Citizen Participation and Public Petitions Committee

Meeting date: Wednesday, June 15, 2022

Official Report 639KB pdf

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Continued Petitions

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Rural Scotland (Healthcare Needs) (PE1845)

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Rural Healthcare (Recruitment and Training) (PE1890)

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Caithness County Council and Caithness NHS Board (Reinstatement) (PE1915)

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Women’s Health Services (Caithness and Sutherland) (PE1924)

Welcome back. Agenda item 2 is consideration of continued petitions.

Members will recall that, at our meeting on 8 June, we held a round-table discussion that embraced four petitions related to rural healthcare. We heard from all four petitioners: Gordon Baird, Maria Aitken, Billy Sinclair and Rebecca Wymer. We also welcomed the participation of our MSP colleagues Emma Harper, Rhoda Grant and Colin Smyth.

During that round-table discussion, we heard about a range of challenges that face rural communities in accessing health services, including the distances that are involved in travelling to appointments, particularly in emergency situations. It was vividly demonstrated in a way that we, sitting here in the central belt, might more easily understand, when it was said that a journey would be the equivalent of us going to Newcastle and back for a minor check-up. That brought home the difficulties that are faced, with which we are not familiar, because of the distances that are involved.

We heard about problems in recruiting and retaining staff, which has become an issue, and we discussed how to ensure that, as new services are framed and developed, the voices of communities are properly heard, rather than new policies being imposed on them without proper consideration.

We agreed to consider at this meeting the evidence that we have heard on all four petitions. I am delighted that Rhoda Grant joins us again, in particular for consideration of PE1890, which we will come to shortly.

We considered the four petitions together, and one of the options that we were asked to consider was the potential to refer the petitions on. I will summarise the four petitions, then we will take a collective view.

We heard evidence on PE1845, which was lodged by Gordon Baird and calls on Parliament to urge the Scottish Government to create an agency to ensure that health boards offer fair and reasonable management of rural and remote healthcare issues. I was struck last week by what Mr Baird said about what he felt were the inadequacies of the existing routes for ensuring that the views of rural residents are heard by decision-making bodies.

Mr Ewing tackled the question whether a single agency can manage the responsibility that could arise from issues that are common across health boards that are far flung across Scotland. Dr Baird also welcomed the Government’s commitment to establishing a national centre of excellence for remote and rural health and social care, but felt that that would address only part of the issue that he raised because, without his proposal, there would be nobody advocating for such services, as opposed to being part of their delivery.

PE1819, in which Rhoda Grant is interested, calls on Parliament to urge the Government to provide more localised training, and to find ways to recruit and retain healthcare staff in difficult-to-recruit positions. Often, communities have limited housing and other services, which means that it can be unaffordable for some people to contemplate accepting positions that are on offer.

The petitioner highlighted how technology had enabled distance and remote learning for teachers, which has supported recruitment of teaching staff to rural areas. She suggested that a similar approach be taken to training, recruitment and retention of healthcare staff to positions in rural Scotland.

Members will also be aware that Rhoda Grant secured a members’ business debate on NHS staff recruitment and retention last Thursday. As she has joined us, I invite her to contribute to our reflection before I touch on the other two petitions.

I do not want to repeat what you have said, convener, but I will echo it. From the start of training for staff all the way through the system, there seems to be a systemic fault, which is that the system is totally geared towards urban areas and does not focus on rural areas. It is clear that, if we base the structure on a rural area, that works in an urban area. During the Covid-19 pandemic, health boards throughout Scotland started using the NHS Near Me system, which was devised especially to save people in Caithness from travelling long distances.

We need systems to be put in place; there is talk of a commissioner or the like. Someone needs to advocate to ensure that the whole system considers rural areas and that we look after their needs initially, which would translate to urban areas. A root and branch approach is needed.

Thank you very much. We will come to solutions in a second or two.

The next petition is PE1915, which was lodged by Billy Sinclair. It calls on Parliament to urge the Scottish Government to reinstate Caithness County Council and Caithness NHS Board. Billy’s position is that local delivery has suffered greatly since services fell under the aegis of NHS Highland and the Highland Council. That is evidenced by the 120-mile journey to Raigmore hospital in Inverness that many expectant mothers have to contemplate. Following his evidence last week, he has provided a further written submission, of which members have a copy.

