Organisation and protocols for service delivery which are appropriate for island and remote and rural communities. The organisation and delivery of statutory health services has become increasingly centralised in pursuit of specific standards and increased cost effectiveness. Overwhelmingly the design of these services has been predicated on the circumstances of densely populated inter-connected urban and semi-urban communities where most of the population lives. This has resulted in a “one size fits all” situation which disadvantages island and other similarly isolated communities. When operational policies and protocols which produce appropriate services for the urban population are applied to island communities then unintended adverse consequences result. To give one example from the emergency services, the needs of the community on Islay (3,500 people living in scattered small groups on an island the size of Singapore, which has only 1 ambulance and 1 ambulance crew available throughout the 24 hrs) cannot be satisfactorily met by a service designed and operated to meet the very different needs of much larger, interconnected, urban communities with multiple crews and vehicles which can be flexibly deployed according to changing circumstances. Similar considerations apply to the organisation and delivery of all health and social care services on islands and other remote and rural locations. The specific circumstances of residents in these communities are not being taken into account in the design and delivery of health services and individual citizens are being harmed as a result.
The committee needs to really look closely at the ways in which services and facilities continually and consistently fail disabled and elderly people. To have no accessible toilets in a brand new hospital on Skye and in new purpose built healthcare buildings, which are accessible to independent wheelchair users in the 21st century is unlawful and abhorrent. Why have these people's needs not been taken into account when the NHS has assessed the needs of these people and provided their large wheelchairs which cannot access these facilities, simply because they failed to take their needs into account and/or failed to follow best practice guidance for accessible facilities.
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