Healthcare in Rural Areas

Baroness Merron Excerpts

Thursday 23rd February 2023 Grand Committee

[Baroness Merron (Lab)]

My Lords, I start by congratulating the noble Baroness, Lady McIntosh, on giving us this opportunity to debate what I believe is a very important matter: equality of access to healthcare. I listened closely to the noble Lord, Lord Mann, as I always do, but for me this is not about rural versus urban. It is about saying that no one thing fits everybody. The health service is not one size fits all.

There are a lot of givens in respect of rural, remote and coastal areas; we heard them outlined today. The Nuffield Trust, which produced an important report after the pandemic, has said that the problems in healthcare were made worse by the pandemic but that it also threw up some new problems. We heard about a number of them today. Like other noble Lords, the right reverend Prelate the Bishop of Exeter talked about workforce challenges, including difficulties with recruitment and retention, higher overall staff costs and the larger distances that people need to travel. There is a high amount of unproductive healthcare time as staff must travel. That is not going to change, because the nature of the areas is based on the distance between them. This matter must be addressed, but the way we address it is not a given. There are challenges relating to the size of areas, such as difficulties in realising economies of scale and access to certain resources—such as telecommunications, training and consultancy—being more expensive or difficult.

It is worth saying that, for all those givens, it was shown just before Christmas that people in certain rural areas are waiting almost three times longer for emergency ambulances than those in urban areas. I make that point in the context of the number of debates we have had in the Chamber about the inadequacy of response times in respect of ambulances across the country. Yet we have a particular issue in rural areas, with an ageing and older population. For example, the longest wait for an ambulance was registered in Cornwall at just over an hour and 41 minutes, whereas—this is the important point—two years previously the equivalent figure was 32 minutes. That begs the question as to why it has gotten so much worse, especially in rural areas; the Minister may be able to assist us on that.

The noble Lord, Lord Mann, expanded on the point that I made earlier today in my Oral Question about access to GP appointments. I want to emphasise that choice is so important. Here is an opportunity in rural areas because one cannot necessarily just wander down the street or get a bus to a GP practice. The Government are going to have to be much more creative. In so doing, they can embrace this and provide choice for people on how they wish to have their consultation.

I want to say one word about the Answer given to me earlier today; perhaps the Minister here can assist. The Minister in the Chamber made an assumption about people being able to use smartphones. I accept that many of us can, but there is a whole swathe of the population for whom this is just not going to happen, which adds to their distress and discomfort. Perhaps the Minister here could assist in this regard.

I want to refer to the matter of dispensing doctors. I am grateful to the Dispensing Doctors’ Association for its briefing, because it threw up a lot of whys for me. I want to put those whys to the Minister. Dispensing doctors are NHS GPs who can dispense medicines in designated rural areas where a community pharmacy is not economically viable. This seems a good thing to me. They account for some 15% of all prescriptions dispensed. We know that pharmacies now provide more clinical services to their patients, such as hospital discharge planning and medicine use reviews. Again, that is a good thing, but such services are not available for rural patients who use dispensing practices. Why not? Can this be addressed?

Similarly, the electronic prescription service is not available for dispensing patients. This builds on the point made by the noble Lord, Lord Allan, about the whole system, to which the right reverend Prelate the Bishop of St Albans also referred. The EPS is not designed with dispensing practices in scope. Can the Minister confirm that, as the NHS moves towards ever more integrated IT solutions, it will be possible for a hospital consultant to send a prescription to a patient who receives their medication from a dispensing practice, which is not currently the case?

It has been said that rural residents are paying more, receiving fewer services and earning less on average than those in urban areas, and that this is inequitable. That is indeed the case. I hope that the Minister can help us today.