UHI Millennium Institute and The University of Aberdeen working in partnership

Remote Service Futures: Designing Services with communities

Amy NimegeerCentre for Rural HealthUHI Millennium InstituteAmy.nimegeer@uhi.ac.uk

UHI Millennium Institute and The University of Aberdeen working in partnership

Remote Service Futures Project (RSF)

• A two year project, looking at finding best practice for engaging remote communities in community level service design

• Four communities in the project, two mainland and two islands

• As part of the project, looked at the services communities already have, what they think is good about them and what could be better, combined this with clinical data

UHI Millennium Institute and The University of Aberdeen working in partnership

• Common strengths and opportunities (assets)

• Common weaknesses and threats (challenges)

• What service providers say rural communities need

• When change occurs

• Better service design

UHI Millennium Institute and The University of Aberdeen working in partnership

Common community assets

Community spirit, people look out for each other

People resourceful, adaptable

Low crime, beautiful scenery, safe place to

raise children

Potential for growth with more online working

Personalised, continuous, preventative care from

local practitioners

Local practitioners = social assets

Local practitioners flexible, resourceful, think and act ‘out of the box’

Air ambulance responsive, connects

community in an emergency

UHI Millennium Institute and The University of Aberdeen working in partnership

Common community challenges

Lack of affordable housing, can make it hard

to attract practitioners

Fears for security in emergency due to

remoteness / weather

Current practitioner about to retire, concern about

replacing them

Older people have to leave community if needs

become too great

Confusion about current service provision, who does what, who to call

and when

Poor access to patient transport to outpatient

facilities

Current practitioner provides ‘above and

beyond’ services, fear this service will be lost

For practitioners providing 24/7 service, concern they may be

insufficiently supported, stress and isolation

UHI Millennium Institute and The University of Aberdeen working in partnership

Service Providers say…

“Anticipatory” care and primary health care Aging populations: more

complex, chronic disease, more need for social care (COPD, high blood pressure, obesity

depression)

Quick emergency response and transfer

UHI Millennium Institute and The University of Aberdeen working in partnership

The disconnect…

• Teams vs. generalists

• Aggregated clinical data vs. narratives of experience

• Chronic conditions vs. emergencies

• Mutuality vs. the welfare state

• BUDGET!

UHI Millennium Institute and The University of Aberdeen working in partnership

When change occurs..

• Sometimes it is accepted, but…

• Often a ‘one size fits all’ model

• Urban models squeezed in to rural areas

• ‘Informal’ work can be lost

UHI Millennium Institute and The University of Aberdeen working in partnership

Some reactions to change…

UHI Millennium Institute and The University of Aberdeen working in partnership

Remote Service Futures

STAGE 1INFORMING AND

CONTEXT MAPPING

STAGE 2ASSETS,

CHALLENGES AND NEEDS

STAGE 3MEET

PROVIDERS, THINK ABOUT THE FUTURE

STAGE 4PLANNING AND PRIORITISING

UHI Millennium Institute and The University of Aberdeen working in partnership

RSF conclusions: how could design be improved?

1. Design services with community BEFORE crisis arises (anticipatory design)

2. More community ownership of process

3. Sharing budget and profiling information

4. Acknowledge informal work

5. Persistence, creativity and feedback!

6. Mechanisms for community to get involved, actively supporting them to develop capacity