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Healthcare in a rural setting

January 2005
Board of Science

Introduction
The Dewar report (1912) [go to reference 1] examined healthcare in rural areas and highlighted many difficulties with service provision. This led to the formation of the Highlands and Islands Medical Scheme, widely held to be a forerunner of the National Health Service. [go to reference 2] Since that report there has been little research in this area, although a recognition of inequalities in health in the UK during recent years [go to reference 3] has led to a re-examination of rural healthcare provision and outcomes, and highlighted the need for further research and improvements. This is shown by a number of projects and organisations committed to improvements in rural health, for example, the joint report by the general practitioners committee (GPC) of the BMA and the Institute of Rural Health (IRH),[3- go the reference] the Rural Health Forum (RHF), [go to reference 4] the IRH [go to reference 5] and the Remote and Rural Areas Resource Initiative C (RARARI).[go to reference 6]

In the UK, rurality is now increasingly recognised as an issue worthy of its own policies.[go to reference 7] The Department of Health (DH) is funding Rural Proofing for Health – a project of the IRH and managed by the RHF. This involves developing a toolkit for use by primary care organisations, to enable them to ‘rural proof’ their policies to take into account the health needs of people living in rural communities.[go to reference 8] Health is a devolved responsibility of the Scottish Parliament, Welsh Assembly and the Northern Ireland Assembly, each with distinct rural communities and identities. This has given new opportunities to improve remote and rural care in these regions,[go to reference 9] and drive policy forward.

Rural healthcare in the UK is not given the same attention as in countries such as Australia, USA and Canada. In these countries, research into the crisis affecting rural healthcare has led to innovative solutions. In this report international examples from Australia and USA are introduced to inform debate. Examples of good practice from other countries where rural healthcare has been addressed may also be usefully explored, and this needs to be further researched. The UK needs to begin to view rural healthcare as a policy area separate from urban healthcare. Many policies work well in urban areas but do not translate to rural ones, [go to reference 10] for example, having large hospitals to cover large populations. In this case, a comparative scale in rural areas would produce prohibitively long distances for the outliers to travel, and long journeys for emergency services, which could compromise clinical outcome. Evidence indicates that different solutions are needed in rural areas.[go to reference 10]

C RARARI ceased to exist on 31 March 2004, however, there are active projects still running.