This document summarizes a discussion around improving healthcare in rural and remote areas. Key points include: - There is a need to break down silos between healthcare organizations and take a more integrated approach. - Communities that have successfully controlled local resources can serve as examples to inspire others. Their approaches need to be shared more widely. - Healthcare must be considered within the broader context of issues like education, housing, and employment opportunities. A holistic approach is needed. - Both community participation and capturing patient experiences are important for planning and delivering healthcare services.

1. What have we learned and do
we have any agreed actions?
Dewar 2013

2. Introduction
These slides hope to capture the
discussion held in the last plenary
session of Dewar 2013 ….

3. The Dewar Process…
Community enterprise and resilience in
evidence demonstrated in the building
The NHS integrated into the community:
participation
Grass roots and community building

4. What is the way forward?
Break down the silos?
Research-led process?
Funding for innovative pilots?
Cross-organisational funding?
How do we achieve this?

5. Ideas: the communities
Control of the land – an amazing
example of success; must demonstrate
success to inspire others
If there are communities doing it well, we
need to spread the word to take and
spread the ideas
We need to change the NHS to what we
want it to be: fundamental change

6. Ideas …Context
Part of the context is massive social and
demographic change: ageing population
– but this is a good problem to have
Context: promotion of rural careers via
social media
Support networks for practitioners via
Skype being piloted – need to embrace
technology

7. More Ideas …Integration
All medical professions are key –
integration?
Team approach = sustainability of
services in R&R areas
Skills sharing, competencies, portfolio
careers
Care in the home

8. Ideas … connections
NHS Highland could work with local
development officers? A joined-up
approach
We need to record processes and
outcomes: we need to measure
outcomes too
Some of this is happening – a qualitative
approach plus Action Learning

9. Ideas …Communities and patients
Communities have to create their own
solutions and models and then they can
take ownership of it?
Must capture the patient experience – in
the planning, the execution
To work with people and make sure they
have an element of choice in their
treatment and care

10. Ideas … Education
Involvement of the patient in the learning
process and education
To mitigate the demographic time-bomb
– to help people look after their own
health better
CCPs also key in facilitating this

11. Community well-being
More research needed on Highlands and
Islands society?
What is community well-being? Is it
about community leadership? Is it age
distribution?
Are the solutions staring us in the face?
They are in Dewar, and in the Birsay
Report

12. The bigger picture?
Healthcare is part of a bigger context –
IT issues, education provision, social
health, employment opportunities, lack
of affordable housing
Let’s tackle the WHOLE picture
POLITICAL matters – bigger than the
NHS
Let’s sort the problems – we have the
answers!

13. Political action
The bigger picture needs political
pressure applied – we can do this as a
group.
What about community/patient
expectations?
What about the next generation of
healthcare workers: inspire school
children, medical students!

14. Community action?
Build up relationships in schools and the
medical schools: methods of gaining
work experience, writing a good
application, giving a good interview, risk
assessment issues
Try to attract people back to
communities in this way
Can use Dewar materials to help with
this

15. The Four Dewar Tests: feedback
Maybe we should take a broader
international perspective e.g. Gujarat,
India – we can learn from other places
We need to measure the outcomes of
what we do
‘Everything is different but nothing has
changed in the last 100 years’

16. The Dewar Group – future?
Continue and broaden what we do –
geographically, politically
We need to move beyond the health
service and build up partnership
networks with other service providers –
chief partners: our communities
A programme of recruitment and
information