Mungall Equitable Access

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Mungall Equitable Access

  1. 1. Ensuring equitable access to health and social care for rural and remote communities Dr I J Mungall
  2. 3. Access to Healthcare <ul><li>Under increasing strain </li></ul><ul><li>Ever increasing centralisation </li></ul><ul><li>Ever increasing specialisation </li></ul>
  3. 4. The Report <ul><li>Rural Health Forum </li></ul><ul><li>Royal College of GPs </li></ul><ul><li>Academy of Medical Royal Colleges </li></ul><ul><li>Available at:- </li></ul><ul><li>www.ruralhealth.co.uk </li></ul><ul><li>And from the Institute of Rural Health </li></ul>
  4. 5. Why ever more centralisation? <ul><li>Cost of infrastructure & gear </li></ul><ul><li>Training </li></ul><ul><li>High volume of work </li></ul><ul><li>The specialist team </li></ul><ul><li>Efficient use of scarce budget </li></ul><ul><li>(though transferring some costs to the patients) </li></ul><ul><li>Status? </li></ul>
  5. 6. Local services lost <ul><li>Why? </li></ul><ul><li>“Inadequate Consultant cover” </li></ul><ul><li>“Insufficient work to maintain the necessary skills” </li></ul><ul><li>“Insufficient experience for Junior doctors’ training needs” </li></ul><ul><li>European Working Time Directive </li></ul>
  6. 7. Access v. Quality <ul><li>Access x Quality = a constant </li></ul><ul><li>(assuming finite resources) </li></ul><ul><li>Whenever Quality improvements are proposed, ask, “ how will this affect Access to care” </li></ul>
  7. 8. Access matters <ul><li>Heart attacks and urgent stenting </li></ul><ul><li>Strokes and CAT scans </li></ul><ul><li>Distance decay </li></ul><ul><li>Outcomes for cancer / distance from GP </li></ul><ul><li>Asthma deaths </li></ul><ul><li>RTAs </li></ul><ul><li>Diabetic eye disease </li></ul>
  8. 9. <ul><li>The process of cancer care: </li></ul><ul><li>Stranraer study </li></ul>
  9. 10. What can be done? <ul><li>Defining best practice </li></ul><ul><li>Innovative thinking about Skills </li></ul><ul><li>Enhancing teamwork </li></ul><ul><li>A rural career path </li></ul><ul><li>Better use of IT </li></ul><ul><li>Improving Rural transport </li></ul>
  10. 11. <ul><li>Equitable funding </li></ul><ul><li>Outreach clinics </li></ul><ul><li>A different relationship between a region’s hospitals </li></ul><ul><li>Realistic expectations </li></ul>
  11. 12. Specific Recommendations <ul><li>Including:- </li></ul><ul><li>Colleges to increase support to rural members </li></ul><ul><li>Standards for Access to care </li></ul><ul><li>Standards for communication </li></ul><ul><li>Transport – improvements crucial </li></ul><ul><li>Rural proofing </li></ul><ul><li>Equitable funding </li></ul>
  12. 13. <ul><li>Enhance use of IT </li></ul><ul><li>Consider the Kerr report ( similar review undertaken in Scotland ) </li></ul>
  13. 14. Progress on the recommendations <ul><li>Remarkably little! </li></ul><ul><li>Why is it so difficult to advance the rural agenda? </li></ul>
  14. 15. <ul><li>Thank you for coming and listening </li></ul><ul><li>I would love to hear your opinions, </li></ul><ul><li>and will try to answer your questions </li></ul>

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