Having spent a wonderful week on the Isle of Harris, and with visits to Lewis I was struck by the stories from residents of how their NHS care is delivered. If the same sense of priority and focus was available to residents in our rural communities in England as in the Highlands and Islands, our rural communities would be transformed. It was pointed out by residents that there are many failings of the system they benefit from, all of which lead to terrible overspends by the relevant Trust. However allowing for these and their rather simple solutions, there is still an enormous lesson for the NHS Trusts in the rest of England and Wales in providing care for their rural patients.
The various stories I heard made it clear that NHS Highland, at least as far as the Hebrides are concerned, presume that the patients will be unable to attend planned Hospital or out patient provision under their own steam. This of course could lead some patients to take advantage of the provision, but it fully reflects that for most of these patients, a journey of many 100 of miles in their own car or by public transport including a 2 hour ferry trip to get to the nearest major hospital is not achievable. This leads the NHS to organise taxis and flights so that patients arrive at the place of care in the best condition. The criticism of these arrangements came from residents who discovered that these arrangements are purchased at full price, rather than using any attempt to achieve discounts for volume, or even the same discounts that residents would receive if booking them personally. However the sense that the NHS cares for these people is impressive.
In our own settings, the sense that residents will be able to attend hospitals or out patients provision is based on what is best for the hospital. In some cases I have been made aware of several failed appointments for individual patients. The idea that the Hospital is concerned about the potential availability of public transport would be treated as something of a joke by local residents. This can be a challenge in the large centres of population such as Brighton, Haywards Heath and Eastbourne or other places where a hospital is situated. However there are many villages and small towns in the land between these places where a regular bus service would be something to wonder at. It is hard to imagine the NHS in England and Wales achieving the same result as NHS Highland but it would be a fantastic achievement if they could work towards such an outcome.