Healthcare in Rural Areas

Lord Mann Excerpts

Thursday 23rd February 2023 Grand Committee

[Lord Mann (Non-Afl)]

My Lords, the Minister was nobbut a lad when I last lived in a city but I do not buy this idea that there is some kind of clash for resource between urban and rural and that rural areas somehow get the worst of it. Having been a parliamentary representative and therefore also having an obligation to live in London, I know that access to services in London is significantly worse than I have ever seen in any rural area.

I think that the issue is different. I have specific questions relating to dispensing pharmacies. I recall the 2008 consultation by the then Government, when I personally put in more than 50% of the national responses and turned over the Government to allow the system, which was crudely a subsidy of local GP services—in particular, therefore, of smaller ones in more rural areas—to maintain the dispensing. That subsidy was critical to the maintenance of the GP practice; that was my argument to the Minister of the day. It was not particularly about convenience, although there are marginal arguments there; it was about the maintenance of GP practices. Have the Government any intention of watering that down or moving away from it in any way, or does that remain guaranteed as a principle that they will actually enshrine further rather than cut away from?

My second point for the Minister is the one that I find the most unfathomable. Let me take the example of stroke care. I live in an area that is generally described as a former coal-mining area; it is not one of the wealthiest areas. Statistics can be used in many ways but, in many of the rural areas that I once represented and where I live, there is no longevity of life. Where is the use of technology?

Let us take Iceland as an example—one that I have cited repeatedly over the years to local health services in the north Midlands and South Yorkshire. Iceland has the best outcomes for stroke care in the world, by quite a degree. I do not know how many noble Lords have had the opportunity to visit Iceland but, if they have not been, they can envisage that it is incredibly rural: it takes a day to get the whole way round it. There is one main hospital, in Reykjavik. What happens when someone has a stroke? You are not going to get, in a golden hour, from any rural part of Iceland into the capital city and the hospital—it is not possible—so they use online consultation. The specialist in Reykjavik, who is available 24 hours a day and is doubtless at home, is there on the computer. This has been the system for the past 20 years. They diagnose on whether to thrombolyse and a skilled, but not particularly highly skilled, nurse of some kind then does the thrombolysis, if that is determined as the outcome. More people live; indeed, all people who have a stroke have a better outcome.

If that can be done in such a rural situation, with one hospital, why are we not doing the same in so many different areas? Let us take me as an example. I may not be a typical patient but I am not that atypical of the people the NHS is a bit worried about and advises, “Make sure you’re looking after yourself. Make sure there’s early diagnosis, otherwise you might be up for a bad time and you’re going to cost us a lot”. I am more than happy to have a face-to-face discussion. I would prefer to be able to speak to a specialist in Sheffield or London—or, frankly, in Tokyo or New York—if that is what is determined rather than having to book to see a generalist GP who can then only refer me on and try to get me to a specialist, about whom the GP may or may not have specialist knowledge about whether they are any good. That is not a coherent system.

We are not using technology in the health service. It is obvious to me that rural communities could be the biggest beneficiaries. I accept that there are issues with broadband in some areas but, frankly, even recent Governments have managed to move us on somewhat in relation to that. It would be a game-changer. If I needed to speak to my local GP, I would be happy to do it face to face, but I suspect that this would be more efficient for them. I am not saying that it should be a system for everybody, that everyone would be comfortable or want to do it or that, in every scenario, I or the medical practitioner would feel that it was appropriate, but does the Minister think that we could do far more in resource to move this forward in the next year or two?