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Better Hospital Care
Local or Community hospitals will play a particularly important role in this approach to remote and rural healthcare. Services offered locally may vary but will usually include a range of outpatient clinics, day case treatment, midwifery services, palliative care and support for people experiencing mental health problems. Emergencies and minor injuries will be treated locally, except where a patient's condition is more serious, when they will be transferred to a larger hospital.
Larger, Rural General Hospitals will be staffed by doctors, nurses and other healthcare professionals with both general and special skills appropriate to the needs of the community. They will have more specialist diagnostic facilities than Community Hospitals and provide a range of outpatient, day case inpatient and rehabilitation services. As a minimum they will provide:
- nurse-led care for urgent cases, managing minor injury and minor illness, with the advice of doctors and other specialists, where this is required
- initial management of broken bones
- routine and emergency surgery
- management of acute medical conditions
- management of patients who have suffered a stroke
- management of long-term conditions
- a wide range of out-patient services
- maternity care, led by midwives
- management of patients with more complicated problems before they are transferred.
Most operations that take place in Rural General Hospitals will be planned - gall bladder surgery, or endoscopy, for example. Certain procedures, such as orthopaedics and gynaecology are likely to be carried out by visiting surgeons, some of whom may come from other Rural General Hospitals.
The Rural General Hospital has a key role to play in emergency care and will be equipped to resuscitate, stabilise and prepare patients for emergency surgery. Some emergency surgery - to remove an appendix or resolve an abdominal problem for example - may be carried out in the Rural General Hospital, whilst other cases may require the patient to be stabilised and transferred to a more specialist centre. Island Rural General Hospitals will also be equipped to carry out caesarean sections in order to reduce the need to transfer patients and to eliminate the stress associated with travel.
In most cases children under five will not be operated on at a Rural General Hospital. Similarly, it is likely that patients who require complex operations on the neck, chest, stomach or liver will be transferred to larger hospitals which have the specialists required to provide the best level of care for patients.
There are six Rural General Hospitals in Scotland at the present time:
- Gilbert Bain Hospital, Lerwick
- Balfour Hospital, Kirkwall
- Western Isles Hospital, Stornoway
- Caithness General Hospital, Wick
- Belford Hospital, Fort William
- Lorn and the Isles Hospital, Oban
The staff in Rural General Hospitals will link with Extended Community Care Teams, helping them to manage patients with more complicated conditions who cannot be cared for at home or in a community hospital. They will also work closely with staff in larger hospitals and other specialist centres, so that patients can be treated locally wherever possible. This will, for example, see visiting specialists holding regular or occasional clinics within the hospital or the use of teleconferencing so that a specialist from another area can be consulted on a particular issue without the need to make an inconvenient or unnecessary journey.
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