire, Sutton on Sea RA and Wonca in Mablethorpe, East Lindsey to bring together community and patient advocates on a “campus for future living” – a health and technology hub. Getting to know the community, influencing how hospitals deliver services and working with policy makers to make changes. Widening trainees experience so that when they return to the hospital environment, they have more understanding of their local communities.
• Being Aware that the move towards health technologies risks widening health inequality. Need to develop digital literacy of community.
• Role modelling – very important to encourage a high quality of service and career progression in rural and challenging community groups.

Locked-up in Lockdown: young people - rural isolation, mental health and Covid-19

• Young Somerset – a youth work charity. Big focus on mental health issues and looking to the future since Covid-19.  Takes time to build up a relationship with young people yet having to be very dynamic in changing the model of how the charity worked by moving services on-line in a matter of days.
• Young people do not see themselves as vulnerable thereby making themselves more vulnerable. Mental health/wellbeing issues are amplified with the rural filter.
• Young people are not hard to reach – it is the services that are hard to reach. Assumption is that older people are lonelier but in fact research has shown that younger people are three times as likely to say they are lonely. Issues with isolation, distance from services, loneliness, lack of transport etc.
• Important to identify those most vulnerable at an early stage. Early intervention is much better.  To put into context, during lockdowns, anxiety levels reduced because schools were closed.  However, big concern re county lines and the speed in which they moved into rural areas and changed their recruitment methods.
• Impact of Covid-19 – greater appreciation of education, looking upwards and outwards, appreciating their rural area.
• Set up shop in Taunton. It is an Enterprise charity to hep develop young people’s skills, to sell goods they have made, access Farmers’ Markets etc.  It is not a charity shop.

Any Other Key Outcomes from the Seminar

RSN’s Revitalising Rural Campaign Specific Policy Asks of the Government is for fairer distribution of national resources to rural areas and more nuanced national policies.  There are 14 Chapters in the campaign and one looks at “Access to Rural Health and Care Services”. As new Government strategies are announced, RSN puts them through a “Rural Lens Review” which adds depth and texture to the Policy Asks. A fresh crosscut of the Revitalising document being worked on will look in more depth at younger and older people, working age families and businesses (includes agri.). It will also look at the impact of various issues on these groups of people and develop case studies (personal experiences) rather than dry policy discussions.

Analysis and Commentary pieces for Rural Services Network by Jessica Sellick, Researcher at Rose Regeneration: Implications of Covid-19 and Brexit on post-millennial generation and Oral Health.