1. North East Commission on Rural Health - A Different Approach Mathew Thomas Project Manager, NHS County Durham and Darlington

2. Background In 2008 the North East Strategic Health Authority identified 8 areas as priority outcomes based on the Lord Darzi Review ‘High Quality Care for All’. Rural health was identified as part of this process and is therefore aligned to the North East Strategic Health Authority’s strategic vision, ‘Our Vision, Our Future’. NHS County Durham and Darlington was tasked with taking this forward by establishing a Commission on Rural Health under the leadership of Sir Peter Carr, Chair, North East Strategic Health Authority, with the support of Chief Executive Sponsor, Yasmin Chaudhry (Chief Executive, NHS County Durham and Darlington).

3. Background Establishing a Commission on Rural Health is central to delivery of the 7 aims within the NE vision: No barriers to health and well being No avoidable deaths, injury or illness No avoidable suffering or pain No helplessness No unnecessary waiting or delays No waste No inequality

4. Rural Health Issues – Comparing Rurality and Deprivation

5. Rural Health Issues – Housing Deprivation

6. Excess Winter Deaths

7. Background The proposed scope of the Commission is to: recommend the right balance between equity for rural populations and overall efficiency identify innovative approaches to addressing the barriers associated with living in a rural area try to ensure the best possible access to high quality healthcare services. Contributes to the achievement of WCC competencies 1, 2, 4, 5 and 8.

8. Background The North East Commission on Rural Health (NECoRH) was launched on 4 th November 2008 with a stakeholder event at Hardwick Hall, Sedgefield. Positive response to launch. High profile work since then means NECoRH is recognised as being at the forefront of rural health issues. NESHA is seen as leading best practice in this field.

9. Background and Establishment of NECoRH Commission on Rural Health Secretariat/ support team Stakeholders NHS NE Chief Executives’ Group NE SHA Board Stakeholders Project Board

10. Background and Establishment of NECoRH To date, the Commission has made great strides and achieved its goals as follows: Founded on partnership principles Analysis of public health data to determine the best way forward Stakeholder analysis Commissioned a service mapping exercise to provide a baseline of current service provision Organised future proofing and horizon scanning event Review of work and research that has been carried out in this field in conjunction with the North East Public Health Observatory Promoting the fact that rural health needs to be a priority for all partnership organisations to collectively deliver on the ambitions set out by Our vision, our future.

11. Background and Establishment of NECoRH The Commission has been asked to present at and contribute to several conferences and forums e.g. Organisation for Economic Co-operation and Development (EU) Commission for Rural Communities Institute of Rural Health – Developing Agendas for Rural Health Research, Policy and Practice NHS Confederation – Forum for top 20 PCTs with rurality and lobbying body to Department of Health on behalf of the PCTs Whitehall and Westminster World: Keynote Address May 2009 Café Politique - Durham

12. Context Our vision, our future, NHS North East’s ten year vision for health services, reflects our commitment to provide healthcare of the highest possible standard both now and in the future to all of the communities we serve. Whilst healthcare in the North East is rated as best in the country there are still improvements to be made. We want to make sure that every single patient, regardless of location, is given treatment and care of the highest possible quality, and which delivers the most effective outcomes for health.

13. Context Our vision, our future underlines these ambitious aims for continuous improvement and the need to firmly embed this further in the way we plan and provide services to rural communities. We must do more for our rural communities if we are to truly have an impact on our regions health and the inequalities that exist, particularly as the public now have legal rights to the services they receive by way of the NHS Constitution. We will not work in isolation but with key public, private and voluntary sector organisations.

14. Context We are confident we can make a difference to benefit every person living within our rural communities within the North East region and add value in the following areas:- Long term conditions Smoking levels, obesity and teenage pregnancy Inward migration of older, retired people creating high demand for healthcare Distance from services associated with poorer health outcomes/late presentation

15. Context The following factors also impact on the health of our rural population and will also be taken into consideration with partners:- Outward migration of young people Hidden pockets of deprivation in relatively affluent areas/concept or rural idyll Influx of temporary residents/tourists Low incomes/less employment opportunities Lack of housing/high housing costs Transport/Access issues – high cost/travel time/availability Decline in local amenities e.g. Post Offices, shops etc. Accidental injuries Fuel poverty/higher fuel costs (no access to gas) Educational attainment

16. Context A summary of the findings of a report commissioned from the North East Public Health Observatory (NEPHO) in October 2009 are as follows: – Healthcare outcomes are a mixed picture but often worse for rural areas. – Access to healthcare is a major issue for rural populations. – The disadvantages are particularly apparent for ‘deep’ rural areas. The report recommends that the Commission needs to work closely with other rural health organisations to which the Commission already adheres to e.g. Institute of Rural Health and the Commission for Rural Communities. This evidence indicates the need for a commission on rural health to improve the variation in access to healthcare services.

17. Future Direction Initial scoping work has identified innovative initiatives (as follows) and requires robust partnership arrangements to enable these initiatives to be driven forward:- County Durham Farmers’ Marts pilot Telehealth Horizon Scanning Workshop Contribution and advice at a local, regional, national and international level

18. Outcomes The North East Commission on Rural Health should focus on, as identified by the NEPHO report in its first recommendation to the Commission, “…the delivery of health care in rural areas. To this end it should consider more specific topics (e.g. ‘primary care for older people with diabetes in rural areas’) that could be developed. A potential mechanism would be to work closely with the eight clinical innovation teams involved in delivering Our Vision, Our Future to establish priorities for each.” Specifically, the pathway groups for Long Term Conditions, End of Life Care, and Mental Health, with rural communities focusing on early intervention and dementia. Rural Health, and therefore the North East Commission on Rural Health, is cross cutting for all these pathway groups and is therefore integral to their successful development.

19. Current Position The Horizon Scanning and Futures workshop has recently been conducted to help set the future strategy so that the Commission can focus on specific areas of work as recommended by NEPHO. NECoRH is moving into the ‘doing’ phase now that the scoping work is nearing completion so we can start embedding changes in the community via various channels e.g. pilot programmes. Funding has been secured from the NE Strategic Health Authority’s Innovations fund to ensure the Commission continues into the future and satisfies its original aim of equity of healthcare for the entire North East region.

20. Summary Having started with a blank sheet of paper, it has taken us 18 months to reach this point. Looking back now it is incredible to think how far we have come and what we have achieved. It does, however, take the vision and support of senior decision makers across all public sectors (not just those in healthcare) to make this successful. In these difficult economic times there is a stronger argument now, than ever before, that we ALL need to work together to make efficiency savings and to make every penny count. At the very least, we hope that we prove that it is possible to take that leap into the unknown no matter how daunting the task ahead may seem.

21. Any Questions? ______________________________________________________________________________________________________________________________ Contact Details Mathew Thomas (Project Manager) e:m.thomas5@nhs.netm.thomas5@nhs.net t:0191 374 4164 Theresa Huddart (Programme Lead) e: theresa.huddart2@nhs.nettheresa.huddart2@nhs.net t:0191 374 4179