Remote Communications in rural areas; care design and delivery


Part of this study is to consider the ways in which infrastructures such as communications technologies, transport, road links and terrain affect the ways in which people make decisions about their everyday.

This part of the blog will be dedicated to examining these infrastructures by describing some of the issues people face and how major and smaller providers are responding.

Communications are a major aspect of care provision; users are now expected to utilise, at the very least, text messaging as a reminder of appointments and so on. However, text messaging is assumed to operate in “real time” ie. a message reaches the recipient within a few seconds of sending. In rural areas signals are so erratic that text messages are stacked and only delivered when the signal is sufficient; this means that some messages may take days to arrive. Not much use then for gentle reminders of  same day appointments. Providers need to consider that none attendance can be due to a simple text reminder wallowing in the ether of cyber space. Perhaps landline phone call reminders may be an effective way to support people with memory difficluties in managing to attend appointments.

Last week I spent a  day in London at a rural health conference as a  delegate. The conference was in part financially supported by a communications group who provide large scale “real time” solutions for large health and social services in the UK and USA. Discussing with them the issues of fragile communication connections was met with a dismissive attitude and as an issue not relevant to the business. I would suggest that if you are funded by the NHS and promoting efficient ways of supporting information sharing in “real time” then the availability of robust, reliable and relevant modes of communication would be key to their future success. Pressure from these companies onto the major player s in the UK would help to secure more consistent services across rural areas. The current impasse is rarely realised by those who are fortunate to live in areas of the UK where impressive speeds of 3/4G are standard. My own speed today is 0.91mps! Unless you’ve experienced erratic services then understandably this has no meaning. Again mobile reception can be patchy and oddly prone to difficulties in extended wet weather in rural areas. So why does this matter in rural areas?

As  indicated earlier it matters to community providers who have to work across these rural areas and need to contact the homes they visit, other services and their colleagues. In the absence of effective signals, staff find themselves having to travel more and spend more time in general sorting things out. This leads to less time to get on with the other demands of the job and can contribute to more stress. Not knowing if a call will get through to request an urgent GP visit can be incredibly stressful for all concerned. Being unable to attain a sat nav. signal late at night to locate a farm can be incredibly challenging for Emergency Ambulances.

It matters in relation to the design and delivery of services which are equitable regardless of where you live. If we are to develop sustainable services then the current rural challenges of sub-standard internet and mobile phone connections need to be assimilated into any service design. There is guaranteed wastage of resources if services presume that connectivity is universally consistent across all areas. In the absence of effective commitment and response from the communications providers then some rural services will have to be designed and developed which consider the use of landlines as the primary communication technology. This will lead to a narrowing of the gap of service accessibility which currently is widening as the focus remains on serving the majority in urban areas.

Rural communities need to be connected by reliable, robust  and affordable communications to minimise the current inequalities in health opportunities.