Healthcare in Rural Areas

Lord Allan of Hallam Excerpts

Thursday 23rd February 2023 Grand Committee

[Lord Allan of Hallam (LD)]

My Lords, we too are grateful to the noble Baroness for creating this opportunity. All health and social care services are under strain, but there are particular challenges in rural areas and it is worth some time to focus on those. I will touch on four important topics: staffing, structure, transport and digital.

On staffing, there are issues with shortages everywhere but an especial challenge with trying to attract qualified staff into rural areas. The right reverend Prelate the Bishop of Exeter referred to the idea of salaried GPs, which is one way to attract people in; it would be interesting to hear the Minister’s views on that. Another approach that I understand can work quite well is to train staff in situ—in other words, to train up people already living in those rural areas, rather than seeking to bring people in from outside.

The Times tells us that the Government are going all out on trying to come up with what are effectively apprenticeship schemes for nurses and doctors to take people already in the profession to the next level. Is that something that the Minister thinks could be particularly important for rural areas, where we have staff with some skills but can train them up to be fully qualified nurses and doctors? Of course, that would require us not to insist that they move out of those rural areas for the training; we should be willing to deliver it where they already are. Additional training is a long-term fix, and I hope the Minister will also be able to offer some shorter-term government initiatives to make sure that we can create attractive options for qualified nursing and NHS staff, in particular doctors, to move into rural areas.

On structure, I know that the Government’s response to everything is integrated care boards, and I expect we will hear that again today. It is interesting that many of the integrated care boards combine rural and urban areas. The noble Lord, Lord Mann, pointed out that there are challenges in both, and we should not necessarily see it as one against the other. I can certainly see that integrated care boards could work in both directions. It could be that by combining those areas you get a particular focus on the rural areas and much better integration of centres that tend to be in the more populated urban areas with need in the rural areas. Equally, it could work the other way; an integrated care board could look at impact on population and think, “We’ll put all the resources into the most densely populated area”. In that context, I wonder whether the Government are carrying out monitoring and research for these integrated care boards, which are a new creature, to understand the impact they are having on rural areas and whether they achieve some positive benefit in bringing together people across a community.

The third area is transport, mentioned by the right reverend Prelate the Bishop of St Albans and the noble Baroness, Lady Bennett, who said that taxis are not always there for patients. Certainly, if you have a medical emergency at the time of the school run, in most rural communities you will find that the taxi or the two taxis in your town or village are already fully booked. There are real issues for patients, but I will focus on the issues for staff and the calculation of travel times for them. As I understand it, health and care staff in the most sparsely populated areas can spend 10 times as many hours on travel as those in the most urban areas. That means that you cannot look after the same number of people with the same number of staff, because the ratio of travel hours versus treatment hours is very different.

The right reverend Prelate the Bishop of Exeter raised the issue of care staff on zero-hours contracts, and that is very relevant. I would be interested to hear what the Minister thinks of the proposal we have put forward that there should be a higher minimum wage for care staff, above the current national minimum wage. Care staff need something more to attract them into the profession. That also means looking at their contracts and making sure that travel time in rural areas is not something they have to absorb but something they are reimbursed for.

Another part of the solution to travel time is to look at where services are delivered, with more local clinics and more diagnostic centres. A lot could be done around bringing services to people rather than necessarily making people go to the services, but that has limits. It is certainly a solution when somebody needs to be on site—when they are producing blood samples or need scanning equipment that can be only in a fixed setting—but, as the noble Lord, Lord Mann, reminded us helpfully with that illustration from Iceland, other services can be delivered entirely remotely.

That brings me to my final point, where I want to touch on digital. There are a couple of issues here. First, Iceland’s system works because it has fully digitised its electronic health records. In the United Kingdom, we still have a real patchwork. To be able to deliver proper, effective digital services, we need a fully electronic national health record. However, we are some way off. I hope that the Minister can talk a little about our ambitions in that direction.

Secondly, on connectivity, again, it is about looking at specific locations. We should not generalise. We should look at specific locations and be prepared to invest where a location is missing the connectivity it needs.

Finally, I turn to digital health skills. Again, one of the differentiators for Iceland, a country I also love, is that it has invested in such skills; I learned this from a friend who is a Pirate Party MP, which says something about Iceland’s approach to digital. People understand how to use these technologies and interpret the results. Again, I hope that the Minister will have something to say about digital health skills. I emphasise the “health” part of that; digital is important but there is something specific about teaching people to use applications to do remote consultations.