One of the most socially excluding policies practised by healthcare services and other organisations in relation to people who live in rural areas is their requirement that people should travel to where the offices or services are based.
That is iniquitous, especially for those service users and carers who, for whatever reason cannot, or find it difficult, to travel.
Services should reach out to rural areas and take the services to where people live.
My policy starts here: I will gladly meet anyone from the healthcare services; NHS governance; overview and scrutiny bodies; local authorities; CPPIH etc., face to face - providing they come here to my rural area to see me. That, in practice, means where I live, or in Loddon or Beccles. I will not travel further than that.
He had been in hospital for some time and was fully ready to return home and desperate to to get back. I failed dismally in my search for services, despite concerted campaigning with the authorities and even battles with my own employer. And despite the existence of a good day centre and plentiful domestic support services available; based just three miles away.
Four weeks later without seeing another soul but myself in his well kept, well appointed little cottage eventually resulted in repeated insidious depression, self neglect, failure to eat and yet another admission to hospital.
His huge disadvantage? He lived in an isolated corner of rural Norfolk. All the people in the rural communities where he lived shopped and socialised in Beccles; just three miles away. But Beccles is in Suffolk!
In 1985, on emergency duty in the small market town of Beccles, I was called to make an assessment for admission to hospital. There was a woman living in a houseboat moored on the river in great distress and threatening to kill herself.
When I arrived at the scene I could do nothing but try to comfort and contain the woman as we waited an hour for an ASW, psychiatrist and ambulance to arrive from Norwich, twenty five miles away - for I then worked for Suffolk
Why? The river was the county boundary and the houseboat was moored on the Norfolk side of the river.
It was a Seminar in Norwich entitled Best Practice hosted by the Norfolk and Waveney Mental Health Partnership NHS Trust. The year: 2003. The particular presentation was called Cultural Competence, an approach which strives to ensure that all aspects of a patient's are taken into account systematically. I again asked the presenter about taking account of service users in rural areas and ensuring they the same standard of service and ease of access to services as those living in Norwich (I had reminded them of this throughout as there was no mention of rural issues in any of the sessions).
A Senior Child Psychologist from the trust, obviously frustrated at my frequent interruptions, shouted at me angrily: THIS IS ABOUT BEST PRACTICE, WHAT HAS “THE STICKS” GOT TO DO WITH IT!!!! - WE CAN'T BE BOTHERED WITH PAROCHIAL MATTERS.”
Extracts from a small Suffolk community newspaper column I wrote in 2003: “It is emerging that living in the villages and hamlets on the Norfolk side of the border face very real problems in obtaining essential services compared to those living in Beccles. And Norfolk Social Services Department is presenting special; difficulties for people needing services that are their statutory right.
The Beccles Volunteer Centre is doing some advocacy work with someone from the Norfolk side just trying to engage Norfolk Social Services Department for statutory services they were referred by their GP for four months ago. This family have failed in their attempts to get contact from this SSD, let alone get desperately needed help.
Despite writing to the Director of Social Services on the family's behalf, we have also had no success in getting a response at the time of writing - even though this issue involves the welfare of a child being in serious jeopardy. In my professional opinion, Norfolk Social Services Department is in breach of its own Area Child Protection Committee protocols and, more pertinently, Department of Health child protection guidelines”
And the follow up report a month later: “Developments in the case are that, after the mother and child and I, as their advocate, had driven the twenty five miles to her nearest Social Services office in Norwich and had demanded an assessment there - wholly unacceptable that someone in her position had to go to those lengths and that level of stress to obtain an essential service - she finally received a home visit after another week's lapse.”
Any similar accounts from YOU can be valuable. if you send them to me I will publish them here and collate a collection to present to the relevant authorities.
And then there are those who are prevented by mental impairments: those with agoraphobias; and a whole spectrum of phobias; those with certain kinds of schizophrenia; those whose depressive inertia chains them inside their homes; those with obsessive/compulsive disorder; those with anxiety disorders; those with certain kinds of personality disorder; those with Tourette's Syndrome; those whose self image is so fragile it is impossible for them to relate to other people; those with drug induced psychoses; those suffering from PTSD; etc, etc........
And then there are those for whom travelling or participating is difficult by the fact of their conditions rendering them social pariahs: those with HIV/AIDS; those with sexually transmitted diseases; those with opiate addiction; etc, etc.........
And there are those for whom travelling is so difficult it is a barrier - by reason of social and financial deficits and complexities: those living on welfare benefits; young people who are seen as deviant and who take on those roles; people from previous generations and social classes for whom travel was never a facile thing ( I have a good friend - a very able person - who worked on the land all his life and who has lived contentedly inside the same three square miles all his life and wouldn't dream of trying to travel the 15 miles into Norwich, even though he has his own car); people who have never learned to drive; people who live in places where the bus arrives once or maybe twice a week; people who can't read or write; people who are afraid to travel because of what they perceive as ever present criminal activity; people with language problems; people with cultural misconceptions; people who live in fear of discrimination; etc, etc.......
“Working for the health and well-being of rural communities”
• Providing a point of national contact for all involved in rural health and social care • Acting as a focal point for all those working to promote the health & well-being of rural communities • Bringing together all aspects of rural health & social care • Influencing policy & practice locally and nationally • Promoting and supporting networking and partnerships
• consider whether their policy is likely to have a different impact in rural areas, because of particular rural circumstances or needs;
• make a proper assessment of those impacts, if they are likely to be significant;
• adjust the policy, where appropriate, with solutions to meet rural needs and circumstances.