Services which are appropriate for these locations cannot be planned, delivered, assessed and justified in the absence of detailed local needs assessment and data collection which specifically takes into account local circumstances and resources and prioritises the wishes and resources of the local community. A service or treatment is that is effective, cost effective, efficient and appropriate on an island or in another remote and rural setting may look very different from a service or treatment which fulfils these criteria in an urban or semi urban setting. “Gold standards” of organisation and response are likely to be based on urban or semi urban circumstances and often mandate the rapid transport of patients to tertiary hospitals with 24 hour A&E departments for assessment and treatment. These are promulgated for general use including islands and other remote and rural locations, without taking into account differences in circumstances. However in a reasonably well equipped community hospital with an appropriately trained remote and rural practitioner, the assessment and treatment of many patients can be undertaken locally and can avoid the need for admission to a tertiary hospital which might be many miles and hours away by ferry or air ambulance. Such an avoidance can have massive cost savings for the across the health services and transport services (air ambulance, tertiary A&E, tertiary in-patient beds, patient transport back home) and equally massive effects socially (avoidance of relatives having to travel and avoidance of psychological and social effects on patients and relatives which can be very significant). Patients from islands are often very unwilling to be “flown off” if appropriate treatment can be provided locally. The positive social and psychological effects of knowing that appropriate local services are available and properly supported can make a very real difference to the confidence and well being of the community. All of these effects should be measured, valued and taken into account in planning and maintaining services. This is not usually the case. We need much more research and data on the effectiveness, cost effectiveness, efficiency and appropriateness of care services in island and remote and rural locations which takes all the specific circumstances into account if the experience and outcomes of patients and service providers is to be improved.
This content is created by the open source Your Priorities citizen engagement platform designed by the non profit Citizens Foundation