Background

The Northern Norway Regional Health Authority (Helse Nord) shares strong similarities with the North of Scotland, including similar challenges in recruitment and retention of health care staff and sustainability of health services in remote and rural communities.

Helse Nord has sent delegations on a number of occasions to the Highlands since 2000 to look at service delivery, organisational structures and the work of the Remote and Rural Areas Resource Initiative (RARARI) 2000-2004. This continued interest and networking enabled a close working relationship to develop between key staff in both areas.

The idea of working together to organise an international conference to highlight worldwide remote and rural health care recruitment and retention came out of subsequent discussions and joint work began on a proposal.  To date, there had been no such event held anywhere in Scotland or Norway.

Challenges
Remote and rural areas have a tough competition to find and keep qualified and committed healthcare professionals. Sustainability of health services in remote communities and the need for public involvement and local authority partnership was also recognised as an early theme. The specific problems and challenges have been well documented. Professional isolation; increasing regulations; standards and directives; out of hours pressures; payment restrictions; expensive locum arrangements; difficult transport and infrastructure; facilities and housing; support for families; increasing specialism and competition with specialist centres; public, political and professional expectations.   

The Making it Work forum
An international event was intended to present a forum to bring together health organisations from different regions and countries who share similar problems, and key stakeholders to share ideas and work together jointly to find solutions. It was designed to be a positive event, sharing good practice and proving solutions are possible.

The advantages of joint collaboration between Scotland and Norway helped to focus attention on the conference and demonstrated partnership working at international level. The benefits also included shared planning costs and shared creativity.

The first Making it Work conference was held in Scotland in september 2003. The second conference was held in Tromsø, Norway, in september 2005. The third conference is to be held in Aviemore, Scotland, 12 & 13 May 2008.

What is different about rural healthcare?
Rural healthcare is quite distinct from urban healthcare in that service delivery and ways of working need to be innovative and responsive in a unique way which ensures equality of access.

Mac Armstrong, Chief Medical Officer for Scotland, described the modern challenges for delivering rural healthcare and the need to tackle these. He said;

"The threats to health and challenges to health care which are common to every health system are even more acutely felt in rural economies. In rural areas, overcoming poverty and social exclusion, meeting the needs of an ageing population, the changing expectations of public and professionals and the demands of new technology are especially challenging and require new thinking. Sharing our experience with others will help us find innovative solutions to the problems of rural health in Scotland."

NHS Highland
NHS Highland’s catchment area comprises the largest and most sparsely populated part of the UK with all the attendant issues of a difficult terrain and a limited internal transport and communications infrastructure. The area covers almost 25,784 km² (10,000 square miles), which represents approximately one third of the Scottish land surface. The geographical nature of the region presents particular challenges for the efficient and effective delivery of health care services.
NHS Highland serves a population of some 208,000 residents and sees a proportion of its patients from the influx of tourists to the Highlands, which at certain times of the year can double or even triple the local population.

The proportion of older people is above the Scottish average. However, levels of morbidity and levels of deprivation are well below the Scottish average

The Health Service in the Highland area is also a major employer, second only to the local authority in the number of people employed. Again, in business terms, this is of major significance to the Highland economy.

NHS Highland website: www.show.scot.nhs.uk/nhshighland

Northern Norway Regional Health Authority (Helse Nord)
Helse Nord, the Northern Norway Regional Health Authority, serves a population of almost half a million spread over 113,000km². Helse Nord has a sparse population, long distances and difficult transport conditions, especially in the wintertime. Recruitment and retention is difficult because of the onerous on-calls, long travelling distances and there is a high staff turn-over with huge locum-costs.

Helse Nord is responsible for delivering all acute services, mental health (secondary care), ambulance services and rehabilition. There are 12 acute hospitals and the biggest Ambulance service in Norway with 132 cars, 23 boats, 6 planes and 4 helicopters.

Helse Nord website: www.helse-nord.no