The NHS is failing to shift resources to community settings in Scotland fast enough to deal with the increasing number of older people living in rural areas, according to a report by the Royal College of Nursing.
More financial investment in community services, increased support for advanced nurse practitioners and improved levels of confidence among clinicians in using technology will be required to tackle the future care needs of these patients, it said.
“For those living on the islands, transport to appropriate healthcare facilities may involve a boat or short plane journey”
The report – called Going the Extra Mile – was jointly produced with the charity Age Scotland.
It looked at the problems facing the following health boards – NHS Western Isles, NHS Shetland, NHS Orkney, NHS Highland, NHS Dumfries and Galloway, NHS Borders and NHS Grampian (Aberdeenshire).
It noted all of these areas – apart from NHS Grampian – were expected to have a higher proportion of their population aged 65 and over by 2037, in comparison to the rest of Scotland.
In particular, almost 40% of people living on the Western Isles are predicted to be aged 65 years or over by that time.
Older people in these areas are reliant on cars to travel around and often have limited access to health services away from their homes due to poor public transport links, noted the report.
From its survey of 170 older people in these areas, RCN Scotland found some respondents were either restricted by transport services – one mentioned the bus only ran three days a week – or chose to use other transport altogether, such as a taxi for a GP appointment, because it was quicker.
“For those living on the islands, transport to appropriate healthcare facilities may also involve a boat or sometimes a short plane journey,” added the report.
“The future may demand a more mobile and flexible nursing workforce along with technologically competent and confident staff and patients”
Meanwhile, the report highlighted that the community nursing workforce was also ageing, noting that some NHS health boards had a far higher proportion of nurses aged 50 and over – almost 60% in the Western Isles – compared with the rest of Scotland (46%).
“A great deal of scepticism” around technology was also found in the RCN’s survey of older people, with more than 88% of respondents saying they would not use email to make an appointment.
More than 90% said they were not interested in using a video link to have an appointment with their care team in their own home.
The report made seven recommendations to improve access to rural healthcare, including a “whole system approach” to recruitment and retention – such as boosting awareness about training and career progression – to attract more staff to work in rural areas.
Nationally agreed standards for training, education and career development of ANPs are also required alongside sustainable workforce planning for this role, it added.
Long-term funding for community services is needed along with “clear, costed” plans for out-of-hours care that include additional resources where necessary, said the report.
In addition, it said staff must feel confident in using technology to help provide care.
“Backfill, training and support needs to be properly planned for community nurses in remote and rural areas to be able to develop the skills necessary to use technology and promote telehealth and telecare in the community,” said the report.
Theresa Fyffe, RCN Scotland director, added: “Patients in remote and rural parts of Scotland already struggle to access services, and the geographical distribution of patients makes delivering a flexible service closer to home much more difficult.
“The future may therefore demand a more mobile and flexible nursing workforce along with technologically competent and confident staff and patients,” she said.