Thoughts on rural health care

Written by David Heath MP and published in Western Gazette on Fri 27th Nov 2009

I'm paying another visit to the new community hospital in Frome on Thursday, in the company of my colleague and party leader Nick Clegg, and I'm very pleased to hear that two of the outstanding issues relating to the hospital may now be on the way to being solved. Firstly, the hours during which treatment can be given for minor injuries is going to be extended; this was an annoyance to people who found that they had to trek off to Bath to deal with some misfortune which couldn't be dealt with at the brand new hospital in the evening. Secondly, the local GPs practice are publishing plans for a new surgery next to the hospital, which is what we hoped for in the first place but which was cut out for budgetary reasons.

That has led me to thinking about how we deliver health services properly in a rural area like ours. There are many people in cities who are quick to jump up and down if any change is made to the pretty extensive provision they enjoy, for instance, of accident and emergency departments. What would they think of the fact that if you live around Bruton, for instance, you face between a three quarters to an hour's drive to either the Royal United at Bath or Yeovil General for treatment? And that's once an ambulance has arrived, which may be many miles away at the time you call. That's why it's so important to keep the smaller ambulance stations open, and why it's important to ensure paramedics carry essential life-saving drugs and equipment, such as the haemostatins for cardiac arrests which I successfully argued for some time ago. It's also, incidentally, why there should be government support for our excellent air ambulance service, rather than relying on charitable giving.

But quite apart from emergencies, the provision of primary care services is also more difficult in a sparsely populated area. Doctors' surgeries are further away, which means that GP surgery dispensaries are a godsend for many patients, and I'm glad we persuaded the government to drop the plans to close them. I know from visits to dispensaries such as the one at Langport how much they are appreciated. Domiciliary visits become more important, but are often not high in the list of priorities. I remember years ago, when I was in practice as an optician, we used to be paid nothing at all for carrying out a home visit, but I also know how important they were for some people who were stuck at home and unable to visit the surgery.

Having talked recently to local doctors, I also know there are still concerns about out of hours cover. Once upon a time that was all arranged by the GPs themselves, using a co-operative system where they covered for each other and shared the burden of attending a patient in distress in the early hours of the morning. Then the contracts were changed, and it's all centrally procured. It wasn't, to be honest, very good, but has got better. But problems remain, and that is neither a criticism of the doctors who provide the service or, indeed, the Somerset Primary Care Trust, which does a pretty good job. It's simply that the resources don't match the needs of a huge geographical area. I'm raising this with ministers at the moment, because I don't think the pressures in rural areas are properly understood.

The key, very often is access and proximity. We are very lucky that our local general hospital at Yeovil is, by any measure, very good. What we need is local community hospitals to back that up, and that's why I have always strongly supported the Verrington at Wincanton, where I hope we will see further improvements in facilities and provision, and why I look forward to the completion of the new South Petherton hospital. It's important to treat minor cases closer to where people live, and to offer recuperation where it is convenient both for patients and visitors, and where a valuable acute care bed is not being made unavailable to more urgent cases.

The trend across the country over recent years has been to concentrate health care in fewer and fewer large units, which are inevitably more remote. Of course, for some specialist areas of care, that is inevitable, and I doubt if anyone worries unduly about being referred to the new Oncology Centre at Taunton, for instance, for specialist cancer care. But in Somerset we seem to be taking amore considered view about local provision, by building and replacing local community hospitals and expanding services in the community. That is as it should be. I'm afraid that our geography and our pattern of settlement don't lend themselves to the alternative, and certainly our public transport systems don't. But there is still more that could be done; using high street practices such as pharmacists or optometrists to provide a wider range of diagnostic tests, for instance. The more we make quality health care more readily available the better, particularly with a rapidly aging population.

Sometimes, that will mean bringing the practitioner closer to the patient. When that is not possible, then we need to make it easier for the patient to get to the practitioner, whether that is for an appointment or eyes, teeth or tests, whether it is picking up a prescription, or whether it is admission for more serious treatments or interventions. One thing is certain. What is "the norm" in a city area just won't work in the countryside. But there, that's true of so many areas of policy.