The final petition is PE1924 from Rebecca Wymer, which calls on Parliament to urge the Scottish Government to compete an emergency in-depth review of women’s health services in Caithness and Sutherland. Rebecca has stated that the services that are now being provided are in breach of basic human rights, and she is concerned that there could be loss of life due to failures in gynaecology care provision. In the wider round-table discussion, she echoed the point about it being difficult and unattractive for people to move to professional positions in Caithness due to the lack of women’s healthcare and maternity services. People who are coming from areas where those services are taken very much for granted suddenly become aware that the absence of them is potentially quite a serious issue.

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I should add that the journey that I mentioned earlier was the equivalent of a journey from Edinburgh to York, not Edinburgh to Newcastle. I understated the scale of the journey that was used by way of illustration.

Rebecca, too, has provided a further written submission. It was suggested—I think by some of our MSP colleagues—that the way forward for the petitions might be for us to consider whether to refer them. Do colleagues have any thoughts on that?

As a member of the Health, Social Care and Sport Committee, I can say that we are finalising our work programme just now, so I would like to refer PE1845, PE1890, PE1915 and PE1924 to that committee, in the context of the committee’s wider consideration of health inequalities.

I would certainly agree with all that.

We have seen in all the petitions the dilemmas that communities face, even with the technological advances that we have seen in medicine and the opportunities that can be dealt in relation to urban areas and rural areas, but that does not seem to be working in many communities. A more in-depth look by the health committee might well bring to the fore areas that have been addressed and concerns that have been raised by petitioners.

The communities have not received the continued support that is vitally important for their livelihoods in relation to any medical process. The health committee could do a much more in-depth analysis of some of the areas that have been brought to our attention, which might help to unravel the issues and to support the petitioners.

I support David Torrance’s suggestion to refer the petitions to the health committee. In the evidence that we heard, many concerns were enunciated about particular issues that are affecting people in rural Scotland; most of Scotland is actually “rural Scotland”, in terms of geography.

As I understand it, as a constituency MSP with a partly rural constituency, some of the issues have not been raised in evidence; that is no criticism of the petitioners. For example, provision of vaccination services by local general practitioners is not available any more because of the terms of the GP contract. Many people feel that that is an unfair restriction on general practices that would like to provide vaccination services as well as other services. That is a hot issue right now; it was not raised by the petitioners, but I raise it as an example from my casework of an important nitty-gritty issue.

It was raised in evidence by the petitioners and by Rhoda Grant that travel allowances for people who must undertake operative treatment in Inverness—people who have to travel from the Western Isles, for example, who must stay in hotels and who have probably driven—are woefully inadequate and do not cover costs. I suspect that that is because of the UK tariff, because I have looked into the matter before for constituents who have had to travel from Inverness to the central belt. The level of travel allowances and travel costs are unfair. I mention that in the hope that, if the committee agrees to refer the petitions to the Health, Social Care and Sport Committee, those issues could be considered, as well as the particular ones that are raised by the petitioners.

Thank you, Mr Ewing. That is an important point that is well made. It is challenging for people for whom such travel is the only option when provision that they rely on is inadequate. That came across quite strongly.

A common theme that came across from all the petitions is governance and the need for checks and balances in relation to the structures of health boards. The rights of rural communities would be better enshrined in a formalised setting by creating some sort of statutory body that advocates for them and places obligations on health boards. We need to set a safety standard that identifies very clearly that driving such distances to access critical care is inherently unsafe.

That would place an obligation on the health board to address that as a standard issue. Perhaps some reflection is needed on how that might look. The petition does not make that demand, but an issue emerged in conversation during the evidence session about whether some sort of body could say, “This is a defective system for these reasons. You need to address it.” Such a body might be equivalent to the Scottish Housing Regulator, for example, and it could place such obligations on health boards. It seems that the idea that that could be done through the health board was challenged—there was a feeling that boards might be prone to groupthink and that what is needed could not necessarily be achieved just by having a rural representative on a health board, because their voice would be drowned out.

Thank you. I think that the committee agrees to refer the four petitions to the Health, Social Care and Sport Committee in the context of its wider consideration of health inequalities. Are we agreed?

Members indicated agreement.

Please could the clerks encapsulate the essence of the discussion and members’ reflections on the evidence this morning in such a way that we can offer that to the Health, Social Care and Sport Committee for its further consideration? Rhoda Grant has a final thought on the matter.

I have not spoken to Mr Sinclair in detail, but I spoke to him after the committee meeting last week. He pointed out that his petition is half about health and half about local government. I think that he is a wee bit concerned that the local government aspect of his petition might be lost. The committee might want to look at that further; I just wanted to make that point.

With regard to the general themes that arose from members’ discussion, referring the petitions to the Health, Social Care and Sport Committee is the best way forward from our point of view at this stage, but I take note of that.