September 25, 2008

Tayside Health Board Has Not Taken the Trouble to Care About Kinloch Rannoch

SANDY Watson, chairman of Tayside Health Board, accuses me of "many inaccuracies", but the inaccuracies are of his making.

He asserts that no decision has been reached with respect to reprovision of GP out-of-hours services in Kinloch Rannoch and that the first-responders scheme is only one of the options being considered by local people. Tayside Health Board has failed to present any other option to residents, who have waited two and a half years for services to be restored.

According to local MSP John Swinney, there have been "absolutely no discussions between the Aberfeldy practice and the local community regarding the creation of new out-ofhours provision".

Contrary to Mr Watson's claim, the first-responder service involves privatisation. It relies on private funding as local communities must both raise the funds for training and find the volunteers. Both are regressive measures constituting a tax on local communities and working against the principles of the NHS.

First Response, although a charity, could be classed as a private business like Bupa.

Mr Watson's emphasis on selfhelp betrays the influence of the US private-sector model. In May he explained community resilience as follows : "Communities are facilitated to develop measures of self- help, utilising all resources available to them, encouraging self- care and using volunteers and informal carers within the local community." He adds that community resilience "fits in with the first-responder model that we are proposing for Kinloch Rannoch".

Mr Watson is not correct when he says that market mechanisms were abolished in Scotland. The Scottish NHS has retained the founding legislation of a market, including powers for health boards to contract out and enter into joint ventures with commercial and not- for-profit companies for out-of-hours care. Is Mr Watson aware that the Health Minister, Nicola Sturgeon, intends to introduce legislation preventing companies from running and operating GP and out-of-hours-care clinical services?

Sparsity of population is not a reason for withdrawing a universal out-of-hours GP service. Of course the per capita costs will be higher, and so, too, will every other cost indicator, but cost measures bear no relation to need or provision of services. A universal service obligation requires risk pooling to meet the higher costs of care in some groups, not the withdrawal of services.

The challenge of providing GP cover to communities in remote and rural areas is not new. For 60 years the Royal College of General Practitioners, the government and the British Medical Association worked to safeguard essential GP-led out-ofhours services to the whole of Scotland. That Tayside Health Board has, after two and a half years, failed to do so is not for want of a solution but rather for want of taking the trouble to care.

Professor Allyson Pollock, Head of the Centre for International Public Health Policy, University of Edinburgh, Edinburgh.

Originally published by Newsquest Media Group.

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